# Rising trends in infant ER encounters for food-induced allergic reactions in the era of early allergenic food introduction

## TL;DR

ER visits for food allergies in infants have increased since 2013, even with new guidelines promoting early food introduction.

## Contribution

This study reveals a significant rise in infant ER visits for food-induced allergic reactions following updated national guidelines.

## Key findings

- Infant ER visits for food-induced reactions increased significantly from 2013 to 2024.
- Postguideline years showed more than double the odds of food-induced reactions in infants compared to pre-guideline years.
- No significant increase in food-induced reactions was observed in children aged 2 to 5 years.

## Abstract

Allergic reactions to food are a leading cause of pediatric emergency room (ER) visits. National guidelines now recommend early introduction of allergenic foods; however, whether these changes have affected ER encounters remains poorly understood.

Our aim was to observe trends in ER encounters for food-induced reactions (FIRs), including food-induced anaphylaxis (FIA), among children aged 0 to 5 years between 2013 and 2024.

We performed a retrospective analysis of ER visits at the University of California Los Angeles from 2013 to 2024. FIRs were identified by using International Classification of Diseases codes and stratified by age (0-1 vs 2-5 years). Logistic regression assessed annual trends. Multivariate logistic regression was used to compare postguideline years (2022-2024) with preguideline years (2013-2016), adjusting for clinical and demographic variables.

Of 67,059 ER visits, 350 FIRs and 182 FIA visits were identified. FIR and FIA annual rates increased significantly over time in infants aged 0 to 1 years (odds ratio [OR] = 1.15 [P = .005] and OR = 1.27 [P = .002]). In children aged 2 to 5 years old, neither FIR nor FIA rates increased. Refractory anaphylactic reactions did not change in either group. In multivariate analysis, infants in the postguideline period had more than twice the odds of a FIR during the preguideline years (OR = 2.21 [95% CI = 1.37-3.55]), whereas no change was observed in the 2- to 5-year age group (OR = 0.82 [95% CI = 0.55-1.2]).

ER visits for food reactions have continued to rise at a steady rate over time among infants. These findings underscore the need for additional research on adoption, parental guidance, and long-term impact of early allergen introduction.