EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

PART II - HEALTH CONDITIONS

5. HEALTH IMPACTS OF NON COMMUNICABLE DISEASES AND RELATED TIME-TRENDS

5.10. Food allergy and intolerance

5.10.2. Data sources

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5.10.2. Data sources

 

 

5.10.2.1. Allergen databases

 

Data on allergens in general, and on food allergens in particular, are scattered among a large number of allergen databases that have been created for a variety of purposes (Table 1). These include molecular databases focused on protein sequences and structures, informational databases focused on clinical, biochemical and epidemiological data related to protein allergens, a database on allergen nomenclature, and other informational websites that are peripherally-related to research on allergens (Brusic et al, 2003; Gendel et al, 2006). The design, structure, search/ability and information contained on the above databases vary greatly, with a high level of redundancy and relatively low coverage of allergens by individual databases. (Brusic et al, 2003).

 

Table 5.10.1. Available allergen databases.

 

Database

Web Address

General Purpose Databases

 

Nucleic Acids Research databases

http://217.169.56.209/nar/database/c/

Allergen Specific

 

AllAllergy

http://allallergy.net/

Allergen Protein Database (FARRP)

http://allergenonline.com

Allergome

http://www.allergome.org/

AllerMatch

http://www.allermatch.org/

AllerPredict

http://sdmc.i2r.a-star.edu.sg/Templar/DB/Allergen/

Asthma and Allergy

http://cooke.gsf.de

Bioinformatics for Food Safety (BIFS)

http://www.iit.edu/~sgendel/fa.htm

Central Science Laboratory (CSL)

http://www.csl.gov.uk/allergen/

Informall

http://foodallergens.ifr.ac.uk/

International Immunogenetics Information System

http://imgt.cines.fr/

IUIS Allergen Nomenclature Sub-Committee list.

http://www.allergen.org

Protall

http://www.ifr.ac.uk/protall/

Structural Database of Allergen Proteins

http://fermi.utmb.edu/SDAP/sdap_ver.html

SWISS-PROT (AllergenIndex)

http://www.expasy.ch/cgi-bin/lists?allergen.txt

 

 

The PROTALL project (FAIR-CT98-4356) established a European network of over 30 clinicians, food scientists and plant biologists with expertise relevant to studying the problems of food allergy, with funding from the European Union (EU) until December 2001. The network examined the relationship between the allergenic potential of plant food proteins, their molecular structures and biological activities, and established a database with biochemical and clinical information on 77 allergens from 48 plant species involved in classical IgE-mediated allergic reactions (http://www.ifr.ac.uk/protall/).

 

More recently, the INFORMALL database has been developed with funding from the European Commission (Communicating about Food AllergiesInformation for Consumers, Regulators and Industry - Informall, QLRT-2001-02284) to provide a credible source of information on allergenic food materials of both plant and animal origin. This search/able database includes the common name, scientific name, occurrence, allergy information (cross-reactivity, clinical manifestations, diagnosis), other information (e.g. EU legislation) and taxonomic information for more than 80 food allergens.

 

5.10.2.2 Most common allergenic foods in Europe

 

As follow-up of discussions in Codex Alimentarius and consultations between the Commission and Member States of the EU on the question of labelling food ingredients to which some individuals may exhibit reactions, the Scientific Committee for Food (SCF) was asked to identify the foods, food components and food ingredients more frequently associated with adverse reactions in European consumers. The major sensitising foods identified were cow’s milk, fruits, legumes (especially peanuts and soybean), eggs, crustaceae (shrimps, crab, lobster and crayfish), tree nuts (almonds, walnuts, hazelnuts, Brazil nuts etc.), fish, vegetables (celery and other foods of the Ombelliferae family), wheat and other cereals (SCF, 1995).

