Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry

Dölle-Bierke S, Höfer V, Francuzik W, Näher AF, Bilo MB, Cichocka-Jarosz E, Lopes de Oliveira LC, Fernandez-Rivas M, García BE, Hartmann K, Jappe U, Köhli A, Lange L, Maris I, Mustakov TB, Nemat K, Ott H, Papadopoulos NG, Pföhler C, Ruëff F, Sabouraud-Leclerc D, Spindler T, Stock P, Treudler R, Vogelberg C, Wagner N, Worm M (2023)

Publication Type: Journal article

Publication year: 2023


DOI: 10.1016/j.jaip.2023.03.026


Background: Food is one of the most common elicitors of anaphylaxis, with an increasing incidence over recent years. Objectives: To characterize elicitor-specific phenotypes and identify factors enhancing the risk or severity of food-induced anaphylaxis (FIA). Methods: We analyzed data from the European Anaphylaxis Registry applying an age- and sex-matched analysis of associations (Cramer's V) for single food triggers and calculated odds ratios (ORs) for severe FIA. Results: We identified 3,427 cases of confirmed FIA showing an age-dependent elicitor ranking (for children: peanut, cow's milk, cashew, and hen's egg; and for adults: wheat flour, shellfish, hazelnut, and soy). The age- and sex-matched analysis revealed defined symptom patterns for wheat and cashew. Wheat-induced anaphylaxis was more frequently associated with cardiovascular symptoms (75.7%; Cramer's V = 0.28) and cashew-induced anaphylaxis with gastrointestinal symptoms (73.9%; Cramer's V = 0.20). Furthermore, concomitant atopic dermatitis was slightly associated with anaphylaxis to hen's egg (Cramer's V = 0.19) and exercise was strongly associated with anaphylaxis to wheat (Cramer's V = 0.56). Additional factors influencing the severity were alcohol intake in wheat anaphylaxis (OR = 3.23; CI, 1.31-8.83) and exercise in peanut anaphylaxis (OR = 1.78; CI, 1.09-2.95). Conclusions: Our data show that FIA is age-dependent. In adults, the range of elicitors inducing FIA is broader. For some elicitors, the severity of FIA seems to be related to the elicitor. These data require confirmation in future studies considering a clear differentiation between augmentation and risk factors in FIA.

Additional Organisation(s)

Involved external institutions

How to cite


Dölle-Bierke, S., Höfer, V., Francuzik, W., Näher, A.F., Bilo, M.B., Cichocka-Jarosz, E.,... Worm, M. (2023). Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry. The Journal of Allergy and Clinical Immunology: In Practice.


Dölle-Bierke, Sabine, et al. "Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry." The Journal of Allergy and Clinical Immunology: In Practice (2023).

BibTeX: Download