Food Allergies: A Growing Public Health Crisis and the Path to Solutions

Abstract

Food allergies are an increasingly urgent global health concern, particularly among children in industrialized nations. This article explores the rise in prevalence through epidemiological trends and examines underlying causes including environmental changes, microbiome disruption and the hygiene hypothesis. It further considers the psychological, social and economic burden of food allergies, while critically assessing current management strategies centered on allergen avoidance and emergency preparedness. Emerging therapies such as oral and epicutaneous immunotherapy, biologic treatments and early allergen introduction are reviewed as promising developments. The article also highlights the role of legislation, public policy and advocacy in creating safer and more inclusive environments. Addressing this complex issue requires a coordinated, multidisciplinary response that prioritizes not just prevention and innovation, but also empathy, equity and societal inclusion.

Keywords: food allergy, epidemiology, hygiene hypothesis, immunotherapy, public policy, psychosocial impact, health equity

  1. NIAID-Sponsored Expert Panel, Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol [Internet]. 2010;126(6 Suppl):S1-58. Available from: https://doi.org/10.1016/j.jaci.2010.10.007
  2. Warren CM, Chadha AS, Sicherer SH, Jiang J, Gupta RS. Prevalence and severity of sesame allergy in the United States. JAMA Netw Open [Internet]. 2019;2(8):e199144. Available from: https://doi.org/10.1001/jamanetworkopen.2019.9144
  3. Zablotsky B, Black LI, Akinbami LJ. Diagnosed allergic conditions in children aged 0-17 years: United States, 2021. NCHS Data Brief [Internet]. 2023;(459):1–8. Available from: https://doi.org/10.15620/cdc:123250
  4. Hayward E. Scientists baffled as food allergies double in a decade. The Times. 2024 Aug 28. Available from: https://www.thetimes.com/uk/healthcare/article/scientists-baffled-food-allergies-double-in-decade-dvshp877t .
  5. Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol [Internet]. 2018;141(1):41–58. Available from: https://doi.org/10.1016/j.jaci.2017.11.003
  6. Savage J, Johns CB. Food allergy: epidemiology and natural history. Immunol Allergy Clin North Am [Internet]. 2015;35(1):45–59. Available from: https://doi.org/10.1016/j.iac.2014.09.004
  7. Gupta RS, Warren CM, Smith BM, Jiang J, Blumenstock JA, Davis MM, et al. Prevalence and severity of food allergies among US adults. JAMA Netw Open [Internet]. 2019;2(1):e185630. Available from: https://doi.org/10.1001/jamanetworkopen.2018.5630
  8. Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The natural history and risk factors for the development of food allergies in children and adults. Curr Allergy Asthma Rep [Internet]. 2024;24(3):121–31. Available from: https://doi.org/10.1007/s11882-024-01131-3
  9. Hossny E, Ebisawa M, El-Gamal Y, Arasi S, Dahdah L, El-Owaidy R, et al. Challenges of managing food allergy in the developing world. World Allergy Organ J [Internet]. 2019;12(11):100089. Available from: https://doi.org/10.1016/j.waojou.2019.100089
  10. Jiang J, Warren CM, Brewer A, Soffer G, Gupta RS. Racial, ethnic, and socioeconomic differences in food allergies in the US. JAMA Netw Open [Internet]. 2023;6(6):e2318162. Available from: https://doi.org/10.1001/jamanetworkopen.2023.18162
  11. Cunico D, Giannì G, Scavone S, Buono EV, Caffarelli C. The relationship between asthma and food allergies in children. Children (Basel) [Internet]. 2024;11(11):1295. Available from: https://doi.org/10.3390/children11111295
  12. Foong R-X, du Toit G, Fox AT. Asthma, food allergy, and how they relate to each other. Front Pediatr [Internet]. 2017;5:89. Available from: https://doi.org/10.3389/fped.2017.00089
  13. Minaker LM, Elliott SJ, Clarke A. Exploring low-income families’ financial barriers to food allergy management and treatment. J Allergy (Cairo) [Internet]. 2014;2014:1–7. Available from: https://doi.org/10.1155/2014/160363
  14. Perry TT, Grant TL, Dantzer JA, Udemgba C, Jefferson AA. Impact of socioeconomic factors on allergic diseases. J Allergy Clin Immunol [Internet]. 2024;153(2):368–77. Available from: https://doi.org/10.1016/j.jaci.2023.10.025
