Refinement and validation of a symptom report-based food allergy prevalence questionnaire for population-based studies - Project Summary/Abstract: While there is general agreement that IgE-mediated food allergy prevalence has increased in recent decades, the estimation of its population-level burden is complicated by increased awareness of a variety of food-induced conditions (e.g., intolerances, pollen-food allergy syndrome, celiac disease). Unlike other survey instruments that evaluate chronic diseases like asthma, symptom-report- algorithm based survey instruments often utilized for food allergy prevalence estimation remain unvalidated among the general US pediatric and adult populations. By validating these algorithms via gold-standard clinical diagnostic methods, the ability to conduct routine disease surveillance, advance treatments, understand clinical management, and evaluate emerging allergy prevention interventions, will each be greatly enhanced. First (AIM 1), we will assemble an expert Delphi panel to develop a bank of FA survey questions that assess key features believed to most accurately, reliably predict true, IgE-mediated food allergy and capture key differential diagnoses for specific allergies (e.g. lactose intolerance for milk allergy). This bank will build upon our established, previously administered National Food Allergy Prevalence Questionnaire. Next (AIM 2), a comprehensive clinical validation study of this survey instrument will be conducted by sampling participants from the general US population residing within the US Census Designated Combined Statistical Areas containing Houston, New York City, and Chicago. Surveys will be completed by 6000 households (obtaining survey responses for roughly 10,000 individuals). 720 individuals reporting ≥1 current food allergy and 40 with no reported FA will be evaluated for reported “top 9” food allergies including allergens that meet and do not meet the refined algorithmic “convincing” criteria. A standardized diagnostic approach adapted from the NIAID-supported Consortium for Food Allergy Research will be used. Finally (AIM 3) we will analyze the survey and clinical data collected in Aim 2 to provide clinically- confirmed estimates of peanut, milk, egg, tree nut, shellfish, fin fish, wheat, soy, & sesame allergy prevalence. We will also finalize our Food Allergy Prevalence Questionnaire, along with a newly developed “short-form” of the prevalence questionnaire using only the most strongly predictive questions. By carrying out the proposed research, we will: 1) enhance understanding of widely-cited food allergy prevalence estimates previously published by our group and currently used to guide policy and public health decision-making; 2) validate and optimize full and short-form food allergy prevalence questionnaires, establishing their diagnostic properties in diverse population-based samples; and 3) estimate the current burden of food allergy and related conditions among the general US pediatric and adult populations in three major US regions (with ≈40 million inhabitants from 8 states), which will be applied to better understand long- term trends in US allergic disease burden and form the foundation of future food allergy surveillance efforts.
