Similar prevalence, different spectrum: IgE-mediated food allergy among Turkish adolescents

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Yepes-Nuñez, J. Bartra, R. Muñoz-Cano, J. Sánchez-López, C. Serrano, J. Mullol, I. Alobid, J. Sastre, C. Picado, A. Valero" "autores" => array:10 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Yepes-Nuñez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Bartra" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Muñoz-Cano" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Sánchez-López" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Serrano" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Mullol" ] 6 => array:2 [ "nombre" => "I." "apellidos" => "Alobid" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Sastre" ] 8 => array:2 [ "nombre" => "C." "apellidos" => "Picado" ] 9 => array:2 [ "nombre" => "A." 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The horizontal bars indicate the geometric means (GM)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Fereidouni, F. Fereidouni, M. Hadian, Sh. Nourani hasankiadeh, M. Mazandarani, M. Ziaee" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Fereidouni" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Fereidouni" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Hadian" ] 3 => array:2 [ "nombre" => "Sh." "apellidos" => "Nourani hasankiadeh" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Mazandarani" ] 5 => array:2 [ "nombre" => "M." 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"apellidos" => "Şekerel" "email" => array:1 [ 0 => "b_sekerel@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hacettepe University, Faculty of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Karadeniz Technical University, Faculty of Medicine, Pediatric Allergy Division, Trabzon, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Celal Bayar University, Faculty of Medicine, Pediatric Pulmonology and Allergy Unit, Manisa, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Akdeniz University, Faculty of Medicine, Pediatric Immunology and Allergy Unit, Antalya, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2763 "Ancho" => 2549 "Tamanyo" => 279810 ] ] "descripcion" => array:1 [ "en" => "Flowchart of prospective evaluation for food allergy of ISAAC Phase II study population." ] ] ] "textoCompleto" => "IntroductionThe term food allergy refers to immunologically mediated hypersensitivity reaction to any food, which is mostly IgE-mediated, but cellular mechanisms may also underlie in a small portion of patients. Other reactions to food that need to be distinguished from food allergies include food intolerance, pharmacological reactions, toxic reactions and food aversions,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> which are collectively regarded as non-allergic food hypersensitivity.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Even though food allergies are a very common childhood health problem, there are little data about the true occurrence of the disease in a population setting. The reason for this is the high rate of perception of food allergy as causal of untoward reactions to food, diagnostic concerns and the time, resource and effort-consuming nature of population-based studies. In addition, there is significant variation in allergenic food profile among different geographical regions.<a class="elsevierStyleCrossRefs" href="#bib0015">3–15</a> Thus, there is universal scarcity of data on epidemiology of food allergy in population; this is also true for Turkey. Population-based studies typically employ questionnaires, skin prick tests (SPT), specific IgE (spIgE) measurements and food challenge tests. Only few studies employ double-blind placebo-controlled challenge tests (DBPCCT), a gold standard diagnostic procedure, because they require substantial effort from the study team and patient compliance is also an important concern. Self-reported food allergy prevalence reported in studies conducted up to date is quite variable, usually within the range of 5–35%.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4,10–14,16,17</a> Confirmed prevalence implementing oral challenge tests is much lower, generally <1%, as documented in studies by different investigators.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4,6,11–13,16</a> Knowledge of the epidemiological impact of the problem is crucial for the effective implementation of health policies.In this study, we aimed to estimate food allergy prevalence and define allergenic food spectrum for urban adolescents from different geographical regions of Turkey.Materials and methodsThe current study is a detailed evaluation for the presence of food allergy of patients from multicentre ISAAC Phase II study conducted in 2005–2006 and which aimed to investigate epidemiology of asthma and allergic disease in childhood. ISAAC Phase II option B protocol<a class="elsevierStyleCrossRef" href="#bib0090">18</a> was implemented in 2005–2006 in five different cities (Ankara, Antalya, Manisa, Trabzon, Van) of Turkey under the support of Prime Ministry State Planning Organization and headed by Hacettepe University, Faculty of Medicine, Pediatric Allergy and Asthma Unit.ISAAC Phase II StudyISAAC Phase II Study was a cross-sectional study that recruited 10–11-year-old primary schoolchildren. Sample size calculation and sampling process involved a two-step layered systematic cluster sampling method. In accordance with the ISAAC II methodology (option B), the study aimed to enrol at least 1000 students from each city, to be recruited from at least 10 schools, with the aim of recruiting at least 100 children who had reported wheezing over the last 12 months.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> City-specific minimum sample sizes were calculated for α=0.05, 1−β=0.80, δ=6.9% (percentage of physician-diagnosed asthma cases recorded in the previous ISAAC study conducted in Turkey<a class="elsevierStyleCrossRef" href="#bib0095">19</a>), and σ=1.2. Detailed information on the study population and sampling process is presented elsewhere.<a class="elsevierStyleCrossRefs" href="#bib0100">20–23</a> Apart from standard workup, food allergy module (Refer to <a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>) was integrated, and skin prick testing was performed with standard food allergens (egg white, cow's milk, walnut, peanut and hazelnut) to all consented participants. Food allergy module consisted of six questions regarding ever and current experiencing any complaint following food intake, spectrum of complaints, presence of complaint following intake of commonly encountered food items, physician aid seeking and history of physician diagnosed food allergy. The questionnaire was validated on a sample of 40 parents/children through in-depth interviews.Definition of ‘suspicious for food allergy’ patientsAny questionnaire holder who answered the question ‘Did your child have any allergic complaint after any food intake within last year?’ (<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>, Question 2) as ‘Yes’ and/or was sensitised to any of tested food allergens was defined as ‘suspicious for food allergy’, and thus was chosen for telephone interview.Telephone interview of patients ‘suspicious for food allergy’Questionnaire holders were contacted via telephone over the period of January 2010–June 2010 by a single paediatrician trained in food allergy. Due to low contact rates and absence of appropriate paediatric allergic setting for referral in Van province, cases from this centre were not included in estimation of confirmed food allergy prevalence because of potential bias. The flowchart of evaluation of ISAAC Phase II study population for food allergy is shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 1</a>.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The detailed telephone interview was conducted with aim to exclude non-allergic food hypersensitivity and non-IgE-mediated food allergy. Adolescents in whom suspicion for IgE-mediated food allergy persisted after obtaining clinical history were chosen for evaluation at allergy departments.We preferred to interview patients themselves or their mothers/caregivers. The reason for this is that culturally Turkish mothers care for their children primarily and therefore are more likely to give reliable information on their children. The interview implemented a standard questionnaire regarding ever and current complaints following food ingestion or complaints linked to any food. Respondents were asked whether they have ever experienced pruritus, erythema, wheals, urticaria, nausea and vomiting, abdominal pain, diarrhoea, cough, dyspnoea, wheezing, lip swelling, itching or sense of swelling in the oropharynx, rhinitis or conjunctivitis symptoms, palpitations or syncope after food consumption. Then, the interviewer reviewed a list of foods commonly involved in food allergy and symptoms related to ingestion of these food items. Cases that reported consistent or suspicious symptoms after food consumption within 12 months, or those that reported ever consistent/suspicious symptoms but had not consumed the food in question within 12 months for any reason were defined as patients who might be food allergic. They were invited for evaluation at allergy departments in the corresponding city. Questionnaire holders were attempted to contact on at least three occasions before deciding they were unavailable.Evaluation of patients at allergy departmentsAdolescents in whom IgE-mediated food allergy could not be ruled by a telephone interview were invited for investigation and evaluated at paediatric allergy clinics in Ankara, Antalya, Manisa or Trabzon between March 2010 and July 2010. Physicians at corresponding clinics were instructed to lead the investigation with intention to diagnose or rule out IgE-mediated food allergy.Diagnostic tools were history, physical examination, SPT, spIgE and food challenge tests. History regarding complaints structurally similar to that asked in the first interview, past medical history and family history were obtained and physical examination performed; skin prick testing and food challenge tests with suspected allergens were applied to all consented patients. In case commercial extracts for prick testing were not available, patients underwent prick-to-prick testing. A wheal diameter of at least 3mm in respect to negative control was accepted as a positive result. SpIgE testing was performed with Pharmacia ImmunoCAP assay (Phadia AB, Uppsala, Sweden). Cases evaluated as positive on basis of history and/or had evidence of sensitisation to food allergens were applied open challenge tests (OCT). When the patient reported a severe reaction, she/he was not challenged and the diagnosis of food allergy was established according to history and sensitisation findings. In order to maintain a methodological uniformity of patient evaluation across study centres, patients with inconsistent history and laboratory data were also open challenged. The dose interval was 20min.Food masking procedures for tomato and kiwi in three blinded challenge tests have been described elsewhere.