Population Studies

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In the European Community Respiratory Health Survey administered to 17280 adults in 15 countries covering the period 1991-1994, 12% of respondents reported a food allergy or intolerance, ranging from 4.6% in Spain to 19.1% in Australia. The foods most commonly reported to cause shortness of breath were peanut in the United States; fruit in Iceland, Belgium, Ireland, and Italy; and hazelnut in Norway, Sweden, and Germany. The reason for the variation in the reported food triggers is unknown.

A population-based study of 33110 people in France defined food allergy on the basis of self-reported typical allergic symptoms only and found a rate of 3.5%. In adults, the main foods reported to trigger allergic reactions were seafood, fruit, and vegetables, whereas in children the main foods were egg and milk.

In a questionnaire offered to approximately 30 000 people in 11388 households in the High Wycombe area of Britain, 3188 of the 18 582 responders (17%) thought that they had some sort of reaction to foods or food additives. A check on the nonresponders showed that they had almost no food-provoked symptoms. Particular attention was then paid to food additives, and it was found that 1372 of the 18 582 responders (7.4%) believed they had adverse reactions to food additives. Of the 1372, 649 attended for a detailed interview, and 132 gave a history of reproducible clinical symptoms after ingestion of food additives. Eighty-one of these completed a trial of double-blind, placebo-controlled challenges with 11 food additives, but a consistent adverse reaction was found in only 2 subjects. One was a 50-year-old atopic man who reported headaches after ingesting coloring agents and who reacted to challenge with annatto, which reproduced his headache at both low (1mg) and high (10 mg) dose after 4 and 5h, respectively. He also reacted to placebo on one occasion. The second was a 31-year-old nonatopic woman who reported abdominal pain after ingestion of foods. She had related this to ingestion of preservatives and antiox-idants. Her symptoms were reproduced on challenge with annatto at low and high dose.

The parents of 866 children from Finland were asked to provide a detailed history of food allergy, and for certain foods the diagnosis was further investigated by elimination and open challenge at home. Food allergy was reported in 19% by the age of 1 year, 22% by 2 years, 27% by 3 years, and 8% by 6 years. In a prospective study of 480 children in the United States of America up to their third birthday, 16% were reported to have had reactions to fruit or fruit juice and 28% to other food. However, open challenge confirmed reactions in only 12% of the former and 8% of the latter.

Estimates of the prevalence of cow's milk protein allergy are reported to range from 0.3 to 7.5% of subjects.

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