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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Appendix B

Food Allergy Prevalence Literature Search Strategy

Two literature searches were conducted to assess the current prevalence of food allergy both nationally and internationally, including overall population prevalence, food-induced anaphylaxis, and the prevalence of allergy to specific foods. The searches were conducted in the online databases Medline and EMBASE and were not limited by country. Peanut, nut, milk, wheat, egg, soy, fish, shellfish, and sesame were included in the initial search. An additional search was conducted that included the previous foods as well as specific types of fish (tuna, salmon, cod), molluscs (clams), nuts (almond, macadamia nut, Brazil nut, pecan, cashew, pine nut, chestnut, pistachio, hazelnut, walnut), seeds (sesame, mustard, sunflower, poppy, pumpkin), coconut, litchi, lupin, fruits, and vegetables. Articles were excluded if they were written in a language other than English, had nonhuman subjects, or were case studies/series, notes, conference abstracts, nonsystematic reviews, or opinion pieces. The searches yielded 767 unduplicated articles. The abstracts of these articles were then screened for food allergy or anaphylaxis population prevalence estimates. Of these, 707 articles did not provide an estimate and were excluded, leaving 60 articles for full text review. These were supplemented by 13 articles suggested by committee members or found through reference mining. This process is illustrated in Figure B-1, and the search terms used are listed in Tables B-1 and B-2. A summary of studies that reported prevalence of food allergy is found in Table B-3. Summary tables of systematic reviews on the prevalence of food allergy are found in Table B-4.

Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Image
FIGURE B-1 Literature search and selection process. a Search was designed to capture studies measuring the prevalence of food allergy and anaphylaxis to peanut, nut, milk, wheat, egg, soy, fish, shellfish, or sesame, and was not limited by country. b Supplemental search was designed to capture studies measuring the prevalence of food allergy and anaphylaxis to additional allergens not included in initial search (see text for complete list) and was not limited by country. c Articles were excluded if they did not give food allergy or anaphylaxis population prevalence estimates.
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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TABLE B-1 Search Terms to Identify Relevant Literature on Global Prevalence of Food Allergy for Medline and EMBASE

Search Number Search Terms
a. Medline Search
1 Food hypersensitivity/
2 Peanut hypersensitivity/
3 Nut hypersensitivity/
4 Milk hypersensitivity/
5 Wheat hypersensitivity/
6 Egg hypersensitivity/
7 Soybean allergy.mp
8 Soy allergy.mp
9 Fish allergy.mp
10 Shellfish allergy.mp
11 Sesame allergy.mp
12 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11
13 Prevalence/
14 Anaphylaxis/
15 Life threatening food allergy.mp
16 13 or 14 or 15
17 12 and 16
b. EMBASE Search
1 Food allergy/
2 Food allergen/
3 Peanut allergy/
4 Nut allergy/
5 Milk allergy/
6 Wheat allergy/
7 Egg allergy/
8 Soy allergy.mp
9 Soybean allergy.mp
10 Fish allergy.mp
11 Shellfish allergy.mp
12 Sesame allergy.mp
13 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12
14 Prevalence/
15 Anaphylaxis/
16 Food allergy prevalence.mp
17 Life threatening food allergy.mp
18 14 or 15 or 16 or 17
19 13 and 18

NOTES: Search terms were mapped to Subject Headings when available; otherwise searched as Keyword (.mp). Searches limited to 2010 to Current.

Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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TABLE B-2 Search Terms to Identify Relevant Literature on Global Prevalence of Food Allergy to Additional Allergens for Medline and EMBASE

Search Numbers Search Terms
a. Medline
1 Prevalence/
2 limit 1 to (English language and humans and yr=“2012 -Current”)
3 Incidence/
4 limit 3 to (English language and humans and yr=“2012 -Current”)
5 Hypersensitivity/
6 limit 5 to (English language and humans and yr=“2012 -Current”)
7 Food Hypersensitivity/
8 limit 7 to (English language and humans and yr=“2012 -Current”)
9 Skin Tests/
10 Immunoglobulin E/
11 2 or 4
12 6 or 8 or 9 or 10
13 11 and 12
14 Milk/
15 13 and 14
16 Egg Hypersensitivity/
17 13 and 16
18 Milk Hypersensitivity/
19 13 and 18
20 Fishes/
21 Tuna/
22 Salmon/
23 Gadiformes/
24 20 or 21 or 22 or 23
25 13 and 24
26 Nut Hypersensitivity/
27 Prunus/
28 Macadamia/
29 Bertholletia/
30 Carya/
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Search Numbers Search Terms
31 Anacardium/
32 Nuts/
33 Pistacia/
34 Corylus/
35 Juglans/
36 pine nut.mp.
37 chestnut.mp.
38 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37
39 13 and 38
40 Peanut Hypersensitivity/
41 13 and 40
42 Wheat Hypersensitivity/
43 13 and 42
44 Soybeans/
45 13 and 44
46 Seeds/
47 Sesamum/
48 Mustard Plant/
49 Helianthus/
50 Papaver/
51 Cucurbita/
52 46 or 47 or 48 or 49 or 50 or 51
53 13 and 52
54 Cocos/
55 13 and 54
56 Litchi/
57 13 and 56
58 Lupinus/
59 13 and 58
60 Fruit/
61 Vegetables/
62 Fragaria/
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Search Numbers Search Terms
63 60 or 61 or 62
64 13 and 63
65 Mollusca/
66 Bivalvia/
67 65 or 66
68 13 and 67
Results from 15, 17, 19, 25, 39, 41, 43, 45, 53, 55, 57, 59, 64, and 68 combined
b. EMBASE Search
1 Prevalence/
2 limit 1 to (human and English language and yr=“2012 -Current”)
3 incidence/
4 limit 3 to (human and English language and yr=“2012 -Current”)
5 hypersensitivity/
6 limit 5 to (human and English language and yr=“2012 -Current”)
7 food allergy/
8 limit 7 to (human and English language and yr=“2012 -Current”)
9 skin test/
10 immunoglobulin E/
11 2 or 4
12 6 or 8 or 9 or 10
13 11 and 12
14 milk allergy/
15 egg allergy/
16 fish/
17 salmon/
18 tuna/
19 Atlantic cod/
20 Crustacea/
21 shellfish/
22 shrimp/
23 lobster/
24 crab/
25 mollusc/
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Search Numbers Search Terms
26 clam/
27 nut allergy/
28 almond/
29 Macadamia/
30 Brazil nut/
31 pecan/
32 cashew nut/
33 pine nut.mp.
34 chestnut/
35 hazelnut/
36 pistachio/
37 walnut/
38 peanut allergy/
39 wheat allergy/
40 soybean/
41 plant seed/
42 sunflower/
43 sesame/
44 Papaver/
45 mustard/
46 squash/
47 coconut/
48 lychee/
49 lupin/
50 fruit/
51 vegetable/
52 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50 or 51
53 13 and 52