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>Statistical evaluationData was statistically evaluated using SPSS v.15 (SPSS Inc., Chicago, Illinois, USA). Descriptive analysis was carried out for ISAAC Phase II study population. Results were expressed as mean and standard error of mean (SEM) or as percentages of responses to each question. Independent samples t-test was used for comparison of means. We used chi-square test to compare proportions in independent groups, and applied Yates correction and Fisher's exact test where required. Test of a single proportion was used to assess whether prevalence rates were different for the whole study population compared to a subset of subjects. A significance level of p<0.05 was chosen. 95% confidence interval (CI) was calculated for prevalence rates. Adjustments for loss to follow-up at each stage were applied in order to estimate for prevalence of food allergy and probable food allergy.Role of the funding sourceISAAC Phase II Study was sponsored by a grant (03K 120 570-05-7) from the Prime Ministry State Planning Organization, Turkey. The Ministry of Health of Turkey (provision of nurses and allied health personnel) and Merck Sharp Dohme Pharmaceutical Co. Istanbul, Turkey [provision of Quantitest lancets (Panatrex Inc, Placentia, California, USA) for the skin prick tests] supported the study. The prospective evaluation phase that included telephone interview and detailed investigations were conducted with use of resources of ISAAC Phase II Study and of corresponding study centres.ResultsISAAC Phase II Study recruited 6963 children. Demographic and clinical features of the study population are given in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>. Parental-reported food allergy prevalence was estimated as 20.22±0.94% (1408/6963, 95% CI) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Sensitisation prevalence to common food allergens detected by skin prick testing was estimated as 5.9±0.6% (361/6134, 95% CI). Parental reported food allergy prevalence for specific food items and skin test sensitisation prevalence for common allergens are given in <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 2</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>A total of 1700 questionnaire holders were defined as ‘suspicious for food allergy’ on basis of history and/or skin prick testing, and they were selected for telephone interview. Allergic co-morbidity prevalence was higher for this subgroup of children compared to the study population (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Contact rate for Van province was low (36%), and cases from this centre (1354 out of 6963 questionnaires) were not included in the estimation of confirmed food allergy prevalence because of potential bias. After exclusion of questionnaires from Van province, 1162 (out of 5609) questionnaires were labelled as ‘suspicious for food allergy’ (301 SPT positive, 909 symptom positive, 48 both positive), and for 813 of them contact was achieved, yielding an overall contact rate of 70%.IgE-mediated food allergy could not be ruled out in 152 adolescents by history alone, and they were invited for further evaluation. Of them, 87 adolescents were admitted to allergy clinics for evaluation. Among admitted patients 79 consented to skin prick testing. The outcome of initially 301 SPT positive children from four study centres is shown in <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 3</a>.<elsevierMultimedia ident="fig0025"></elsevierMultimedia>Subjects admitted to allergy clinics (n=87) reported 160 food allergies. There were 109 open food challenges planned and 82 performed. They resulted in 13 positive (in 12 patients) and 69 negative reactions. Among the 12 patients that reacted positively, eight patients were diagnosed food allergy and four patients offered DBPCCT. Two of them consented to DBPCCT and were negative for food allergy. The other two patients refused DBPCCT and thus formed a probable food allergy group. DBPCCT was available in three patients, all of which proved negative. Two had oropharyngeal reaction on open challenge with tomato, while the third patient reported oropharyngeal symptoms upon kiwi intake. We found in retrospect that she had been previously challenged with kiwi in blinded fashion, thus no further investigation was pursued.Consequently, food allergy was diagnosed in nine patients, was ruled out in 55 patients, and three patients were sensitised without clinical relevance. There were 20 patients diagnosed as having ‘probable food allergy’ because they declined further investigation (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 1</a>).Among nine patients diagnosed with food allergy, eight had been open challenged and one was not because of a potentially severe reaction. Ten open challenges in these patients resulted in cutaneous symptoms (n=6, 60%), gastrointestinal symptoms (n=4, 40%), oropharyngeal (n=2, 20%) and anaphylaxis (n=1, 10%). Reactions in challenge testing were mostly mild. Only one patient developed a potentially severe anaphylaxis with peanut, and refused further testing with other food items. She was administered i.m. adrenaline and hospitalised for follow up. Allergens found to cause food allergy in these patients were walnut (n=3), beef meat (n=2), hen's egg (n=1), peanut (n=1), hazelnut (n=1), peach (n=1), spinach (n=1), cheese (n=1) and kiwi (n=1).Patients diagnosed as having ‘probable food allergy’ reported symptoms with intake of hen's egg (n=5), walnut (n=5), chocolate (n=3), fish (n=2), hazelnut (n=2), peanut (n=2), almond (n=1), blackberry (n=1), tomato (n=1), meat and meat products (n=3), raspberry (n=1), black pepper (n=1), red pepper (n=1), and pickled cucumbers (n=1). In this patient group, 17 out of 20 were skin pricked. Oral challenge tests were available in two patients, one of which reported itching upon egg ingestion, and the other patient developed urticaria and itching six hours after chocolate intake. Both had negative skin prick testing and declined double-blind challenge. Out of 29 planned open challenges, 27 could not be performed.Further evaluation implementing food challenge testing proved IgE-mediated food allergy in 10% (9/87) of those diagnosed by history alone. Thus, IgE-mediated food allergy prevalence in ISAAC Phase II Study population was estimated to be at least 0.16±0.11% (9/5609, 95% CI).DiscussionISAAC Phase II study was the first study to encompass such a large number of children in the region with the aim of assessing allergic disease burden. Parental reported food allergy prevalence was 20.2±0.94% (1408/6963, 95% CI), the sensitisation rate to food allergens was 5.9±0.6% (361/6963, 95% CI). IgE-mediated food allergy prevalence was estimated to be at least 0.16±0.11% (9/5609, 95% CI) in ISAAC Phase II study group. Allergenic foods in nine patients diagnosed as having food allergy were unique to this study [walnut (n=3), beef meat (n=2), hen's egg (n=1), peanut (n=1), hazelnut (n=1), peach (n=1), spinach (n=1), cheese (n=1) and kiwi (n=1)]. Thus, we conclude that while prevalence was within the previously reported range, there might be regional differences in allergenic food profile.Zuberbier et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> addressed 13,300 Berlin inhabitants of adult age by questionnaire and reported lifetime self-reported food allergy prevalence as 34.9%. Telephone interview of 11,816 Istanbul (Turkey) inhabitants of adult age group yielded a lifetime self-reported food allergy prevalence of 9.5% in a recent study by Gelincik et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Osterballe et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> investigated a cohort of 1272 young adults and calculated reported food hypersensitivity prevalence as 19.6%. Orhan et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> assessed 2739 school children (6–9-year olds) from the Eastern Black Sea region of Turkey and estimated parental reported food allergy prevalence as 5.7%. Parental reported food allergy prevalence in Trabzon (a central city in the Eastern Black Sea region, Turkey) in ISAAC Phase II population was 15% (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> in <a class="elsevierStyleCrossRef" href="#sec0085">Appendix B</a> for findings by study centre), which is somewhat higher. This discrepancy might have resulted from different age groups assessed or different response rates to questionnaire. Systematic review by Rona et al.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> on the topic indicates similar reported food allergy prevalence in the range of 3–35% for any food.ISAAC Phase II study demonstrated that parents most frequently blamed hen's egg for causing allergy (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 2</a>A). Parental reported food allergy prevalence for common food allergens was compatible with ranges stated in systematic reviews<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> on the topic.Prevalence of sensitisation to food allergens (5.9%) on skin prick test in ISAAC Phase II study population was consistent with previous studies. Obeng et al.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> performed skin prick testing with peanut and six fruits in 1714 Ghanaian children 5–16 years of age and reported the sensitisation rate as 5%. Venter et al.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> followed prospectively a birth cohort of 969 children on the Isle of Wight, and reported cumulative sensitisation prevalence to cow's milk, hen's egg, whey, sesame, and fish at ages 1–3 as 5.3%. Specific IgE measurements at ages 0, 1, 2, 3, 5 were available in 216 children from MAS birth cohort and sensitisation point prevalence was estimated as 10% during first 6 years of life.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> Sensitisation rates for ISAAC Phase II study population did not significantly differ from sensitisation rates for symptomatic subgroup of cases (cases that reported a symptom upon food ingestion). In contrast to this finding, ranges reported for sensitisation rates in symptomatic subgroup vs. general population in systematic review by Rona et al.