Temporal, Age, and Racial and Ethnic Trends in Allergen Consumption from 2-Day 24-Hour Recalls, NHANES 2003-2023.

Abstract

Recommendations for food allergy prevention have shifted from delayed allergen introduction during infancy to early oral exposure. Little is known about population-wide allergen consumption patterns in the United States. To examine peanut, egg, and tree nut consumption over time, by age, race and ethnicity from 2003 to 2023 using nationally representative data. We analyzed data from 56,394 participants in the National Health and Nutrition Examination Survey (2003-2023), who completed two 24-hour dietary recalls. Allergen consumption was defined using food codes. Survey-weighted logistic regression examined consumption by age group (infants, toddlers, and children/adults), survey cycle, race and ethnicity (non-Hispanic White, non-Hispanic Black, and Mexican American), adjusting for covariates. A spline regression modeled infant peanut consumption by guideline period. Infant peanut consumption was low (6%). Racial and ethnic differences emerged after infancy, with 50% to 100% higher peanut consumption reported by non-Hispanic White toddlers (27%) and children/adults (30%) compared with non-Hispanic Black toddlers (19%) and children/adults (19%), and Mexican American toddlers (13%) and children/adults (16%). Egg consumption was lowest in infants (17%) but more common in toddlers (37%) and children/adults (36%), with Mexican American participants reporting the highest intake across all age groups. Tree nut consumption remained low in infants (1%) and toddlers (4%) but more than doubled in children/adults from 2003 to 2023 (9%-21%). Despite updated guidelines, peanut consumption in infants remains low. Racial and ethnic differences emerged after infancy. Cultural and familial dietary patterns must be considered in public health early allergen introduction efforts.