Food allergy is a major pediatric health issue that is on the rise globally. The statistics suggest that food allergy has increased in many developed countries. It has also begun to increase in developing countries as well. The biggest issue remains the apparent surge of incidences in older children and teenagers. This age group poses a high risk of mortality due to food anaphylaxis. The behavioral tendencies often lead to a high number of anaphylactic deaths among teenagers. Teenagers tend to take riskier decisions regarding their food choices increasing their vulnerability to allergic attacks (Sagan, 2015).
However, despite the rising incidences, the accurate measurement of the extent of allergy is still unavailable. This is due to various factors like self-reporting by patients, a lack of reliable population-based data, usage of surrogate markers and high reliance on outpatient presentations. One similar issue is the poor understanding of the disorder of food allergy by the general mass. They tend to confuse it with food intolerance, personal preferences and similar conditions (Boye, 2012).
Furthermore, there are more than 160 food items that can cause allergic reactions from food (FDA, 2017). The Food Allergen Labelling and Consumer Protection Act (2004) identifies eight most commonly allergenic foods, as shown below. These food items account for 90% of food allergic reactions. They also commonly serve as sources for the derivation of many other ingredients.
Hereditary factors leading to food allergy
The incidence of food allergy in an individual depends on various factors like genetic disposition, the extent to which the food is exposed and molecular features of the allergen (I & RJ, 2002).
The individual predisposed genetically to allergic diseases is at the greatest risk of developing the food allergies. This is so because the genetic make-up as determined prior to birth does not allow any avoidable risk factors. Studies suggest that the risk of development of the allergy in offspring of healthy parents ranges from 5% to 15%. If one of the parents is allergic it increases to 40% and if both parents are allergic it surges to 60-80% (Żukiewicz-Sobczak, Agnieszka, Adamczuk, Kopczyński, & Wróblewska, 2013).
Environmental factors such as better hygiene, lifestyle, food habits and nutritional status play a significant role in the development of food allergy. High consumption of genetically modified products often leads to the development of food allergies. Furthermore, globalization promotes inter-cultural migration, thereby promoting travel resulting in global food exchange. Due to routine exposure to new foods, dietary habits are also changing (EUFIC, 2013).
Food customs adopted in the cultures of different nations foster the intake of certain food items. These food items when ingested repeatedly in large amounts can lead to allergic symptoms due to increased exposure of the body lining to intact proteins, contained in respective food items. For example, Italy faces a large number of cases of allergy to certain fruits, raw vegetables, tomatoes, and corn. In the countries of northern Europe, the allergy to cod, often consumed in the daily diet, dominates (Mahi, 2013). In India, chickpeas and Bengal gram are common allergic triggers (Anugu, 2015).
Hygiene leading to rising food allergy incidences
The tremendous rise in the obsession to fight germs inspired by TV commercials and media publicity, has led to a society scared of germs. Due to high adherence to preventive measures, the exposure to infectious agents in neonatal, infancy and early childhood diminishes. This further leads to a condition where the immune system confuses food proteins with an invading microorganism. Although the research of this theory is still in infancy and debated, a substantial number of clinicians believe it to be a leading cause of food allergy (Sally F Bloomfield, Shanahan, Stanwell-Smith, & Turner, 2016).
Overuse of certain medications like antibiotics or antacids causes alteration of the early life colonization of the gastrointestinal tract. Once altered this negatively affects the development of the immune system. The studies suggest that low microbial diversity in early infancy indicates that the composition of microorganism in early life promotes the susceptibility to food allergy (Bashir, Louie, Shi, & Nagler-Anderson, 2004).
Change in dietary habits
The understanding regarding the relation between diet during infancy and development of food allergies still lacks. However, the introduction of a diverse range of foods during early life inversely relates to the development of food allergies. Also, substitution of breastfeeding with artificial formulas having huge quantities of proteins inflicts undesirable immunological response in the child. The consumption of preserved foods loaded with additives and propagation of modernistic eating habits have contributed to the increase in the number of potential allergens (Laura Polloni, Gregori, & Muraro, 2013).
