The prevalence, cost and basis of food allergy across Europe

Abstract The development of effective management strategies to optimize the quality of life for allergic patients is currently hampered by a lack of good quality information. Estimates of how many individuals suffer from food allergy and the major foods involved vary widely and inadequacies of in vitro diagnostics make food challenges the only reliable means of diagnosis in many instances. The EuroPrevall project brings together a multidisciplinary partnership to address these issues. Cohorts spanning the main climatic regions of Europe are being developed in infants through a birth cohort, community surveys in school-age children and adults and an outpatient clinic study. Confirmatory double-blind placebo-controlled food challenge diagnosis is being undertaken using foods as they are eaten with titrated doses to allow no-effect and lowest-observable effect levels for allergenic foods to be determined. The cohorts will also facilitate validation of novel in vitro diagnostics through the development of the EuroPrevall Serum Bank. Complementary studies in Ghana, western Siberia, India and China will allow us to gain insights into how different dietary patterns and exposure to microorganisms affect food allergies. New instruments to assess the socioeconomic impact of food allergy are being developed in the project and their application in the clinical cohorts will allow, for the first time, an assessment to be made of the burden this disease places on allergy sufferers and their communities. IgE-mediated food allergy is a disease affecting all age groups and because the only treatment is still avoidance (1), it changes quality of life in a profoundly negative way (2). Allergy sufferers have to deal with disbelief about their condition and face difficulties in managing their social life. Patients¿ (or allergic children¿s parents¿) anxiety about severe reactions can lead to social isolation and mental health problems (3). Everyday activities become complicated, requiring forethought and preparation, even extending to the need for special diets during hospitalization. Clear food labelling regarding food allergens is essential to help allergic consumers manage their condition, although precautionary labelling can lead to unnecessary restrictions (4). Such social problems are compounded by the fact that, whilst knowledge of the diagnosis and treatment of food allergy by health professionals and dieticians should be standard, it is frequently inadequate (5). The majority of food allergies are IgE-mediated, but sensitization to a specific food does not always lead to clinical reactivity. Consequently serological tests for food-specific IgE cannot be used alone for diagnosis. As a consequence of inadequate diagnostic procedures, food allergy is sometimes over-diagnosed (6). On the other hand, food allergy is also often not recognized or incorrectly treated. Therefore, patients still leave the hospital without either a prescription for self-injectable adrenaline or even referral to an allergy specialist after treatment for acute anaphylaxis (7). Within this context it is the objective of the EU-funded integrated project EuroPrevall (http://www.europrevall.org) to deliver the information and tools necessary for policy makers, regulators, clinicians and allergic consumers, together with the food industry, to effectively manage food allergies and the allergens that cause them. This is being undertaken in a pan-European manner with a view of improving the quality of life of food allergic consumers. The project includes 56 partners from 21 different countries (from 19 European countries, Ghana, India and China) with additional collaborating centres and partners from the USA, Australia and New Zealand.