Food Protection Trends - November/December 2017 - 462

John H. Silliker Lecture

Food Allergies - A Public Health Dilemma
How Did We Get Here? Where are We Going?
Steve L. Taylor

Professor & Co-Director
Food Allergy Research & Resource Program
Department of Food Science & Technology
University of Nebraska
Lincoln, Nebraska
Food allergies seem to have recently emerged as a serious
public health issue. In many respects, the trend mirrors those
that occur in foodborne disease outbreaks. The prevalence is
continuously rising and appears to be doubling every 10 years.
The severity of allergic reactions to foods is also increasing as
food allergy reactions are the leading cause of anaphylactic
reactions appearing in hospital emergency rooms in the U.S.
The number of children with allergies to multiple foods is also on
the rise. And, although many infants develop and then outgrow
allergies to milk, eggs, wheat and soybean, the persistence of all
food allergies (even milk and egg) is growing and the prevalence
of allergies and severe reactions to persistent allergenic foods
such as peanut and tree nuts is growing as well.
But, since food allergies are an abnormal response of the
human immune system to exposure to certain dietary proteins,
this trend seems somewhat surprising. Because food allergies
involve a response of the immune system, we might assume that
a constant proportion of the population would be susceptible
to the development of food allergies. So, is this trend real? Are
food allergies actually increasing? Or is the trend reflecting
an increased awareness of food allergies within the health
professional community and among the consuming public?
Evidence indicates that the trend is real although increased
awareness and improved access to appropriate diagnostic
approaches has contributed to the trend. The percentage of
the population with the susceptibility to develop food allergies
may be rather large. The abnormal response of the immune
system underlies not only food allergies but also allergies to
pollen, animal dander, mold spores, house dust mites, bee
venom, occupational agents, drugs, and other sources. The
environmental source of the allergenic protein is different and
the route of exposure (oral vs. respiratory, cutaneous or even
injected) might be different but the basic mechanism underlying
allergic sensitization is the same. Thus, many people may be
born with susceptibility to develop food allergies in comparison
to the number who actually do develop food allergies.
Historically, despite this susceptibility, relatively few people
had food allergies. The first published report of a food allergy
was a description of egg allergy in 1912. But food allergies have
likely been around since long before that date. Milk allergy in
infants has been discussed in pediatric literature for decades.
Whether the prevalence of milk allergy among young infants
(about 2% worldwide) has changed in recent decades is
debatable. The number of milk-allergic adolescents and adults
does appear to be increasing as the usual tendency to outgrow
milk allergy seems to be decreasing. In my primary school years,
I am not aware that any of my classmates had a food allergy.
Today, it is common that every elementary classroom has one,
two or more children with food allergies and often some with

462

Food Protection Trends November/December

multiple food allergies.
What are we doing
differently? Why was
the prevalence of food
allergy development so
low before the end of
the last century when
the susceptibility was
likely always there?
Multiple factors
likely contribute to
the rising trend in
food allergies. IgE
antibodies (the key humoral immune factor involved in food
allergies) exist to ward off parasitic infections. So the lack of
parasites in the developed world appears to correlate with
the food allergy trend. But few of us would choose to trade
food allergies for parasites and the decrease in parasitic
infections in the U.S. likely pre-dated the rise in food allergies
by several decades. Food allergies are more prevalent in urban
populations than among rural ones. Of course, this may be due
in part to the access to allergy specialists in urban centers.
But this observation has led to the development of the hygiene
hypothesis - dirtier environments are protective against the
development of food allergies. One of the major pieces of
evidence for the hygiene hypothesis comes from a comparative
food allergy prevalence study between Finland and Estonia,
two countries with rather similar genetic backgrounds. Finland
is very clean and has one of the world's highest rates of food
allergies. Estonia is less clean but has a low prevalence of food
allergies.
The gut microbiota is likely linked to the development
of food allergies as well. The nature of this linkage remains
unknown. But as diets change, and they invariably do, the gut
microbiota also is altered and these alterations may lead to
enhanced propensity to develop food allergies. When babies
are born by Cesarean section, their gastrointestinal tracts are
sterile whereas babies born vaginally are born with bacteria
acquired from their mothers. Some evidence exists to suggest
that infants born by Cesarean section are more likely to develop
food allergies but the increased risk appears to be small.
Certainly research on the linkage between the gut microbiota
and the development of food allergies in coming years may
reveal approaches that could be used to reverse the existing
trend.
Recent evidence suggests that changes in weaning
practices may be responsible for a large part of the rise in
food allergy prevalence. Several decades ago, public health
authorities and pediatric societies began to advocate the



Table of Contents for the Digital Edition of Food Protection Trends - November/December 2017

