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Allergy Today News Bites: Food allergy in adults

US research findings of a high prevalence of food allergy in adults highlights the lack of New Zealand research into adult food allergy and the need for this to be addressed.

While a lot of studies internationally have focused on food allergy in children, there has been very little investigation into what is happening in adults. The assumption has been that prevalence in adults is less than in children, as many children outgrow allergies, particularly to milk or egg. It has also been assumed that food allergy develops primarily in early childhood.Allergy foods-805

However, a US study published recently suggests there is a higher prevalence of food allergies among American adults than identified in children. It found around 10.8 per cent of adults had a ‘convincing’ food allergy, whereas another study by the same lead researcher, Lurie Children’s Hospital and Northwestern University professor of paediatrics Dr Ruchi Gupta, had found prevalence in US children was around 8 per cent.

The adult study was based on a household survey of 40,000 adults, in which participants self-reported food allergies. Questions were designed to identify symptoms and related healthcare consistent with having IgE-mediated food allergy, to determine a ‘convincing’ food allergy.

While prevalence data is difficult to substantiate in the New Zealand context due to lack of research, there are some interesting findings in the US study that point to areas where investigation is urgently needed.

One is that adult-onset food allergy may be more common than we know. Nearly half of the respondents in the study identified as having a ‘convincing’ food allergy had developed food allergies as an adult.

Adult-onset allergies were identified to all the main allergy foods, with shellfish, soy, tree-nut and fin fish the most common. The most prevalent allergy overall in the adult population identified was to shellfish, followed by milk and peanut.

The study also found that food allergy rates were significantly higher in adults ‘other than White’ (in the US context this refers to Hispanic, non-Hispanic Black and Asian ethnicities). Only a quarter of participants with a ‘convincing’ food allergy had a current adrenaline prescription (e.g., an EpiPen®).

Little is known about the prevalence and patterns of food allergy in New Zealand adults, other than a study in 2016 by Auckland University’s School of Population Health. This found a near doubling of hospital admissions for food-triggered anaphylaxis in the 10 years to 2011, with significantly higher rates in the adult Pacific Island population compared to NZ European population. The most common food trigger (where identified) was shellfish.

Food allergy in adults is an emerging public health issue and is known to have a high social and economic impact. Research is urgently needed to understand more about prevalence and patterns in New Zealand, how to minimise risk, particularly in Pacific communities here, and long term, to reduce the impact overall.  

References

Gupta RS, Warren CM, Smith BM, et al. Prevalence and severity of food allergies among US adults JAMA Netw Open. 2019;2(1):e185630.

Gupta RS, Warren CM, Smith BM, et al. The public health impact of parent-reported childhood food allergies in the United States Pediatrics. 2018 Dec;142(6):e20181235.

Kool B, Chandra D, Fitzharris P. Adult food-induced hospital presentations in New Zealand Postgrad Med J. 2016 Nov;92(1093):640-644

Allergy New Zealand Allergy Advisor Penny Jorgensen

March 2019