NOTES: Search terms were mapped to Subject Headings when available; otherwise searched as Keyword (.mp). Searches limited to human studies, English language, and published 2012 to Current.

Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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TABLE B-3 Summary of Food Allergy Prevalence Studies

Reference Country Study Design Number Invited or Eligible Participants Participation Rate N (%)
Grabenhenrich et al., 2016 Europe Cross-sectional N/A 1,970 (reports of anaphylaxis)
McGowan et al., 2016 US Cross-sectional N/A NHANES III (1988-1994): 4,995

NHANES (2005-2006): 2,901
Xepapadaki et al., 2016 Europe Cohort 12,049 9,336 (77%)
Datema et al., 2015 Europe Cross-sectional Not indicated 731
Le et al., 2015 Europe (The Netherlands) Cross-sectional 6,600 3,864 (59%)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Age of Participants Food Allergens Method of Outcome Assessment Estimated Prevalence of Food Allergy, % (95% CI)
<18 years Hen egg, cow milk, nuts Report of anaphylaxis in the European Anaphylaxis Registry Food-related anaphylaxis: 66% of reports
6-19 years Peanut, milk, egg, shrimp sIgE Food sensitization NHANES III: 24.3 (22.1-26.5) NHANES 2005-2006: 21.6 (19.5-23.7)

Shrimp sensitization NHANES III: 11.2 (10.0-12.5) NHANES 2005-2006: 6.1 (4.5-7.7)
2 years Hen egg sIgE, SPT,
DBPCOFC
Mean raw incidence: 0.84 (0.67-1.03)

Adjusted mean incidence: 1.23 (0.98-1.51)

(Adjusted for eligible children who were not challenged)
Mean age: 32.3 ± 14.8 (SD) years Hazelnut SPT
sIgE
DBPCOFC
(N=124)
77.4
83.7
70.2
20-54 years Hen egg, cow milk, peanut, hazelnut, celery, apple, peach, fish, or shrimp Self-report

Clinical evaluation medical history, sIgE

DBPCOFC
10.8

4.1

3.2
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Reference Country Study Design Number Invited or Eligible Participants Participation Rate N (%)
Schoemaker et al., 2015 Europe Cohort 12,049 9,336 (77%)

358 eligible for DBPCOFC; 248 agreed to at least 1 challenge
Soller et al., 2015 Canada Cross-sectional 12,762 households 5,734 households/15,022 individuals (45%) (full participants)

524 households (4%) (partial participants)
Winberg et al., 2015 Sweden Cohort Not indicated 2,612 (96%)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Age of Participants Food Allergens Method of Outcome Assessment Estimated Prevalence of Food Allergy, % (95% CI)
12 and 24 months Cow milk Parent-report, clinical examination, sIgE or SPT, DBPCOFC Raw incidence: 0.54 (0.41-0.70)

Adjusted incidence: 0.74 (0.56-0.97)

(Adjusted for children who were eligible but not challenged, were placebo reactors, or who had inconclusive challenge outcomes, or who were lost to follow up)
Adults and children Peanut, tree nuts, fish, shellfish, sesame, milk, egg, wheat, and/or so Self-report, convincing history, physician diagnosis Self-reported food allergy to any food

Full participants: 6.4 (6.0-6.8) (unweighted) 7.5 (6.9-8.1) (weighted)

Partial participants: 2.1 (1.4-2.9) (unweighted)
11-12 years Milk, egg, cod, wheat Parent-report

Clinical evaluation + sIgE

DBPCOFC
Reported food allergy: 4.8 (4-6)

Clinically evaluated food allergy: 1.4 (1-2)

DBPCOFC-proven food allergy: 0.6 (0-1)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Reference Country Study Design Number Invited or Eligible Participants Participation Rate N (%)
Bunyavanich et al., 2014 US Cohort study 1,277 616 (48.2)
Burney et al., 2014 Europe Cross-sectional 28,269 17,366 (54.6)
GasparMarques et al., 2014 Portugal Cross-sectional 2,228 1,225 (55.0) participated

1,217 (54.6) included in analysis
Salo et al., 2014 US Cross-sectional 10,348 10,348
Wood et al., 2014 US Cross-sectional (patient survey) 1,651 1,059 (64%)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Age of Participants Food Allergens Method of Outcome Assessment Estimated Prevalence of Food Allergy, % (95% CI)
7-10 years Peanut Self-reported symptoms, sIgE levels, clinical information, and combinations of these variables Self-reported food allergy: 4.6 (2.9-6.3) Clinical food allergy based on sIgE: 5.0% (3.5-7.1)
Peanut sIgE ≥0.35 kU/L and prescribed epi auto-injector: 4.9 (3.2-6.7)
Peanut sIgE ≥14 kU/L: 2.9 (1.6-4.3)
Peanut sIgE ≥14 kU/L and prescribed epi auto-injector: 2.0 (0.9-3.2)
20-54 years Various Self-report, physician diagnosis, sIgE (≥0.35 kUA/L) Self-report: 21.0 Physician diagnosis: 4.4
IgE to any foods: 15.81
0-3 years 4-6 years Various Self-report Ever had a food allergy 0-3 years: 8.6 (6.4-11.5) 4-6 years: 12.1 (10.0-14.7) Total: 10.8 (9.1-12.6)

