Nov. 30, 2016


True Prevalence of Food Allergies Unknown Due to Misinterpretation of Symptoms and Lack of Simple Diagnostic Tests; New Report Outlines Steps to Address Public Health Concerns of Food Allergy Safety

WASHINGTON – Although there is widespread perception among the public and medical professionals that food allergy prevalence is on the rise, no study in the U.S. has been conducted with sufficient sample size and in various populations to determine the true prevalence of food allergies, and most studies likely overestimate the proportion of the population with this condition, says a new report from the National Academies of Sciences, Engineering, and Medicine.  In addition, the public and health care providers frequently misinterpret a food allergy and its symptoms, cannot differentiate a food allergy from other immune and gastrointestinal diseases -- such as lactose intolerance and gluten sensitivity -- and don’t know which management and prevention approaches are effective and best to use.  

Current evidence is insufficient to associate any of the following behaviors with prevention of food allergy, the report says: food allergen avoidance diets for pregnant or lactating women; prolonged allergen avoidance in infancy; vaginal delivery; breast-feeding; use of infant formulas containing partially or extensively hydrolyzed protein; and supplementation with specific nutrients -- for example, vitamin D -- in children or adults. 

Improving the quality of life for individuals with a food allergy is important, as allergic reactions can be traumatic or life-threatening.  As the first step in its suggested roadmap to greater public safety regarding food allergies, the committee that conducted the study and wrote the report recommended that the Centers for Disease Control and Prevention (CDC) obtain prevalence estimates in a systematic and statistically sound manner in both children and adults and in groups defined by race, ethnicity, and socio-economic status.  In addition, better methods for collecting information about anaphylactic reactions are needed, as are estimates of the various costs associated with food allergy, given the financial burden that medical and other expenditures for managing food allergies place on society, on the individuals affected, and on their caregivers.

“To prioritize food allergy as a public health concern and ensure that adequate resources are directed at the issue, the extent of the problem must first be defined,” said committee chair Virginia Stallings, Jean A. Cortner Endowed Chair in Gastroenterology, director of the Nutrition Center at the Children’s Hospital of Philadelphia, and professor of pediatrics at the Perelman School of Medicine, University of Pennsylvania.  “Also, because people with food allergies are in different settings throughout their daily lives, concerted efforts by early care and education systems, schools and universities, food establishments, and the travel industry -- in addition to the health care system -- are necessary to bring about a safe environment for those with food allergies.  Many policies, practices, and behaviors could be changed in the short term to substantially improve food safety, which would enhance the health and quality of life for individuals with this chronic disease and save lives."

The report identifies additional steps that various stakeholders should take to promote food allergy safety.

Use proper diagnostic methods and provide evidence-based health care.  The committee recommended that physicians use evidence-based, standardized procedures as the basis for food allergy diagnosis and avoid non-standardized and unproven procedures, such as applied kinesiology and electro dermal testing.  No simple, accurate diagnostic tests exist for food allergy.  The patient’s medical history and other test results, such as from a skin prick test, can suggest the likelihood of a food allergy, but in some cases an oral food challenge -- which involves a gradual, medically supervised ingestion of increasingly larger doses of the food being tested as a possible allergen -- is needed to confirm diagnosis. 

Identify evidence-based prevention approaches.  Recent studies suggest that the practice of delaying the introduction of foods with common allergens may have contributed to the presumptive rise in food allergy prevalence.  Public health authorities and clinical practice guidelines should include consistent, clear, and evidence-based advice for families and health care providers, including dietitians, about the potential benefits of introducing allergenic foods (e.g., peanut products, egg, dairy, and wheat) when an infant is developmentally ready -- around 6 months of age -- but not before 4 months of age, particularly to those at high risk of allergy.

Improve education and training for health care providers, patients and their caregivers, the food industry, and the general public.  The committee recommended that public health authorities, such as the National Institutes of Health, the World Health Organization, and professional societies, regularly update guidelines on diagnosis, prevention, and management of food allergy based on strong scientific evidence, as emerging data become available.

Medical schools and residency and fellowship programs should include training in the management of food allergy and anaphylaxis, as well as training on approaches to counseling patients and their caregivers.  In addition, organizations that provide emergency training to first responders and the public, such as the American Red Cross or National Safety Council, should include food allergy and anaphylaxis emergency management in their curricula.

The committee found deficiencies in the knowledge of food industry personnel about how to manage and communicate about food allergens. Therefore, food industry leaders should work to integrate food allergy training into existing general food safety and customer service training for employees at all levels and stages in the food industry, which encompasses processing sites, retail food and grocery stores, restaurants, and other food service venues.

Implement improved policies and practices to prevent the occurrence of severe reactions.  The current precautionary labeling system for allergenic foods is not effective in informing consumers about the risks from food allergens.  The food manufacturing industry, the Food and Drug Administration (FDA), and the U.S. Department of Agriculture should work cooperatively to replace the precautionary allergen labeling system for low-level allergen contaminants with a new risk-based labeling approach.  In addition, the priority lists of allergens should be based on evidence of regional preference and severity of food allergies.  For example, in the U.S., some foods listed by the FDA as tree nuts (such as butternut and coconut) could be removed from the current priority list based on the lack of data or low frequency of allergic reactions.  On the other hand, evidence of allergy prevalence and reaction severity to sesame seeds may warrant their inclusion on the priority allergen list in the U.S. 

