As dietary habits evolve, so too does our susceptibility to food allergies. A recent study analyzing data from over 1,000 patients has revealed a broadening spectrum of allergenic foods, moving beyond the traditionally recognized “big 8.” While peanuts and tree nuts remain significant concerns, the research highlights a growing prevalence of reactions to fruits, vegetables, seeds, and even pine nuts.
Shifting Allergic Landscape
Researchers analyzed data from 1085 patients who attended the allergology outpatient clinic of the University Medical Centre Utrecht in the Netherlands between and . Participants reported experiencing food allergy symptoms within two hours of consuming a suspected allergen. The study categorized patients into two groups: those with probable food allergy (showing both symptoms and sensitization) and those with possible food allergy (experiencing symptoms without available sensitization data). The average age of participants was 36, with 71% being female.
The findings indicate that fruit is now the most commonly reported cause of allergic symptoms, affecting 69% of those studied, followed by nuts (63%), legumes (40%), vegetables (34%), and seeds or pits (14%). Specifically, apple was identified as the most common single allergen, triggering reactions in 44% of participants. Kiwi fruit, hazelnut, walnut, and peanut each caused symptoms in a third of those studied, while cherry, almond, peach, and pear affected a quarter.
Severity and Emerging Allergens
While fruit is the most frequent trigger, severe reactions are more often associated with seeds (40%), fish (39%), legumes (35%), nuts (32%), and crustaceans (31%). Peanut, hazelnut, walnut, almond, apple, and kiwi fruit were the foods most frequently linked to severe reactions in absolute numbers. Tropical fruits, like lychee, were particularly associated with severe symptoms within the fruit category, though fruit overall accounted for only 17% of severe responses.
These findings suggest a need to re-evaluate the traditional focus on a limited set of “big 8” allergens – cow’s milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish – which have historically formed the basis of most prevalence studies. “Basically, the message is, any food can cause allergy in any person,” explains Professor Connie Katelaris, an allergist and professor of Immunology and Allergy at the University of Western Sydney.
The Role of Dietary Changes
The increasing prevalence of allergies to foods like pine nuts and seeds is linked to changing dietary patterns. Professor Katelaris notes that increased consumption of these foods, driven by their perceived health benefits – such as fiber and positive impact on the microbiome – is likely contributing to greater sensitization. Similarly, increased access to a wider variety of fruits, including tropical varieties, due to globalization is also playing a role.
“Things like pine nuts and seeds from various things are becoming more common, and that’s because people are eating these more,” Professor Katelaris stated. “So, you’re suddenly seeing people putting sunflower seeds and chia seeds and all sorts of things on their cereals and whatever, [and with] the more frequent use of these foods, we’re going to see more become sensitised.”
Implications for Labeling and Diagnosis
The study underscores the importance of recognizing that less common allergens are becoming more prevalent. This has implications for food labeling and diagnostic practices. Currently, food packaging in the UK and EU lists the 14 most common allergens, but the researchers suggest that at least four more – goat’s and sheep’s milk, buckwheat, peas-lentil, and pine nuts – should be added to the mandatory risk list.
According to the study authors, given their frequency, severity, recurrence, and potential for hidden exposure, these four foods warrant consideration for inclusion in the standard allergen list. The FDA in the United States recently issued final guidance for industry regarding food allergen labeling, including updates on tree nut labeling as of , and sesame was added as a major allergen under the FASTER Act in . The FDA also announced a virtual public meeting on food allergen thresholds scheduled for .
Professor Katelaris emphasizes the need for clinicians to consider unusual foods when evaluating patients with suspected allergies. “If everybody’s only concerned about the sort of eight to nine allergens that we see most commonly in infancy and childhood, you are going to miss warnings,” she said. She recommends thorough testing and, when necessary, oral food challenges to accurately diagnose allergies.
The study also noted that symptoms were uncommon for foods that already have mandatory labeling requirements in the Netherlands, such as lupine, fish, certain crustaceans, mustard, and celery.
Prevalence and Public Health Impact
Food allergy is estimated to affect one in 10 babies, one in 20 teens, and one in 50 adults, according to Allergy and Anaphylaxis Australia. Between and , the Allergy Vigilance Network in Europe reported 3,000 cases of food-induced anaphylaxis, including 413 reactions and two deaths caused by emerging food allergies.
The findings from this study, published in the Journal of Allergy and Clinical Immunology on , highlight the dynamic nature of food allergies and the need for ongoing vigilance and adaptation in both clinical practice and food safety regulations.