Current food allergy 0-3 years: 4.7 (3.1-7.0) 4-6 years: 6.4 (4.9-8.4) Total: 5.7 (4.6-7.2)
≥1 year Egg white, cow milk, peanut, shrimp sIgE Prevalence of food sensitization: 28
Adults (median age 52 years) Not specified Self-report of anaphylaxis to food Reported anaphylaxis: 31
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Reference Country Study Design Number Invited or Eligible Participants Participation Rate N (%)
Kaya et al., 2013 Turkey Cross-sectional 11,233 10,096 (89.9)
Gupta et al., 2012 US Cross-sectional 40,104 38,465 (96)
Gupta et al., 2011, 2013 US Cross-sectional 40,104 38,480 (96)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Age of Participants Food Allergens Method of Outcome Assessment Estimated Prevalence of Food Allergy, % (95% CI)
11-15 years Various Parent-report

Confirmation by: clinical history, sIgE, SPT, OFC, DBPCOFC
Lifetime parent-reported: 11.3 (10.7-11.9)
Parent-reported point prevalence: 3.6 (3.2-3.8)

Confirmed food allergy: 0.15
Confirmed peanut: 0.05
Confirmed tree nut: 0.05
0-17 years All allergens (peanut, shellfish, milk, fin fish, egg, tree nuts, wheat, soy) Parent report of physician diagnosis, sIgE, SPT, OFC, reaction history Urban centers: 9.8 (8.6-11.0)
Metro cities: 9.2 (8.4-10.1)
Urban outskirts: 7.8 (7.0-8.6)
Suburban areas: 7.6 (6.9-8.2)
Small towns: 7.2 (5.7-8.6)
Rural areas: 6.2 (5.6-6.8) P<0.0001
0-17 years Egg, fin fish, milk, peanut, shellfish, soy, tree nuts, wheat, or strawberry Parent report of physician diagnosis, sIgE, SPT, OFC, reaction history All allergens: 8.0 (7.7-8.3)
Egg: 0.8 (0.7-0.9)
Fin fish: 0.5 (0.4-0.6)
Milk: 1.7 (1.5-1.8)
Peanut: 2.0 (1.8-2.2)
Shellfish: 1.4 (1.2-1.5)
Soy: 0.4 (0.3-0.4)
Tree nuts: 1.0 (0.9-1.2)
Wheat: 0.4 (0.3-0.5)
Strawberry: 0.4 (0.4-0.5)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Reference Country Study Design Number Invited or Eligible Participants Participation Rate N (%)
Osborne et al., 2011 Australia Cohort 3,898 2,848 (73)
Sicherer et al., 2010 US Cross-sectional 12,658 households 5,300 households (13,534 subjects) (42)
Venter et al., 2010 UK Cohort Cohort A: 1,456
Cohort B: 2,858
Cohort C: 969
Cohort A: 1,218 (84)
Cohort B: 1,273 (44)
Cohort C: 891 (92)
Ben-Shoshan et al., 2009 Canada Cross-sectional 8,039 (64)
Branum and Lukacs, 2009 US Cross-sectional Not indicated Not indicated

NOTE: CI = confidence interval; DBPCOFC = double-blind, placebo-controlled oral food challenge; IgE = immunoglobulin E; N/A = not applicable; OFC = oral food challenge; SE = standard error; sIgE = food-specific serum IgE; SPT = skin prick test; UK = United Kingdom; US = United States.

Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Age of Participants Food Allergens Method of Outcome Assessment Estimated Prevalence of Food Allergy, % (95% CI)
12 months Raw egg, peanut, sesame, shellfish, or cow milk SPT, DBPCOFC

 Shellfish and milk: no food challenge performed
Overall prevalence (raw egg, peanut or sesame): 10.4 (9.3-11.5)

Raw egg: 8.9 (7.8-10.0)
Peanut: 3.0 (2.4-3.8)
Sesame: 0.8 (0.5-1.1)
<18 years Peanut, tree nuts, sesame Self-report Peanut: 1.4 (1.0-1.9)
Tree nuts: 1.1
Sesame: 0.1 (0-0.2)
3-4 years Peanut Cohort A: clinical history
Cohorts B and C: SPT and clinical history or OFC
Cohort A: 0.5
Cohort B: 1.4
Cohort C: 1.2
K-grade 3 students Peanut Clinical history, SPT, sIgE, DBPCOFC 1.62 (1.31-1.98)
0-17 years Not indicated Parent-report 3.9 ± 0.3 (SE)
Peanut, egg, milk, shrimp (in children ≥6 years) sIgE

Food allergy-related ambulatory care visits to hospital facilities and physician offices and hospitalizations
Proportion estimate ± SE
sIgE (peanut): 9.3 ± 0.8
sIgE (egg): 6.7 ± 0.6
sIgE (milk): 12.2 ± 0.9
sIgE (shrimp): 5.2 ± 0.6

317,000 (95% CI: 196,000-438,000) visits per year
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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TABLE B-4 Prevalence of Food Allergy: Systematic Review Summaries

Author, year McWilliam et al., 2015
Aims/Key questions To provide a comprehensive, up-to-date systematic review of the population prevalence of tree nut allergy in children and adults, including details of all individual tree nuts in various regions of the world
Study eligibility criteria

Inclusion criteria:

  • Types of studies: Population, cross-sectional, and cohort studies.
  • Types of participants: Adults and children; no age restrictions.
  • Primary outcomes: All forms of allergic reactions (primary and secondary IgE-mediated and non-IgE-mediated reactions) were included. All tree nut allergy outcomes were included for both individual and combined tree nut allergies. Included eligible studies that reported tree nut allergy based on self-report, sensitization (sIgE or SPT), OFC/DBPCOFC or convincing clinical history.

