INTRODUCTION

What is allergy?
Allergies are your body’s reaction to a
normally harmless substance such as
pollen, molds, animal dander, latex,
certain foods and insect stings. Allergy
symptoms range from mild – rash or
hives, itchiness, runny nose, watery/red
eyes – to life-threatening. Treatments
include antihistamines, decongestants,
nasal steroids, asthma medicines and
immunotherapy.

Allergies are your body’s reaction to a substance it views as a harmful “invader.” For
example, coming into contact with what is normally a harmless substance, such as pollen,
might cause your immune system (your body’s defense system) to react. Substances that cause
these reactions are called allergens. An “allergic reaction” is the way our body responds to the
allergen. A chain of events occur that result in an allergic reaction.

If someone is prone to allergies, the first

time the person is exposed to a specific
allergen (such as pollen), the body responds
by producing allergic (IgE) antibodies. The
job of these antibodies is to find the
allergens and help remove them from the
body system. As a result, a chemical called
histamine is released and causes symptoms
of allergies.
 Pollen allergy
Seasonal allergic rhinitis or hay fever, is an allergic response to pollen. It causes inflammation
and swelling of the lining of nose and of the protective tissue of your eyes (conjunctiva).

Symptoms include sneezing, congestion (feeling stuffy), and itchy, watery eyes, nose and
mouth. Treatment options include over-the-counter and prescription oral antihistamines, anti-
leukotrienes, nasal steroids, nasal antihistamines and nasal cromolyn. In some people, allergic
asthma symptoms (wheezing, shortness of breath, coughing, and/ or chest tightness) can be
caused by exposure to pollen. Symptoms can be reduced by avoiding pollen. Stay indoors
when pollen counts are high, close your windows, and use air conditioning.
There may be different types of pollen allergies depending upon the type of pollen
inhaled.
 Allergy due to the pollen of trees like birch, oak, cedar, olive, hazelnut, etc.
 Allergy due to grasses like Ryegrass, Timothy.
 Allergy due to weeds such as ragweed, nettle, sorrel, sagebrush, or tumbleweed.

The Pollen Allergy Treatment:

Treatment of pollen allergies includes medications some of which are:
  ANTIHISTAMINES: These over the counter medications can come in the form of
pills, nasal sprays, or liquids. Antihistamines usually relieve allergy symptoms like
sneezing and itchy nose & eyes.
 LEUKOTRIENE RECEPTOR ANTAGONISTS: which block the action of certain
allergy-causing neurotransmitters relieving bronchoconstriction.
 NASAL CORTICOSTEROIDS: in a form of nasal sprays, works as anti-
inflammatories reducing nasal congestion and allergic rhinitis. But corticosteroids have
some side effects too.
 DECONGESTANTS: Available in the form of sprays, liquid drops, or pills, the nasal
decongestants help reduce inflammation thereby relieving nasal stuffiness.

Dust mites
Dust mites are tiny organisms that live in dust and in the fibres of household objects, such
as pillows, mattresses, carpet, and upholstery. Dust mites grow in warm, humid areas.
 House dust mites are present in all homes in the UK. They are microscopic insects that live
off human skin scales and form part of the dust in our homes. The climate and conditions
inside our houses are ideal for their survival. They prefer bedrooms- in particular beds and
bedding. This is where we shed skin cells for them to feed on, where we sweat, providing
them with water, and where the warmth sustains them and allows breeding.
The allergen that triggers the immune system and cause allergic problems is found mainly
in the faeces of the house dust mites. These droppings are very dry, they fragment easily
and the fine particles disperse into air. The particles settle quickly into our pillows,
mattresses, duvets, carpets and are difficult to eradicate. This means it is difficult to remove
the source of the problems and prevent allergic symptoms.

What is the exact cause of house dust mite and pet allergies?
Tiny particles found in the air inside the home that cause allergic symptoms are called
aero-allergens. These particles can include the faeces of house dust mites, and animal
saliva, skin and urine. (Mould spores are another type of aero-allergen present in some
homes, especially those with damp problems).
Allergens are substances that cause an allergic response in certain sensitive people. They
commonly cause problems with nasal, eye and respiratory symptoms. These include
rhinitis, conjunctivitis and wheezing. They can aggravate conditions such as asthma.
Aero- allergens rarely cause severe allergic reactions such as anaphylaxis. They are,
however, some of the most common causes of allergies in general.

