Products - Data Briefs - Number 121 - May 2013: Trends in Allergic Conditions Among Children: United States, 1997–2011

Products – Data Briefs – Number 121 – May 2013

NCHS Data Brief

Number 121, May 2013

Trends in Allergic Conditions Among Children: United States, 1997–2011

On This Page

• Key findings


• The prevalence of food and skin allergies increased in children aged 0–17 years from 1997–2011.


• Younger children were more likely to have skin allergies, while older children were more likely to have respiratory allergies.


• Hispanic children had lower rates of all three types of allergies compared with children of other race or ethnicities. Non-Hispanic black children were more likely to have skin allergies and less likely to have respiratory allergies compared with non-Hispanic white children.


• The prevalence of food and respiratory allergy, but not skin allergy, increased with higher income levels.


• Summary


• Definitions


• Data source and methods


• About the authors


• References


• Suggested citation

PDF Version  (444 KB)
Kristen D. Jackson, M.P.H.; LaJeana D. Howie, M.P.H., C.H.E.S.; Lara J. Akinbami, M.D.

Key findings

Data from the National Health Interview Survey, 1997–2011

• The prevalence of food and skin allergies increased in children under age 18 years from 1997–2011.


• The prevalence of skin allergies decreased with age. In contrast, the prevalence of respiratory allergies increased with age.


• Hispanic children had a lower prevalence of food allergy, skin allergy, and respiratory allergy compared with children of other race or ethnicities. Non-Hispanic black children were more likely to have skin allergies and less likely to have respiratory allergies compared with non-Hispanic white children.


• Food and respiratory allergy prevalence increased with income level. Children with family income equal to or greater than 200% of the poverty level had the highest prevalence rates.

Allergic conditions are among the most common medical conditions affecting children in the United States (1–5). An allergic condition is a hypersensitivity disorder in which the immune system reacts to substances in the environment that are normally considered harmless (6,7). Food or digestive allergies, skin allergies (such as eczema), and respiratory allergies (such as hay fever) are the most common allergies among children. Allergies can affect a child’s physical and emotional health and can interfere with daily activities, such as sleep, play, and attending school (8,9). A severe allergic reaction with rapid onset, anaphylaxis, can be life threatening. Foods represent the most common cause of anaphylaxis among children and adolescents (10,11). Early detection and appropriate interventions can help to decrease the negative impact of allergies on quality of life (6). This report presents recent trends in the prevalence of allergies and differences by selected sociodemographic characteristics for children under age 18 years.
Keywords: allergy, National Health Interview Survey

The prevalence of food and skin allergies increased in children aged 0–17 years from 1997–2011.

Among children aged 0–17 years, the prevalence of food allergies increased from 3.4% in 1997–1999 to 5.1% in 2009–2011. The prevalence of skin allergies increased from 7.4% in 1997–1999 to 12.5% in 2009–2011. There was no significant trend in respiratory allergies from 1997–1999 to 2009–2011, yet respiratory allergy remained the most common type of allergy among children throughout this period (17.0% in 2009–2011). Skin allergy prevalence was also higher than food allergy prevalence for each period from 1997–2011 (Figure 1).

Figure 1. Percentage of children aged 0–17 years with a reported allergic condition in the past 12 months: United States, 1997–2011

¹Significant increasing linear trend for food and skin allergy from 1997–1999 to 2009–2011.
SOURCE: CDC/NCHS, Health Data Interactive, National Health Interview Survey.

Younger children were more likely to have skin allergies, while older children were more likely to have respiratory allergies.

Food allergy prevalence was similar among all age groups. Skin allergy prevalence decreased with the increase of age (14.2% among 0–4 years, 13.1% among 5–9 years, and 10.9% among 10–17 years); while respiratory allergy prevalence increased with the increase of age (10.8% among 0–4 years, 17.4% among 5–9 years, and 20.8% among 10–17 years) (Figure 2).

Figure 2. Percentage of children aged 0–17 years with a reported allergic condition in the past 12 months, by age group: United States, average annual 2009–2011

¹Significant trend by age group.
SOURCE: CDC/NCHS, Health Data Interactive, National Health Interview Survey.

Hispanic children had lower rates of all three types of allergies compared with children of other race or ethnicities. Non-Hispanic black children were more likely to have skin allergies and less likely to have respiratory allergies compared with non-Hispanic white children.