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> were 2% to 5% vs. 7% to 17%. Orhan et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> reported a quite high sensitisation rate (33.1%) in symptomatic subset of patients compared to rates (8.6%) for the same region in ISAAC Phase II study (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> in <a class="elsevierStyleCrossRef" href="#sec0085">Appendix B</a>). But since skin prick testing was not available in all patients in the study by Orhan et al.,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> sensitisation prevalence for the paediatric population in the Eastern Black Sea region (Turkey) could not be deduced from this study. Sensitisation rate for general population in Trabzon province was 11.3% in our study. Most common foods that caused a positive SPT reaction in ISAAC Phase II study population were walnut, cow's milk and peanut (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 2</a>B). While hen's egg, cocoa and cow's milk most commonly resulted in positive SPT in the study by Orhan et al.,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> hen's egg and tomato were most commonly encountered in adults in the study by Gelincik et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Since inhalant antigen sensitisation rates increase with age,<a class="elsevierStyleCrossRef" href="#bib0130">26</a> adults are more likely to have sensitisation to fruit and vegetable antigens, which cross-react with birch and grass pollens,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> and this is reflected by SPT and spIgE findings of a study conducted on adults.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Despite high reported food allergy rate, proven food allergy prevalence estimated in ISAAC Phase II study population was somewhat lower than that reported previously for various populations.<a class="elsevierStyleCrossRefs" href="#bib0015">3–6,11,25</a> This might have resulted because of the loss to follow-up of potential food allergic cases, thus we decided to apply correction for this factor in order to estimate the range for IgE-mediated food allergy prevalence. Assuming that the outcome of questionnaire holders who could not be contacted via telephone is similar (thus four extra patients would have been diagnosed), IgE-mediated food allergy prevalence is estimated as 0.23±0.13% (13/5609, 95% CI) (<a class="elsevierStyleCrossRef" href="#sec0090">Appendix C</a>). Assuming that patients who declined complete investigation have food allergy (because the probability of food allergy is expected to be higher in these patients than in the general population), IgE-mediated food allergy prevalence (definite and probable) in ISAAC Phase II Study population could have been as high as 0.75%<a class="elsevierStyleCrossRef" href="#fn0005">*</a>±0.23% (42<a class="elsevierStyleCrossRef" href="#fn0005">*</a>/5609, 95% CI) (<a class="elsevierStyleCrossRef" href="#sec0090">Appendix C</a>). We found that these estimates were within the range reported for Turkish population.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> Gelincik et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> estimated IgE-mediated food allergy prevalence in adulthood as 0.1%, while it was 0.8% for primary schoolchildren in the study by Orhan et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Osterballe et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> investigated a cohort of 1272 young adults with oral food challenge tests and reported food allergy prevalence as 1.7%. The same investigator estimated confirmed food allergy prevalence in the paediatric population as 2.3% for 3-year olds and 1% for children older than 3 years of age.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>In addition, spectrum of allergenic foods was different from previous studies, which may be related to geographic and cultural factors unique to this region. Recent reports underline the presence of region specific allergens beside common childhood allergens (egg, peanut, soy and wheat) and pollen associated group 2 allergens in adulthood. Gelincik et al.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> reported hen's egg, tomato, black pepper, red chilli, food additives and chocolate as the most common food items that caused positive reaction on oral challenge testing. This spectrum was somehow different for children in the study by Orhan et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> who reported chocolate, hen's egg, beef, and cow's milk as the most common foods accused of food allergy. A recent study from Australia defined raw eggs, peanut and sesame as the most common foods to which infants reacted on challenge.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> Kajosaari et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> defined citrus fruits, tomato, hen's egg, strawberry and fish as the most allergenic foods by history, provocation and elimination performed at home in 866 Finnish children 1–6 years of age. A group of investigators from Israel found cow's milk, egg, sesame and soy as the most allergenic.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> Some authors speculate that sesame allergy in Middle East region might be related to early introduction of sesame oil based product halvah into diet.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Moreover, there is evidence that sesame allergy is an emerging global problem.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> Rance reported mustard as an important evolving allergen in French children.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> A large population-based questionnaire survey was conducted in two Asian countries, Singapore and Philippines, which included 23,425 respondents of paediatric age. Although investigators relied on history alone to diagnose IgE-mediated food allergy, they concluded that while shellfish allergy is more common among native children, compared to children born outside Asia, tree nut and peanut allergy are more common in the latter.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Beef meat was persistently found among common allergic foods both in our study and in the study by Orhan et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Although Anatolian region is well known for its cuisine with abundant meat, beef is also heavily consumed in central and western Europe, where beef allergy has been concluded to be rare.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> All these geographic differences require further investigation, which will shed light on evolvement of food allergy in respect to environment.The major limitation of our study is suboptimal participation rate and a relatively long time lapse between ISAAC Phase II study and the telephone interview phase. If it were shorter, contact rates, participation rates and compliance to challenge tests would be higher. Moreover, during this period, some subjects might have outgrown their allergies, and some developed new allergies. Although every effort was shown to prevent loss to follow-up, this remains an important issue in population-based studies,<a class="elsevierStyleCrossRefs" href="#bib0055">11,13</a> thus authors agree that only crude estimates can be drawn from these results. Time and effort consuming nature of food challenges is also an important reason for discrepancy between planned and performed procedures. Another important drawback of our study is that DBPCCT was not available for all the suspected patients.Turkey is a developing country and has a very heterogeneous population in terms of socioeconomic and educational status across its length from east to west. This renders conduction of population-based studies difficult, especially if the study is to involve a city from an underdeveloped part of the country. Limitations of the current study are predictable under these circumstances. Because data on epidemiology of food allergy for paediatric age group in Turkey is limited to a regional study by Orhan et al.,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> despite its limitations, this is the first multicentre study recruiting a large population of children from different geographic regions of Turkey. The results of this study are valuable in this aspect, and enable us to draw conclusions on reported food allergy prevalence, food allergen sensitisation rate and proven IgE-mediated food allergy prevalence. Finding of high reported food allergy rate and low proven food allergy prevalence was in line with results of previous studies. Furthermore, this study shows us that the allergenic food profile might differ for different geographic regions. Further investigation into the field with well-planned studies implementing double-blind placebo-controlled challenge tests is essential.Ethical disclosuresPatients’ data protectionConfidentiality of data. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.Right to privacy and informed consentRight to privacy and informed consent. The authors declare that no patient data appears in this article.Protection of human subjects and animals in researchProtection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this investigation.Conflict of interestThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres296085" "titulo" => array:5 [ 0 => "Abstract" 1 => "Background" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec279759" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "ISAAC Phase II Study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Definition of ‘suspicious for food allergy’ patients" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Telephone interview of patients ‘suspicious for food allergy’" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Evaluation of patients at allergy departments" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical evaluation" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Role of the funding source" ] ] ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Patients’ data protection" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Protection of human subjects and animals in research" ] ] ] 7 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack69191" "titulo" => "Acknowledgements" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-02-21" "fechaAceptado" => "2012-05-17" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec279759" "palabras" => array:5 [ 0 => "Child" 1 => "Food allergy" 2 => "Oral food challenge" 3 => "Prevalence" 4 => "Skin prick test" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundScarcity of reliable data on food allergy prevalence exists in Turkey. We aimed to assess reported and confirmed IgE-mediated food allergy prevalence, and define the spectrum of allergenic food. MethodsWe prospectively evaluated the ISAAC Phase II study population for food allergy. Participants that reported experiencing food allergy symptom in the last year and/or were skin prick test positive for a predefined list of food allergens, were interviewed via telephone, and those considered as having food allergy were invited to undergo clinical investigation, including challenge tests. ResultsA total of 6963 questionnaires were available. Parental reported food allergy prevalence and skin prick sensitisation rate were 20.2±0.9% and 5.9±0.6%. According to the above-defined criteria, 1162 children (symptom positive n=909, skin prick test positive n=301, both positive n=48) were selected and 813 (70.0%) were interviewed via telephone. Out of 152 adolescents reporting a current complaint, 87 accepted clinical investigation. There were 12 food allergies diagnosed in nine adolescents, with food allergy prevalence of 0.16±0.11%. The most common foods involved in allergic reactions were walnut (n=3) and beef meat (n=2), followed by hen's egg (n=1), peanut (n=1), spinach (n=1), kiwi (n=1), cheese (n=1), hazelnut (n=1) and peach (n=1). ConclusionsWhile parental reported food allergy prevalence was within the range reported previously, confirmed IgE-mediated food allergy prevalence among adolescents was at least 0.16%, and the spectrum of foods involved in allergy differed from Western countries, implying environmental factors may play a role." