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      Frequency of food allergy in Europe: An updated systematic review and meta‐analysis

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          Abstract

          Food allergy (FA) is increasingly reported in Europe, however, the latest prevalence estimates were based on studies published a decade ago. The present work provides the most updated estimates of the prevalence and trends of FA in Europe. Databases were searched for studies published between 2012 and 2021, added to studies published up to 2012. In total, 110 studies were included in this update. Most studies were graded as moderate risk of bias. Pooled lifetime and point prevalence of self‐reported FA were 19.9% (95% CI 16.6–23.3) and 13.1% (95% CI 11.3–14.8), respectively. The point prevalence of sensitization based on specific IgE (slgE) was 16.6% (95% CI 12.3–20.8), skin prick test (SPT) 5.7% (95% CI 3.9–7.4), and positive food challenge 0.8% (95% CI 0.5–0.9). While lifetime prevalence of self‐reported FA and food challenge positivity only slightly changed, the point prevalence of self‐reported FA, sIgE and SPT positivity increased from previous estimates. This may reflect a real increase, increased awareness, increased number of foods assessed, or increased number of studies from countries with less data in the first review. Future studies require rigorous designs and implementation of standardized methodology in diagnosing FA, including use of double‐blinded placebo‐controlled food challenge to minimize potential biases.

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          Two-sided confidence intervals for the single proportion: comparison of seven methods.

          Simple interval estimate methods for proportions exhibit poor coverage and can produce evidently inappropriate intervals. Criteria appropriate to the evaluation of various proposed methods include: closeness of the achieved coverage probability to its nominal value; whether intervals are located too close to or too distant from the middle of the scale; expected interval width; avoidance of aberrations such as limits outside [0,1] or zero width intervals; and ease of use, whether by tables, software or formulae. Seven methods for the single proportion are evaluated on 96,000 parameter space points. Intervals based on tail areas and the simpler score methods are recommended for use. In each case, methods are available that aim to align either the minimum or the mean coverage with the nominal 1 -alpha.
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            Prevalence of common food allergies in Europe: a systematic review and meta-analysis.

            Allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish constitutes the majority of food allergy reactions, but reliable estimates of their prevalence are lacking. This systematic review aimed to provide up-to-date estimates of their prevalence in Europe.Studies published in Europe from January 1, 2000, to September 30, 2012, were identified from searches of four electronic databases. Two independent reviewers appraised the studies and extracted the estimates of interest. Data were pooled using random-effects meta-analyses. Fifty studies were included in a narrative synthesis and 42 studies in the meta-analyses. Although there were significant heterogeneity between the studies, the overall pooled estimates for all age groups of self-reported lifetime prevalence of allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish were 6.0% (95% confidence interval: 5.7-6.4), 2.5% (2.3-2.7), 3.6% (3.0-4.2), 0.4% (0.3-0.6), 1.3% (1.2-1.5), 2.2% (1.8-2.5), and 1.3% (0.9-1.7), respectively. The prevalence of food-challenge-defined allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish was 0.6% (0.5-0.8), 0.2% (0.2-0.3), 0.1% (0.01-0.2), 0.3% (0.1-0.4), 0.2% (0.2-0.3), 0.5% (0.08-0.8), 0.1% (0.02-0.2), and 0.1% (0.06-0.3), respectively. Allergy to cow's milk and egg was more common among younger children, while allergy to peanut, tree nuts, fish, and shellfish was more common among the older ones. There were insufficient data to compare the estimates of soy and wheat allergy between the age groups. Allergy to most foods, except soy and peanut, appeared to be more common in Northern Europe. In summary, the lifetime self-reported prevalence of allergy to common foods in Europe ranged from 0.1 to 6.0%. The heterogeneity between studies was high, and participation rates varied across studies reaching as low as <20% in some studies. Standardizing the methods of assessment of food allergies and initiating strategies to increase participation will advance this evidence base. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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              The epidemiology of food allergy in Europe: a systematic review and meta-analysis.