 

5.10.2.3. Prevalence of food hypersensitivity and food allergy

 

The first attempt to collect data on prevalence rates of self-perceived FHS using standardized questions to allow between-country comparisons across Europe has been made in the context of the European Community Respiratory Health Survey (ECRHS, http://www.ecrhs.org/), a multicenter research study funded by the European Commission (EC) aimed to compare the prevalence of adult asthma between countries (mostly European), using standardized epidemiological methods and to identify the risk factors associated with the international variation in asthma prevalence throughout Europe.

 

Data of similar quality and consistency are lacking, however, for FA. At present, available data on FA prevalence come from individual studies conducted in single Member States by using different methodologies that preclude cross-comparisons, and usually refer to hospital populations of sensitive individuals among whom FA are more common than in the general population. Notably, little information on sex and gender differences has been collected, although the impact of these factors on both self-perceived and clinically diagnosed FA may be substantial and age-dependant (DunnGalvin A, 2006). In addition, most of the available studies have used as diagnostic criteria for FA questionnaires on self-reported FA (which usually do not differentiate between FA and food intolerance) and/or sensitization tests (e.g., skin prick tests, specific IgE tests) rather than gold standard methodology (i.e food challenge studies and particularly double blind placebo controlled), which can be implemented only under strict conditions and are often avoided in highly sensitised subjects. Questionnaires and sensitization tests tend to overestimate the prevalence of clinically relevant IgE-mediated FA and to underestimate the prevalence of FA non IgE-mediated (Woods et al, 2002; EFSA, 2004). Finally, allergic reactions to foods are often inconsistently classified and reported by the medical community, and are not always adequately recognised and treated. Indeed, there are serious discrepancies in the way the International Classification of Diseases (ICD) coding is used to characterise and classify food allergic reactions across Europe (WHO, 1975 and 1993). It should also be noted that in ICD-9, there is no specific reference to food allergy, apart from dermatitis due to ingested food (Table 2).

 

Table 5.10.2.  ICD codes presumed to have been used for the classification of allergic reactions to food in 11 countries of the European Union

 

 

 

Code

Diagnostic description

ICD-9

693.1

Dermatitis due to ingested food

995.0

Anaphylactic shock

995.1

Angioneurotic oedema

995.3

Allergy, unspecified

E865

Accidental poisoning from foodstuffs and poisonous plants

490

Bronchitis

491

Chronic bronchitis

492

Emphysema

493

Asthma

493.0

Asthma, extrinsic

493.1

Asthma, intrinsic

493.9

Asthma, unspecified

495.9

Unspecified allergic alveolitis

496

Chronic airways obstruction, not elsewhere classified

995.2

Unspecified adverse effect of drug, medicament and biological substance

ICD-10

L27.2

Dermatitis due to ingested food

T78.0

Anaphylactic shock due to adverse food reaction

T78.1

Other adverse food reactions, not elsewhere classified

T78.2

Anaphylactic shock, unspecified

T78.3

Angioneurotic oedema

T78.4

Allergy, unspecified

Source: EU SCOOP Report of experts participating in Task 7.2, 1998

 

 

Taking into account the above, the EC has funded EuroPrevall (http://www.europrevall.org/), a pan-European project including 56 partners from 21 countries (19 European) with the objective of characterising the patterns and prevalence of IgE-mediated FA across Europe in infants, children and adults including, but not restricted to, foods for which labelling is mandatory under Community legislation (see section 5). EuroPrevall is still ongoing and no prevalence data have been published yet. However, a meta-analysis of published data has been performed in the context of this project to assess the prevalence of IgE-mediated FA to the foods that are responsible for the majority of FA episodes (peanut, milk, egg, fish and shellfish), taking into account the age group and the method used for diagnosis of FA (Rona et al, 2007). For the purpose of this report, additional, data for other common allergenic foods will be extracted from the Opinion of the Scientific Panel on Dietetic Products, Nutrition and Allergies on a request from the Commission relating to the evaluation of allergenic foods for labelling purposes (EFSA, 2004), which is the most updated review of available data on FA prevalence across Europe for those foods.