Food Allergy: International and Developing World Perspectives

Purpose of Review: Epidemiological data on food allergy worldwide suffer from the challenges of variability in methods of diagnosis, sampling, and response rates. There are little data on food allergy in the developing world and populations with food allergy in such settings may suffer from challenges that are different from those experienced by subjects with food allergy in the developed world. Recent Findings: Data based on IgE-mediated food allergy established by food challenge in unselected childhood populations exist only from the USA, Europe, China, Thailand, Australia, and South Africa. In the developing world, barriers to food allergy diagnosis and care include lack of public awareness of food allergy, poor education of health care providers, under- and over-diagnosis of food allergy, lack of access to care, inadequate availability and affordability of testing, insufficient trained health care providers and emergency medication, inadequate labeling legislation, poor availability of food substitutes, and cultural or language issues. Recent data question the use of internationally derived 95 % positive predictive values of specific IgE and skin prick tests for food challenge outcome in children in developing world settings. Summary: The little data on food allergy from rural and developing world settings suggest that the prevalence may be lower but challenges experienced by patients may be higher than that in the urban developed world. Differences in food sensitization and food allergy rates between populations may reflect genetic variation, unique environmental exposures or both, via epigenetic modulation. © 2016, Springer Science + Business Media New York.