Food allergy and non-allergic food hypersensitivity in children and adolescents

Clin Exp Allergy. 2004 Oct;34(10):1534-41. doi: 10.1111/j.1365-2222.2004.02080.x.


Background: Previous studies have shown a 10-fold discrepancy of self-reported food-induced symptoms and physician-diagnosed food hypersensitivity. Little information is available on the prevalence of food hypersensitivity in unselected paediatric populations. No data were available for German children.

Objective: To study the perception of food-induced symptoms in the paediatric population, to investigate the allergens accused, to objectify patients' reports, and to identify subgroups at risk of having food-induced allergy (FA) or non-allergic food hypersensitivity (NAFH) reactions.

Methods: This paper presents the data of the paediatric group (0-17 years) of a representative, randomly sampled, cross-sectional population-based survey studying 13 300 inhabitants of the German capital city Berlin regarding food-related symptoms. Instruments included mailed questionnaires, structured telephone interviews, physical examination, skin-prick tests, specific serum IgE and standardized, controlled and blinded oral food challenges.

Results: Two thousand three hundred and fifty-four individuals were contacted by mailed questionnaire, 739 (31.4%) responses could be fully evaluated. Four hundred and fifty-five (61.5%) participants reported symptoms related to food ingestion, 284 (38.4%) affirmed reproducible symptoms in the standardized telephone interview. One hundred and eighty-four (24.8%) individuals were fully examined. Reproducible symptoms to food were found in 31 (4.2%) children and adolescents: 26 (3.5%) showed symptoms of FA and five (0.7%) of NAFH. The oral allergy syndrome was most often observed. Foods most commonly identified by oral challenges were apple, hazelnut, soy, kiwi, carrot and wheat.

Conclusion: The perception of food-related symptoms is common among children and adolescents from the general population. Self-reports could be confirmed in around one out of 10 individuals, still resulting in 4.2% of proven clinical symptoms. However, most reactions were mild and mainly because of pollen-associated FA, while NAFH reactions were less common. Severe IgE-mediated FA was observed in individuals with pre-existing atopic disease, who should be fully investigated for clinically relevant FA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Allergens / immunology*
  • Asthma / epidemiology
  • Asthma / immunology
  • Child
  • Child, Preschool
  • Conjunctivitis, Allergic / epidemiology
  • Conjunctivitis, Allergic / immunology
  • Cross-Sectional Studies
  • Dermatitis, Atopic / epidemiology
  • Dermatitis, Atopic / immunology
  • Female
  • Food / adverse effects
  • Food Hypersensitivity / epidemiology*
  • Food Hypersensitivity / immunology
  • Fruit / adverse effects
  • Germany / epidemiology
  • Humans
  • Immunoglobulin E / immunology
  • Infant
  • Male
  • Population Surveillance / methods
  • Prevalence
  • Rhinitis, Allergic, Perennial / epidemiology
  • Rhinitis, Allergic, Perennial / immunology
  • Skin Tests / methods
  • Urticaria / epidemiology
  • Urticaria / immunology


  • Allergens
  • Immunoglobulin E