Identifying key priorities for research to protect the consumer with food hypersensitivity: A UK Food Standards Agency Priority Setting Exercise

Access to health care and food in children with food allergy

Food allergies and intolerance represent important health concerns to consumers who are predisposed to these illnesses. Unlike many current food safety issues, food sensitivities are complicated by both complex and multiple individual adverse reactions, which can vary from emotional to pathophysiological ailments. In some instances, the underlying mechanisms that result in the development of food allergies or intolerance have marked differences but produce common symptoms. The present-day diagnosis of these disorders can be impeded by intrinsic limitations in generating accurate information from patient history and biochemical, physicochemical, and immunochemical tests. Oral challenge tests represent effective methods for confirming and testing food allergens and food intolerance; however, these procedures are often restricted to clinical trials. It is important to be able to distinguish among food allergy, intolerance, and autoimmune disease in the management of these disorders. The role of food in the development of autoimmune disease may be exemplified by celiac disease, a food-induced enteropathy, requiring exposure to prolamins in wheat, rye, and barley. Various wheat and soy protein sources, including the soy protein isolates used to make infant formulas, have been related to juvenile or insulin-dependent diabetes mellitus (IDDM), a common chronic disease of childhood. Employing food process technologies to eliminate food constituents with potential for intolerance in some individuals is a potentially viable approach for reducing risk to food-related disorders. Finally, the development of food labelling regulations that require the identification of potential food allergens or agents for intolerance in the ingredient declaration on prepackaged food is a positive step toward the prevention of severe adverse reactions in hypersensitive individuals.

<p>Food allergies and intolerance represent important health concerns to consumers who are predisposed to these illnesses. Unlike many current food safety issues, food sensitivities are complicated by both complex and multiple individual adverse reactions, which can vary from emotional to pathophysiological ailments. In some instances, the underlying mechanisms that result in the development of food allergies or intolerance have marked differences but produce common symptoms. The present-day diagnosis of these disorders can be impeded by intrinsic limitations in generating accurate information from patient history and biochemical, physicochemical, and immunochemical tests. Oral challenge tests represent effective methods for confirming and testing food allergens and food intolerance; however, these procedures are often restricted to clinical trials. It is important to be able to distinguish among food allergy, intolerance, and autoimmune disease in the management of these disorders. The role of food in the development of autoimmune disease may be exemplified by celiac disease, a food-induced enteropathy, requiring exposure to prolamins in wheat, rye, and barley. Various wheat and soy protein sources, including the soy protein isolates used to make infant formulas, have been related to juvenile or insulin-dependent diabetes mellitus (IDDM), a common chronic disease of childhood. Employing food process technologies to eliminate food constituents with potential for intolerance in some individuals is a potentially viable approach for reducing risk to food-related disorders. Finally, the development of food labelling regulations that require the identification of potential food allergens or agents for intolerance in the ingredient declaration on prepackaged food is a positive step toward the prevention of severe adverse reactions in hypersensitive individuals.</p>

PurposeFor attendees with allergies, intolerances and coeliac disease, accessing safe, nutritious and good quality food and drink is a vital but challenging dimension of events. This study sought to capture and analyse the lived event experiences of individuals with a variety of food-related health, wellbeing and safety needs.Design/methodology/approachThis study adopted an inductive approach, using semi-structured interviews to gather qualitative data from participants with various food allergies and intolerances or coeliac disease.FindingsAttendees had low expectations regarding food choice, quality and value, which stemmed from past event experiences. Poor information about suitable food and drink, coupled with frontline staffs' perceived knowledge, responsiveness and care were frequently seen as sources of service failures. The data stress how exposure to potentially harmful foods and food avoidance influenced attendees' experiences. The findings also help to appreciate consumers' agency, identifying various coping strategies used by affected individuals to anticipate risks, engage in compensatory behaviours and mitigate the effects of unsuitable food and drink.Originality/valueThis study is unique in examining the event experiences of individuals with food allergies, intolerances and coeliac disease. It demonstrates how practices in the crucial domain of food and drink provision can affect the overall event experience, with potential consequences at, across and potentially beyond the venue and occasion. From a theoretical perspective, the study conceptualises intersections of risk, value-creation/destruction and experiential consumption. It shows the “episodic” and “perpetual” impacts of “risk loaded” consumption, while arguing that diverse value-creation/destruction practices mediate pathways leading to different experiential outcomes.