Exclusion criteria:

  • Types of studies: Reviews, case reports, and studies without full-text.
  • Types of participants: Selected patient groups or those performed in hospital or allergy clinic settings.
Literature search dates or year range January 1996 to December 2014
Number of food allergy studies included 36
Synthesis methods Summary tables, narrative text, meta-analysis
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Key findings Confirmed food allergy: Seven studies (all in children) using OFC (or convincing recent history of allergic reaction together with positive allergen-specific IgE) to determine a prevalence range of 0-1.6%.
Probable food allergy: Nine studies combined self-reported food allergy with additional objective assessment (e.g., specific details regarding doctor diagnosis or sensitization details [sIgE/SPT]) and were classified as probable food allergy for this review. The overall probable tree nut allergy prevalence range was 0.05-4.9%, with only one study reporting adult data.
Self-reported food allergy: Twenty studies based on self-report found tree nut allergy prevalence range was wider for adults (0.18-8.9%) and those studies including both adults and children (0.4-11.4%) than for those studies including only children (0-3.8%). Overall self-reported tree nut allergy prevalence ranged from 0 to 11.4%.
Pollen-associated food allergy: Prevalence estimates that included pollen-associated food allergy reactions to tree nut were significantly higher (8-11.4%) and were predominantly from Europe.
Geographic Differences: Prevalence of individual tree nut allergies varied significantly by region, with hazelnut the most common tree nut allergy in Europe; walnut and cashew the most common in the US; and Brazil nut, almond, and walnut the most common in the UK.
Limitations Small number of studies reporting challenge-confirmed tree nut allergy prevalence.
Unable to pool the prevalence estimates due to the large heterogeneity between the studies.
Data are largely limited to European, US, and UK studies.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y (limited to English-language articles)
List of studies (included and excluded) provided? Y/N (no list of excluded studies)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? N
Conflict of interest (COI) stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Author, year Umasunthar et al., 2015
Aims/Key questions To quantify the risk of anaphylaxis for food-allergic people
Study eligibility criteria

Inclusion criteria:

  • Study design: Prospective or retrospective registries, databases or cohort studies.
  • Participants: People with a medically diagnosed food allergy or a defined population where an assumed population rate of food allergy could be applied.
  • Follow-up: To enable calculation of total person-years of observation, the authors included studies that specified either total population and duration of data collection or anaphylaxis incidence rate.
  • Outcomes: The authors included reports of number of food anaphylaxis events during the follow-up period. Anaphylaxis determined by self-report, medical coding, or anaphylaxis admission to hospital.

Exclusion criteria:

  • Food-allergic reactions reported were not anaphylactic, or severity was not defined.
  • Time period not defined.
  • Population in which food anaphylaxis cases occurred could not be quantified.
Literature search dates or year range January 1946 to September 5, 2012
Number of food allergy studies included 34
Synthesis methods Summary tables, narrative text, meta-analysis
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Key findings

Self-reported food anaphylaxis in food allergic people:

  • Based on data from 10 studies, meta-analysis gave an incidence of 4.93 (95% CI: 2.78-8.74; range 0.60-57.89) per 100 person-years for people ages 0-19 years.
  • For peanut allergic people meta-analysis of data from four studies gave an incidence rate of 2.64 (95% CI: 1.13-6.17; range 1.64-8.90) per 100 person-years.

Medically coded food anaphylaxis in food-allergic people:

  • Based on nine studies, the incidence rate was 0.14 per 100 person-years (95% CI: 0.05-0.35; range 0.01-1.28).
  • Based on nine studies, the incidence rate for people ages 0-19 years was 0.20 (95% CI: 0.09-0.43; range 0.01-2.55; sensitivity analysis 0.08-0.39).
  • In sensitivity analysis using different estimated food allergy prevalence, the incidence varied from 0.11 to 0.21 per 100 person-years.
  • The incidence rate of up to 7.00 per 100 person-years has been reported for children ages 0-4 years.

Hospital admission due to food anaphylaxis in food-allergic people:

  • Based on four studies, the incidence rate was 0.09 (95% CI: 0.01-0.67; range 0.02-0.81) per 1,000 person-years.
  • Based on eight studies, the incidence rate for people ages 0-19 years was 0.20 (95% CI: 0.10-0.43; range 0.04-2.25).
  • Based on six studies, the incidence rate for children agse 0-4 years was 0.50 (95% CI: 0.26-0.93; range 0.08-2.82).
Limitations High heterogeneity between study results, possibly due to variation in study populations, anaphylaxis definition, and data collection methods.
Some uncertainty exists about the precision of the risk estimates, so mean estimates should be interpreted with caution.
The rate of self-reported anaphylaxis varied widely across studies. Study quality was generally rated as low for studies of self-reported anaphylaxis. It is likely that studies of self-reported anaphylaxis overestimate the true incidence of anaphylaxis.
The rate of medically coded anaphylaxis also varied widely between studies. These data may underestimate food anaphylaxis occurrence.
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y
List of studies (included and excluded) provided? Y/N (no list of excluded studies)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? Y
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Author, year Katz et al., 2014
Aims/Key questions To identify the adjusted prevalence of IgE-mediated soy allergy in children and perform a secondary analysis of the impact of age (less than and more than 6 months).
Study eligibility criteria

Inclusion criteria:

  • Types of studies: analytical transversal studies, studies of cases and controls, cohort studies, and clinical trials.
  • Types of participants: infants and children up to 19 years old, including newborns.
  • Primary outcomes: prevalence of sensitization or allergy to soy identified by clinical manifestations, parent reports, serum concentrations of sIgE, SPT, or an OFC.

Exclusion criteria:

  • Types of studies: narrative reviews; studies of people older than age 19 years; studies lacking sufficient congruence and/or yield between what was described in the objectives and what was reported.
Literature search dates or year range 1909 to March 2013
Number of food allergy studies included 40
Synthesis methods Summary tables, meta-analysis
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Key findings

Ten studies reported OFC-proven soy protein allergy in the general population (i.e., the referred population). Quality of evidence was low or moderate.

