Prevalence and Incidence of Food Allergy 1980 – 2010

Food Allergy :

Prevalence and Incidence

 

Adverse food reactions can be broadly classified into 2 categories. The first category consists of immunologically-mediated adverse reactions to foods that are termed food allergies. Food allergies can result in disorders with an acute onset of symptoms following ingestion of the triggering food allergen  and in chronic disorders. The second category is composed of adverse reactions that are not immune-mediated. An example is lactose intolerance caused by a deficiency of lactase. Adverse reactions to foods can also occur from toxic (eg, bacterial food poisoning) or pharmacologic (eg, caffeine) effects

In contrast to respiratory allergies, the epidemiology of food allergy has been little studied, and there is no strong evidence for an increasing incidence, either among infants and children or in adults. Neither are there any studies showing regional differences in prevalence. On the contrary, studies in many country indicate a similar prevalence during the first 2 years of life, both in verified food allergy and reported food intolerance. This is despite a low prevalence of respiratory allergies in the two former countries and a high prevalence in other country.

Food allergy is a large public health problem in the world  and the prevalence is growing. Awareness of the problem continues to grow and child day care, schools, and public institutions are developing protective policies and health programs to deal with the issue. A representative nationwide sample is needed, though, to get an accurate estimate of the prevalence of food allergies in the world wide. Population to help public health policy makers and care providers in planning and allocating resources for the recognition and treatment of food allergy.

The major problem with such epidemiological studies lies in the fact that there are no simple diagnostic criteria to verify the diagnosis. So far IgE determinations have been the only available diagnostic test, and their value is limited by poor sensitivity and the fact that at best they would only verify a small proportion of food intolerance, i.e. that caused by IgE-mediated reactions. A diagnosis of food allergy/intolerance must be based on a double-blind placebo-controlled food challenge, and not on the patient’s or doctor’s impression. More studies are required from different regions in order to identify similarities and differences in the patterns of food allergy. In particular, there is a need for properly conducted epidemiological studies in adults. Such studies should be interdisciplinary, as the cultural and social perceptions of food allergy and food intolerance would be expected to have a major impact on prevalence, perhaps even more than medical factors.