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "Adjusted for cases for whom contact could not be achieved." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:3 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="fig0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Food allergy module in ISAAC Phase II Study" "identificador" => "sec0080" ] 1 => array:3 [ "apendice" => "See <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>" "etiqueta" => "Appendix B" "identificador" => "sec0085" ] 2 => array:4 [ "apendice" => "<elsevierMultimedia ident="fig0010"></elsevierMultimedia>" "etiqueta" => "Appendix C" "titulo" => "Adjustments for losses to follow-up" "identificador" => "sec0090" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2763 "Ancho" => 2549 "Tamanyo" => 279810 ] ] "descripcion" => array:1 [ "en" => "Flowchart of prospective evaluation for food allergy of ISAAC Phase II study population." ] ] 1 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2558 "Ancho" => 1626 "Tamanyo" => 108509 ] ] "descripcion" => array:1 [ "en" => "(A) Parental reported food allergy prevalence for specific food items in ISAAC Phase II study population (n=6963). (B) Skin prick test sensitisation prevalence to common food allergens in ISAAC Phase II study population." ] ] 2 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3190 "Ancho" => 2547 "Tamanyo" => 290013 ] ] "descripcion" => array:1 [ "en" => "Outcome of prospective evaluation of initially 301 SPT positive patients from ISAAC Phase II study population." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.3 (3572) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (mean±SEM)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.83±0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptom upon food ingestion within last year, % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.2 (1408/6963) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SPT<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> positive, % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.9 (361/6134) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both SPT<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> and symptom positive, % (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0 (69/6963) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431775.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Age at ISAAC Phase II Study period." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Standard food allergen SPT battery." ] ] ] "descripcion" => array:1 [ "en" => "Demographic and some clinical features of ISAAC Phase II study population (n=6963)." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Features \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">ISAAC Phase II study population</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Suspicious for food allergy subgroup</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ever wheezing<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.93±0.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2392/6848 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.83±1.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">699/1671 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current wheezing<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.49±0.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1121/6799 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.79±1.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">409/1650 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ever rhinitis<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.03±0.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3615/6817 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.74±1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1132/1671 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current rhinitis<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.61±0.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2972/6662 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.35±1.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">962/1621 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current eczema<a class="elsevierStyleCrossRefs" href="#tblfn0015">a,b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.79±0.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">597/6791 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.69±0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">325/1651 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Familial atopy<a class="elsevierStyleCrossRefs" href="#tblfn0015">a,c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.83±0.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2635/6963 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.12±1.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">835/1700 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431777.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Results expressed as raw percentages and standard error." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Defined as self-reported eczema symptoms within last year and typical lesion distribution by history." ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "c" "nota" => "Defined as presence of asthma or allergic rhinitis in either parent." ] ] ] "descripcion" => array:1 [ "en" => "Clinical features of ISAAC Phase II study population and ‘suspicious for food allergy’ subgroup." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Van \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Manisa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Ankara \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Antalya \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Trabzon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parental reported food allergy prevalence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.85±2.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.93±2.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.03±1.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.61±1.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.20±1.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.22±0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SPT sensitisation rate in the entire study population \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.02±1.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.55±1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.00±1.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.59± 1.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.30±1.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.89± 0.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SPT sensitisation rate in symptomatic group \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.82±2.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.06±2.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.73±3.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.21±2.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.56±4.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.324 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.54±1.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab431776.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "a" "nota" => "Standard food allergen SPT battery." ] 1 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "b" "nota" => "A subgroup of patients that reported experiencing untoward effects related to food consumption within last year." ] 2 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "c" "nota" => "Prevalences expressed as percentage, 95% confidence interval." ] ] ] "descripcion" => array:1 [ "en" => "Distribution of parental-reported food allergy prevalence, SPT<a class="elsevierStyleCrossRef" href="#tblfn0030">a</a> sensitisation findings in ISAAC Phase II study population and symptomatic group<a class="elsevierStyleCrossRef" href="#tblfn0035">b</a> by study centre.<a class="elsevierStyleCrossRef" href="#tblfn0040">c</a>" ] ] 6 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 3485 "Ancho" => 2333 "Tamanyo" => 429016 ] ] ] 7 => array:5 [ "identificador" => "fig0010" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx2.jpeg" "Alto" => 2520 "Ancho" => 2667 "Tamanyo" => 527730 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Food allergy: manifestations, diagnosis and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.L. 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Ballmer-Weber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "smw-12603" "Revista" => array:6 [ "tituloSerie" => "Swiss Med Wkly" "fecha" => "2009" "volumen" => "139" "paginaInicial" => "264" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19418309" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack69191" "titulo" => "Acknowledgements" "texto" => "We are indebted to Dr. İlke Kılıç (Karadeniz Technical University, Faculty of Medicine, Pediatric Allergy Division, Trabzon, Turkey), Dr. Ahmet Türkeli (Celal Bayar University, Faculty of Medicine, Pediatric Pulmonology and Allergy Unit, Manisa, Turkey), Dr. Betül Büyüktiryaki (Hacettepe University, Faculty of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey), Dr. Serkan Filiz (Akdeniz University, Faculty of Medicine, Pediatric Immunology and Allergy Unit, Antalya, Turkey), Dr. Recep Sancak (Ondokuz Mayıs University, Faculty of Medicine, Pediatric Allergy Unit, Samsun, Turkey) and Dr. Yakup Canıtez (Uludağ University, Faculty of Medicine, Pediatric Allergy Unit, Bursa, Turkey) who helped us to evaluate patients at the allergy departments. The processing of data would have been impossible without the supporting attitude of Dr. Banu Çakır (Hacettepe University, Faculty of Medicine, Public Health Department, Ankara, Turkey) and Dr. Pınar Özdemir (Hacettepe University, Faculty of Medicine, Biostatistics Department, Ankara, Turkey). We are also very grateful to nurses and technicians at allergy departments who helped us with diagnostic and laboratory procedures." ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004100000006/v1_201312010029/S0301054612001735/v1_201312010029/en/main.assets" "Apartado" => array:4 [ "identificador" => "5554" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004100000006/v1_201312010029/S0301054612001735/v1_201312010029/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612001735?idApp=UINPBA00004N"]

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R. Mustafayeva, E. Civeleka, F. Orhanb, H. Yükselc, A.B. Bozd, B.E. Şekerela,

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b_sekerel@yahoo.com

Corresponding author.