How common are allergies to house dust mite?

Allergies to house dust mite and pets are common. Also, in some countries, particularly
in the developed world, atopic diseases affect up to 1 in 3 of the population (atopic
diseases include asthma, eczema and hay fever). About 1 in 2 adults with asthma, and
about 8 in 10 children in asthma, have allergic components to their disease

What are the symptoms of house dust mite allergy?

Symptoms of house dust mite and pet allergies include-

 Rhinitis- This is an inflammation of the lining of the nose. Typically, you may have
a runny nose, nasal stuffiness, sneezing, itching or a combination of these.
 Conjunctivitis- Generally, this would mean watery, itchy eyes- sometimes with
redness.
 Wheezing- Such allergies can irritate the lungs. This may cause narrowing of the
airways, leading to noisy breathing called wheezing. People with asthma frequently
wheeze and allergies can cause this same symptom. People with asthma may wheeze
more if they have allergies too.
To help manage dust mite allergies, try using dust mite encasements (airtight
plastic/polyurethane covers) over pillows, mattresses, and box springs. Also,
remove carpet, or vacuum frequently with a high-efficiency filter vacuum
cleaner. Treatment may include medications to control your nasal/eye and chest
symptoms. Immunotherapy
may be recommended if your
symptoms are not adequately
controlled with avoidance
methods and medications.

Recent studies suggest that at

least 45 percent of young
people with asthma are allergic
to house dust mites. Unlike
“seasonal” allergies caused by
molds and pollen, people who
are allergic to dust mites often
will have symptoms year round.
The role of house dust mites in
inducing allergy has been
increasingly recognized by allergologist and aerobiologists. However, clinical
investigations of house-dust mite allergy in tropics are few. The significant role
of mites in the house dust responsible for health hazard such as respiratory
allergy, nasobronchial, nasal, and skin allergy in sensitive individuals is well
documented. Group 1 allergens of
the mites Dermatophagoides
farinae (Der f1)
and Dermatophagoides
pteronyssinus (Der p1) are the
most significant allergens; 80%
to 95% of patients allergic to dust
mites have an elevated IgE
response to them.

Shivpuri and co-workers were the

first Indian acarologists to conduct extensive and intensive studies on mites and
recorded that mites could grow well in house dust at 25°C temperature and 80%
relative humidity. Besides West Bengal and Maharastra no much work on
indoor dust mites survey has been carried out in other parts of India. In the
present study, an attempt has been made to investigate the variety and
variability of dust mites in the floor and bed dust of atopic allergic patients and
to correlate it with the severity of allergic diseases in selected patients from
Assam which is situated in the North-eastern part of India. The average
atmospheric temperature and relative humidity of this part of India ranges from
29 to 32°C and 90 to 94%, respectively.

In the present study, only soft cell mites present in the house dust samples were
selected. Population of dust mites at the residence of 150 atopic patients from
Assam was surveyed from January to December 2005, to record the diversity
and abundance of house dust mites in floor and bed dust samples. Allergic
diagnostic profile was developed through standard questionnaires developed in
the format provided by Patel Chest Institute, Delhi, to categorize the patients on
the basis of age, sex, symptoms, housing patterns, and so forth. Patients of
different economic status, age, and sex were selected for investigation. Of the
total population selected, 47% were living in RCC type buildings (buildings
with concrete wall, floor, and roof), 39% in Assam type (semi-RCC buildings
having roof made of tin metallic element) buildings, 13% in bamboo house, and
rest 7% in wooden houses. Sex wise, 73% of the selected patients were male
and 27% were female. Only those patients who were having case history of
allergic diseases (i.e., respiratory and skin allergic diseases) were selected for
present study. Patients were identified and categorized after verifying their
medical reports. Allergy confirmation reports in certain cases were found
doubtful due to which all the selected patients were grouped as suspected
allergic patients.