• The increasing prevalence of allergic diseases in westernized countries poses a significant health problem and a tremendous burden on quality of life and healthcare expenditure. Food allergy affects as many as 6% of young children and 3% to 4% of adults. While the majority of children outgrow their allergy to milk, egg, wheat and soy, allergies to peanut, tree nuts, fish and shellfish are often life-long. Currently, there are no treatments that can cure or provide long-term remission from food allergy.
• General surveys report that as many as 25-30% of households consider at least 1 family member to have a food allergy. This high rate is not supported by controlled studies in which oral food challenges (a medically supervised, gradual test feeding) are used to confirm patient histories. The actual prevalence of food allergies is estimated to be 5-6% in infants and children and 3.7 % in adults. However, comprehensive studies that include oral food challenges are few in number. Considering allergy to milk, egg, peanut, and seafood in a meta-analysis of 6 international studies using oral food challenges, estimated rates of 1-10.8% were obtained. In a meta-analysis including allergy to fruits and vegetables (excluding peanut), only 6 international studies included oral food challenges, and estimates of allergy varied widely from 0.1-4.3% for fruits and tree nuts to 0.1-1.4% for vegetables to under 1% for wheat, soy, and sesame.
• Studies in the United States and the United Kingdom indicate a rise in peanut allergy among young children in the past decade.
•  One study showed an increase of peanut allergy in children from 0.4% in 1997 to 0.8% in 2002. Recent studies from Canada and the United Kingdom indicate allergy rates to peanut of over 1% in children.
• Based upon available studies, estimations of the rate of food allergies in children have been summarized as follows for common food allergens: cow milk, 2.5%; eggs, 1.3%; peanuts, 0.8%; wheat, 0.4%; and soy, 0.4%.  Allergic reactions to non-protein food additives are uncommon
• An estimated 2.5% of the U.S. population has it; blacks, males and children are at increased risk for it, and it may be a factor in severe episodes of asthma.
  General surveys report that as many as 25-30% of households consider at least 1 family member to have a food allergy. This high rate is not supported by controlled studies in which oral food challenges (a medically supervised, gradual test feeding) are used to confirm patient histories.
• A recent report from the Centers for Disease Control and Prevention (CDC) indicated an 18% rise in food allergy among children in the past decade
• The actual prevalence of food allergies is estimated to be 5-6% in infants and children and 3.7 % in adults.
• Comprehensive studies that include oral food challenges are few in number. Considering allergy to milk, egg, peanut, and seafood in a meta-analysis of 6 international studies using oral food challenges, estimated rates of 1-10.8% were obtained.
• In a meta-analysis including allergy to fruits and vegetables (excluding peanut), only 6 international studies included oral food challenges, and estimates of allergy varied widely from 0.1-4.3% for fruits and tree nuts to 0.1-1.4% for vegetables to under 1% for wheat, soy, and sesame.
• A cross-sectional survey of data on food allergy among children <18 years of age, as reported in the 1997–2007 National Health Interview Survey, 2005–2006 National Health and Nutrition Examination Survey, 1993–2006 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, and 1998–2006 National Hospital Discharge Survey, was performed. Reported food allergies, serum immunoglobulin E antibody levels for specific foods, ambulatory care visits, and hospitalizations were assessed.
• In 2007, 3.9% of US children <18 years of age had reported food allergy. The prevalence of reported food allergy increased 18% (z = 3.4; P < .01) from 1997 through 2007. In 2005–2006, serum immunoglobulin E antibodies to peanut were detectable for an estimated 9% of US children. Ambulatory care visits tripled between 1993 and 2006 (P < .01). From 2003 through 2006, an estimated average of 317000 food allergy-related, ambulatory care visits per year (95% confidence interval: 195000–438000 visits per year) to emergency and outpatient departments and physician’s offices were reported. Hospitalizations with any recorded diagnoses related to food allergy also increased between 1998–2000 and 2004–2006, from an average of 2600 discharges per year to 9500 discharges per year (z = 3.4; P < .01), possibly because of increased use of food allergy V codes.
• Studies in the United States and the United Kingdom indicate a rise in peanut allergy among young children in the past decade.[16,17 ]One study showed an increase of peanut allergy in children from 0.4% in 1997 to 0.8% in 2002.
• Severe anaphylactic reactions, including death, can occur following the ingestion of food. Symptoms observed in a food-induced anaphylactic reaction may involve the skin, gastrointestinal tract, and respiratory tract. Frequently observed symptoms include oropharyngeal pruritus, angioedema (eg, laryngeal edema), stridor, dysphonia, cough, dyspnea, wheezing, nausea, vomiting, diarrhea, flushing, urticaria, and angioedema. Fatalities result from severe laryngeal edema, irreversible bronchospasm, refractory hypotension, or a combination thereof.
• Peanuts, tree nuts, fish, and shellfish are the foods most often implicated in severe food-induced anaphylactic reactions, though anaphylactic reactions have been reported to a wide variety of foods. Fatalities caused by reactions to milk are increasingly noted.
• Risk factors or associations for fatal food-induced anaphylaxis include: (1) the presence of asthma, especially in patients with poorly controlled disease; (2) previous episodes of anaphylaxis with the incriminated food; (3) a failure to recognize early symptoms of anaphylaxis; and (4) a delay or lack of immediate use of epinephrine to treat the allergic reaction. Teenagers and young adults appear to be overrepresented in registries of food allergy fatalities and present a special risk group.
• Among children, males appear to be more affected; among adults, females are more frequently affected.  In infants and children younger than 3 years, the prevalence of food allergy is approximately 5-6%. The estimated prevalence in adults is approximately 3.7%
• Recent studies from Canada and the United Kingdom indicate allergy rates to peanut of over 1% in children.
• Based upon available studies, estimations of the rate of food allergies in children have been summarized as follows for common food allergens: cow milk, 2.5%; eggs, 1.3%; peanuts, 0.8%; wheat, 0.4%; and soy, 0.4%. Allergic reactions to non-protein food additives are uncommon.
• A recent report from the Centers for Disease Control and Prevention (CDC) indicated an 18% rise in food allergy among children in the past decade.
• Severe anaphylactic reactions, including death, can occur following the ingestion of food.Symptoms observed in a food-induced anaphylactic reaction may involve the skin, gastrointestinal tract, and respiratory tract. Frequently observed symptoms include oropharyngeal pruritus, angioedema (eg, laryngeal edema), stridor, dysphonia, cough, dyspnea, wheezing, nausea, vomiting, diarrhea, flushing, urticaria, and angioedema. Fatalities result from severe laryngeal edema, irreversible bronchospasm, refractory hypotension, or a combination thereof.