  15. Perkin MR, Strachan DP. The hygiene hypothesis for allergy - conception and evolution. Front Allergy [Internet]. 2022;3:1051368. Available from: https://doi.org/10.3389/falgy.2022.1051368
  16. Yang L, Lin Z, Gao T, Wang P, Wang G. The role of skin-gut-lung microbiome in allergic diseases. J Allergy Clin Immunol Pract [Internet]. 2025;13(8):1935-1942.e4. Available from: https://doi.org/10.1016/j.jaip.2025.04.041
  17. Khalil M, Di Ciaula A, Mahdi L, Jaber N, Di Palo DM, Graziani A, et al. Unraveling the role of the human gut microbiome in health and diseases. Microorganisms [Internet]. 2024;12(11):2333. Available from: https://doi.org/10.3390/microorganisms12112333
  18. Peters RL, Mavoa S, Koplin JJ. An overview of environmental risk factors for food allergy. Int J Environ Res Public Health [Internet]. 2022;19(2):722. Available from: https://doi.org/10.3390/ijerph19020722
  19. Thomas T, Nashwan AJ. Air pollution and disrupted microbiomes: Tracing the impact on human health. Cureus [Internet]. 2025;17(8):e89267. Available from: https://doi.org/10.7759/cureus.89267
  20. Matsui T, Tanaka K, Yamashita H, Saneyasu K-I, Tanaka H, Takasato Y, et al. Food allergy is linked to season of birth, sun exposure, and vitamin D deficiency. Allergol Int [Internet]. 2019;68(2):172–7. Available from: https://doi.org/10.1016/j.alit.2018.12.003
  21. Giannetti A, Bernardini L, Cangemi J, Gallucci M, Masetti R, Ricci G. Role of vitamin D in prevention of food allergy in infants. Front Pediatr [Internet]. 2020;8:447. Available from: https://doi.org/10.3389/fped.2020.00447
  22. Valero-Moreno S, Torres-Llanos R, Pérez-Marín M. Impact of childhood food allergy on quality of life: A systematic review. Appl Sci (Basel) [Internet]. 2024;14(23):10989. Available from: https://doi.org/10.3390/app142310989
  23. Warren C, Nimmagadda SR, Gupta R, Levin M. The epidemiology of food allergy in adults. Ann Allergy Asthma Immunol [Internet]. 2023;130(3):276–87. Available from: https://doi.org/10.1016/j.anai.2022.11.026
  24. Kachru R. Psychosocial issues and quality of life associated with food allergy. J Food Allergy [Internet]. 2020;2(1):95–8. Available from: https://doi.org/10.2500/jfa.2020.2.200025
  25. Walker SO, Mao G, Caruso D, Hong X, Pongracic JA, Wang X. Cardiovascular risk factors in parents of food-allergic children. Medicine (Baltimore) [Internet]. 2016;95(15):e3156. Available from: https://doi.org/10.1097/md.0000000000003156
  26. Fong AT, Ahlstedt S, Golding MA, Protudjer JLP. The economic burden of food allergy: What we know and what we need to learn. Curr Treat Options Allergy [Internet]. 2022;9(3):169–86. Available from: https://doi.org/10.1007/s40521-022-00306-5
  27. Gupta R, Holdford D, Bilaver L, Dyer A, Holl JL, Meltzer D. The economic impact of childhood food allergy in the United States. JAMA Pediatr [Internet]. 2013;167(11):1026–31. Available from: https://doi.org/10.1001/jamapediatrics.2013.2376
  28. Bilaver LA, Kester KM, Smith BM, Gupta RS. Socioeconomic disparities in the economic impact of childhood food allergy. Pediatrics [Internet]. 2016;137(5):e20153678. Available from: http://dx.doi.org/10.1542/peds.2015-3678
  29. Ciaccio C, Dunne J, Bever A, Johnston K, Kowal S, Seetasith A, et al. Living with and caring for people with multiple food allergies: A qualitative study. Patient Prefer Adherence [Internet]. 2024;18:1949–60. Available from: https://doi.org/10.2147/PPA.S466749
  30. Wang J. Epinephrine autoinjectors for individuals with food allergy: Who, how many, and when to use. J Food Allergy [Internet]. 2024;6(1):32–6. Available from: https://doi.org/10.2500/jfa.2024.6.240004
  31. White MV, Hogue SL, Bennett ME, Goss D, Millar K, Hollis K, et al. EpiPen4Schools pilot survey: Occurrence of anaphylaxis, triggers, and epinephrine administration in a U.S. school setting. Allergy Asthma Proc [Internet]. 2015;36(4):306–12. Available from: https://doi.org/10.2500/aap.2015.36.3859
  32. Golden DBK, Wang J, Waserman S, Akin C, Campbell RL, Ellis AK, et al. Anaphylaxis: A 2023 practice parameter update. Ann Allergy Asthma Immunol [Internet]. 2024;132(2):124–76. Available from: https://doi.org/10.1016/j.anai.2023.09.015
  33. Warren CM. Prevalence of food allergies in US adults: Data from the National Health and Nutrition Examination Survey. The Journal of Allergy and Clinical Immunology. 2021;147(5):1428–36.
