A Methodology of Epidemiologic Study in the General Population Focusing on Food Allergy — China, 2020

INTRODUCTION: Adverse reactions to food (ARF) are a major worldwide public health and food safety problem. Among the various causes of ARF, food allergies (FA) are particularly serious as the immune response that is triggered can be fatal even at very low doses. However, the prevalence of ARF and FA in the general population in China is presently unclear. This study aims to determine the epidemiological characteristics and risk factors for ARF and FA, which can be a basis for estimating thresholds for major food allergens. METHODS: This is a multicenter, cross-sectional, epidemiologic survey with a case-control study nested among a selected population in China. Random individuals were recruited using stratified cluster random sampling; ARF and FA were comprehensively assessed using modified EuroPrevall FA Project questionnaires as well as structured interviews, sensitization testing, and double-blind placebo-controlled food challenges (DBPCFC). RESULTS: This method of epidemiologic study on ARF and FA was a pilot application in Jiangxi Province from January 2020; among the total 21,273 children and adults that completed the questionnaire, 5.8% reported ARF and 4.3% reported FA. ARF were determined to be associated with age, gender, and region. Animal-derived foods were the dominant offending foods, especially shrimp, and skin symptoms were the most commonly reported ARF. DISCUSSION: This is the first multi-center, large-scale, epidemiologic study on ARF and FA using standardized methods, including DBPCFC, in the Chinese general population. This study presents an important approach to assessing ARF and FA, provides significant insights about the prevalence of ARF and FA, and facilitates support for updating the list of allergenic food labels: which will be essential for improving ARF prevention and management in China.