There is insufficient evidence to back the widespread perception that the prevalence of food allergies is rising, says a new report from the National Academies of Sciences, Engineering, and Medicine.

No study in the United States has been conducted with sufficient sample size to determine the true prevalence of food allergies, and most studies likely overestimate the proportion of the population with this condition, the committee that wrote the report says.

The 577-page report, "Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Prevention, Management and Public Policy," was published November 30.

After looking at all the data, it became "clear that we have no real good prevalence data," committee member Hugh Sampson, MD, professor of pediatrics, Icahn School of Medicine at Mount Sinai in New York City, said during a press briefing.

An accurate assessment of the prevalence of food allergy is a "major need for the country because this helps us prioritize food allergy as a public health problem [and] helps direct appropriate resources towards the problem and also really helps us assess the risk of various food allergic reactions in different populations," Dr Sampson added.

The report notes that the public and health providers often misinterpret a food allergy and its symptoms; have trouble differentiating 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 best.

The report also says current evidence is insufficient to say whether any of the following behaviors will help ward off food allergy: food allergen avoidance diets for pregnant or lactating women; prolonged allergen avoidance in infancy; vaginal delivery; breastfeeding; use of infant formulas containing partially or extensively hydrolyzed protein; and supplementation with specific nutrients, such as vitamin D, in children or adults.

The Road Ahead

As a first step on the path to greater public safety regarding food allergies, the committee recommends that the Centers for Disease Control and Prevention work to get more precise prevalence estimates in both children and adults and in groups defined by race, ethnicity, and socioeconomic status. They say better methods for collecting information about anaphylactic reactions are needed, as are estimates of the costs associated with dealing with food allergy.

"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," committee chair Virginia Stallings, MD, director, Nutrition Center at the Children's Hospital of Philadelphia, and professor of pediatrics, University of Pennsylvania Perelman School of Medicine, said in news release.

In addition, "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," she said.

Among the committee's recommendations to foster food allergy safety:

Use proper diagnostic methods and provide evidence-based healthcare. No simple, accurate diagnostic tests exist for food allergy, the committee notes. They advise physicians to use standardized evidence-based procedures to guide food allergy diagnosis and avoid nonstandardized and unproven procedures, such as applied kinesiology and electrodermal testing. The 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 is needed to confirm diagnosis, the committee says.

Identify evidence-based prevention approaches. The committee says recent studies have suggested that delaying the introduction of foods with common allergens may have contributed to the presumptive rise in the prevalence of food allergy. Families and healthcare providers need evidence-based advice about the potential benefits of introducing allergenic foods when an infant is developmentally ready (around age 6 months, but not before age 4 months), particularly to those at high risk for allergy, they say.

Improve education and training for healthcare providers, patients and their caregivers, the food industry, and the general public. The committee urges the National Institutes of Health, the World Health Organization, and professional societies to periodically update guidelines on diagnosis, prevention, and management of food allergy as new data become available. They encourage medical schools and residency and fellowship programs to include training in the management of food allergy and anaphylaxis. They ask organizations that provide emergency training to first responders and the public, such as the American Red Cross, to include food allergy and anaphylaxis emergency management in their curricula. And they call on food industry leaders to integrate food allergy training into general food safety and customer service training for employees at all levels and stages in the food industry.

Implement improved policies and practices to prevent the occurrence of severe reactions. The committee says the current precautionary product labeling system for allergenic foods fails to adequately convey risks from food allergens. They call on the food manufacturing industry, the US Food and Drug Administration (FDA), and the US Department of Agriculture to work together to replace the labeling system for low-level allergen contaminants with a new risk-based labeling approach. The committee also calls on relevant federal agencies to convene a task force of stakeholders to establish and implement prevention policy guidelines. The guidelines should ensure emergency epinephrine capabilities are in place for children and adults in appropriate public venues and provide food allergy and anaphylaxis first aid training to school and university health staff, early care and education providers, and airline flight crews.

Expand research programs. The committee identified a comprehensive list of research priorities in areas such as diagnosis and prognosis, mechanisms, risk determinants, and management, which they say are critical to future improvements in food allergy safety.

The report was supported by the FDA, the Food and Nutrition Service of the US Department of Agriculture, the National Institute of Allergy and Infectious Diseases, 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 Seafood Industry Research Fund.