Objective:
To assess the incidence and risk factors associated with immunoglobulin E–mediated food allergy through a systematic review and meta-analysis.
Approach:
- Study Design: Systematic review and meta-analysis of 190 studies including approximately 2.8 million participants.
- Incidence Assessment: Pooled analysis of 16 studies (n = 18,279) confirmed the incidence of food allergy by food challenge.
- Risk Factor Analysis: 176 studies identified 342 potential predictors of food allergy.
Key Findings:
- The incidence of food allergy is approximately 5% by age 6 years.
- Higher incidence rates were observed in Australia (10%) and the US (7%), while lower rates were found in the Middle East (2%) and Africa (2%).
- Strongest risk factors include early allergic disease (atopic dermatitis associated with 3.88 times the odds), delayed allergen introduction (peanut introduction after 12 months associated with 2.55 times the odds), genetic susceptibility, and antibiotic exposure (systemic antibiotic exposure during the first month of life associated with 4.11 times the odds).
Interpretation:
Food allergy likely arises from the interaction of genetic, microbial, environmental, social, and comorbid mechanisms combined with allergen exposure.
Limitations:
- Many risk factors were supported by low- or very low-certainty evidence, complicating the understanding of interactions between risk factors.
- Most evidence is derived from higher-income countries, limiting generalizability.
Conclusion:
Food allergy development is multifactorial, involving major risk factors and additional contributing elements.
Sources:
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