• Peanuts, tree nuts, fish, and shellfish are the foods most often implicated in severe food-induced anaphylactic reactions, though anaphylactic reactions have been reported to a wide variety of foods. Fatalities caused by reactions to milk are increasingly noted.
• Risk factors or associations for fatal food-induced anaphylaxis include: (1) the presence of asthma, especially in patients with poorly controlled disease; (2) previous episodes of anaphylaxis with the incriminated food; (3) a failure to recognize early symptoms of anaphylaxis; and (4) a delay or lack of immediate use of epinephrine to treat the allergic reaction.
• Teenagers and young adults appear to be overrepresented in registries of food allergy fatalities and present a special risk group.
• Incidence of food allergy and related hospital visits increased significantly from 1997 to 2007, according to CDC researchers. However, officials remain uncertain as to whether the statistics represent actual increases in clinical disease or reflect parental and health care provider awareness.
• Data analysis from several nationally representative surveys revealed the following:  In 2007, 3.9% of all children reported having experienced a food or digestive allergy in the previous 12 months — an 18% increase from rates reported in 1997 (P<.01).
• Food allergy–related outpatient visits tripled between 1993 and 2006 (P<.01) and were estimated at about 317,000 during that period.
• Hospitalization with documented food-related diagnoses rose from an average of 2,600 discharges per year (1998-2000) to 9,500 discharges per year (2004-2006; P<.01).
• The adoption of diagnostic V codes in 2000, which record health issues not directly related to hospitalization, may play a part in the observed inflations, according to the researchers.
• Reported food allergy is increasing among children of all ages, among boys and girls and among children of different races/ethnicities.
• Blood test results revealed that immunoglobulin E antibody responses varied depending on race/ethnicity, with black children more likely to have detectable levels of antibody to peanut and milk compared with white children, and a four times greater likelihood of having detectable antibody to shellfish.
• Hispanic children were more likely than white children to experience food allergies but less likely than black children. This might demonstrate disparities in awareness and reporting among different demographic groups. Alternatively, racial differences between food-specific IgE levels and self-reported food allergies might be attributable to differences in dietary habits or other factors that differ among these racial/ethnic groups.”
• Among children, males appear to be more affected; among adults, females are more frequently affected.
• In infants and children younger than 3 years, the prevalence of food allergy is approximately 5-6%.
• The estimated prevalence in adults is approximately 3.7%.
• By the age of 3 years, 5-6% of children suffer from FHS based on food challenges and a good clinical history. There were large discrepancies between reported and diagnosed FHS. Comparing our data with a study performed in the USA more than 20 years ago, there were no significant differences in the cumulative incidence of FHS.
• The data from the nation-wide Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) telephone survey, sponsored by Health Canada and the AllerGen research network, was presented at the American Academy of Allergy, Asthma & Immunology’s conference in March, 2009.
• While the information is not complete – it reflects about 90 per cent of the 9,000 individuals on whom data was collected: A greater prevalence of peanut allergy in Canadian children, and a greater prevalence of tree nut allergy overall, and in Canadian children.
• In Canada, 1.52 per cent of children are allergic to peanuts, based on a history of allergic reaction. The comparable figure in the U.S., from a 2002 survey, is .83 per cent, representing an 83 per cent higher rate in Canada. Similarly, the rate of tree nut allergy is about 120 per cent higher for Canadian children: 1.13 per cent have a history of reaction here, compared to .51 per cent in the United States.
• About 50 per cent higher rate of the allergy in U.S. adults compared to Canadian adults.
• That the differences come with a few caveats: the Canadian data was collected six years after the U.S. data, and some of the difference could be attributed to an increase in food allergies over that time. Also, the SCAAALAR team has not analyzed the demographics of the Canadian survey respondents yet, so it’s unclear if the studies represent the same socio-economic groups. This analysis will be done before the final results are published next year. (Updated U.S. statistics are also coming next year.)
• While the rates of allergy that Clarke and her team used to compare to U.S. figures are based on having a history of food allergy reactions, they also collected data on those who have had a medical diagnosis of food allergy, without a previous reaction. It might mean that the parent is going in with a child and saying, well, his brother has peanut allergies so I’m concerned he might be allergic, but he’s never eaten it.
• The physician then does a skin or blood test and makes a diagnosis based on the results. The SCAAALAR team is currently contacting all physicians who made the diagnoses in these cases to confirm that yes, that patient is deemed to have a true food allergy.
• The final figures for food allergy prevalence in Canada for individual foods, as well as overall incidence figures, will be based on those who have had a history of allergic reaction, as well as those who have a confirmed physician diagnosis
• Data from some study representative health and health care surveys indicate increases in reported food allergy estimates among world wide children . However, it cannot be determined how much of the increases in estimates are truly attributable to increases in clinical disease and how much are attributable to increased awareness by physicians, other health care providers, and parents. However, the consistent increases across surveys and among children in all age, gender, and race/ethnicity groups provide evidence that the increases are not limited to a certain setting, reporting mechanism, or demographic group.

Reference :

• Kagan RS, Joseph L, Dufresne C, Gray-Donald K, Turnbull E, Pierre YS, et al. Prevalence of peanut allergy in primary-school children in Montreal, Canada. J Allergy Clin Immunol. Dec 2003;112(6):1223-8. 
• Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. Sep 2007;120(3):638-46. 
• Zuidmeer L, Goldhahn K, Rona RJ, Gislason D, Madsen C, Summers C, et al. The prevalence of plant food allergies: a systematic review. J Allergy Clin Immunol. May 2008;121(5):1210-1218.e4. 
• Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol. Dec 2003;112(6):1203-7. 
• Grundy J, Matthews S, Bateman B, Dean T, Arshad SH. Rising prevalence of allergy to peanut in children: Data from 2 sequential cohorts. J Allergy Clin Immunol. Nov 2002;110(5):784-9. 

 

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