Hispanic children had a lower prevalence of food allergy (3.6%), skin allergy (10.1%), and respiratory allergy (13.0%) compared with non-Hispanic white and non-Hispanic black children. Non-Hispanic black children had a higher percentage of reported skin allergy (17.4%) compared with non-Hispanic white children (12.0%) and a lower percentage of respiratory allergy (15.6%) compared with non-Hispanic white children (19.1%) (Figure 3).

Figure 3. Percentage of children aged 0–17 years with a reported allergic condition in the past 12 months, by race and ethnicity: United States, average annual 2009–2011

¹Hispanic significantly different than all other race groups.
²The differences between all race groups are statistically significant.
SOURCE: CDC/NCHS, Health Data Interactive, National Health Interview Survey.

The prevalence of food and respiratory allergy, but not skin allergy, increased with higher income levels.

The prevalence of both food allergy and respiratory allergy increased with the increase of income level. Among children with family income less than 100% of the poverty level, 4.4% had a food allergy and 14.9% had a respiratory allergy. Food allergy prevalence among children with family income between 100% and 200% of the poverty level was 5.0%, and respiratory allergy prevalence was 15.8%. Among children with family income above 200% of the poverty level, food allergy prevalence was 5.4%, and respiratory allergy prevalence was 18.3%. There was no significant difference in the prevalence of skin allergy by poverty status (Figure 4).

Figure 4. Percentage of children aged 0–17 years with a reported allergic condition in the past 12 months, by poverty status: United States, average annual 2009–2011

¹Significant trend by poverty status.
SOURCE: CDC/NCHS, Health Data Interactive, National Health Interview Survey.

Summary

Among children under age 18 years in the United States, the prevalence of food and skin allergies increased from 1997–1999 to 2009–2011. The prevalence of respiratory allergy, which is the most prevalent type of allergy among children, did not change during this period. There was no significant difference in food allergy prevalence between age groups. However, skin allergy decreased with the increase of age, and respiratory allergy increased with the increase of age. The prevalence of allergies varies by race and ethnicity, with Hispanic children having the lowest prevalence of food, skin, and respiratory allergies compared with non-Hispanic white and non-Hispanic black children. Non-Hispanic black children were more likely to have skin allergies and less likely to have respiratory allergies compared with non-Hispanic white children. The prevalence of allergies differed by poverty status. Food allergy and respiratory allergy increased with the increase of income level, but there was no difference in the prevalence of skin allergy by poverty status.

Definitions

Respiratory allergy prevalence: Estimated based on affirmative responses to either of the two National Health Interview Survey (NHIS) question(s): “During the past 12 months, has your child had hay fever?” and “During the past 12 months, has your child had any kind of respiratory allergy?”
Food allergy prevalence: Estimated based on an affirmative response to the NHIS question: “During the past 12 months, has your child had any kind of food or digestive allergy?”
Skin allergy prevalence: Estimated based on an affirmative response to the NHIS question: “During the past 12 months, has your child had eczema or any kind of skin allergy?”
Poverty status: Based on family income, family size, and the number of children in the family; and for families with two or fewer adults, on the age of the adults in the family. The poverty level is based on a set of income thresholds that vary by family size and composition. Families or individuals with income below their appropriate thresholds are classified as below the poverty level. These thresholds are updated annually by the U.S. Census Bureau to reflect changes in the Consumer Price Index for all urban consumers (12). Estimates by poverty status from NHIS are based on both reported and imputed family income (13).

Data source and methods

Prevalence estimates for allergic conditions were obtained from the Health Data Interactive (HDI) table, “Allergic conditions, ages 0–17: U.S., 1997–2011,” available from the Health Data Interactive website. NHIS data were used to estimate the prevalence of allergic conditions for this HDI table.
NHIS data are collected continuously throughout the year for the Centers for Disease Control and Prevention’s National Center for Health Statistics by interviewers from the U.S. Census Bureau. NHIS collects information about the health and the health care of the civilian noninstitutionalized U.S. population. Interviews are conducted in respondents’ homes, but follow-ups to complete the interviews may be conducted over the telephone. The Sample Child component collects detailed data on health conditions for a randomly selected child in households with at least one child. All of the data in the Sample Child component are obtained from a proxy respondent and not from medical records. A responsible adult, usually a parent, responds to the survey questions as proxy for the sample child. For further information about NHIS and the questionnaire, visit the NHIS website.
NHIS is designed to yield a sample that is representative of the civilian noninstitutionalized population of the United States, and the survey uses weighting to produce national estimates. Data weighting procedures are described in more detail elsewhere (14). Point estimates and estimates of corresponding variances for the HDI estimates were calculated using SUDAAN software (15) to account for the complex sample design of NHIS. The Taylor series linearization method was chosen for variance estimation.
Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Terms such as “higher” and “lower” indicate statistically significant differences. Terms such as “no difference” indicate that the statistics being compared were not significantly different. Lack of comment regarding the difference between any two statistics does not necessarily suggest that the difference was tested and found to be not significant. All estimates shown in this report have a relative standard error less than or equal to 30%. The significance of trends was tested using weighted least squares regression models of the log of each outcome and Joinpoint software (16) to determine whether an apparent change over time was statistically significant, taking into account the standard error for each data point. Because there were limited data points over the period, linear regression (zero joinpoints) was specified for all models.