  34. Food and Drug Administration. FDA approves first nasal spray for treatment of anaphylaxis. FDA News Release. 2024 Aug 9. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-first-nasal-spray-treatment-anaphylaxis .
  35. Tal Y, Ribak Y, Rubin L, Talmon A, Shamriz O, Hershko AY, et al. Fast acting, dry powder, needle-free, intranasal epinephrine spray: A promising future treatment for anaphylaxis. J Allergy Clin Immunol Pract [Internet]. 2023;11(10):3047–54. Available from: https://doi.org/10.1016/j.jaip.2023.06.044
  36. Ebisawa M, Takahashi K, Takahashi K, Yanagida N, Sato S, Lieberman J, et al. Epinephrine nasal spray improves allergic symptoms in patients undergoing oral food challenge, phase 3 trial. J Allergy Clin Immunol Pract [Internet]. 2025; Available from: https://doi.org/10.1016/j.jaip.2025.06.038
  37. Aquestive Therapeutics. Aquestive Therapeutics announces FDA acceptance of new Drug application and PDUFA date for Anaphylm™ for the treatment of severe allergic reactions. News Release. 2025 June 16. Available from: https://investors.aquestive.com/news-releases/news-release-details/aquestive-therapeutics-announces-fda-acceptance-new-drug-0 .
  38. Kraus CN, Wargacki S, Golden D, Lieberman J, Greenhawt M, Camargo CA Jr. Integrated phase I pharmacokinetics and pharmacodynamics of epinephrine administered through sublingual film, autoinjector, or manual injection. Ann Allergy Asthma Immunol [Internet]. 2025;134(5):580–6. Available from: https://doi.org/10.1016/j.anai.2025.01.006
  39. Varjan S, Wargacki S, Buono V, Tsodikov G. Stability results of AnaphylmTM (epinephrine sublingual film) under extreme temperature conditions. J Allergy Clin Immunol [Internet]. 2025;155(2):AB98. Available from: https://doi.org/10.1016/j.jaci.2024.12.310
  40. Dantzer JA, Kim EH. New approaches to food allergy immunotherapy. J Allergy Clin Immunol Pract [Internet]. 2024;12(3):546–52. Available from: https://doi.org/10.1016/j.jaip.2023.10.018
  41. Food and Drug Administration. Palforzia. U.S. FDA website. 2024 Aug 1. Available from: https://www.fda.gov/vaccines-blood-biologics/allergenics/palforzia .