  • The weighted prevalence for the general population: 0.27 (95% CI: 0.1%-0.44%) (N/total=4/1,946)
  • The weighted prevalence for the referred population: 1.9 (95% CI: 1.1%-2.7%) (N/total=35/1,807)
  • The weighted prevalence for atopic children: 2.7 (95% CI: 1.8%-3.3%) (N/total=19/708)

Six studies reported the prevalence of self-reported soy allergy in the general population. The quality of evidence was low.

  • The prevalence was 0.2 (95% CI: 0.0%-0.30%) (N/total=39/19,732)

Twelve studies reported the prevalence of allergy to soy after the use of infant formula with soy-based protein. Quality of evidence was low to moderate.

  • The weighted prevalence of OFC-proven soy allergy was 2.5% (95% CI: 2.1%-8.3%) (N/total=18/720)

Six studies reported prevalence of self-reported soy allergy after use of soy-based formula. Quality of evidence was moderate except for one study.

  • Weighted prevalence was 4.4% (95% CI: 0%-5.6%) (N/total=108/2,439)
Limitations All four positive cases of OFC-proven soy allergy in the general population originated from one study. Cutaneous signs were noted in only one of these cases.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y
List of studies (included and excluded) provided? Y/N (no for excluded studies)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? Y
Conflict of interest stated? N
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Author, year Keet et al., 2014
Aims/Key questions To determine the prevalence of self-reported food allergy in children in the US, and explore sources of variation in prevalence estimates, including case definition, changes over time, and racial/ethnic differences.
Study eligibility criteria

Inclusion criteria:

  • Types of studies: national surveys; population-based original reports.
  • Types of participants: US general population; children.
  • Primary outcomes: self-reported food allergy.

Exclusion criteria:

  • Types of studies: studies without individual level data; abstracts only.
  • Types of participants: adults.
Literature search dates or year range Up to February 2012
Number of food allergy studies included 27 survey administrations (20 survey administrations were used in the meta-regression)
Synthesis methods Summary tables, narrative text, meta-analysis with meta-regression
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Key findings Seven surveys reported self-reported food allergy (National Maternal and Infant Health Survey; NHANES III; National Survey of Children’s Health 2003 and 2007; NHIS 1997-2011; NHANES 2007-2008 and 2009-2010).
Prevalence: It appears that the prevalence of self-reported food allergy is between 3 and 6 percent.
Prevalence (current versus ever): Compared to estimates of prevalence of self-reported current food allergy, the prevalence of self-reported history of food allergy ever was considerably higher, even after adjusting for year of study (difference: 2.5 percentage points between current and ever/time undefined food allergy, 95% CI: 1.5%-3.4%; P<0.001 for all children).
Change over time: The self-reported prevalence of food allergy among children was estimated to have increased by 1.2 percentage points per decade during 1988-2011 (95% CI: 0.7%-1.6%).
Racial/ethnic differences: The rate of increase in self-reported food allergy prevalence varied significantly by race/ethnicity; the estimated increase in food allergy prevalence per decade among Black children was 2.1 percentage points (95% CI: 1.5%-2.7%) compared to 1.2 percentage points among Hispanics (95% CI: 0.7%-1.7%) and 1.0 percentage points (95% CI: 0.4%-1.6%) among whites (P=0.01 for comparison of trends between blacks and whites, and P=0.04 for comparison between blacks and Hispanics).
Limitations Surveys included in meta-regression were limited to those conducted by the CDC.
The studies have too much heterogeneity to calculate a summary measure of food allergy prevalence.
All outcomes were based on self-report.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y (English-only)
List of studies (included and excluded) provided? Y/N (no list of excluded studies)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Methods used to combine the findings appropriate? Y
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Likelihood of publication bias assessed? Y
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Author, year Nwaru et al., 2014
Aims/Key questions To provide up-to-date estimates of the prevalence of allergy to cow milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish in Europe.
Study eligibility criteria

Inclusion criteria:

  • Types of studies: Systematic reviews and meta-analyses, cohort studies, case-control studies, cross-sectional studies, and routine health care studies published in Europe.
  • Types of participants: All ages; population-based.
  • Primary outcomes: Allergy to cow milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish. Assessments based on self-report, SPT, sIgE, OFC/DBPCOFC, or convincing clinical history (i.e., outcomes confirmed by a convincing clinical judgment by a physician without food challenge).

Exclusion criteria:

  • Types of studies: Review and discussion papers, nonresearch letters and editorials, case studies and case series, animal studies, and all randomized controlled trials.
Literature search dates or year range January 2000 to September 30, 2012
Number of food allergy studies included 65 (based on 50 primary studies)
Synthesis methods Summary tables, narrative text, meta-analysis
Key findings Self-reported food allergy: The overall pooled estimates for all age groups of self-reported lifetime prevalence of allergy to cow milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish were 6.0% (95% CI: 5.7%-6.4%), 2.5% (2.3%-2.7%), 3.6% (3.0%-4.2%), 0.4% (0.3%-0.6%), 1.3% (1.2%-1.5%), 2.2% (1.8%-2.5%), and 1.3% (0.9%-1.7%), respectively.
Food-challenge-defined food allergy: The prevalence of food-challenge-defined allergy to cow milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish was 0.6% (0.5%-0.8%), 0.2% (0.2%-0.3%), 0.1% (0.01%-0.2%), 0.3% (0.1%-0.4%), 0.2% (0.2%-0.3%), 0.5% (0.08%-0.8%), 0.1% (0.02%-0.2%), and 0.1% (0.06%-0.3%).
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Limitations Significant heterogeneity between the studies.
Limited generalizability (limited to European studies published after 2000).
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y
List of studies (included and excluded) provided? Y/N (no list of excluded studies)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? N
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Author, year Greenhawt et al., 2013
Aims/Key questions To understand the racial and ethnic disparities in food allergy in the US.
Study eligibility criteria

Inclusion criteria:

  • Types of studies: English-language articles with data from the US and research that presented original data related to racial/ethnic disparity in reported or diagnosed food allergy (including food sensitization), prevalence, treatment, or clinical course.

