National registers of severe allergic reactions in Europe: where are we now?

A mandatory, unique, standardized register for all EU member States is necessary, despite the difficulties of implementation. However, such a register is still a long way off.    

 

Introduction  

While most people around the world can enjoy their meals without a second thought, for an unlucky few, what is on their plate could be a death sentence. A single peanut, a sesame seed on top of a baguette, even traces of shrimp on kissing lips (Steensma 2003): touching the offending food or touching someone who has recently eaten the food can be enough to cause an anaphylactic reaction.  

Anaphylaxis is the most severe allergic reaction. The word anaphylaxis refers to a misdirected protective reaction of the body against a foreign substance as if it were a serious health threat. Anaphylactic reactions typically affect more than one part of the body at the same time and have life-threatening consequences. Unfortunately, anaphylactic reactions are not always easy to recognize because symptoms can range from skin changes to respiratory and/or cardiac arrest. Moreover, there is no agreement among scientists upon the severity of reaction at which anaphylaxis can be officially diagnosed (ECARF 2017).  

The exact number of people worldwide at risk for food-associated anaphylaxis is unknown, but a marked increase in hospitalizations due to food allergy has been observed in the past two decades (Baseggio Conrado et al. 2021; NHS Digital 2019; Sicherer et al. 2010; Sampson 2016).    

What is the prevalence of food allergies?  

The true prevalence of food allergies worldwide is unknown. Reports from Europe and the US show that six to eight percent of children and three to five percent of adults have symptoms of food allergy confirmed by a positive allergy test (specific IgE in serum) (Allen and Koplin 2012, Sicherer and Sampson 2014). Five to ten times more people experience symptoms they believe are caused by a food allergy even if they lack a medical diagnosis for a food allergy (Altman and Chiaramonte 1996; Sampson 2005).  

The uncertainty in determining the precise prevalence of food allergies is related to numerous factors that may affect the reported data. It is difficult to understand if these increasing numbers reflect true variations in disease frequency or other differences related to:  

- Perception. Three to four times as many people think they have a food allergy as actually do (Loh and Tang 2018), primarily because most people confuse food allergy with food intolerance or even with cases of mild food poisoning (Hadley 2006).  

- Diagnostic criteria. Data on the prevalence of food anaphylaxis should be viewed with caution due to the lack of a universally accepted definition of anaphylaxis and the resultant risk of misclassification (EFSA 2014). Moreover, diagnostic tests have changed rather drastically over recent decades, making comparisons difficult.  - Geographical variation. Food allergies are driven by genetic factors and further modified by regional or local factors (e.g. differences in food habits) (Hadley 2006). The dominant foods implicated in anaphylaxis vary among countries: peanut and tree nuts in North America and Australia; shellfish in Asia; sesame in the Middle East; peanut, tree nuts, sesame, wheat, and shellfish in central Europe (Cardona


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