Supplementary Material for: IgE specific to common food allergens and risks of all-cause, cancer, and non-cancer mortality in US adults: A cohort study

Background: Recent studies have shown that food allergen-specific IgE is associated with cardiovascular mortality. We aimed to investigate the associations of common food-specific IgE sensitization with all-cause, cancer, and non-cancer mortality. Methods: This study was a cohort analysis using data from the 2005-2006 US National Health and Nutrition Examination Survey (NHANES). Participants examined for allergen-specific IgE were included, and mortality outcomes up to 2019 were ascertained through linkage with the National Death Index. Cox proportional hazards models adjusted for demographic, lifestyle, and clinical factors assessed associations between food-specific IgE sensitization and mortality, with subgroup analyses among participants consuming the corresponding foods. Results: 4,424 adults were included. During a median follow-up of 13.8 years, there were 879 (19.9%) all-cause mortality, including 705 non-cancer mortality and 174 cancer-related mortality. Sensitization to at least 1 animal-derived food (HR 1.32, 95% CI 1.02-1.70, p=0.035) was associated with higher all-cause mortality, particularly for sensitization to milk (HR 1.44, 95% CI 1.08-1.94, p=0.015), shrimp (HR 1.46, 95% CI 1.06-2.01, p=0.022), and egg (HR 1.30, 95% CI 1.04-1.63, p=0.023), but not peanut. For non-cancer mortality, consistent and stronger associations were observed. In food consumers, associations were further strengthened for sensitization to milk (HR 1.63, 95% CI 1.27-2.09, p<0.001), egg (HR 1.58, 95% CI 1.25-2.01, p<0.001), and shrimp (HR 1.89, 95% CI 1.02-3.50, p=0.043) as risk factors for non-cancer mortality. Conclusions: Food-specific IgE sensitization was associated with increased risks of all-cause and non-cancer mortality, suggesting that IgE sensitization may carry systemic implications extending beyond allergy.