Five hundred milligrams (500 mg) of the indoor house dust sample were
collected from both the floor and bed of the selected patient's house. Since the
vacuum cleaners are not used in majority of Indian homes, therefore, dust
sample was collected manually following the method described by Tilak et al.
Patients were advised not to clean their floor and sleeping bed for two days
before collecting the dust sample. Samples were collected in autoclaved plastic
container. Large particles and fibrous materials in the dust were separated by
sieving through 300 mess brass sieve of 6 mm diameter. Mites were isolated
from the dust sample manually with the help of a painting brass (no. 6). Isolated
mites were made clear by putting in 50% lactic acid for 24 hrs. Then they were
mounted in the centre of a glass slide with a drop of melted glycerine jelly. The
presence of house dust mites was confirmed by examining them under the
microscope. Mites types were categorized on the basis of genus, species, and
their gender. The identification of house dust mites was done with the help of
reference slides and literatures available. About 48.6% of the patients reported
maximum allergic symptoms during winter, while 21.4% suffer maximum
during summer. However, 25.7% patients reported allergic problem round the
year irrespective of season. The meteorological data was collected from the
Tocklai research center, Silchar.

An attempt has been made to correlate the total mites population recorded in the
dust samples of each patient with the severity of their allergic attack. On the
basis of the allergic attack, patients were graded under four grades as follows.

 G1:Occasional skin allergy attack

 G2:Frequent skin allergy attack

 G3:Occasional respiratory attack

 G4:Frequent respiratory attack.

Samples were categorized on the basis of allergic symptoms, housing pattern,

seasons, and surface types (bed/floor). Correlation analysis was done to
examine the relationship between allergic/respiratory symptoms and indoor dust
mite's population. To explore the relationship between mite counts and RH and
temperature, a simple product-moment correlation analysis was conducted.
Statistical analysis like mean, correlation, and regression were carried out using
MINITAB 11.2 and ORIGIN 7.0 statistical software.

Results:
Fifty percent of the total patients selected for indoor mites survey were of the age group
between >30–50 yrs, and 31% were of the age group upto 30 yrs, while the rest 20% were of
the age group of >50 yrs. Sex wise, 73% of the patients were male and the rest 27% were
female. About 60% of the patients were reported to be suffering from respiratory allergic
disorders, and the rest 40 from skin allergy (including dermal, ocular, etc.)

Age Group No of patients (%) Allergic symptoms Dust mites recorded

(%)
1-30 yrs 42 43 834
>30–50 yrs 77 80 795
>50 yrs 29 56 887

Classification of patients on the basis of sex and allergic disorders. Total mites
population in the house of different age group of patients are also revealed.
 Molds

Molds are tiny fungi (like Penicillium) with spores that float in the air like
pollen. Mold is a common trigger for allergies. Mold can be found indoors in
damp areas, such as the basement, kitchen, or bathroom, as well as outdoors in
grass, leaf piles, hay, mulch or under mushrooms. Mold spores reach a peak
during hot, humid weather.

What are the symptoms ?