Does atopic dermatitis cause food allergy? A systematic review

5 - Food allergies and food intolerances in children

BackgroundThis study investigated risk factors associated with food allergy or food intolerance among school children in two Swedish towns.MethodsQuestionnaires were used to collect data on self-reported food allergy or intolerance (SRFA) in children aged 7–8 years from Mölndal in southwestern Sweden and Kiruna in northern Sweden. It included questions about specific food allergy or intolerance to cows’ milk, hens’ eggs, fish, peanuts, tree nuts, and cereals and also age of onset, type of symptoms and age of cessation. Information was also gathered on family allergy history, dietary habits, and certain lifestyle aspects.ResultsOf 1838 questionnaires distributed, 1029 were returned: 717/1354 (53%) from Mölndal and 312/484 (64%) from Kiruna. The cumulative incidence of SRFA was 19.6% with a significantly higher cumulative incidence in Kiruna (28.5%) than in Mölndal (15.7%), P < .001. Solids were introduced at a later age in Kiruna. Introduction of solids into a child’s diet from the age of 7 months or later, and maternal history of allergic disease, were both risk factors associated with a higher risk of food allergy or intolerance.ConclusionLate introduction of solids into an infant’s diet may be one risk factor for developing food allergy or intolerance. Later introduction of solids in Kiruna may be one explanation for the higher cumulative incidence of SRFA in that region.

Chapter 29 - Food allergies, sensitivities, and intolerances

Food and You 2 is a biannual ‘Official Statistic’ survey commissioned by the Food Standards Agency (FSA). The survey measures self-reported consumers’ knowledge, attitudes and behaviours related to food safety and other food issues amongst adults in England, Wales, and Northern Ireland. This report presents the findings from Waves 5 and 6 of the Food and You 2 survey, collected from respondents in Northern Ireland. Wave 5 (Opens in a new window) fieldwork was conducted between 26th April and 24th July 2022 and Wave 6 (Opens in a new window) fieldwork was conducted between 12th October 2022 and 10th January 2023. A total of 1,875 adults in Northern Ireland took part in Wave 5 and 1,644 adults in Northern Ireland took part in Wave 6. The modules presented in this report include ‘Food you can trust’, ‘Concerns about food’, ’Food security’, ‘Eating out and takeaways’, ‘Food allergies, intolerances and other hypersensitivities’, ‘Eating at home’ and ‘Food shopping and labelling’. Findings presented in this report refer to data collected in Northern Ireland unless otherwise specified. Where the same data were collected in both Waves 5 and 6, the findings from Wave 6 are reported.

Atopic allergic diseases (atopies) are recently becoming more common. Despite different sites of allergic inflammation, the sensitizing allergens can show cross-reactive effects, which raises the issues of atopic comorbidity. A combination of allergic rhinitis with food allergies, as well as asthma with food allergies, is becoming more frequent, but still not well understood. The aim of the work was to investigate food sensitization in the permanent allergic rhinitis and asthma and to assess relationships between this conditions and respiratory atopies, due to preferential sensitization to the dust mite Dermatophagoides pteronissinus. The study included 276 patients aged 18-60 years, both males and females, with perennial allergic rhinitis (n = 168) and bronchial asthma (n = 108). We determined blood concentrations of five specific IgE antibodies to food allergens from G8 group, as well as antibodies to the most significant Der p 1 allergen of dust mites Dermatophagoides pteronissinus, which are the leading source of sensitization in respiratory atopies. The data obtained were processed by descriptive statistics taking into account a distribution, calculation of non-parametric criteria, and correlation indexes. All patients were divided into three groups: (1) free of food allergies and sensitization symptoms (46%), (2) with absent clinical manifestations of food allergies, but latent food sensitization (26.1%), and (3) evidence of both symptoms and proven sensitization (27.9%). Thus, food sensitization was found in more than half of the cases of allergic rhinitis and asthma, An expected moderate correlation has been found between antibodies to shrimp and dust mite allergens. No association of IgE to Der p I with other food allergens was revealed. Meanwhile, a significantly higher frequency of clinical food allergies was found in asthma compared to allergic rhinitis. However, when accounting for a sum of subclinical and clinical sensitization, we did not reveal a significant difference between each other. This result may indicate a more reliable maintenance of allergic tolerance against food allergens, or a lack of factors for ceasing the tolerance condition at preclinical stage in allergic rhinitis, as compared to asthma.

Prevalence of Food Sensitization and Food Allergy in Children Across Europe

Aim of the paper was to make a review of available evidence for food allergies and food intolerance, to make a distinction between allergy and intolerance, and to emphasize the current knowledge about the prevalence and preventive measures. We made a search through PubMed and Google scholar, using the search terms "food", "allergy", "intolerance", "prevalence", "prevention" and "measures" for the period from 2000 to 2020, in order to find appropriate papers and publications. Food intolerance is defined as a non-immunological reaction to certain natural food ingredients or food additives that causes pharmacological, metabolic and gastro-intestinal reactions to food or food compounds. Food allergy is defined as an immune-mediated reaction to food, that is almost always mediated by immunoglobulin E (IgE). The worldwide prevalence of IgE-mediated allergic reactions is not exactly known. It is believed that about 1-2% of adults and between 5-7% of the children suffer from some type of food allergy and this number is growing. The most frequent specific food allergens are eggs, fish, peanuts, nuts, cow's milk, cereals containing gluten, (such as wheat, rye, barley, oats) seafood, soybeans, sesame, celery and mustard. Food intolerance can sometimes be controlled by limiting the amount of a certain type of food that is consumed, but when it comes to food allergies, much stricter avoidance of the food is required. Only food allergy, not food intolerance, can lead to a potentially fatal anaphylaxis reaction. In order to avoid food allergy, it is necessary to label the products for the presence of allergens.