Vitamin D deficiency
Recently, researchers have shown that Vitamin D deficiency contributes towards food sensitization as well as the IgE-mediated food allergy. For example, children of Australian-born parents who had vitamin D deficiency showed an increased probability of egg and peanut allergy (G, et al., 2013). The incidence of food allergy or anaphylaxis cases is higher at higher absolute latitudes. This is because of lack of ultra violet-B intensity in the autumn and winter seasons for synthesis of vitamin D. Lower levels of Vitamin D in the body lead to compromised barrier function, modified microbial composition of the gut, and along with the effects of immune system components inclines an individual to allergic reactions to food allergens (Cairncross, Grant, Conlon, & Stonehouse, 2016)
The lifestyle of people in last few decades has changed tremendously. Majority of the changes have deteriorated the health conditions of an average human lifestyle. Like the widespread use of genetically-modified organisms into the food in recent times. Convincing evidence indicates a positive link between genetically modified crops and food allergies. Some of the food items that are most commonly genetically engineered foods are soy, corn, milk, peanuts, yeast. The list is similar to the list of major food allergens which also give an idea of the authenticity of the evidence (Buczynski, 2014).
Gravity of the issue
Despite the lack of research on the extent of food allergy’s rise, it can be safely said that its prevalence has increased manifolds globally. The reliability of the food allergy studies remains one of the biggest issues in managing this disorder. The existing and upcoming public health issues, consequential social and economic effects, demand global attention for the prevention and management of food allergies. Some of the factors like poor dietary habits or excessive hygiene are avoidable while others like genetic predisposition and cultural differences are not. The rise in food allergy is also related to usage of feeding formula for babies, and maintenance of excessive hygiene.
The difference in the definition of food allergy in society and in medicine also leads to the problem in collecting and defining the figures of tracing the change in the pattern of prevalence over the period of time and to identify the underlying causes of food allergy.This also results in slowing down of the implementation of policy changes like guidelines on food labeling as the extent of the problem is unclear.Food allergy therapies like Oral immunotherapy, Sublingual immunotherapy, and Epicutaneous immunotherapy are still in the initial research phase researching phase in clinical trials and are not available for public use which indicates that food allergy has been neglected area of allergy research.
- Bashir, M.E.H., Louie, S., Shi, H.N. & Nagler-Anderson, C., 2004. Toll-Like Receptor 4 Signaling by Intestinal Microbes Influences Susceptibility to Food Allergy. The Journal of Immunology, 172, pp.6978–87.Boye, J.I., 2012. Food allergies in developing and emerging economies: need for comprehensive data on prevalence rates. Clinical and Translational Allergy, 2(25).
- Buczynski, B., 2014. 3 Reasons Food Allergies Are on the Rise. [Online] Available at: https://www.care2.com/causes/3-reasons-food-allergies-are-on-the-rise.html [Accessed 17 January 2018].
- Cairncross, C., Grant, C., Conlon, C. & Stonehouse, W., 2016. The Relationship between Vitamin D Status and Allergic Diseases in New Zealand Preschool Children. Nutrients, 8(6), p.326doi: 10.3390/nu8060326
- EUFIC, 2013. Food allergens. [Online] Available at: http://www.eufic.org/en/healthy-living/article/food-allergens [Accessed 18 January 2018].G, Z. et al., 2013. Vitamin D insufficiency is associated with challenge-proven food allergy in infants. The Journal of allergy and Clinical immunology, 131(4), pp.1109-16.
- Akinbami, L.J., Schoendorf, C., A.E.S. & Kenneth, 2016. Trends in allergy prevalence among children aged 0–17 years by asthma status, United States, 2001–2013. Journal of Asthma, 53(4), pp.356–62.doi: 10.3109/02770903.2015.1126848
- Laura Polloni, 1.A.T.F.L.I.B.F.F., Gregori, D. & Muraro, A., 2013. Nutritional behavior and attitudes in food allergic children and their mothers. Clinical and Translational Allergy, 3(41).