I. Sneezing: Persistent sneezing is a tell-tale sign of a mold allergy. Histamine

is one of the most reliable weapons our immune system wields. This
compound, which the immune system releases under threat, elicits responses
that purge an immune system’s trigger from the body. These can include
itchiness, tearing, and, most commonly, sneezing and coughing. The
overreaction of a histamine response is why we so often take antihistamines
as an over-the-counter response to allergic reactions. By suppressing this
overreaction, we can avoid some of these uncomfortable allergy symptoms.
II. Coughing: Another one of the most immediate symptoms of a mold allergy
is a dry and scratchy throat, prompting a nagging cough. In some cases, mold
can cause heavier coughs as well. Mucus and histamine production can lead
to persistent coughing as your body tries to clear the throat of mucus
buildup. Treat your cough using hot tea with lemon and honey, cough drops,
or ginger root. Most of all, try to identify the source of the mold allergy and
remove it from your surroundings, if possible.
III. Congestion: A stuffy nose often accompanies an allergic reaction to
mold. Again, histamine is the culprit for much of this discomfort. Histamine
is a vasodilator—a chemical that expands the blood vessels. (Contrast with a
vasoconstrictor, such as epinephrine or adrenaline.) By opening the blood
vessels and sending more blood to the head, inflammation occurs around the
paranasal sinuses, blocking airflow through the nose. An antihistamine can
relieve some of this immune response, but again, your goal should be to
reduce the presence of mold if you can.
IV. Runny Nose and Postnasal Drip: Your body’s overproduction of mucus
can reveal itself not only through a persistent cough but also through your
body’s attempts to dispose of it. The body continually produces mucus, a
viscous fluid that serves to lubricate as well as clean. It’s the second of these
two functions that is pertinent to the allergic response. Mucus captures
foreign invaders, like viruses and bacteria, and flushes them out, often
harmlessly and unnoticeably. But when the body produces more mucus in
the respiratory system than it can quietly dispose of, you notice the output in
the form of a runny nose or postnasal drip. Whether excess mucus drains
through the nostrils or down the throat, the discomfort it creates can indicate
that the body is responding to the presence of mold.
V. Runny nose and Postnasal drip: Your body’s overproduction of mucus
can reveal itself not only through a persistent cough but also through your
body’s attempts to dispose of it. The body continually produces mucus, a
viscous fluid that serves to lubricate as well as clean. It’s the second of these
two functions that is pertinent to the allergic response. Mucus captures
foreign invaders, like viruses and bacteria, and flushes them out, often
harmlessly and unnoticeably. But when the body produces more mucus in
the respiratory system than it can quietly dispose of, you notice the output in
the form of a runny nose or postnasal drip. Whether excess mucus drains
through the nostrils or down the throat, the discomfort it creates can indicate
that the body is responding to the presence of mold.
VI. Sneezing: Persistent sneezing is a tell-tale sign of a mold allergy. Histamine
is one of the most reliable weapons our immune system wields. This
compound, which the immune system releases under threat, elicits responses
that purge an immune system’s trigger from the body. These can include
itchiness, tearing, and, most commonly, sneezing and coughing. The
overreaction of a histamine response is why we so often take antihistamines
as an over-the-counter response to allergic reactions. By suppressing this
overreaction, we can avoid some of these uncomfortable allergy symptoms.
VII. Coughing: Another one of the most immediate symptoms of a mold allergy
is a dry and scratchy throat, prompting a nagging cough. In some cases, mold
can cause heavier coughs as well. Mucus and histamine production can lead
to persistent coughing as your body tries to clear the throat of mucus
buildup. Treat your cough using hot tea with lemon and honey, cough drops,
or ginger root. Most of all, try to identify the source of the mold allergy and
remove it from your surroundings, if possible.
VIII. Congestion: A stuffy nose often accompanies an allergic reaction to mold.
Again, histamine is the culprit for much of this discomfort. Histamine is a
vasodilator—a chemical that expands the blood vessels. (Contrast with a
vasoconstrictor, such as epinephrine or adrenaline.) By opening the blood
vessels and sending more blood to the head, inflammation occurs around the
paranasal sinuses, blocking airflow through the nose. An antihistamine can
relieve some of this immune response, but again, your goal should be to
reduce the presence of mold if you can.
IX. Runny Nose and Postnasal Drip: Your body’s overproduction of mucus
can reveal itself not only through a persistent cough but also through your
body’s attempts to dispose of it. The body continually produces mucus, a
viscous fluid that serves to lubricate as well as clean. It’s the second of these