About the author

Kristen D. Jackson, LaJeana D. Howie, and Lara J. Akinbami are with the Centers for Disease Control and Prevention’s National Center for Health Statistics, Office of Analysis and Epidemiology.

References

1. 
   Friedman AH, Morris TL. Allergies and anxiety in children and adolescents: A review of the literature. J Clin Psychol Med Settings 13(3):318–31. 2006.


2. 
   Gupta RS, Springston EE, Smith B, Kim JS, Pongracic JA, Wang X, Holl J. Food allergy knowledge, attitudes, and beliefs of parents with food-allergic children in the United States. Pediatr Allergy Immunol 21(6):927–34. 2010.


3. 
   Vassallo MF, Banerji A, Rudders SA, Clark S, Mullins RJ, Camargo CA Jr. Season of birth and food allergy in children. Ann Allergy Asthma Immunol 104(4):307–13. 2010.


4. 
   Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of childhood asthma in the United States, 1980–2007. Pediatrics 123 Suppl 3:S131–45. 2009.


5. 
   Mailhol C, Lauwers-Cances V, Rancé F, Paul C, Giordano-Labadie F. Prevalence and risk factors for allergic contact dermatitis to topical treatment in atopic dermatitis: A study in 641 children. Allergy 64(5):801–6. 2009.


6. 
   Stone KD. Atopic diseases of childhood. Curr Opin Pediatr 14(5):634–46. 2002.


7. 
   Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G. The management of anaphylaxis in childhood: Position paper of the European Academy of Allergology and Clinical Immunology. Allergy 62(8):857–71. 2007.


8. 
   Baiardini I, Braido F, Brandi S, Canonica GW. Allergic diseases and their impact on quality of life. Ann Allergy Asthma Immunol 97(4):419–28. 2006.


9. 
   Marklund B, Ahlstedt S, Nordstrom G. Health-related quality of life among adolescents with allergy-like conditions—with emphasis on food hypersensitivity. Health Qual Life Outcomes 2:65. 2004.


10. 
    De Silva IL, Mehr SS, Tey D, Tang ML. Paediatric anaphylaxis: A 5 year retrospective review. Allergy 63(8):1071–6. 2008.


11. 
    Lee JK, Vadas P. Anaphylaxis: Mechanisms and management. Clin Exp Allergy 41(7):923–38. 2011.


12. 
    U.S. Census Bureau. Poverty. 2012.


13. 
    Schenker N, Raghunathan TE, Chiu PL, et al. Multiple imputation of family income and personal earnings in the National Health Interview Survey: Methods and examples. Hyattsville, MD: National Center for Health Statistics. 2010.


14. 
    Botman SL, Moore TF, Moriarity CL, Parsons VL. Design and estimation for the National Health Interview Survey, 1995–2004. National Center for Health Statistics. Vital Health Stat 2(130). 2000.


15. 
    SUDAAN, release 9.1 [computer software]. Research Triangle Park, NC: RTI International. 2004.


16. 
    Joinpoint Regression Program, version 3.4 [computer software]. Bethesda, MD: National Institutes of Health, National Cancer Institute. 2010.

Suggested citation

Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997–2011. NCHS data brief, no 121. Hyattsville, MD: National Center for Health Statistics. 2013.