  42. PALISADE Group of Clinical Investigators, Vickery BP, Vereda A, Casale TB, Beyer K, du Toit G, et al. AR101 oral immunotherapy for peanut allergy. N Engl J Med [Internet]. 2018;379(21):1991–2001. Available from: https://doi.org/10.1056/NEJMoa1812856
  43. Sindher SB, Fiocchi A, Zuberbier T, Arasi S, Wood RA, Chinthrajah RS. The role of biologics in the treatment of food allergy. J Allergy Clin Immunol Pract [Internet]. 2024;12(3):562–8. Available from: https://doi.org/10.1016/j.jaip.2023.11.032
  44. Dantzer JA, Wood RA. Anti-IgE and food allergy. J Allergy Clin Immunol [Internet]. 2025;155(1):1–11. Available from: https://doi.org/10.1016/j.jaci.2024.10.020
  45. Sampson HA, Bird JA, Fleischer D, Shreffler WG, Spergel JM. Who are the potential patients for omalizumab for food allergy? Ann Allergy Asthma Immunol [Internet]. 2024;132(5):569–71. Available from: https://doi.org/10.1016/j.anai.2024.03.006
  46. Greenhawt M, Sindher SB, Wang J, O’Sullivan M, du Toit G, Kim EH, et al. Phase 3 trial of epicutaneous immunotherapy in toddlers with peanut allergy. N Engl J Med [Internet]. 2023;388(19):1755–66. Available from: https://doi.org/10.1056/NEJMoa2212895
  47. Fleischer DM, Greenhawt M, Sussman G, Bégin P, Nowak-Wegrzyn A, Petroni D, et al. Effect of epicutaneous immunotherapy vs placebo on reaction to peanut protein ingestion among children with peanut allergy: The PEPITES randomized clinical trial: The PEPITES randomized clinical trial. JAMA [Internet]. 2019;321(10):946–55. Available from: https://doi.org/10.1001/jama.2019.1113
  48. Kim EH, Bird JA, Keet CA, Virkud YV, Herlihy L, Ye P, et al. Desensitization and remission after peanut sublingual immunotherapy in 1- to 4-year-old peanut-allergic children: A randomized, placebo-controlled trial. J Allergy Clin Immunol [Internet]. 2024;153(1):173-181.e10. Available from: https://doi.org/10.1016/j.jaci.2023.08.032
  49. Kim EH, Keet CA, Virkud YV, Chin S, Ye P, Penumarti A, et al. Open-label study of the efficacy, safety, and durability of peanut sublingual immunotherapy in peanut-allergic children. J Allergy Clin Immunol [Internet]. 2023;151(6):1558-1565.e6. Available from: https://doi.org/10.1016/j.jaci.2023.01.036
  50. Rad LM, Arellano G, Podojil JR, O’Konek JJ, Shea LD, Miller SD. Engineering nanoparticle therapeutics for food allergy. J Allergy Clin Immunol [Internet]. 2024;153(3):549–59. Available from: https://doi.org/10.1016/j.jaci.2023.10.013
  51. Hughes KR, Saunders MN, Landers JJ, Janczak KW, Turkistani H, Rad LM, et al. Masked delivery of allergen in nanoparticles safely attenuates anaphylactic response in Murine models of peanut allergy. Front Allergy [Internet]. 2022;3:829605. Available from: https://doi.org/10.3389/falgy.2022.829605
  52. Prickett SR, Voskamp AL, Dacumos-Hill A, Symons K, Rolland JM, O’Hehir RE. Ara h 2 peptides containing dominant CD4+ T-cell epitopes: candidates for a peanut allergy therapeutic. J Allergy Clin Immunol [Internet]. 2011;127(3):608-15.e1-5. Available from: https://doi.org/10.1016/j.jaci.2010.09.027
  53. Voskamp AL, Khosa S, Phan T, DeBerg HA, Bingham J, Hew M, et al. Phase 1 trial supports safety and mechanism of action of peptide immunotherapy for peanut allergy. Allergy [Internet]. 2024;79(2):485–98. Available from: https://doi.org/10.1111/all.15966
  54. Alam T, Rustgi S. Peanut genotypes with reduced content of immunogenic proteins by breeding, biotechnology, and management: Prospects and challenges. Plants [Internet]. 2025;14(4):626. Available from: https://doi.org/10.3390/plants14040626
  55. Gelaye Y, Luo H. Application of epigenetics for allergen-free peanut production: a comprehensive review. Epigenetics Insights [Internet]. 2025;18(1):e006. Available from: https://doi.org/10.48130/epi-0025-0006
  56. Berreiros-Hortala H, Vilchez-Pinto G, Diaz-Perales A, Garrido-Arandia M, Tome-Amat J. Virus-like particles as vaccines for allergen-specific therapy: An overview of current developments. Int J Mol Sci [Internet]. 2024;25(13):7429. Available from: https://doi.org/10.3390/ijms25137429