two functions that is pertinent to the allergic response. Mucus captures
foreign invaders, like viruses and bacteria, and flushes them out, often
harmlessly and unnoticeably. But when the body produces more mucus in
the respiratory system than it can quietly dispose of, you notice the output in
the form of a runny nose or postnasal drip. Whether excess mucus drains
through the nostrils or down the throat, the discomfort it creates can indicate
that the body is responding to the presence of mold
X. Sneezing: Persistent sneezing is a tell-tale sign of a mold allergy. Histamine
is one of the most reliable weapons our immune system wields. This
compound, which the immune system releases under threat, elicits responses
that purge an immune system’s trigger from the body. These can include
itchiness, tearing, and, most commonly, sneezing and coughing. The
overreaction of a histamine response is why we so often take antihistamines
as an over-the-counter response to allergic reactions. By suppressing this
overreaction, we can avoid some of these uncomfortable allergy symptoms.
XI. Coughing: Another one of the most immediate symptoms of a mold allergy
is a dry and scratchy throat, prompting a nagging cough. In some cases, mold
can cause heavier coughs as well. Mucus and histamine production can lead
to persistent coughing as your body tries to clear the throat of mucus
buildup. Treat your cough using hot tea with lemon and honey, cough drops,
 or ginger root. Most of all, try to identify the source of the mold allergy and
remove it from your surroundings, if possible.
XII. Congestion: A stuffy nose often accompanies an allergic reaction to mold.
Again, histamine is the culprit for much of this discomfort. Histamine is a
vasodilator—a chemical that expands the blood vessels. (Contrast with a
vasoconstrictor, such as epinephrine or adrenaline.) By opening the blood
vessels and sending more blood to the head, inflammation occurs around the
paranasal sinuses, blocking airflow through the nose. An antihistamine can
relieve some of this immune response, but again, your goal should be to
reduce the presence of mold if you can.
XIII. Runny Nose and Postnasal Drip: Your body’s overproduction of mucus
can reveal itself not only through a persistent cough but also through your
body’s attempts to dispose of it. The body continually produces mucus, a
viscous fluid that serves to lubricate as well as clean. It’s the second of these
two functions that is pertinent to the allergic response. Mucus captures
foreign invaders, like viruses and bacteria, and flushes them out, often
harmlessly and unnoticeably. But when the body produces more mucus in
the respiratory system than it can quietly dispose of, you notice the output in
the form of a runny nose or postnasal drip. Whether excess mucus drains
through the nostrils or down the throat, the discomfort it creates can indicate
that the body is responding to the presence of mold.
XIV. Itchy, Watery Eyes: The body’s histamine response can even manifest
itself in your eyes. Not only are your eyes the proverbial window to the soul,
but they’re also useful windows into your health at large, and irritated eyes
can be indicative of illness. Just like the nose, mouth, and lungs, the eyes
feature mucous membranes that look to catch and release irritants such as
mold spores. As the eyes attempt to flush these irritants, you’ll feel the
discomfort of that effort. Vasoconstricting eyedrops may seem like an apt
response, but the eyes can become dependent on them and dilate even more
in response. If your eyes are reacting to an allergy along with your
respiratory system, it’s best not to treat the eyes directly.
XV. Asthma Attacks: Sometimes, a mold allergy can go beyond what feels like
the common cold. Mold spores can reach the lungs and trigger asthma attacks.
Most pernicious about a mold allergy that progresses to this stage is that one
need not be in the presence of a great deal of mold to have an attack. Another
instance of the immune system being too vigilant for its own good is that it
remembers its adversaries, so it may take only a tiny amount of mold for the
immune system to go into overdrive. Many allergens can elicit asthma attacks,
but mold, along with tobacco smoke and air pollution, is among the most
common owing to its ubiquity in the environment.
Mold Around the House
While antihistamines can address many of the symptoms of a mold allergy, they
are often not a sufficient standalone response to mold. Antihistamines can have
sedating effects on users and adversely interact with other prescription and
over-the-counter medications, so it is best not to rely on them entirely. Instead,
after identifying signs and symptoms of a mold allergy, work to reduce the
presence of mold in your home. This process often involves optimizing air
filtration systems, cleaning bathrooms regularly, and making basement living
spaces as hypoallergenic as possible by limiting porous surfaces, such as
carpeting, where moisture and attendant mold can build up. While it is
impossible to eliminate mold exposure, especially outdoors, you can
significantly mitigate mold exposure within the home.