Exclusion criteria:

  • Types of studies: Systematic reviews, meta-analyses, abstracts, gray literature, and non-US studies.
Literature search dates or year range Not provided
Number of food allergy studies included 20
Synthesis methods Summary tables, narrative text
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Key findings None of the studies used OFC/DBPCOFC to assess food allergy.
In 12 studies, blacks (primarily children) had significantly increased adjusted odds of food sensitization or significantly higher proportion or odds of food allergy by self-report, discharge codes, or clinic-based chart review than did white children.
Limitations Major differences in study methodology and reporting precluded calculation of a pooled estimate of effect.
Food allergy outcomes were measured indirectly.
Low AMSTAR rating.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? N (did not state the literature search dates or range)
Status of the publication as an inclusion criterion? N
List of studies (included and excluded) provided? Y/N (list of excluded studies not provided)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? N
Scientific quality used in formulating conclusions? N
Methods used to combine the findings appropriate? N
Likelihood of publication bias assessed? N
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Author, year Lee et al., 2013
Aims/Key questions To summarize the current literature on food allergy in Asia and compare it with Western populations.
Study eligibility criteria

Inclusion criteria:

  • Types of studies: Reviews, epidemiological/prevalence studies, clinical studies, anaphylaxis studies, case series/reports.
  • Types of participants: Asian populations.
  • Outcomes: Food allergy determined by self-report, SPT, food elimination testing, DBPCOFC, convincing history, food avoidance, sIgE, physician diagnosis, or OFC.

Exclusion criteria:

  • Types of studies: Articles from the Middle East and Turkey; non-English studies.
Literature search dates or year range January 2005 to December 2012
Number of food allergy studies included 53
Synthesis methods Summary table, narrative text
Key findings The overall prevalence of food allergy in Asia is somewhat comparable to the West. However, the types of food allergy differ in order of relevance. Shellfish is the most common food allergen from Asia.
The prevalence of peanut allergy in Asia is extremely low compared to the West. Among young children and infants, egg and cow milk allergy are the two most common food allergies, with prevalence data comparable to Western populations.
Wheat allergy, though uncommon in most Asian countries, is the most common cause of anaphylaxis in Japan and Korea, and is increasing in Thailand.
Limitations Low AMSTAR rating
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? N
Comprehensive literature search? N (did not supplement the database searches)
Status of the publication as an inclusion criterion? N
List of studies (included and excluded) provided? Y/N (did not include list of excluded studies)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Characteristics of included provided? Y/N (not for all 53 studies)
Scientific quality of the included studies assessed and reported? N
Scientific quality used in formulating conclusions? N
Methods used to combine the findings appropriate? Not applicable (findings were not combined)
Likelihood of publication bias assessed? N
Conflict of interest stated? N
Author, year Panesar et al., 2013
Aims/Key questions To understand and describe the epidemiology of anaphylaxis from any cause in Europe and describe how these characteristics vary by person, place, and time.
Study eligibility criteria

Inclusion criteria:

  • Types of studies: Systematic reviews and/or meta-analyses, cohort studies, cross-sectional studies, case-control studies, and routine health care studies.
  • Primary outcomes: Incidence, prevalence, and trends over time of anaphylaxis in Europe.

Exclusion criteria:

  • Types of studies: Reviews, discussion papers, nonresearch letters and editorials, case studies, and case series plus animal studies.
Literature search dates or year range January 1, 2000, to September 30, 2012
Number of food allergy studies included 49 (3 included in meta-analysis)
Only 10 were food allergy studies and none of these was in the meta-analysis
Synthesis methods Summary tables, narrative text, meta-analysis
Key findings Meta-analysis yielded a pooled estimated prevalence of anaphylaxis, due to any cause, of 0.3% (95% CI 0.1%-0.5%).
Ten studies found that the proportions of food allergy reactions that resulted in anaphylaxis ranged from 0.4% to 39.9%.
One study of 163 children found the food allergens that most commonly resulted in anaphylaxis were cow milk (29%), hen egg (25%), hazelnut (5%), peanut (4%), kiwi (4%), walnut (4%), pine nut (3%), fish (3%), wheat (2%), soy (2%), shrimp (2%), apricot (2%), and sesame (2%).
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Limitations No discussion of how food allergy was determined.
Very few studies were on food allergy.
Limited to European populations.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y
List of studies (included and excluded) provided? Y
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? N
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Author, year Umasunthar et al., 2013
Aims/Key questions To estimate the incidence of fatal food-induced anaphylaxis for people with food allergy and relate this to other mortality risks in the general population.
Study eligibility criteria

Inclusion criteria:

  • Study design: Registries, databases, or cohort studies including ≥1 case of fatal food anaphylaxis.
  • Participants: A defined population where an assumed population rate of food allergy could be applied.
  • Follow-up: To enable calculation of total person-years of observation, the authors included studies that specified either total population and duration of data collection or anaphylaxis incidence rate.
  • Outcomes: Reports of number of fatal food anaphylaxis events during the follow-up period.

