True food allergy is less prevalent than common ly perceived. Up to 34% of individuals or parents think that they or a family member has a food allergy and 22% avoid particular foods because the food may possibly contain an allergen. However, only 1 6% of persons test positive on full evaluation, which may include doubleblind placebocontrolled food challenges. [14] Epidemiology of IgEmediated food allergyThe prevalence of food allergy varies significantly based on geographical region, allergens tested, diagnostic criteria, population age and concurrent atopic conditions.[5] Variations in food allergy definitions and inconsistencies in study design make studies on food allergy prevalence difficult to compare. Self reporting significantly overestimates food allergy prevalence up to 10fold; [4] hence, objective measurements are necessary to establish a true food allergy diagnosis. Similarly, sensitisation to foods is much higher than clinically relevant allergies; therefore, sensitisation should always be combined with more objective information to prove allergies. Food challenge testing is the optimal way of proving food allergy, albeit labour and cost intensive. Recent large populationbased studies, such as the EuroPrevall study in Europe [6] and HealthNuts study in Australia, [7] have used food challenge testing and can be considered flagship studies of food allergy prevalence. Prevalence of food allergyDespite the large number of foods that can cause immunoglobulin E (IgE)mediated reactions, most prevalence studies have focused on the most common allergenic foods, i.e. cow's milk, hen's egg, peanut, tree nut, wheat, soya, fish and shellfish. [8] Food allergy peaks during the first two years of life, and then diminishes towards late childhood as tolerance to several foods develops over time. Based on metaanalyses and large populationbased studies, the true prevalence of food allergy varies from 1% to >10%, depending on the geographical area and age of the patient.[919] Allergy prevalence to the most common allergenic foods is summarised in Table 1. The prevalence of food allergy in South Africa (SA) is currently being studied. An unselected population of 211 Xhosa highschool students showed an overall sensitisation to foods of 5%. [20,21] Preliminary data from the South African Food Sensitisation and Food Allergy (SAFFA) study, [22] which is investigating food allergy in an unselected cohort of 1 3yearolds, show a prevalence of skin prick tests of ≥1 mm (11.6%), ≥3 mm (9.9%) and ≥7 mm (4.2%) to all foods tested. Challengeproven food allergy to any food is 1.8% after the preliminary analysis; recruitment is ongoing. Correspondence to : C Gray (claudiagray.paediatrics@gmail.com) Despite the large number of foods that may cause immunoglobulin E (IgE)mediated reactions, most prevalence studies have focused on the most common allergenic foods, i.e. cow's milk, hen's egg, peanut, tree nut, wheat, soya, fish and shellfish. ARTICLE Epidemiology of IgEFood allergy peaks during the first two years of life, and then dim...
Venom immunotherapy is the standard of care for people with severe reactions and has been proven to reduce risk of future anaphylactic events. There is a moral imperative to ensure production, supply and worldwide availability of locally relevant, registered, standardized commercial venom extracts for diagnosis and treatment. Insects causing severe immediate allergic reactions vary by region worldwide. The most common culprits include honeybees (Apis mellifera), social wasps including yellow jackets (Vespula and Dolichovespula), paper wasps (Polistes) and hornets (Vespa), stinging ants (Solenopsis, Myrmecia, Pachycondyla, and Pogonomyrmex), and bumblebees (Bombus). Insects with importance in specific areas of the world include the Australian tick (Ixodes holocyclus), the kissing bug (Triatoma spp), horseflies (Tabanus spp), and mosquitoes (Aedes, Culex, Anopheles). Reliable access to high quality venom immunotherapy to locally relevant allergens is not available throughout the world. Many current commercially available therapeutic vaccines have deficiencies, are not suitable for, or are unavailable in vast areas of the globe. New products are required to replace products that are unstandardized or inadequate, particularly whole-body extract products. New products are required for insects in which no current treatment options exist. Venom immunotherapy should be promoted throughout the world and the provision thereof be supported by health authorities, regulatory authorities and all sectors of the health care service.
Up to 34% of individuals or parents think that they or a family member has a food allergy and 22% avoid particular foods because of the mere possibility that the food may contain an allergen, when in fact only between 1% and 6% test positive on full evaluation. [1] A working group was constituted of medical professionals with interest and expertise in food allergy in South Africa (SA) with representation from the Allergy Society of South Africa (ALLSA), the South African Gastroenterology Society (SAGES) and the Association for Dietetics in South Africa (ADSA). The structure and content of the document was networked, individuals were allocated sections to write and a draft document was compiled. A meeting was then held to discuss the draft document, resolve controversial issues and achieve a consensus document. The document is endorsed by ALLSA, SAGES and ADSA. Definitions Adverse reactions to food can be divided into psychological reactions (food aversion), organic reactions (e.g. peptic ulcer disease), anatomical reactions (e.g. strictures), toxic reactions (e.g. food poisoning) and nontoxic reactions (Fig. 1). [2] Non-toxic reactions imply an individual hypersensitivity to the food, either immune-mediated (food allergy) or not immunemediated [3] (food intolerance) (Fig. 2). Non-REVIEW South African food allergy consensus document 2014
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