While allergic reactions to substances like peanuts and bee stings are
unmistakable, a mold allergy certainly sounds a lot like just “being sick.” Mold
allergies are not just uncomfortable but deceptive as well. Diagnosing a mold
allergy can be challenging because it’s so easy to mistake it for a cold, the flu,
or another upper respiratory infection.
Treatment may include medications to control nasal/eye and chest symptoms.
Immunotherapy may be recommended if your symptoms are not adequately
controlled with avoidance and medications.

Animal dander
 Allergic reactions can be caused by the proteins secreted by sweat glands in an
animal’s skin, which are shed in dander, and by the proteins in an animal’s saliva.
Avoidance measures don’t work as well as simply removing the pet from your home.
However, because many people are reluctant to do this, second-best measures include
keeping your pet out of your bedroom, using air cleaners with HEPA filtration and
washing your pet (cat or dog) frequently.
Treatment may include medications to control your nasal/eye and chest symptoms.
Immunotherapy may be recommended if your symptoms are not adequately controlled
with avoidance methods and medications.

How can you prevent pet dander allergy?

The best way to manage a pet allergy is to minimize exposure and avoid contact. If
being around the animal can’t be avoided, you can prevent the pet dander from
lingering by ensuring all furniture, carpets and clothing are cleaned immediately and
frequently after contact. Wash your hands, or even bath, if you have had direct contact
with the animal. Brush your pet in a closed off area, away from the person with
asthma. You can also create a pet free zone and use air cleaners to decrease the
amount of allergens in the air.
If the symptoms still aren’t controlled, talk to your health care provider about
medications. Many over the counter antihistamines and decongestants will do, but in
severe cases corticosteroids or leukotriene modifiers may be helpful. Talking to an
allergist and getting an allergy test is the best way to determine what course of action
the patient should take.

Certain foods
Substantial numbers of children and adults professionals to help their patients and
report having immunoglobulin E–mediated clients identify foods to which they are
food allergies. However, generating allergic and aid in planning diets that are
accurate food allergy prevalence data is nutritionally adequate despite elimination
difficult. Self-reported data can of these foods – Nutr Today, 2020/5/5
overestimate prevalence when compared 22:29
with prevalence estimates established by
more rigorous methods. As of 2004, in the
United States, the Food Allergen Labelling
and Consumer Protection Act mandated
Food allergies develop when your body develops a specific antibody to a specific
food. An allergic reaction occurs within minutes of eating the food, and symptoms can
be severe. In adults, the most common food allergies are shellfish, peanuts and tree
nuts. In children, they include milk, egg, soy, wheat, shellfish, peanuts and tree nuts.

If you have a food allergy, your symptoms include itching, hives, nausea, vomiting,
diarrhoea, breathing difficulties and swelling around your mouth.

It is extremely important to avoid the foods that cause allergy symptoms. If you
(or your child) have a food allergy, your doctor may prescribe injectable
epinephrine (adrenaline) for you to carry at all times. This is needed in case
you accidentally eat foods that cause allergies. There are new therapies for
peanut allergies called oral immunotherapy.

Immunoglobulin E (IgE)–mediated food

allergy is a significant public health issue
that affects an estimated 3% to 10% of
adults and 8% of children worldwide.1–4
Not all evidence5,6 indicates that food
allergy may be on the rise. This review
deals only with IgE-mediated food allergy.
While data on prevalence of IgE-mediated
allergy are discussed, it must be
remembered that there is a vast difference
between confirmed clinical food allergy
and food sensitization. The National
Institute of Allergy and Infectious Diseases (NIAID) divides adverse food reactions
into immune-mediated (food allergies) and non–immune-mediated (food intolerances)
reactions. Food allergies are defined as “an adverse health effect arising from a
specific immune response that occurs reproducibly on exposure to a given food.” 7
This definition includes both IgE-mediated food allergy and non– IgE-mediated food
allergies. Immunoglobulin E–mediated food allergy refers to an allergic reaction to a
food that is immune mediated and occurs within 2 hours of consumption. Non–IgE-
mediated is also immune mediated but occurs over a timeline usually more than 1 to 2
hours after consuming a food. Food intolerances, for example, lactose intolerance, do
not involve any immune-mediated reactions. Food sensitivities, other than nonceliac
gluten sensitivities, are not a recognized term by any of the national or international
allergy or gastrointestinal societies or associations.8 The dietetic management of any
type of food allergy typically involves information on food avoidance and label
reading, identifying substitute foods and ensuring the diet is nutritionally sound.9 The
type of food allergy (IgE or non–IgE mediated), possible cross-reactive and coexisting
allergies, and knowledge of tolerance levels are important points to address
individualized food allergen avoidance and tailor information on food labeling (Table
1). While more than 200 foods have been shown to be allergenic,10 regulatory
agencies have recognized the need to focus allergen labeling regulations on a limited
set of priority allergens. In 2004, the US Congress passed the Food Allergen Labeling
and Consumer Protection Act (FALCPA), which mandates that the label of a food that
contains an ingredient that is or is derived protein from a “major food allergen” must
declare the presence of the allergen in the manner described by the law. Eight
allergenic foods, commonly referred to as the “Big 8,” fall under the FALCPA.
The Big 8 foods that must be declared on product labels in the United States are
milk/dairy, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soy.
The labeling requirement passed by Congress has undoubtedly increased
awareness of the foods responsible for most food-allergic reactions in the United
States. However, the significant degree to which the prevalence of these 8
allergies to food proteins varies may not be fully appreciated. From a public
health perspective, the failure to recognize this variation takes on added
significance because the prevalence of perceived (self-reported [SR]) food
allergy is greater than prevalence estimates based on rigorous diagnostic
methods.11,12 For example, a very recent survey involving 40 443 US adults
found 10.8% of respondents were likely to have a food allergy, that is, to have
signs and symptoms to specific allergens that were consistent with IgE-
mediated reactions, whereas 19.0% SR a food allergy. Consequently, many
consumers may be unnecessarily avoiding foods to which they are not allergic.
The food industry has responded by developing foods based on consumers'
perceived food allergy prevalence, rather than on actual prevalence. Therefore,
dietary intake is potentially being shaped by a misunderstanding of food allergy
prevalence, the consequences of which are difficult to assess, but potentially
detrimental. For example, the adoption of gluten-free diets, which is more
common than dictated by the actual prevalence of celiac disease and nonceliac
gluten sensitivity, has been reported to adversely affect nutriture. On the other
hand, those with true food allergies need to be vigilant in their efforts to avoid
offending foods. It is important to establish conditions so that doing so is as
easy as realistically possible. This brief review addresses current understanding
about the prevalence of IgE-mediated food allergy (see Table 2 for definition)
based on recently published surveys. Before discussing these surveys, some
background information on food allergy is provided to set the data in context.