a Hacettepe University, Faculty of Medicine, Pediatric Allergy and Asthma Unit, Ankara, Turkey

b Karadeniz Technical University, Faculty of Medicine, Pediatric Allergy Division, Trabzon, Turkey

c Celal Bayar University, Faculty of Medicine, Pediatric Pulmonology and Allergy Unit, Manisa, Turkey

d Akdeniz University, Faculty of Medicine, Pediatric Immunology and Allergy Unit, Antalya, Turkey

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Self-reported food allergy prevalence reported in studies conducted up to date is quite variable&#44; usually within the range of 5&#8211;35&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;10&#8211;14&#44;16&#44;17</span></a> Confirmed prevalence implementing oral challenge tests is much lower&#44; generally &#60;1&#37;&#44; as documented in studies by different investigators&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;11&#8211;13&#44;16</span></a> Knowledge of the epidemiological impact of the problem is crucial for the effective implementation of health policies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this study&#44; we aimed to estimate food allergy prevalence and define allergenic food spectrum for urban adolescents from different geographical regions of Turkey&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The current study is a detailed evaluation for the presence of food allergy of patients from multicentre ISAAC Phase II study conducted in 2005&#8211;2006 and which aimed to investigate epidemiology of asthma and allergic disease in childhood&#46; ISAAC Phase II option B protocol<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> was implemented in 2005&#8211;2006 in five different cities &#40;Ankara&#44; Antalya&#44; Manisa&#44; Trabzon&#44; Van&#41; of Turkey under the support of Prime Ministry State Planning Organization and headed by Hacettepe University&#44; Faculty of Medicine&#44; Pediatric Allergy and Asthma Unit&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">ISAAC Phase II Study</span><p id="par0025" class="elsevierStylePara elsevierViewall">ISAAC Phase II Study was a cross-sectional study that recruited 10&#8211;11-year-old primary schoolchildren&#46; Sample size calculation and sampling process involved a two-step layered systematic cluster sampling method&#46; In accordance with the ISAAC II methodology &#40;option B&#41;&#44; the study aimed to enrol at least 1000 students from each city&#44; to be recruited from at least 10 schools&#44; with the aim of recruiting at least 100 children who had reported wheezing over the last 12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> City-specific minimum sample sizes were calculated for <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; 1<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;80&#44; <span class="elsevierStyleItalic">&#948;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;9&#37; &#40;percentage of physician-diagnosed asthma cases recorded in the previous ISAAC study conducted in Turkey<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#41;&#44; and <span class="elsevierStyleItalic">&#963;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;2&#46; Detailed information on the study population and sampling process is presented elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;23</span></a> Apart from standard workup&#44; food allergy module &#40;Refer to <a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41; was integrated&#44; and skin prick testing was performed with standard food allergens &#40;egg white&#44; cow&#39;s milk&#44; walnut&#44; peanut and hazelnut&#41; to all consented participants&#46; Food allergy module consisted of six questions regarding ever and current experiencing any complaint following food intake&#44; spectrum of complaints&#44; presence of complaint following intake of commonly encountered food items&#44; physician aid seeking and history of physician diagnosed food allergy&#46; The questionnaire was validated on a sample of 40 parents&#47;children through in-depth interviews&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Definition of &#8216;suspicious for food allergy&#8217; patients</span><p id="par0030" class="elsevierStylePara elsevierViewall">Any questionnaire holder who answered the question &#8216;Did your child have any allergic complaint after any food intake within last year&#63;&#8217; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#44; Question 2&#41; as &#8216;Yes&#8217; and&#47;or was sensitised to any of tested food allergens was defined as &#8216;suspicious for food allergy&#8217;&#44; and thus was chosen for telephone interview&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Telephone interview of patients &#8216;suspicious for food allergy&#8217;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Questionnaire holders were contacted via telephone over the period of January 2010&#8211;June 2010 by a single paediatrician trained in food allergy&#46; Due to low contact rates and absence of appropriate paediatric allergic setting for referral in Van province&#44; cases from this centre were not included in estimation of confirmed food allergy prevalence because of potential bias&#46; The flowchart of evaluation of ISAAC Phase II study population for food allergy is shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The detailed telephone interview was conducted with aim to exclude non-allergic food hypersensitivity and non-IgE-mediated food allergy&#46; Adolescents in whom suspicion for IgE-mediated food allergy persisted after obtaining clinical history were chosen for evaluation at allergy departments&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We preferred to interview patients themselves or their mothers&#47;caregivers&#46; The reason for this is that culturally Turkish mothers care for their children primarily and therefore are more likely to give reliable information on their children&#46; The interview implemented a standard questionnaire regarding ever and current complaints following food ingestion or complaints linked to any food&#46; Respondents were asked whether they have ever experienced pruritus&#44; erythema&#44; wheals&#44; urticaria&#44; nausea and vomiting&#44; abdominal pain&#44; diarrhoea&#44; cough&#44; dyspnoea&#44; wheezing&#44; lip swelling&#44; itching or sense of swelling in the oropharynx&#44; rhinitis or conjunctivitis symptoms&#44; palpitations or syncope after food consumption&#46; Then&#44; the interviewer reviewed a list of foods commonly involved in food allergy and symptoms related to ingestion of these food items&#46; Cases that reported consistent or suspicious symptoms after food consumption within 12 months&#44; or those that reported ever consistent&#47;suspicious symptoms but had not consumed the food in question within 12 months for any reason were defined as patients who might be food allergic&#46; They were invited for evaluation at allergy departments in the corresponding city&#46; Questionnaire holders were attempted to contact on at least three occasions before deciding they were unavailable&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Evaluation of patients at allergy departments</span><p id="par0050" class="elsevierStylePara elsevierViewall">Adolescents in whom IgE-mediated food allergy could not be ruled by a telephone interview were invited for investigation and evaluated at paediatric allergy clinics in Ankara&#44; Antalya&#44; Manisa or Trabzon between March 2010 and July 2010&#46; Physicians at corresponding clinics were instructed to lead the investigation with intention to diagnose or rule out IgE-mediated food allergy&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Diagnostic tools were history&#44; physical examination&#44; SPT&#44; spIgE and food challenge tests&#46; History regarding complaints structurally similar to that asked in the first interview&#44; past medical history and family history were obtained and physical examination performed&#59; skin prick testing and food challenge tests with suspected allergens were applied to all consented patients&#46; In case commercial extracts for prick testing were not available&#44; patients underwent prick-to-prick testing&#46; A wheal diameter of at least 3<span class="elsevierStyleHsp" style=""></span>mm in respect to negative control was accepted as a positive result&#46; SpIgE testing was performed with Pharmacia ImmunoCAP assay &#40;Phadia AB&#44; Uppsala&#44; Sweden&#41;&#46; Cases evaluated as positive on basis of history and&#47;or had evidence of sensitisation to food allergens were applied open challenge tests &#40;OCT&#41;&#46; When the patient reported a severe reaction&#44; she&#47;he was not challenged and the diagnosis of food allergy was established according to history and sensitisation findings&#46; In order to maintain a methodological uniformity of patient evaluation across study centres&#44; patients with inconsistent history and laboratory data were also open challenged&#46; The dose interval was 20<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Food masking procedures for tomato and kiwi in three blinded challenge tests have been described elsewhere&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical evaluation</span><p id="par0065" class="elsevierStylePara elsevierViewall">Data was statistically evaluated using SPSS v&#46;15 &#40;SPSS Inc&#46;&#44; Chicago&#44; Illinois&#44; USA&#41;&#46; Descriptive analysis was carried out for ISAAC Phase II study population&#46; Results were expressed as mean and standard error of mean &#40;SEM&#41; or as percentages of responses to each question&#46; Independent samples <span class="elsevierStyleItalic">t</span>-test was used for comparison of means&#46; We used chi-square test to compare proportions in independent groups&#44; and applied Yates correction and Fisher&#39;s exact test where required&#46; Test of a single proportion was used to assess whether prevalence rates were different for the whole study population compared to a subset of subjects&#46; A significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was chosen&#46; 95&#37; confidence interval &#40;CI&#41; was calculated for prevalence rates&#46; Adjustments for loss to follow-up at each stage were applied in order to estimate for prevalence of food allergy and probable food allergy&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Role of the funding source</span><p id="par0070" class="elsevierStylePara elsevierViewall">ISAAC Phase II Study was sponsored by a grant &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">03K 120 570-05-7</span>&#41; from the <span class="elsevierStyleGrantSponsor" id="gs0005">Prime Ministry State Planning Organization&#44; Turkey</span>&#46; The Ministry of Health of Turkey &#40;provision of nurses and allied health personnel&#41; and Merck Sharp Dohme Pharmaceutical Co&#46; Istanbul&#44; Turkey &#91;provision of Quantitest lancets &#40;Panatrex Inc&#44; Placentia&#44; California&#44; USA&#41; for the skin prick tests&#93; supported the study&#46; The prospective evaluation phase that included telephone