INTRODUCTION
The prevalence of food allergies in children has increased by 8%–10% over 15 years.1,2 The main allergy-causing foods are peanuts, tree nuts, hen’s egg (HE), and milk in the U.S. and HE, milk, wheat, and peanuts in Japan.3,4
Managing food allergies primarily involves dietary avoidance5,6, but prevention of accidental allergic reactions (AAR) remains challenging,7,8 causing anxiety among children and their guardians 9,10. In the U.S., the annualized rate of allergic reactions among preschool children with CM, HE, or peanut allergies is 0.81, with 87% of these reactions being AAR11. An online cross-sectional survey conducted in the U.S, UK, Australia, and South Africa found AAR prevalence of 0.53.12 Similarly, another study reported that 40% of Spanish children with CM allergy experienced AAR.13Surveys incorporating oral food challenges (OFCs) and standardized clinical follow-up are scarce, particularly in Japan, despite its unique food culture and allergen labeling.
Prior research has identified young age, history of anaphylaxis, multiple food allergies, and high specific immunoglobulin E (sIgE) levels as risk factors for AAR.11–15 However, pediatrician-assessed factors, such as reaction thresholds, remain underexplored.
This study aimed to examine AAR prevalence in Japanese children with immediate-type food allergies to HE, CM, wheat, or peanuts, confirmed through pediatrician-led diagnosis and follow-up. Additionally, we evaluated AAR risk factors, including clinical indicators such as sIgE levels and thresholds determined by response to low doses.