Exclusion criteria:

  • Fatalities neither probably nor definitely due to anaphylaxis, in the judgment of the original study authors.
  • Time period not defined.
  • Population in which food anaphylaxis cases occurred could not be quantified.
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Literature search dates or year range January 1946 to September 5, 2012
Number of food allergy studies included 13
Synthesis methods Summary table, meta-analysis
Key findings

Meta-analysis estimates the incidence rate of fatal food anaphylaxis in a food-allergic person as:

  • 1.81 (95% CI: 0.94-3.45; range 0.63-6.68) per million person-years (micromorts) based on 10 studies
  • 3.25 (95% CI: 1.73-6.10; range 0.94-15.75) micromorts in those ages 0 to 19 based on 10 studies
  • 2.13 (95% CI: 1.09-4.16; range 1.03-8.77) micromorts for peanut allergy based on seven studies
In sensitivity analysis with different estimated food allergy prevalence, the incidence varied from 1.35 to 2.71 per million person-years.
Limitations Study quality was mixed, and study results had high heterogeneity, possibly due to variation in food allergy prevalence and data collection methods.
Study authors were unable to exclude the possibility of a systematic bias operating across different studies, in either the acquisition and coding of fatal food anaphylaxis data or the estimation of food allergy prevalence.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y
List of studies (included and excluded) provided? Y/N (list of excluded studies was not provided)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? Y
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Author, year Chafen et al., 2010
Aims/Key questions To systematically review the evidence on the prevalence of food allergies.
Study eligibility criteria

Inclusion criteria:

  • The initial inclusion criteria were broad and included prior systematic reviews, meta-analyses, or both, and studies presenting original data related to the prevalence, diagnosis, management, or prevention of food allergy. After assessing the relative quantities of studies on these topics, the authors restricted studies of prevalence to those with population-based samples (and systematic reviews of such studies); studies of diagnostic tests to those that presented sufficient data to calculate both sensitivity and specificity, had a prospective, defined study population, and used food challenge as a criterion standard; and studies of management and prevention to those that were either controlled trials (both randomized and nonrandomized) or systematic reviews.
Literature search dates or year range January 1988 to September 2009
Number of food allergy studies included 6 studies on prevalence of food allergy
Synthesis methods Narrative text
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Key findings

One meta-analysis on incidence and prevalence.

  • The pooled estimate of prevalence of cow milk allergy was 3.5% (95% CI: 2.9%-4.1%) by self-report; 0.6% to 0.9% from SPT, sIgE, and DBPCOFC.
  • The pooled estimates (%, 95% CI) for self-report and other methods were: 1.3% (95% CI: 1.0%-1.6%) versus 0.3% to 0.9% (egg); 0.75% (95% CI: 0.6%-0.9%) versus 0.75% (peanut); 0.6% (95% CI: 0.5%-0.7%) versus 0.2% to 0.3% (fish); and 1.1% (95% CI: 1.0%-1.2%) versus 0.6% (shellfish).

Three population-based studies on change in prevalence over time in the UK, Canada, and the US.

  • The UK study found the parent-reported prevalence of peanut allergy increased from 0.5% in 1989 to 1.0% in 1994-1996 (P=0.20), and the prevalence of IgE antibodies increased from 1.1% to 3.3% (P=0.001).
  • In Canada, prevalence of peanut allergy was 1.5% in 2000-2002 and increased to 1.63% in 2005-2007 (nonsignificant difference) (based on parent-report, SPT, sIgE, and food challenge).
  • In the US, authors estimated that 3.3% of US children had food allergies in 1997 versus 3.9% in 2007 (statistically significant difference).

Overall Findings:

  • Food allergy affects more than 1% to 2% but less than 10% of the population.
  • It is unclear whether the prevalence of food allergies is increasing.
Limitations
  • Heterogeneity in the criteria used for the diagnosis of food allergy made comparisons of prevalence across studies dependent on the methods used for the diagnosis and prevented data pooling.
  • Authors were unable to perform formal evaluations for publication bias due to the heterogeneity of the included studies.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? Y (limited to English-only articles)
List of studies (included and excluded) provided? N
Characteristics of included provided? N
Scientific quality of the included studies assessed and reported? Y
Scientific quality used in formulating conclusions? Y
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Methods used to combine the findings appropriate? Not applicable (findings on prevalence were not combined)
Likelihood of publication bias assessed? N
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Author, year Zuidmeer et al., 2008
Aims/Key questions To assess the prevalence of allergies to plant food according to the different subjective and objective assessment methods.
Study eligibility criteria

Inclusion criteria:

  • Types of studies: Population-based cross-sectional and cohort studies.
  • Primary outcomes: Food allergy (OFC/DBPCOFC), food sensitization (SPT, sIgE), or perceived food allergy (parent-/ self-report).

Exclusion criteria:

