Original Article
The Prevalence of Food Allergy in Young Israeli Adults

https://doi.org/10.1016/j.jaip.2019.05.046Get rights and content

Background

Information regarding the prevalence of food allergy (FA) among adults is limited due to their inaccessibility for thorough epidemiological evaluations.

Objective

To evaluate the prevalence of FA among Israeli young adults.

Methods

All recruits (n = 12,592, ages 17-18 years) signing up over 6 months at a single recruitment center of the Israeli army were evaluated for FA. The evaluation included a frontal interview by physicians who used a focused screening set of questions, medical documentation collection, tests of IgE reactivity, and oral food challenges. The latter were performed at an allergy care institute in ambiguous cases. A prediction model for the identification of individuals with true allergy among recruits eliminating foods due to suspected FA was developed using multivariable logistic regression.

Results

Foods elimination due to suspected FA was reported by 148 recruits (1.2%). After diagnostic testing, FA was confirmed in 0.67% (84 of 12,592). The prevalence of food elimination versus diagnosed allergy was 0.2%/0.16% milk, 0.2%/0.14% peanuts, 0.13%/0.09% fish, 0.1%/0.09% sesame, 0.04%/0.015% egg, and 0.36%/0.28% tree nuts, respectively. On multivariable logistic regression analysis, male gender (adjusted odds ratio [OR] = 3.2, 95% confidence interval [CI]: 1.4-7.7), report of a common food allergen (OR = 3.6, 95% CI: 1.4-9.3), previous allergist evaluation for FA (OR = 7.8, 95% CI: 3-20.2), and FA reactions within the past 2 years (OR = 2.8, 95% CI: 1.2-6.7) were significantly identified as independent predictors of true FA.

Conclusions

The prevalence of FA among Israeli young adults is lower than reported for other western countries. Reliance on food elimination alone does not accurately rule in FA. The use of the identified predictors for FA can facilitate large-scale epidemiological studies in adults.

Section snippets

Subjects

All recruits (17 years old) from one urban area recruitment center of the Israel Defense Forces (IDF), who started their medical evaluation between May and October 2016, were included. By law, all Jewish non-ultra-orthodox 17-year-olds, with the exception of severely handicapped and some psychiatric patients, are obligated to undergo a medical examination in a regional recruitment center, before their army service. This ensures a high catchment of the study population, estimated to be more than

Reported and diagnosed food allergy in cohort

Overall, 12,592 recruits (46.5% males) were evaluated during their recruitment procedure. Food avoidance due to an allergy was reported by 148 recruits (Figure 1), 45.9% of whom were males. Among these 148 recruits, 22.3% (33) carried a physician diagnosis of asthma after the age of 6 years. The prevalence of reported and diagnosed FA for the major allergenic foods is presented in Table I. The most frequently reported and diagnosed foods in this study were tree nuts, milk, peanuts, fish, and

Discussion

This study provides data on the prevalence of FA in young adulthood. All recruits from one urban region in Israel were screened as to whether they eliminated foods due to allergy and their allergy was validated. It also provides information about what clinical characteristics predict true clinical allergy using this approach. The screening procedure reported here provides a framework for evaluation of FA in large epidemiological studies.

The overall prevalence of reported FA in this study

Acknowledgments

Y. Katz is supported by the Leon Alcalay Chair in Pediatric Immunology, Tel Aviv University. M. R. Goldberg is funded by a Kamea grant from the Ministry of Health, Israel. We would like to thank Mali Dook for coordinating the recruits' clinical visits at the Institute of Allergy, Immunology and Pediatric Pulmonology, of the Assaf Harofeh Medical Center. We would also like to acknowledge Professor Jacob Moran-Gilad and Professor Gideon Lack for helpful discussions.

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    Research reported in this publication was supported by the Israel Defense Forces (IDF) Medical Corps and Directorate of Defense Research & Development, Israeli Ministry of Defense (IMOD DDR&D). This study was funded by grant no. 4440716034 of the Academy section, Medical Corps, Israel Defense Army.

    Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

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