The rise of food allergies in children and adults is of great concern to the medical community.
The introduction of new foods into the diet—including novel plant proteins—likely plays a role.
It’s important for physicians to diagnose and monitor their patients for food allergies, while providing necessary counseling.
In the past decade, research has shown that food allergies are on the rise in your patients. But not for every patient population—geographic location and the influx of diet trends are hypothesized to be the primary drivers of the increase, but other theories abound.
Here’s what you need to know to keep your patients safe.
Results from a population-based survey (n=40,443) published in JAMA Network Open suggest that 10.8% of US adults were food allergic, and 19% believed they were food allergic. Approximately half of adults with a food allergy exhibited at least one adult-onset food allergy, with 38% of them reporting at least one food-allergy-associated emergency department visit during their lifetime.
Results of this study indicate that food allergies are frequent and severe in US adults, with food allergy often beginning during childhood. Among children, 1 of 13 in the United States in 2011 had a food allergy, and the incidence has been rising ever since.
The hygiene hypothesis
The exact reasons why food allergies are on the rise is unclear. One leading proposal is the “hygiene hypothesis.”
This hypothesis was first introduced in 1989 to explain rising asthma rates; it posits that early microbial exposure affects the immune system.
Indeed, results of recent studies demonstrate that early-life viral infections (eg, rhinovirus or RSV) may predict increased asthma. As for food allergy, skin barrier deficiencies secondary to atopic dermatitis may be linked to food allergy and food sensitization.
Other factors at play
In addition to the hygiene hypothesis, other thoughts on why food allergies are on the rise abound.
“It is not yet clear whether the changing prevalence of allergy relates to an increase in the identification and diagnosis of allergy, an absolute rise in the number of food allergies being reported or the importance of environmental factors in allergic susceptibility,” wrote the authors of a review published in Trends in Food Science & Technology.
“What is clear,” they added, “is that increases in prevalence have preferentially affected industrialized regions and there is evidence of increasing prevalence in rapidly developing countries in line with rising economic growth. The prevalence and nature of food allergy in different regions reflect the commonly consumed food allergens in those regions.”
"Research studies have demonstrated how factors like immigration, ethnicity and consumer behavior affect food allergy development."
— Authors, Trends in Food Science & Technology
New foods are continuously introduced into the human diet—especially with a trend toward veganism and vegetarianism. To meet a growing demand for plant-based foods that have the texture, satiety, and mouthfeel of animal-based products, new plant-based proteins have been developed based on nuts, seeds, cereals, legumes, and tubers.
These foods, the review authors explain, are widely recognized as a cause of most food allergies. These novel allergens result in new exposures and allergen cross-reactivity. Indeed, plant proteins are more likely to be recognized as non-self than are animal proteins.
Although meat allergies are rare, a dietary trend to introduce new animal-based proteins is afoot, which could play a role in the rise in the rates of allergy. Examples include lab-grown meat (ie, cell-based meat and seafood) and edible insects.
Cell-based meat and seafood are derived from animal stem cells grown in a controlled laboratory setting. They confer the same risk in people allergic to regular meat, fish, and crustacean products. Edible insects also introduce new allergens into the diet. Considering there is a known cross-reactivity between crustaceans and dust mites, the ability of thermal processing of insects to reduce their allergenicity needs to be determined.
Ultimately, food manufacturers should specify the origin of these products to consumers. Another factor underlying increases in food allergies could relate to globalization and the introduction of regional foods from one area to another. This cross-cultural exchange could result in novel exposures and heightened frequencies of new allergens in the diet.
What can be done
Various stakeholders play a role in managing food allergies. First, regulators must develop flexible food policies that reflect changing food consumption practices and scientific advances.
Food manufacturers must employ good manufacturing practices and clearly label their products. Clinicians should diligently monitor and diagnose their patients for food allergies. Consumers should read all food labels.
The authors writing in JAMA Network Open acknowledge that a better understanding of the burden of food allergy can help keep it in perspective.
“In light of the considerable economic and quality of life consequences associated with allergen avoidance and other food allergy management behaviors,” they say, “individuals with a suspected food allergy should receive appropriate confirmatory testing and counseling to counter unnecessary avoidance of allergenic food. Greater patient education efforts regarding key differences between food intolerances and allergies also may be warranted.”
Patients should be encouraged to visit with their physician to receive proper diagnosis, counseling on food allergies, and an epinephrine prescription as needed. The review authors writing in Trends in Food Science & Technology point out that there are preventive benefits of early allergen exposure, and thus adults should be informed of these new strategies to prevent food allergies in their children.
What this means for you
As a physician, it’s important to monitor and diagnose your pediatric or adult patients for food allergies, and prescribe epinephrine as needed. Providing counseling to patients on food allergies—noting that novel plant proteins found in vegan or vegetarian offerings may be of particular concern—while stressing the need to read labels is also tantamount to patient care.
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