Phenotypic characterization of childhood- and adult-onset food allergy among adults in the United States

Background: Food allergy (FA) affects ∼10% of adults; however, little is known about the extent to which FA phenotypes and psychosocial burden vary depending on timing of allergy onset, whether in childhood or as an adult. Objective: This study explored FA characteristics according to timing of FA onset in US adults. Methods: Between 2015 and 2016, a cross-sectional survey was administered to 40,443 US adults. Complex survey–weighted results were tabulated across key demographic and clinical strata. Linear regression models explored covariate-adjusted variability in FA-related psychosocial burden across 3 groups: (1) adults solely with childhood-onset FA, (2) adults solely with adult-onset FA, and (3) adults with both childhood- and adult-onset FA. Results: Adults with both childhood- and adult-onset FAs, compared to adults with solely childhood- or adult-onset FAs, are significantly more likely to have severe FAs (57.3%, 52.6%, 43.2%), physician-diagnosed FAs (54.2%, 52.4%, 33.0%), and multiple FAs (74.8%, 41.0%, 30.3%) (P <.001). Adults solely with childhood-onset FA, compared to adults solely with adult-onset FA, had significantly lower rates of environmental allergies (27.6% vs 39.2%; P <.001) and medication allergies (17.3% vs 25.9%; P <.001). Adults with both childhood- and adult-onset FAs reported highest rates of all comorbidities. Adults solely with adult-onset FA reported significantly lower FA-related psychosocial burden (P <.05). Conclusion: Differences exist in reaction severity, health care utilization, atopic comorbidities, and psychosocial burden according to the timing of FA onset. Future research exploring the heterogeneity of phenotypic expressions of adult FA may inform underlying mechanisms.