  • Types of studies: Case-control studies; studies in selected patient groups (e.g., asthma or eczema patients); studies performed in clinical settings; studies that had enriched study samples with patients with allergy (for further clinical studies); or articles that did not report the sample size.
Literature search dates or year range January 1990 to December 2006
Number of food allergy studies included 36 (33 publications)
Synthesis methods Summary tables, meta-analysis
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Key findings Based on 4 studies using food challenge tests, the prevalence of allergy to fruits ranged from 0.1% to 4.3%.
Based on 2 studies using food challenge tests, the prevalence of allergy to vegetables ranged from 0.1% to 0.3%.
Based on 3 studies using food challenge tests, the prevalence of allergy to nuts ranged from 0.1% (almond) to 4.3% (hazelnut).
Both for challenge tests and for sensitization assessed by SPT, the highest prevalence estimates of more than 4% were found for hazelnut.
Two studies from the UK and one from Germany reported positive wheat challenge tests in children with a prevalence as high as 0.5%. In adults, the prevalence of sensitization to wheat (assessed by IgE) was >3% in several studies.
In adults and adolescents, the highest prevalence estimates of allergy to soy were found in three Swedish studies (sensitization assessed by IgE as high as almost 3%). Studies from all other countries showed prevalences well below 1% regardless of method used or age group.
Meta-analyses showed significant heterogeneity between studies regardless of food item or age group. In adults, there was significant heterogeneity (P<0.001) among the seven studies regarding perception of allergy caused by fruits (summary prevalence estimate, 1.22%; 95% CI: 0.82%-1.63%), vegetables (six studies: 0.98%; 95% CI: 0.52%-1.45%), and wheat (five studies: 0.40%; 95% CI: 0.21%-0.59%), as well as for sensitization against wheat (assessed by IgE in five studies: 2.08%; 95% CI: 0.87%-3.29%). Similarly, among studies in children, the heterogeneity was significant (P<0.001) for perception of allergy caused by tree nuts (five studies: 0.52%; 95% CI: 0.20%-0.85%) or soy (seven studies: 0.34%; 95% CI: 0.12%-0.56%), whereas the heterogeneity was of a lower level but still significant (P=5.016) among the five studies assessing sensitization against wheat by SPT (0.43%; 95% CI: 0.16%-0.70%).
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Limitations Few studies used OFC or DBPCOFC to determine food allergy. Meta-analysis was done only when five or more studies were available, so, due to the lack of studies using OFC or DBPCOFC, meta-analysis was done only for studies that determined food allergy by SPT, sIgE, or self-report.
The authors could not rule out that studies were missed, particularly from non-European or non-American journals.
The comparison of prevalence estimates from different studies is hampered by using different types of prevalence.
A limitation of the interpretation of findings on allergic sensitization may be that positive IgE or SPT results to plant-derived foods can be a result of cross-reactivity to pollen. Consequently, the prevalence of food allergy may rise or fall with the presence of the sensitizing pollen in the study area, which depends on the season and climate and may vary from year to year.
Fairly low AMSTAR rating.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y (study selection)/ Not clear for data extraction
Comprehensive literature search? N (searched only one database)
Status of the publication as an inclusion criterion? N
List of studies (included and excluded) provided? Y/N (no list of excluded studies)
Characteristics of included provided? Y
Scientific quality of the included studies assessed and reported? N
Scientific quality used in formulating conclusions? N
Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? N
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Author, year Rona et al., 2007
Aims/Key questions To assess the prevalence of food allergy by performing a meta-analysis according to the method of assessment used.
Study eligibility criteria

Inclusion criteria:

  • Primary outcomes: Self-reported symptoms, specific IgE positive, specific skin prick test positive, symptoms combined with sensitization, and food challenge studies.

Exclusion criteria:

  • Types of studies: Studies restricted to the prevalence of food allergy in groups with asthma, eczema, or allergic rhinitis and those performed in selected patients in a clinical setting. Also excluded studies using a case control design if it did not provide a prevalence estimate for the community, and duplicate publications. Excluded articles when the original community sample was enriched with a sample including patients, or the sample size was not provided.
Literature search dates or year range January 1990 to December 2005
Number of food allergy studies included 51
Synthesis methods Narrative text, summary tables, meta-analysis
Key findings The studies showed marked heterogeneity regardless of type of assessment or food item considered, and in most analyses this persisted after age stratification.
Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food.

Prevalence of food allergy determined by OFC or DBPCOFC:

  • The prevalence for fish was near 0% (based on two studies).
  • The prevalence for milk varied from 0% to 3% (based on seven studies). A marked heterogeneity was observed for milk in preschool children, the only group for which sufficient studies were available for useful analysis.
  • The prevalence for egg varied from 0% to 1.7% (based on three studies).
  • The prevalence for any food varied from 1% to 10.8% (based on six studies).
Meta-analysis results were presented graphically in this paper.
Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×
Limitations In the overall estimate of the prevalence of food allergy related to food challenge, the authors were unable to omit positive challenges to nonallergic food hypersensitivity; thus, these estimates may give an overestimate of prevalence.
Marked heterogeneity among studies.
AMSTAR rating
An a priori design? Y
Duplicate study selection and data extraction? Y
Comprehensive literature search? Y
Status of the publication as an inclusion criterion? N
List of studies (included and excluded) provided? Y/N (list of excluded studies not provided)
Characteristics of included provided? N
Scientific quality of the included studies assessed and reported? N
Scientific quality used in formulating conclusions? N
Methods used to combine the findings appropriate? Y
Likelihood of publication bias assessed? N
Conflict of interest stated? Y/N (COI of the systematic review authors was provided but not provided for included studies)

NOTE: CDC = Centers for Disease Control and Prevention; CI = confidence interval; DBPCOFC = double-blind, placebo-controlled oral food challenge; IgE = immunoglobulin E; NHANES = National Health and Nutrition Examination Survey; NHIS = National Health Interview Survey; sIgE = food-specific serum IgE; SPT = skin prick test; UK = United Kingdom; US = United States.

Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
×

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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Suggested Citation:"Appendix B: Food Allergy Prevalence Literature Search Strategy." National Academies of Sciences, Engineering, and Medicine. 2017. Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy. Washington, DC: The National Academies Press. doi: 10.17226/23658.
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Page 438
Next: Appendix C: Risk Determinants Literature Search Strategy »
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Over the past 20 years, public concerns have grown in response to the apparent rising prevalence of food allergy and related atopic conditions, such as eczema. Although evidence on the true prevalence of food allergy is complicated by insufficient or inconsistent data and studies with variable methodologies, many health care experts who care for patients agree that a real increase in food allergy has occurred and that it is unlikely to be due simply to an increase in awareness and better tools for diagnosis. Many stakeholders are concerned about these increases, including the general public, policy makers, regulatory agencies, the food industry, scientists, clinicians, and especially families of children and young people suffering from food allergy.

At the present time, however, despite a mounting body of data on the prevalence, health consequences, and associated costs of food allergy, this chronic disease has not garnered the level of societal attention that it warrants. Moreover, for patients and families at risk, recommendations and guidelines have not been clear about preventing exposure or the onset of reactions or for managing this disease.

Finding a Path to Safety in Food Allergy examines critical issues related to food allergy, including the prevalence and severity of food allergy and its impact on affected individuals, families, and communities; and current understanding of food allergy as a disease, and in diagnostics, treatments, prevention, and public policy. This report seeks to: clarify the nature of the disease, its causes, and its current management; highlight gaps in knowledge; encourage the implementation of management tools at many levels and among many stakeholders; and delineate a roadmap to safety for those who have, or are at risk of developing, food allergy, as well as for others in society who are responsible for public health.

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