Atopic dermatitis (AD) and food allergy (FA) share similar type 2 inflammation and commonly co-occur, but the precise proportion of AD patients with FA and vice versa, as well as the effect of AD disease severity on the strength of this association remains uncertain. The aim of this comprehensive systematic review and meta-analysis was to determine the prevalence and bidirectional associations of AD with food sensitivity (FS), FA and challenge-proven food allergy (CPFA). We searched PubMed and EMBASE and three independent reviewers performed title/abstract and full-text review and data extraction. Overall, 557 articles (n=225,568 individuals with AD, n=1,128,322 reference individuals; n=1,357,793 individuals with FS, FA or CPFA, n=1,244,596 reference individuals) were included in quantitative analyses. The overall pooled prevalence of FS, FA and CPFA in individuals with AD were 48.4% (95% confidence interval: 43.7-53.2), 32.7% (28.8-36.6) and 40.7% (34.1-47.5) respectively. AD prevalence among individuals with FS, FA and CPFA were 51.2% (46.3-56.2), 45.3% (41.4-49.3) and 54.9% (47.0-62.8) respectively. Children with AD had higher pooled FS (49.8% (44.4-55.1)) and FA (31.4% (26.9-36.1)) prevalences than adults with AD (28.6% (13.4-46.8) and 24.1% (12.1-38.7) respectively). Prevalences of FS and FA numerically increased with AD severity. FS, FA and CPFA are common comorbidities of AD and are closely related. Physicians should be attentive to this relationship to optimize management and treatment strategies in patients.

Immunologically mediated hypersensitivity to foods is defined as food allergy, mainly due to immunglobulins of classE (IgE) triggering immediate reactions (typeI hypersensitivity) with possible involvement of mucosa, skin, airways, intestinal tract, and the vascular system. Primary food allergy is based on (early) IgE sensitization against animal (e. g., cow's milk, hen's eggs) or plant proteins (e. g. peanut, hazelnut or wheat). In the case of secondary food allergies, IgE against pollen proteins (e. g., birch) reacts to structurally related food proteins (with cross-reactions to stone and pit fruits). Non-immunological food intolerance reactions are mostly based on carbohydrate malassimilation (e. g., lactose intolerance, fructose malabsorption) and are rarely due to pseudo-allergies (e. g., flavors, dyes, preservatives) primarily in patients with chronic urticaria. Common intestinal symptoms are mainly due to functional disorders (e. g., irritable bowel disease), rarely because of inflammatory intestinal diseases (e. g., celiac disease). Histamine intolerance, gluten hypersensitivity, and so-called food typeIII hypersensitivities are controversial diagnoses. The aforementioned disease entities/models are of variable importance for the affected individuals, the public health system, and society in general.

Allergy affects approximately one-third of the world's population, and the rates are growing. In Europe, it has been noticed that the risk of asthma and allergy is lower in the rural as opposed to urban population. There is a tendency for several allergic diseases to be present in the same person at the same time. The aim of the study was to verify the co-occurrence of allergic multimorbidity and food allergy and intolerance in a group of children. The multicentre cross-sectional study enrolled 1,008 children and adolescence aged 6-18 years (51.2% boys, 48.8% girls). The study comprised a questionnaire (respondents' declarations) and an outpatient examination (diagnostic examination followed by a medical diagnosis). The study was conducted as part of the 2016-2020 National Health Programme. In the study group, allergic rhinitis (AR) was present in 46.4%, bronchial asthma (BA) in 11.2% and atopic dermatitis (AD) in 6%. Allergic multimorbidity (simultaneous presence of 2 or more of the allergic diseases AR, BA and AD) was diagnosed in 9.7%. A single allergic disease (of the 3) was diagnosed in 43.4%. A diagnosis of food allergy and food intolerance was reported respectively at 29.6% and 14.3% participants with doctor-diagnosed allergic multimorbidity. Among those without any of the 3 allergic diseases, the percentage were 14.4% and 9.1%, respectively. Food allergy or food intolerance was more common in subjects with allergic multimorbidity than in subjects diagnosed with one allergic disease or those free of allergic diseases.