  57. Layhadi JA, Starchenka S, De Kam P-J, Palmer E, Patel N, Keane ST, et al. Ara h 2-expressing cucumber mosaic virus-like particle (VLP Peanut) induces in vitro tolerogenic cellular responses in peanut-allergic individuals. J Allergy Clin Immunol [Internet]. 2025;155(1):153–65. Available from: https://doi.org/10.1016/j.jaci.2024.08.010
  58. Sobczak JM, Krenger PS, Storni F, Mohsen MO, Balke I, Reseviča G, et al. The next generation virus-like particle platform for the treatment of peanut allergy. Allergy [Internet]. 2023;78(7):1980–96. Available from: https://doi.org/10.1111/all.15704
  59. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med [Internet]. 2015;372(9):803–13. Available from: https://doi.org/10.1056/NEJMoa1414850
  60. Du Toit G, Katz Y, Sasieni P, Mesher D, Maleki SJ, Fisher HR, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol [Internet]. 2008;122(5):984–91. Available from: https://doi.org/10.1016/j.jaci.2008.08.039
  61. Du Toit G, Huffaker MF, Radulovic S, Feeney M, Fisher HR, Byron M, et al. Follow-up to adolescence after early peanut introduction for allergy prevention. NEJM Evid [Internet]. 2024;3(6):EVIDoa2300311. Available from: https://doi.org/10.1056/EVIDoa2300311
  62. Perkin MR, Logan K, Marrs T, Radulovic S, Craven J, Flohr C, et al. Enquiring About Tolerance (EAT) study: Feasibility of an early allergenic food introduction regimen. J Allergy Clin Immunol [Internet]. 2016;137(5):1477-1486.e8. Available from: https://doi.org/10.1016/j.jaci.2015.12.1322
  63. Trogen B, Jacobs S, Nowak-Wegrzyn A. Early introduction of allergenic foods and the prevention of food allergy. Nutrients [Internet]. 2022;14(13):2565. Available from: https://doi.org/10.3390/nu14132565
  64. Ho V. Natasha's Law: UK introduces new food allergen labeling regulations. The Guardian. 2024 Aug 17. Available from: https://www.theguardian.com/society/article/2024/aug/17/food-firms-must-up-the-ante-on-allergy-knowledge-after-teenagers-death .
  65. Russell AF, Bingemann TA, Cooke AT, Ponda P, Pistiner M, Jean T, et al. The need for required stock epinephrine in all schools: A work group report of the AAAAI adverse reactions to foods committee. J Allergy Clin Immunol Pract [Internet]. 2023;11(4):1068-1082.e1. Available from: https://doi.org/10.1016/j.jaip.2022.12.047
  66. Tarr Cooke A, Meize-Grochowski R. Epinephrine auto-injectors for anaphylaxis treatment in the school setting: A discussion paper. SAGE Open Nurs [Internet]. 2019;5:2377960819845246. Available from: https://doi.org/10.1177/2377960819845246
  67. Fiocchi A, Risso D, DunnGalvin A, González Díaz SN, Monaci L, Fierro V, et al. Food labeling issues for severe food allergic patients. World Allergy Organ J [Internet]. 2021;14(10):100598. Available from: https://doi.org/10.1016/j.waojou.2021.100598
  68. Stankovich GA, Warren CM, Gupta R, Sindher SB, Chinthrajah RS, Nadeau KC. Food allergy risks and dining industry - an assessment and a path forward. Front Allergy [Internet]. 2023;4:1060932. Available from: https://doi.org/10.3389/falgy.2023.1060932
  69. Nishida N, Maeda Y, Okafuji I, Ueki S. Lived experiences of school-age children with food allergies: A qualitative systematic review and meta-synthesis. Children (Basel) [Internet]. 2025;12(8):1053. Available from: https://doi.org/10.3390/children12081053
  70. Dhanjal R, Dine K, Gerdts J, Merrill K, Frykas TLM, Protudjer JL. An online, peer-mentored food allergy education program improves children’s and parents’ confidence. Allergy Asthma Clin Immunol [Internet]. 2023;19(1):47. Available from: https://doi.org/10.1186/s13223-023-00800-8
  71. Bingemann TA, LeBovidge J, Bartnikas L, Protudjer JLP, Herbert LJ. Psychosocial impact of food allergy on children and adults and practical interventions. Curr Allergy Asthma Rep [Internet]. 2024;24(3):107–19. Available from: https://doi.org/10.1007/s11882-023-01121-x
  72. Dehbozorgi S, Ramsey N, Lee ASE, Coleman A, Varshney P, Davis CM. Addressing health equity in food allergy. J Allergy Clin Immunol Pract [Internet]. 2024;12(3):570–7. Available from: https://doi.org/10.1016/j.jaip.2024.01.026

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