The prevalence of plant food allergies: A systematic review

doi:10.1016/j.jaci.2008.02.019

Journal of Allergy and Clinical Immunology

Volume 121, Issue 5, May 2008, Pages 1210-1218.e4

https://doi.org/10.1016/j.jaci.2008.02.019 Get rights and content

Background

There is uncertainty regarding the prevalence of allergies to plant food.

Objective

To assess the prevalence of allergies to plant food according to the different subjective and objective assessment methods.

Methods

Our systematic search of population-based studies (since 1990) in the literature database MEDLINE focused on fruits, vegetables/legumes, tree nuts, wheat, soy, cereals, and seeds. Prevalence estimates were categorized by food item and method used (food challenges, skin prick test, serum IgE, parent/self-reported symptoms), complemented by appropriate meta-analyses.

Results

We included 36 studies with data from a total of over 250,000 children and adults. Only 6 studies included food challenge tests with prevalences ranging from 0.1% to 4.3% each for fruits and tree nuts, 0.1% to 1.4% for vegetables, and <1% each for wheat, soy, and sesame. The prevalence of sensitization against any specific plant food item assessed by skin prick test was usually <1%, whereas sensitization assessed by IgE against wheat ranged as high as 3.6% and against soy as high as 2.9%. For fruit and vegetables, prevalences based on perception were generally higher than those based on sensitization, but for wheat and soy in adults, sensitization was higher. Meta-analyses showed significant heterogeneity between studies regardless of food item or age group.

Conclusion

Population-based prevalence estimates for allergies to plant products determined by the diagnostic gold standard are scarce. There was considerable heterogeneity in the prevalence estimates of sensitization or perceived allergic reactions to plant food.

Section snippets

General approach

The methods are described in detail in our first report of an overall estimate of the prevalence of FA, as well as on specific allergies to cow's milk, hen's egg, peanut, fish, and shellfish.¹³ For the current report, we defined 6 categories of plant food: fruits, vegetables/legumes, tree nuts, soy, wheat, and sesame/cereals/spices/herbs. We summarized the information in 4 separate categories of assessment: food challenge studies including both open challenge and DBPCFC, sensitization assessed

Results

Out of 396 identified references (380 hits in MEDLINE plus 16 hand search articles), we excluded 363 after screening the title/abstract or reading the full text for the following reasons: 160 articles were about plant FA but did not indicate prevalence estimates; 124 articles reported prevalences only from studies with selected participants such as workers in a food processing factory, patients attending an allergy clinic, and so forth; and 76 articles were editorials, narrative reviews,

Principal findings

The majority of prevalence estimates for allergies to plant food was based on self-reported reactions to food. Few studies used objective assessments such as open or double-blind food challenge tests or determined sensitization to foods (by serum IgE or SPT). As in our previous meta-analyses of the most commonly reported foods,¹³ our current findings for plant FA also showed that prevalence estimates based on self-reported assessments were well above those based on any of the objective

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: The authors met and discussed the paper within the framework of EuroPrevall, an Integrated Project funded by the European Commission (FOOD-CT-2005-514000). L.Z. was funded by the European Union through the EuroPrevall project (FOOD-CT-2005-514000).

: Disclosure of potential conflict of interest: J. Dahlstrom is employed by Phadia AB. E. Sodergren is employed by Phadia AB. R. J. Rona was Ad Honorem advisor to the International Life Science Institute. The rest of the authors have declared that they have no conflict of interest.

View full text

Food, drug, insect sting allergy, and anaphylaxisThe prevalence of plant food allergies: A systematic review

Background

Objective

Methods

Results

Conclusion

Section snippets

General approach

Results

Principal findings

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Public Health

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Prevalence of food allergy and intolerance in the adult Dutch population

J Allergy Clin Immunol

The prevalence of food hypersensitivity in an unselected population of children and adults

Pediatr Allergy Immunol

Food allergy and non-allergic food hypersensitivity in children and adolescents

Clin Exp Allergy

Health-related quality of life among adolescents with allergy-like conditions: with emphasis on food hypersensitivity

Health Qual Life Outcomes

Health-related quality of life in food hypersensitive schoolchildren and their families: parents' perceptions

Health Qual Life Outcomes

A framework for measuring costs to society of IgE-mediated food allergy

Allergy

The prevalence, cost and basis of food allergy across Europe

Allergy

IgE-Mediated food allergy diagnosis: current status and new perspectives

Mol Nutr Food Res

Food, drug, insect sting allergy, and anaphylaxis
The prevalence of plant food allergies: A systematic review