Food Allergies at Halloween: Trick or Treat?

Food allergies affects 15 million Americans.^1-3 Approximately 4% of children have an allergy to food declining to 1% in adults.  There is an increased prevalence in food allergies, however, the past 2 decades.  These allergies result from a delay in the development of oral tolerance or who are genetically or environmentally predisposed to the development of atopic disease.^{1, 4} Eight foods are the most common food allergens in the United States.  These include milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish.¹ Recently sesame appears to be increasing in prevalence.⁵ A question remains about whether there is a seasonal or even holiday variation in presenting with food allergies to health care facilities? 

The answer maybe yes.  A group of Canadian scientists collected data on confirmed pediatric cases of anaphylaxis presenting to emergency departments in four Canadian provinces.⁶ Data were collected from 1390 cases of children with median age of 5.4 years (62% boys) from 2011-2020.  During Halloween and Easter, there were higher rates of anaphylaxis to unknown nuts (IRR 1.66; 95% CI: 1.13-2.43 and 1.71; 95% CI: 1.21-2.42) and peanuts (IRR 1.86; 95% CI: 1.12-3.11 and IRR 1.57; 95% CI: 0.94-2.63) when compared to the rest of the year.  In contrast, no increase in events was noted at Christmas, Diwali, Chinese New Year or Eid al-Adha.   

As we are in the Halloween season, it is prudent to watch out for children who may need emergent or urgent care for tree nut or peanut allergies.  Furthermore, pharmacists should be educating parents to the potential for increased risk at this time of year. 

Mark A. Munger, PharmD, FCCP, FACC, is a professor of pharmacotherapy and adjunct professor of internal medicine, at the University of Utah, where he also serves as the associate dean of Academic Affairs for the College of Pharmacy.  

References 

1. Jones SM, Burks AW. Food Allergy.  NEJM 2017;377:1168-76.
2. Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010;126:Suppl: S1-S58.
3. Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics 2009;124:1549-55.
4. Berin MC, Shreffler WG, Mechanism underlying induction of tolerance to foods. Allergy Clin North Am 2016;36:87-102.
5. Sesame allergy common among children with food allergies. https://www.nih.gov/news-events/nih-research-matters/sesame-allergy-common-among-children-food-allergies   Accessed 10/2020.
6. Leung M, Clarke AE, Gabrielli S, et al. Risk of peanut- and tree-nut-induced anaphylaxis during Halloween, Easter and other cultural holidays in Canadian children. CMAJ 2020;192:E1084-92.