Within the next year, relevant federal agencies, such as the FDA, CDC, and Federal Aviation Administration, should convene a special task force that includes participants from the medical community, food companies, and advocacy stakeholder groups to establish and implement policy guidelines.  The guidelines should ensure emergency epinephrine capabilities are in place for children and adults in public venues, including schools, early care and education facilities, and airplanes together with providing food allergy and anaphylaxis first aid training to appropriate school and university health staff, early care and education providers, and on-board flight crews.

Expand research programs.  Critical to future improvements in food allergy safety, the committee identified a list of research priorities in areas such as diagnosis and prognosis, mechanisms, risk determinants, and management.

Food allergy is a complex disease arising from a specific immune response that occurs reproducibly on exposure to a given food, and can cause skin, respiratory, and gastrointestinal reactions, and for some individuals, it can lead to severe allergic reactions and death.  Eight food groups are considered to be major allergens, including milk, eggs, peanuts, tree nuts, wheat, soy, fish, and crustacean shellfish.  Food allergies typically develop within the first year of life but they can also develop later in life.  The quality of life of individuals with food allergy is diminished as their social interactions and routine life activities are affected.  Although promising therapeutic approaches are being tested, no effective treatments currently exist for people with food allergies.

The study was supported by the following federal sponsors: Food and Drug Administration, Food and Nutrition Service of the U.S. Department of Agriculture, and National Institute of Allergy and Infectious Diseases.  Nonfederal sponsors include the Asthma and Allergy Foundation of America, Egg Nutrition Center, Food Allergy Research & Education, International Life Sciences Institute North America, International Tree Nut Council Nutrition Research & Education Foundation, National Dairy Council, National Peanut Board, and the Seafood Industry Research Fund.  The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine.  The Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.  For more information, visit  A committee roster follows.

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Copies of Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy are available from the National Academies Press on the Internet at or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).


Health and Medicine Division
Food and Nutrition Board

Committee on Food Allergies: Global Burden, Causes, Treatment, Prevention, and Public Policy

Virginia A. Stallings, M.D., M.S.* (chair)
Professor of Pediatrics
University of Pennsylvania Perelman School of Medicine, and
Jean A. Cortner Endowed Chair in Pediatric Gastroenterology, and
Nutrition Center Director
The Children’s Hospital of Philadelphia

Katrina Allen, Ph.D.
University of Melbourne, and
Centre of Food and Allergy Research
Murdoch Childrens Research Institute

Wesley Burks, M.D.
Curnen Distinguished Professor and Executive Dean
University of North Carolina School of Medicine
Chapel Hill

Nancy R. Cook, Sc.D.
Department of Epidemiology
Harvard T.H. Chan School of Public Health, and 
Department of Medicine
Harvard Medical School and Brigham & Women's Hospital

Sharon M. Donovan, Ph.D.
Professor and Melissa M. Noel Endowed Chair in Nutrition and Health
University of Illinois

Stephen J. Galli, M.D.*
Mary Hewitt Loveless M.D. Professor
Stanford University School of Medicine
Stanford, Calif.

Bernard Guyer, M.D., M.P.H.*
Zanvyl Kreiger Professor of Children’s Health Emeritus
Johns Hopkins Bloomberg School of Public Health

Gideon Lack, M.B.B.Ch
Head of the Clinical Academic Paediatric Allergy Service
Guy’s and St Thomas’ NHS Foundation Trust, and
Professor and Head
Department of Paediatric Allergy
King’s College
London, United Kingdom

Ann S. Masten, Ph.D.
Regents Professor and Irving B. Harris Professor of Child Development
University of Minnesota

Jose M. Ordovas, Ph.D.
Senior Scientist and Director
Nutrition and Genomics Laboratory
Tufts University

Hugh A. Sampson, M.D.*
Kurt Hirschhorn Professor of Pediatrics
Icahn School of Medicine at Mount Sinai
New York City

Scott H. Sicherer, M.D.
Elliot and Roslyn Jaffe Professor of Pediatrics, Allergy, and Immunology
Icahn School of Medicine at Mount Sinai
New York City

Anna Maria Siega-Riz, M.S., Ph.D.
Professor of Public Health Sciences and Obstetrics & Gynecology
Department of Public Health Sciences
University of Virginia

Stephen L. Taylor, M.S., Ph.D.
Food Allergy Research and Resource Program
University of Nebraska

Xiaobin Wang, Sc.D., M.P.H., M.D.
Professor and Director of the Center on the Early Life Origins of Disease
Johns Hopkins Bloomberg School of Public Health


Maria Oria, Ph.D.
Study Director

*Member, National Academy of Medicine