interview and detailed investigations were conducted with use of resources of ISAAC Phase II Study and of corresponding study centres&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">ISAAC Phase II Study recruited 6963 children&#46; Demographic and clinical features of the study population are given in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>&#46; Parental-reported food allergy prevalence was estimated as 20&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;94&#37; &#40;1408&#47;6963&#44; 95&#37; CI&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Sensitisation prevalence to common food allergens detected by skin prick testing was estimated as 5&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#37; &#40;361&#47;6134&#44; 95&#37; CI&#41;&#46; Parental reported food allergy prevalence for specific food items and skin test sensitisation prevalence for common allergens are given in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A total of 1700 questionnaire holders were defined as &#8216;suspicious for food allergy&#8217; on basis of history and&#47;or skin prick testing&#44; and they were selected for telephone interview&#46; Allergic co-morbidity prevalence was higher for this subgroup of children compared to the study population &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Contact rate for Van province was low &#40;36&#37;&#41;&#44; and cases from this centre &#40;1354 out of 6963 questionnaires&#41; were not included in the estimation of confirmed food allergy prevalence because of potential bias&#46; After exclusion of questionnaires from Van province&#44; 1162 &#40;out of 5609&#41; questionnaires were labelled as &#8216;suspicious for food allergy&#8217; &#40;301 SPT positive&#44; 909 symptom positive&#44; 48 both positive&#41;&#44; and for 813 of them contact was achieved&#44; yielding an overall contact rate of 70&#37;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">IgE-mediated food allergy could not be ruled out in 152 adolescents by history alone&#44; and they were invited for further evaluation&#46; Of them&#44; 87 adolescents were admitted to allergy clinics for evaluation&#46; Among admitted patients 79 consented to skin prick testing&#46; The outcome of initially 301 SPT positive children from four study centres is shown in <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Subjects admitted to allergy clinics &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#41; reported 160 food allergies&#46; There were 109 open food challenges planned and 82 performed&#46; They resulted in 13 positive &#40;in 12 patients&#41; and 69 negative reactions&#46; Among the 12 patients that reacted positively&#44; eight patients were diagnosed food allergy and four patients offered DBPCCT&#46; Two of them consented to DBPCCT and were negative for food allergy&#46; The other two patients refused DBPCCT and thus formed a probable food allergy group&#46; DBPCCT was available in three patients&#44; all of which proved negative&#46; Two had oropharyngeal reaction on open challenge with tomato&#44; while the third patient reported oropharyngeal symptoms upon kiwi intake&#46; We found in retrospect that she had been previously challenged with kiwi in blinded fashion&#44; thus no further investigation was pursued&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Consequently&#44; food allergy was diagnosed in nine patients&#44; was ruled out in 55 patients&#44; and three patients were sensitised without clinical relevance&#46; There were 20 patients diagnosed as having &#8216;probable food allergy&#8217; because they declined further investigation &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 1</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Among nine patients diagnosed with food allergy&#44; eight had been open challenged and one was not because of a potentially severe reaction&#46; Ten open challenges in these patients resulted in cutaneous symptoms &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44; 60&#37;&#41;&#44; gastrointestinal symptoms &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; 40&#37;&#41;&#44; oropharyngeal &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44; 20&#37;&#41; and anaphylaxis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; 10&#37;&#41;&#46; Reactions in challenge testing were mostly mild&#46; Only one patient developed a potentially severe anaphylaxis with peanut&#44; and refused further testing with other food items&#46; She was administered i&#46;m&#46; adrenaline and hospitalised for follow up&#46; Allergens found to cause food allergy in these patients were walnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; beef meat &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; hen&#39;s egg &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; peanut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; hazelnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; peach &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; spinach &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; cheese &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and kiwi &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Patients diagnosed as having &#8216;probable food allergy&#8217; reported symptoms with intake of hen&#39;s egg &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; walnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; chocolate &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; fish &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; hazelnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; peanut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; almond &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; blackberry &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; tomato &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; meat and meat products &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; raspberry &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; black pepper &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; red pepper &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; and pickled cucumbers &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46; In this patient group&#44; 17 out of 20 were skin pricked&#46; Oral challenge tests were available in two patients&#44; one of which reported itching upon egg ingestion&#44; and the other patient developed urticaria and itching six hours after chocolate intake&#46; Both had negative skin prick testing and declined double-blind challenge&#46; Out of 29 planned open challenges&#44; 27 could not be performed&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Further evaluation implementing food challenge testing proved IgE-mediated food allergy in 10&#37; &#40;9&#47;87&#41; of those diagnosed by history alone&#46; Thus&#44; IgE-mediated food allergy prevalence in ISAAC Phase II Study population was estimated to be at least 0&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;11&#37; &#40;9&#47;5609&#44; 95&#37; CI&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">ISAAC Phase II study was the first study to encompass such a large number of children in the region with the aim of assessing allergic disease burden&#46; Parental reported food allergy prevalence was 20&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;94&#37; &#40;1408&#47;6963&#44; 95&#37; CI&#41;&#44; the sensitisation rate to food allergens was 5&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#37; &#40;361&#47;6963&#44; 95&#37; CI&#41;&#46; IgE-mediated food allergy prevalence was estimated to be at least 0&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;11&#37; &#40;9&#47;5609&#44; 95&#37; CI&#41; in ISAAC Phase II study group&#46; Allergenic foods in nine patients diagnosed as having food allergy were unique to this study &#91;walnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; beef meat &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; hen&#39;s egg &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; peanut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; hazelnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; peach &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; spinach &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; cheese &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and kiwi &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#93;&#46; Thus&#44; we conclude that while prevalence was within the previously reported range&#44; there might be regional differences in allergenic food profile&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Zuberbier et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> addressed 13&#44;300 Berlin inhabitants of adult age by questionnaire and reported lifetime self-reported food allergy prevalence as 34&#46;9&#37;&#46; Telephone interview of 11&#44;816 Istanbul &#40;Turkey&#41; inhabitants of adult age group yielded a lifetime self-reported food allergy prevalence of 9&#46;5&#37; in a recent study by Gelincik et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Osterballe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> investigated a cohort of 1272 young adults and calculated reported food hypersensitivity prevalence as 19&#46;6&#37;&#46; Orhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> assessed 2739 school children &#40;6&#8211;9-year olds&#41; from the Eastern Black Sea region of Turkey and estimated parental reported food allergy prevalence as 5&#46;7&#37;&#46; Parental reported food allergy prevalence in Trabzon &#40;a central city in the Eastern Black Sea region&#44; Turkey&#41; in ISAAC Phase II population was 15&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> in <a class="elsevierStyleCrossRef" href="#sec0085">Appendix B</a> for findings by study centre&#41;&#44; which is somewhat higher&#46; This discrepancy might have resulted from different age groups assessed or different response rates to questionnaire&#46; Systematic review by Rona et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> on the topic indicates similar reported food allergy prevalence in the range of 3&#8211;35&#37; for any food&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">ISAAC Phase II study demonstrated that parents most frequently blamed hen&#39;s egg for causing allergy &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 2</a>A&#41;&#46; Parental reported food allergy prevalence for common food allergens was compatible with ranges stated in systematic reviews<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> on the topic&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Prevalence of sensitisation to food allergens &#40;5&#46;9&#37;&#41; on skin prick test in ISAAC Phase II study population was consistent with previous studies&#46; Obeng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> performed skin prick testing with peanut and six fruits in 1714 Ghanaian children 5&#8211;16 years of age and reported the sensitisation rate as 5&#37;&#46; Venter et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> followed