The origins of “Big 8”

An understanding of the historical origins of the creation of the Big 8 serves to

highlight the limited prevalence data that were available at the time it was
established. In 1993, a working paper on food allergens was presented to the
Codex Committee on Food labelling, which was followed by a Food and
Agriculture Organization (FAO) Technical Consultation on Food Allergens in
1995. These efforts led to the adoption of a list of foods of concern in 1999 as part
of the Codex General Standard for the labelling of Pre-packaged Food (Codex
Alimentarius, 2001). The FAO report, which relied heavily upon paediatric data on
comparative prevalence of food allergies in clinic populations, was pivotal and
eventually led to the creation of the Big 8. However, data on adults and on the
prevalence of specific food allergies in the general population were lacking at that
time. In fact, in the 1995 FAO report, despite the listing of individual foods,
including soy, as allergens, no specific data were cited as support for its inclusion.
Subsequently, an International Life Sciences Institute–Europe Task Force on Food
Allergy took a more in-depth look at foods that merited placement on the priority
allergenic foods list.24 The task force determined that the priority list should
include milk, egg, fish, crustacean shellfish, peanut, soy, tree nuts, wheat, and
sesame. The criteria used by this group included clinical evidence of an allergic
reaction through DBPCFCs and published evidence of severe and/or fatal
anaphylactic reactions. However, data on prevalence were considered by the task
force to be insufficient. The justification for including soy protein on this priority
list is especially illustrative, because although 11 references were cited in support
of including soy, none of these allowed conclusions to be made about the relative
prevalence of clinically relevant soy protein allergy, although 1 small study not
cited did provide prevalence data on soy. The Big 8 list adopted by Congress was
that established by Codex in 1999. No specific data in support of this list were
cited in the 2004 report published by Congress associated with the establishment of
the Big 8. One year later, a report from the US Food and Drug Administration
(FDA) entitled “Approaches to Establish Thresholds for Major Food Allergens and
for Gluten in Food” included prevalence data for the Big 8. However, as can be
seen from Table, prevalence data were not available for wheat or for soy among
adults. Furthermore, the references in support of the prevalence data do not allow
for accurately drawing conclusions about the prevalence of soy allergy among
children. Thus, it is clear that the Big 8 was established on the basis of relatively
few prevalence data overall and was especially limited in the case of soy and
wheat.

Age group Any food Milk Egg Peanut Fish Soy

Children 6.0 2.5 1.3 0.8 0.1 0.2
Adults 3.7 0.3 0.2 0.6 0.4 Unknown
Figure: Change in the prevalence (percent of population) of self- or proxy-reported any food
allergy by age among children and adolescents.