Copyright information

All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S. Acting Director
Jennifer H. Madans, Ph.D., Associate Director for Science

Office of Analysis and Epidemology

Irma E. Arispe, Ph.D., Director

Announcements: National Physical Fitness and Sports Month — May 2013

Announcements: National Physical Fitness and Sports Month — May 2013

	MMWR Weekly Volume 62, No. 17 May 3, 2013

Announcements: National Physical Fitness and Sports Month — May 2013

Weekly

May 3, 2013 / 62(17);339

May is designated National Physical Fitness and Sports Month to raise awareness about the important role physical activity plays in maintaining health. According to the 2008 Physical Activity Guidelines for Americans, physical activity can help control weight, improve mental health, and lower the risk for early death, heart disease, type 2 diabetes, and some cancers. Physical activity also can improve cardiovascular and muscular fitness (1). In 2011, however, only one in five U.S. adults participated in enough physical activity to gain substantial health benefits (2).
To achieve substantial health benefits, the guidelines recommend that adults perform at least 150 minutes a week of moderate-intensity aerobic activity, or 75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activities (1). The guidelines also recommend including muscle-strengthening activities that involve all major muscle groups on 2 or more days a week. Additional information about physical activity and resources for increasing participation in physical activity are available at http://www.health.gov/paguidelines and http://www.cdc.gov/physicalactivity.

References

1. US Department of Health and Human Services. 2008 physical activity guidelines for Americans. Hyattsville, MD: US Department of Health and Human Services; 2008. Available at http://www.health.gov/paguidelines/guidelines/default.aspx.



2. CDC. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. Vital Health Stat 2012;10(256).

Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children, Kenya - Vol. 19 No. 2 - February 2013 - Emerging Infectious Disease journal - CDC

full-text â–º
Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children, Kenya – Vol. 19 No. 2 – February 2013 – Emerging Infectious Disease journal – CDC

Table of Contents
Volume 19, Number 2– February 2013

Volume 19, Number 2—February 2013

Research

Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children, Kenya

Article Contents

• Methods


• Study Population


• Results


• Discussion


• Acknowledgments


• References


• Figure 1


• Figure 2


• Table 1


• Table 2


• Technical Appendix  [104 KB - 2 pages]


• Suggested Citation

Patrick Kiio Munywoki , Eric O. Ohuma, Mwanajuma Ngama, Evasius Bauni, J. Anthony G. Scott, and D. James Nokes

Author affiliations: Author affiliations: KEMRI-Wellcome Trust Research Programme Centre for Geographic Medicine Research–Coast, Kilifi, Kenya (P.K. Munywoki, E.O. Ohuma, M. Ngama, E. Bauni, J.A.G. Scott, D.J. Nokes); University of Oxford, Oxford, UK (E.O. Ohuma, J.A.G. Scott); University of Warwick, Coventry, UK (D.J. Nokes)

Suggested citation for this article

Abstract

Severe lower respiratory tract infection (LRTI) in infants caused by respiratory syncytial virus (RSV) has been associated with later pneumonia hospitalization among children. To determine risk for pneumonia after RSV hospitalization in infancy, we conducted a retrospective cohort analysis of 2,813 infants admitted to a hospital in Kenya and identified readmissions for pneumonia among this group during early childhood (<60 months of age). Incidence of readmission for pneumonia was higher for children whose first admission as infants was for LRTI and who were <3 months of age than for children who were first admitted as infants for non-LRTI, irrespective of RSV status. Incidence of readmission for pneumonia with wheeze was higher for children whose first admission involved RSV compared with those who had non-RSV LRTI. Excess pneumonia risk persisted for 2 years after the initial hospitalization. Close postdischarge follow-up of infants with LRTI, with or without RSV, could help prevent severe pneumonia later in childhood.

Pneumonia is a major cause of illness and death among children 15>
,2), and respiratory syncytial virus (RSV) is the most common viral cause of pneumonia and bronchiolitis in this age group (3,4). RSV infection in infancy is associated with other long-term respiratory problems (5–10) and, in one study, with pneumonia (11). The magnitude and duration of the increased risk for pneumonia after RSV infection are poorly defined (12). In addition, it is not clear whether this association is specific to RSV or whether other causes of lower respiratory tract infection (LRTI) in infancy are also associated with later pneumonia (11). A study in The Gambia reported an increased incidence of hospital admission for pneumonia, measurable up to 3 years after discharge (11). We report results of a retrospective cohort analysis of children admitted to a rural district hospital in Kenya using data from a prospective longitudinal clinical surveillance project nested within a health and demographic surveillance system (13). The cohort was defined as all infants admitted to the hospital during 9 RSV seasons during 2002–2010; the infants were classified into exposure groups on the basis of the clinical features of LRTI and laboratory diagnosis of RSV at the first admission. The main outcome was readmission to a hospital for pneumonia before the age of 5 years.