prospectively a birth cohort of 969 children on the Isle of Wight&#44; and reported cumulative sensitisation prevalence to cow&#39;s milk&#44; hen&#39;s egg&#44; whey&#44; sesame&#44; and fish at ages 1&#8211;3 as 5&#46;3&#37;&#46; Specific IgE measurements at ages 0&#44; 1&#44; 2&#44; 3&#44; 5 were available in 216 children from MAS birth cohort and sensitisation point prevalence was estimated as 10&#37; during first 6 years of life&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Sensitisation rates for ISAAC Phase II study population did not significantly differ from sensitisation rates for symptomatic subgroup of cases &#40;cases that reported a symptom upon food ingestion&#41;&#46; In contrast to this finding&#44; ranges reported for sensitisation rates in symptomatic subgroup vs&#46; general population in systematic review by Rona et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> were 2&#37; to 5&#37; vs&#46; 7&#37; to 17&#37;&#46; Orhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> reported a quite high sensitisation rate &#40;33&#46;1&#37;&#41; in symptomatic subset of patients compared to rates &#40;8&#46;6&#37;&#41; for the same region in ISAAC Phase II study &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> in <a class="elsevierStyleCrossRef" href="#sec0085">Appendix B</a>&#41;&#46; But since skin prick testing was not available in all patients in the study by Orhan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> sensitisation prevalence for the paediatric population in the Eastern Black Sea region &#40;Turkey&#41; could not be deduced from this study&#46; Sensitisation rate for general population in Trabzon province was 11&#46;3&#37; in our study&#46; Most common foods that caused a positive SPT reaction in ISAAC Phase II study population were walnut&#44; cow&#39;s milk and peanut &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 2</a>B&#41;&#46; While hen&#39;s egg&#44; cocoa and cow&#39;s milk most commonly resulted in positive SPT in the study by Orhan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> hen&#39;s egg and tomato were most commonly encountered in adults in the study by Gelincik et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Since inhalant antigen sensitisation rates increase with age&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> adults are more likely to have sensitisation to fruit and vegetable antigens&#44; which cross-react with birch and grass pollens&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> and this is reflected by SPT and spIgE findings of a study conducted on adults&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Despite high reported food allergy rate&#44; proven food allergy prevalence estimated in ISAAC Phase II study population was somewhat lower than that reported previously for various populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6&#44;11&#44;25</span></a> This might have resulted because of the loss to follow-up of potential food allergic cases&#44; thus we decided to apply correction for this factor in order to estimate the range for IgE-mediated food allergy prevalence&#46; Assuming that the outcome of questionnaire holders who could not be contacted via telephone is similar &#40;thus four extra patients would have been diagnosed&#41;&#44; IgE-mediated food allergy prevalence is estimated as 0&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;13&#37; &#40;13&#47;5609&#44; 95&#37; CI&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Appendix C</a>&#41;&#46; Assuming that patients who declined complete investigation have food allergy &#40;because the probability of food allergy is expected to be higher in these patients than in the general population&#41;&#44; IgE-mediated food allergy prevalence &#40;definite and probable&#41; in ISAAC Phase II Study population could have been as high as 0&#46;75&#37;<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">&#42;</span></a><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#37; &#40;42<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">&#42;</span></a>&#47;5609&#44; 95&#37; CI&#41; &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Appendix C</a>&#41;&#46; We found that these estimates were within the range reported for Turkish population&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Gelincik et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> estimated IgE-mediated food allergy prevalence in adulthood as 0&#46;1&#37;&#44; while it was 0&#46;8&#37; for primary schoolchildren in the study by Orhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Osterballe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> investigated a cohort of 1272 young adults with oral food challenge tests and reported food allergy prevalence as 1&#46;7&#37;&#46; The same investigator estimated confirmed food allergy prevalence in the paediatric population as 2&#46;3&#37; for 3-year olds and 1&#37; for children older than 3 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In addition&#44; spectrum of allergenic foods was different from previous studies&#44; which may be related to geographic and cultural factors unique to this region&#46; Recent reports underline the presence of region specific allergens beside common childhood allergens &#40;egg&#44; peanut&#44; soy and wheat&#41; and pollen associated group 2 allergens in adulthood&#46; Gelincik et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> reported hen&#39;s egg&#44; tomato&#44; black pepper&#44; red chilli&#44; food additives and chocolate as the most common food items that caused positive reaction on oral challenge testing&#46; This spectrum was somehow different for children in the study by Orhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> who reported chocolate&#44; hen&#39;s egg&#44; beef&#44; and cow&#39;s milk as the most common foods accused of food allergy&#46; A recent study from Australia defined raw eggs&#44; peanut and sesame as the most common foods to which infants reacted on challenge&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Kajosaari et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> defined citrus fruits&#44; tomato&#44; hen&#39;s egg&#44; strawberry and fish as the most allergenic foods by history&#44; provocation and elimination performed at home in 866 Finnish children 1&#8211;6 years of age&#46; A group of investigators from Israel found cow&#39;s milk&#44; egg&#44; sesame and soy as the most allergenic&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Some authors speculate that sesame allergy in Middle East region might be related to early introduction of sesame oil based product halvah into diet&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Moreover&#44; there is evidence that sesame allergy is an emerging global problem&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Rance reported mustard as an important evolving allergen in French children&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> A large population-based questionnaire survey was conducted in two Asian countries&#44; Singapore and Philippines&#44; which included 23&#44;425 respondents of paediatric age&#46; Although investigators relied on history alone to diagnose IgE-mediated food allergy&#44; they concluded that while shellfish allergy is more common among native children&#44; compared to children born outside Asia&#44; tree nut and peanut allergy are more common in the latter&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Beef meat was persistently found among common allergic foods both in our study and in the study by Orhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Although Anatolian region is well known for its cuisine with abundant meat&#44; beef is also heavily consumed in central and western Europe&#44; where beef allergy has been concluded to be rare&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> All these geographic differences require further investigation&#44; which will shed light on evolvement of food allergy in respect to environment&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The major limitation of our study is suboptimal participation rate and a relatively long time lapse between ISAAC Phase II study and the telephone interview phase&#46; If it were shorter&#44; contact rates&#44; participation rates and compliance to challenge tests would be higher&#46; Moreover&#44; during this period&#44; some subjects might have outgrown their allergies&#44; and some developed new allergies&#46; Although every effort was shown to prevent loss to follow-up&#44; this remains an important issue in population-based studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;13</span></a> thus authors agree that only crude estimates can be drawn from these results&#46; Time and effort consuming nature of food challenges is also an important reason for discrepancy between planned and performed procedures&#46; Another important drawback of our study is that DBPCCT was not available for all the suspected patients&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Turkey is a developing country and has a very heterogeneous population in terms of socioeconomic and educational status across its length from east to west&#46; This renders conduction of population-based studies difficult&#44; especially if the study is to involve a city from an underdeveloped part of the country&#46; Limitations of the current study are predictable under these circumstances&#46; Because data on epidemiology of food allergy for paediatric age group in Turkey is limited to a regional study by Orhan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> despite its limitations&#44; this is the first multicentre study recruiting a large population of children from different geographic regions of Turkey&#46; The results of this study are valuable in this aspect&#44; and enable us to draw conclusions on reported food allergy prevalence&#44; food allergen sensitisation rate and proven IgE-mediated food allergy prevalence&#46; Finding of high reported food allergy rate and low proven food allergy prevalence was in line with results of previous studies&#46; Furthermore&#44; this study shows us that the allergenic food profile might differ for different geographic regions&#46; Further investigation into the field with well-planned studies implementing double-blind placebo-controlled challenge tests is essential&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients&#8217; data protection</span><p id="par0155" class="elsevierStylePara elsevierViewall">Confidentiality of data&#46; The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0160" class="elsevierStylePara elsevierViewall">Right to privacy and informed consent&#46; The authors declare that no patient data appears in this article&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human subjects and animals in research</span><p id="par0165" class="elsevierStylePara elsevierViewall">Protection of human and animal subjects&#46; The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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          "titulo" => "Materials and methods"
