Quality of life is lower in adults labeled with childhood-onset food allergy than in those with adult-onset food allergy

Background: Immunoglobulin E-mediated food allergy (FA) affects children and adults with variable age of onset. Phenotype and quality of life (QoL) differences between childhood-onset FA (COFA) and adult-onset FA (AOFA) are not known. Objective: To identify phenotypic and QoL differences between AOFA and COFA. Methods: A cross-sectional study of adults (>= 18 years old) seen at Northwestern Memorial HealthCare clinics between 2002 and 2017 with an International Classification of Diseases ninth and tenth revision diagnosis of FA. Subjects completed a FA history survey and a FA QoL questionnaire. FA characteristics and QoL scores were compared between groups. Results: Among 294 consented subjects, 202 had a clinical history consistent with labeled immunoglobulin E-mediated FA. The onset of FA symptoms occurred before age 18 years (COFA) in 80 subjects and after age 18 years in 122 (AOFA) subjects. Shellfish reactions were most common in AOFA-labeled subjects (28%), whereas tree nut reactions were the most common in COFA-labeled subjects (55%) compared with other triggers. Hives (68% vs 52%, P=.03), facial swelling (69% vs 50%, P=.009), wheezing (56% vs 29%, P<.001), and vomiting (41% vs 22%, P=.005) were more often observed in COFA compared with AOFA. Total QoL was significantly reduced in COFA compared with AOFA (3.6 vs 3.0, P=.003) along with specific domains related to the following: allergen avoidance and dietary restriction (3.7 vs 3.1, P=.006), emotional impact (3.9 vs 3.2, P=.003), and risk of accidental exposure (3.6 vs 2.8, P=.001). Conclusion: There are differences in specific food triggers and symptoms in adult-onset and childhood-onset labeled FA. Adults labeled with childhood-onset FA have reduced QoL. (C) 2021 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.