Frequency and severity of 192 foods causing food allergy in adults

Background: To date, studies have mainly focused on the frequency and severity of the so-called big 8 foods; less is known about other foods. Objective: We investigated the frequency and severity of allergy to all foods reported to cause food allergic symptoms. Methods: Adult patients with symptoms within 2 hours after ingestion of any food were included. Sensitization was measured by skin prick test and/or specific IgE for the culprit food(s) when possible. Results: A total of 1085 patients were included, of whom 66.9% had a probable food allergy (FA) (reported symptoms with sensitization) and 33.1% only a possible FA (reported symptoms, independent of sensitization). Patients reported symptoms to a total of 192 foods, and sufficient sensitization data were available for 45 foods. The ranking in frequency and severity of symptoms was comparable between probable and possible FA. Regarding possible FA, fruit was most commonly reported (68.8%), followed by nuts (63.0%), legumes (39.5%), vegetables (34.0%), and seeds or pits (14.4%). Severe symptoms were most frequently reported for seeds (39.8%), fish (39.2%), legumes (34.8%), nuts (31.9%), and crustaceans (31.3%), and least frequently for fruit (16.5%). Nevertheless, in absolute numbers, fruit ranked in position 3 (n = 125), with especially tropical fruit (eg, lychee) frequently causing severe symptoms. Regarding probable FA, severe symptoms were most common for sunflower seeds (80.0%), pine nut (66.7%), Brazil nut (60.0%), cashew (57.1%), and pistachio (51.7%). Conclusion: Food allergies are caused by almost 200 different foods in adults. Although not mandatorily labeled, seeds most commonly cause severe symptoms, and fruit causes severe symptoms in a large number of patients. This study highlights the importance of food allergies outside the big 8.