              Food allergy (FA) is an important atopic disease although its precise burden is unclear. This systematic review aimed to provide recent, up-to-date data on the incidence, prevalence, time trends, and risk and prognostic factors for FA in Europe. We searched four electronic databases, covering studies published from 1 January 2000 to 30 September 2012. Two independent reviewers appraised the studies and qualified the risk of bias using the Critical Appraisal Skills Programme tool. Seventy-five eligible articles (comprising 56 primary studies) were included in a narrative synthesis, and 30 studies in a random-effects meta-analysis. Most of the studies were graded as at moderate risk of bias. The pooled lifetime and point prevalence of self-reported FA were 17.3% (95% CI: 17.0-17.6) and 5.9% (95% CI: 5.7-6.1), respectively. The point prevalence of sensitization to ≥1 food as assessed by specific IgE was 10.1% (95% CI: 9.4-10.8) and skin prick test 2.7% (95% CI: 2.4-3.0), food challenge positivity 0.9% (95% CI: 0.8-1.1). While the incidence of FA appeared stable over time, there was some evidence that the prevalence may be increasing. There were no consistent risk or prognostic factors for the development or resolution of FA identified, but sex, age, country of residence, familial atopic history, and the presence of other allergic diseases seem to be important. Food allergy is a significant clinical problem in Europe. The evidence base in this area would benefit from additional studies using standardized, rigorous methodology; data are particularly required from Eastern and Southern Europe. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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                Author and article information

                Contributors
                bright.nwaru@gu.se
                Journal
                Allergy
                Allergy
                10.1111/(ISSN)1398-9995
                ALL
                Allergy
                John Wiley and Sons Inc. (Hoboken )
                0105-4538
                1398-9995
                07 November 2022
                February 2023
                : 78
                : 2 ( doiID: 10.1111/all.v78.2 )
                : 351-368
                Affiliations
                [ 1 ] Department of Clinical Sciences and Community Health University of Milan Milan Italy
                [ 2 ] School of Public Health and Community Medicine Institute of Medicine, University of Gothenburg Gothenburg Sweden
                [ 3 ] Krefting Research Centre University of Gothenburg Gothenburg Sweden
                [ 4 ] ACT Institutet Sweden Gothenburg Sweden
                [ 5 ] Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet Stockholm Sweden
                [ 6 ] Faculty of Medicine University of Southampton Southampton UK
                [ 7 ] Section of Allergy and Immunology, School of Medicine University of Colorado Denver, Children's Hospital Colorado, Anschutz Medical Campus Aurora Colorado USA
                [ 8 ] Department of Experimental Immunology and Department of Otorhinolaryngology Amsterdam University Medical Centers Amsterdam the Netherlands
                [ 9 ] Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology Charité Universitätsmedizin Berlin Berlin Germany
                [ 10 ] Department of Pediatrics OLVG Hospital Amsterdam the Netherlands
                [ 11 ] Department of Pediatrics Rijnstate Hospital Arnhem the Netherlands
                [ 12 ] Usher Institute, University of Edinburgh Edinburgh UK
                [ 13 ] Department of Mother and Child Health, The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region University of Padua Padua Italy
                [ 14 ] David Hide Asthma and Allergy Centre St Mary's Hospital Isle of Wight UK
                [ 15 ] Wallenberg Centre for Molecular and Translational Medicine University of Gothenburg Gothenburg Sweden
                Author notes
                [*] [* ] Correspondence

                Bright I. Nwaru, Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.

                Email: bright.nwaru@ 123456gu.se

                Author information
                https://orcid.org/0000-0002-7473-5355
                https://orcid.org/0000-0002-3449-1245
                https://orcid.org/0000-0001-7962-5406
                https://orcid.org/0000-0003-2252-1248
                https://orcid.org/0000-0002-2876-6089
                Article
                ALL15560 ALL-2022-00731.R2
                10.1111/all.15560
                10099188
                36271775
                de89e3fd-3b6e-4c41-a4b5-3fb9caa21786
                © 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 14 October 2022
                : 15 July 2022
                : 18 October 2022
                Page count
                Figures: 6, Tables: 3, Pages: 18, Words: 9733
                Funding
                Funded by: DBV Technologies SA
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                February 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.7 mode:remove_FC converted:13.04.2023

                Immunology
                epidemiology,europe,food allergy,sensitization,systematic review
                Immunology
                epidemiology, europe, food allergy, sensitization, systematic review

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