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The rate of true food allergy in young adults: an Israeli cohort

Published online: June 6, 2019

Information regarding food-allergy prevalence among adults is limited because thorough food allergy evaluations are difficult to undertake on a population-wide basis. Studies that rely on patient self-report of food allergy are notoriously inaccurate. Additionally, little is known about the rate of food allergy in adults in various geographic locations.

In a paper by Nachshon et al, recently published in The Journal of Allergy and Clinical Immunology: In Practice, food allergy (FA) prevalence in an Israeli population of 12,592 young-adults was studied utilizing a unique opportunity-a mandatory pre-army recruitment health-check. In an in-person interview, physicians ascertained if subjects eliminated foods due to allergy. Those who answered affirmatively were asked to provide their latest medical documentation and tests of IgE-reactivity. Oral food challenges (OFC) were performed in cases that remained ambiguous.

Only 1.2% of the recruits reported elimination of a food due to FA. After diagnostic testing, FA was confirmed in approximately half of them (0.67%, 84/12,592). OFC ruled out FA in 9% of IgE-reactive subjects and was negative in all those without IgE reactivity. The prevalence of food-elimination versus diagnosed allergy, were: 0.36%/0.28% tree-nuts, 0.2%/0.16% milk, 0.2%/0.135% peanuts, 0.13%/0.09% fish, 0.1%/0.09% sesame, and 0.04%/0.015% egg, respectively. On multivariable logistic regression analysis, report of elimination of a major allergenic food such as milk, nuts or sesame, a previous allergist evaluation for FA, male gender, and FA reactions within the past 2 years were identified as significant independent predictors of true FA in this cohort.

The authors concluded that the prevalence of FA among Israeli young adults is lower than reported for other western countries. They suggest that the screening procedure reported, together with the identified predictors of true FA, may provide a framework for future epidemiological studies evaluating FA in adults.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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