Food allergy outside the eight big foods in Europe: A systematic review and meta-analysis

Background: The 2014 estimates of prevalence of food allergy (FA) in Europe published by the European Academy of Allergy and Clinical Immunology included only the eight so-called big foods (cow's milk/egg/wheat/soy/peanut/tree nuts/fish/shellfish). Those estimates have recently been updated. Complementing this, we sought to identify and estimate the prevalence of allergy to other foods that have been reported during the last decade. Methods: Six databases were searched for studies published 2012–2021. Random-effects meta-analysis was performed to derive pooled prevalence of allergy to each food. Results: Twenty-seven studies were included, containing a total of 66 FAs. Among the most frequently reported FAs, the lifetime and point prevalence range of self-reported kiwi allergy was 0.1%–1.0% and 0.2%–8.1%, respectively, while the food challenge (FC)-verified kiwi allergy point prevalence range was 0.01%–0.10%. The point prevalence range for self-reported peach allergy was 0.2%–3.2%, while the range for FC-verified peach allergy was 0.02%–0.05%. The lifetime and point prevalence range for self-reported tomato allergy was 0.01%–1.8% and 0.2%–2.1%, respectively. Conclusion: Allergy to some foods traditionally not considered important are now emerging as relevant FAs. The focus on FA in Europe should not be limited to the so-called eight big FA, but extended to other types of foods which need to be considered both for clinical purposes and population risk assessment.