Food allergies have been described in the medical literature for over 100 years But the first 75 years of that history were fairly quiescent. Beginning in about 1990, food allergies began to emerge as an important public health issue. The prevalence of food allergies began to rise and rise dramatically especially among infants and young children. Food allergies began to be recognized as a potentially severe, life-threatening condition. And, the potency of certain foods as allergens – “it only takes one bite” – became known. As the awareness and seriousness of food allergies emerged, the food industry struggled because the most commonly allergenic foods and especially milk, egg, soy and wheat were almost ubiquitous in food processing facilities. The industry had no tools or ability to assess the risk. The public health authorities similarly lacked tools and knowledge but were obliged to take a conservative approach to protect food-allergic consumers.

In the intervening 25 years, enormous progress in our understanding of food allergies has been made. We are beginning to understand the reasons for the increasing prevalence of food allergies. The path toward prevention of the development of food allergies among infants and young children seems clear. While a cure for food allergies still seems elusive, clinicians are investigating immunotherapy strategies that promise to curtail the potency and severity of food allergies. On the public health side, improved labeling regulations have been implemented in the U.S. and several other countries; packaged foods are safer for those with food allergies than they have ever been. The Food Safety Modernization Act identifies food allergen as a recognized public health hazard and mandates the development of preventive allergen controls. The industry now has the analytical tools needed to identify allergen hazards and assess the effectiveness of allergen control approaches. Quantitative risk assessment is emerging as a decision-making approach to guide labeling and industrial allergen management.

We may not put this public health issue completely behind us over the next 25 years but I do think that we will lessen the public health impact of food allergies considerably.

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