Iatrogenic Blood-borne Viral Infections in Refugee Children from War and Transition Zones ▲Medscape CME Activity - Vol. 19 No. 6 - June 2013 - Emerging Infectious Disease journal - CDC

full-text â–º see below
Medscape CME Activity – Vol. 19 No. 6 – June 2013 – Emerging Infectious Disease journal – CDC

 
CME Articles
Volume 19, Number 6–June 2013

Volume 19, Number 6—June 2013

CME ACTIVITY

Iatrogenic Blood-borne Viral Infections in Refugee Children from War and Transition Zones

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/eid; (4) view/print certificate.

Release date: May 22, 2013; Expiration date: May 22, 2014

Learning Objectives

Upon completion of this activity, participants will be able to:

•Describe observations regarding and factors contributing to iatrogenically transmitted blood-borne virus (BBV) infection in refugee children from central Asia, Southeast Asia, and Sub-Saharan Africa, based on a literature review and case reports

•Describe the role of contaminated injections and unsafe blood transfusions in health care settings in contributing to increased prevalence of BBVs in refugee children from central Asia, Southeast Asia, and Sub-Saharan Africa, based on a literature review and case reports

•Describe the role of other factors contributing to increased prevalence of BBVs in refugee children from central Asia, Southeast Asia, and Sub-Saharan Africa, based on a literature review and case reports.

CME Editor

Karen L. Foster, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Karen L. Foster has disclosed no relevant financial relationships.

CME Author

Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Authors

Disclosure: Paul Goldwater, MD, has disclosed no relevant financial relationships.

  
CME Articles
Volume 19, Number 6–June 2013

full-text â–º large
Iatrogenic Blood-borne Viral Infections in Refugee Children from War and Transition Zones – Vol. 19 No. 6 – June 2013 – Emerging Infectious Disease journal – CDC

Volume 19, Number 6—June 2013

CME ACTIVITY

Iatrogenic Blood-borne Viral Infections in Refugee Children from War and Transition Zones

Article Contents

• Medscape CME Activity


• Methods and Definitions


• Case Reports


• Discussion of Cases


• Modes of Transmission Contributing to Increased BBV Prevalence


• Implications and the Future


• Acknowledgment


• References


• Table


• Suggested Citation

Paul N. Goldwater 

Author affiliation: Women’s and Children’s Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide

Suggested citation for this article

Abstract

Pediatric infectious disease clinicians in industrialized countries may encounter iatrogenically transmitted HIV, hepatitis B virus, and hepatitis C virus infections in refugee children from Central Asia, Southeast Asia, and sub-Saharan Africa. The consequences of political collapse and/or civil war—work migration, prostitution, intravenous drug use, defective public health resources, and poor access to good medical care—all contribute to the spread of blood-borne viruses. Inadequate infection control practices by medical establishments can lead to iatrogenic infection of children. Summaries of 4 cases in refugee children in Australia are a salient reminder of this problem.

Blood-borne viruses (BBVs) have benefitted from internal political strife, migration, prostitution, intravenous/injection drug use, and defective public health resources in some Central Asian republics and Southeast Asian and sub-Saharan African countries. Iatrogenic transmission of HIV in children in Romania (1) and the Russian republic of Kalmykia (2) are well-known examples. Refugee children are a special risk category for infection with BBVs (3). When iatrogenic transmission was encountered in a pediatric infectious diseases clinic in Adelaide, South Australia, Australia, concern was raised about whether it was an isolated or a more widespread phenomenon.
The United Nations High Commissioner for Refugees estimates that there were 43.7 million forcibly displaced persons worldwide at the end of 2010, the highest number in 15 years. Of these, 27.5 million were internally displaced persons, 15.4 million were refugees, and 837,500 were asylum seekers (4). Children constituted more than half of the humanitarian refugee population in Australia (5). A refugee is legally defined as a person who is outside his or her country of nationality and is unable to return due to a well-founded fear of persecution because of race, religion, nationality, political opinion, or membership in a particular social group. By receiving refugee status, persons are guaranteed protection of their basic human rights and cannot be forced to return to a country where they fear persecution (4).
Australia receives refugees from all countries experiencing internal conflict. Some arriving refugees have parasite infestations and bacterial and viral infections, especially undiagnosed BBVs (6,7). During 2010–2011, a total of 13,799 persons were admitted under Australia’s Humanitarian Program.
The extent of the unusual problem of iatrogenic transmission of BBVs remains unknown because modes of transmission of individual cases are difficult to document. This report summarizes cases in 4 children from South Asia that illustrate the conditions extant in 1 city in Uzbekistan (Andijan), where medical procedures have resulted in transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV). Among the case-patients are 2 children with BBV co-infection.