The Cleanliness of Resusable Water Bottles: How Contamination Levels are Affected by Bottle Usage and Cleaning Behaviors of Bottle Owners
Impact of Carcass Anatomical Location on the Microbiological Profile of Beef Trimmings
Thermal Processing Parameters to Ensure a 5-log Reduction of Escherichia coli O157:H7, Salmonella enterica, and Listeria monocytogenes in Acidified Tomato-based Foods
Experimental Evaluation of Performance of Sampling Techniques for Microbiological Quantification on Carcass Services
Effect-based Analytics for Toxicological Screening - Concepts for Future Developments
Beyond the Bio - John Luchansky
PDF Highlight - Food Chemical Hazards and Food Allergy PDG
IAFP 2017 In Review
Industry Products
Coming Events
Food Protection Trends - November/December 2017 - Cover1
Food Protection Trends - November/December 2017 - Cover2
Food Protection Trends - November/December 2017 - 385
Food Protection Trends - November/December 2017 - 386
Food Protection Trends - November/December 2017 - 387
Food Protection Trends - November/December 2017 - 388
Food Protection Trends - November/December 2017 - 389
Food Protection Trends - November/December 2017 - 390
Food Protection Trends - November/December 2017 - 391
Food Protection Trends - November/December 2017 - The Cleanliness of Resusable Water Bottles: How Contamination Levels are Affected by Bottle Usage and Cleaning Behaviors of Bottle Owners
Food Protection Trends - November/December 2017 - 393
Food Protection Trends - November/December 2017 - 394
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Food Protection Trends - November/December 2017 - 399
Food Protection Trends - November/December 2017 - 400
Food Protection Trends - November/December 2017 - 401
Food Protection Trends - November/December 2017 - 402
Food Protection Trends - November/December 2017 - Impact of Carcass Anatomical Location on the Microbiological Profile of Beef Trimmings
Food Protection Trends - November/December 2017 - 404
Food Protection Trends - November/December 2017 - 405
Food Protection Trends - November/December 2017 - 406
Food Protection Trends - November/December 2017 - 407
Food Protection Trends - November/December 2017 - 408
Food Protection Trends - November/December 2017 - Thermal Processing Parameters to Ensure a 5-log Reduction of Escherichia coli O157:H7, Salmonella enterica, and Listeria monocytogenes in Acidified Tomato-based Foods
Food Protection Trends - November/December 2017 - 410
Food Protection Trends - November/December 2017 - 411
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Food Protection Trends - November/December 2017 - 415
Food Protection Trends - November/December 2017 - 416
Food Protection Trends - November/December 2017 - 417
Food Protection Trends - November/December 2017 - 418
Food Protection Trends - November/December 2017 - Experimental Evaluation of Performance of Sampling Techniques for Microbiological Quantification on Carcass Services
Food Protection Trends - November/December 2017 - 420
Food Protection Trends - November/December 2017 - 421
Food Protection Trends - November/December 2017 - 422
Food Protection Trends - November/December 2017 - 423
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Food Protection Trends - November/December 2017 - 425
Food Protection Trends - November/December 2017 - 426
Food Protection Trends - November/December 2017 - 427
Food Protection Trends - November/December 2017 - 428
Food Protection Trends - November/December 2017 - 429
Food Protection Trends - November/December 2017 - Effect-based Analytics for Toxicological Screening - Concepts for Future Developments
Food Protection Trends - November/December 2017 - 431
Food Protection Trends - November/December 2017 - 432
Food Protection Trends - November/December 2017 - 433
Food Protection Trends - November/December 2017 - 434
Food Protection Trends - November/December 2017 - 435
Food Protection Trends - November/December 2017 - 436
Food Protection Trends - November/December 2017 - 437
Food Protection Trends - November/December 2017 - Beyond the Bio - John Luchansky
Food Protection Trends - November/December 2017 - 439
Food Protection Trends - November/December 2017 - 440
Food Protection Trends - November/December 2017 - PDF Highlight - Food Chemical Hazards and Food Allergy PDG
Food Protection Trends - November/December 2017 - 442
Food Protection Trends - November/December 2017 - 443
Food Protection Trends - November/December 2017 - 444
Food Protection Trends - November/December 2017 - IAFP 2017 In Review
Food Protection Trends - November/December 2017 - 446
Food Protection Trends - November/December 2017 - 447
Food Protection Trends - November/December 2017 - 448
Food Protection Trends - November/December 2017 - 449
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Food Protection Trends - November/December 2017 - 532
Food Protection Trends - November/December 2017 - 533
Food Protection Trends - November/December 2017 - Industry Products
Food Protection Trends - November/December 2017 - 535
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Food Protection Trends - November/December 2017 - Coming Events
Food Protection Trends - November/December 2017 - Cover3
Food Protection Trends - November/December 2017 - Cover4
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