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              "identificador" => "sec0015"
              "titulo" => "ISAAC Phase II Study"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Definition of &#8216;suspicious for food allergy&#8217; patients"
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            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Telephone interview of patients &#8216;suspicious for food allergy&#8217;"
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            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Evaluation of patients at allergy departments"
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              "titulo" => "Statistical evaluation"
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              "identificador" => "sec0040"
              "titulo" => "Role of the funding source"
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          "titulo" => "Ethical disclosures"
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              "titulo" => "Patients&#8217; data protection"
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              "titulo" => "Right to privacy and informed consent"
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          "titulo" => "References"
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    "fechaRecibido" => "2012-02-21"
    "fechaAceptado" => "2012-05-17"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Child"
            1 => "Food allergy"
            2 => "Oral food challenge"
            3 => "Prevalence"
            4 => "Skin prick test"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scarcity of reliable data on food allergy prevalence exists in Turkey&#46; We aimed to assess reported and confirmed IgE-mediated food allergy prevalence&#44; and define the spectrum of allergenic food&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We prospectively evaluated the ISAAC Phase II study population for food allergy&#46; Participants that reported experiencing food allergy symptom in the last year and&#47;or were skin prick test positive for a predefined list of food allergens&#44; were interviewed via telephone&#44; and those considered as having food allergy were invited to undergo clinical investigation&#44; including challenge tests&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 6963 questionnaires were available&#46; Parental reported food allergy prevalence and skin prick sensitisation rate were 20&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;9&#37; and 5&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#37;&#46; According to the above-defined criteria&#44; 1162 children &#40;symptom positive <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>909&#44; skin prick test positive <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>301&#44; both positive <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41; were selected and 813 &#40;70&#46;0&#37;&#41; were interviewed via telephone&#46; Out of 152 adolescents reporting a current complaint&#44; 87 accepted clinical investigation&#46; There were 12 food allergies diagnosed in nine adolescents&#44; with food allergy prevalence of 0&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;11&#37;&#46; The most common foods involved in allergic reactions were walnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; and beef meat &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; followed by hen&#39;s egg &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; peanut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; spinach &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; kiwi &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; cheese &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; hazelnut &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; and peach &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">While parental reported food allergy prevalence was within the range reported previously&#44; confirmed IgE-mediated food allergy prevalence among adolescents was at least 0&#46;16&#37;&#44; and the spectrum of foods involved in allergy differed from Western countries&#44; implying environmental factors may play a role&#46;</p>"
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                  \t\t\t\t">Age &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SEM&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Symptom upon food ingestion within last year&#44; &#37; &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;2 &#40;1408&#47;6963&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SPT<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> positive&#44; &#37; &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9 &#40;361&#47;6134&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Both SPT<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> and symptom positive&#44; &#37; &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0 &#40;69&#47;6963&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab431775.png"
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              "nota" => "<p class="elsevierStyleNotepara">Age at ISAAC Phase II Study period&#46;</p>"
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            1 => array:3 [
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Demographic and some clinical features of ISAAC Phase II study population &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6963&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Features&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">ISAAC Phase II study population</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Suspicious for food allergy subgroup</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ever wheezing<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">34&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2392&#47;6848&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">699&#47;1671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Current wheezing<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">16&#46;49<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1121&#47;6799&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">409&#47;1650&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ever rhinitis<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3615&#47;6817&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1132&#47;1671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Current rhinitis<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&#46;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2972&#47;6662&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;35<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">962&#47;1621&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Current eczema<a class="elsevierStyleCrossRefs" href="#tblfn0015"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">597&#47;6791&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">325&#47;1651&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Familial atopy<a class="elsevierStyleCrossRefs" href="#tblfn0015"><span class="elsevierStyleSup">a&#44;c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">37&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2635&#47;6963&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">835&#47;1700&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Van&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Manisa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ankara&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Antalya&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Trabzon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Parental reported food allergy prevalence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">36&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">20&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;94&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">SPT sensitisation rate in the entire study population&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span> 1&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span> 0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SPT sensitisation rate in symptomatic group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">8&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;324&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;27&nbsp;\t\t\t\t\t\t\n
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                        "paginaFinal" => "143"
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                      "titulo" => "A revised nomenclature for allergy&#58; an EAACI position statement from the EAACI nomenclature task force"
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                            2 => "J&#46; Bousquet"
                            3 => "C&#46; Bruijnzeel-Koomen"
                            4 => "S&#46; Dreborg"
                            5 => "T&#46; Haahtela"
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                            3 => "B&#46;J&#46; Vlieg-Boerstra"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0175" class="elsevierStylePara elsevierViewall">We are indebted to Dr&#46; &#304;lke K&#305;l&#305;&#231; &#40;Karadeniz Technical University&#44; Faculty of Medicine&#44; Pediatric Allergy Division&#44; Trabzon&#44; Turkey&#41;&#44; Dr&#46; Ahmet T&#252;rkeli &#40;Celal Bayar University&#44; Faculty of Medicine&#44; Pediatric Pulmonology and Allergy Unit&#44; Manisa&#44; Turkey&#41;&#44; Dr&#46; Bet&#252;l B&#252;y&#252;ktiryaki &#40;Hacettepe University&#44; Faculty of Medicine&#44; Pediatric Allergy and Asthma Unit&#44; Ankara&#44; Turkey&#41;&#44; Dr&#46; Serkan Filiz &#40;Akdeniz University&#44; Faculty of Medicine&#44; Pediatric Immunology and Allergy Unit&#44; Antalya&#44; Turkey&#41;&#44; Dr&#46; Recep Sancak &#40;Ondokuz May&#305;s University&#44; Faculty of Medicine&#44; Pediatric Allergy Unit&#44; Samsun&#44; Turkey&#41; and Dr&#46; Yakup Can&#305;tez &#40;Uluda&#287; University&#44; Faculty of Medicine&#44; Pediatric Allergy Unit&#44; Bursa&#44; Turkey&#41; who helped us to evaluate patients at the allergy departments&#46; The processing of data would have been impossible without the supporting attitude of Dr&#46; Banu &#199;ak&#305;r &#40;Hacettepe University&#44; Faculty of Medicine&#44; Public Health Department&#44; Ankara&#44; Turkey&#41; and Dr&#46; P&#305;nar &#214;zdemir &#40;Hacettepe University&#44; Faculty of Medicine&#44; Biostatistics Department&#44; Ankara&#44; Turkey&#41;&#46; We are also very grateful to nurses and technicians at allergy departments who helped us with diagnostic and laboratory procedures&#46;</p>"
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2012.05.005

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	1	5
2024 October	37	6	43
2024 September	32	7	39
2024 August	22	11	33
2024 July	17	5	22
2024 June	29	7	36
2024 May	18	4	22
2024 April	28	14	42
2024 March	30	10	40
2024 February	36	5	41
2024 January	46	4	50
2023 December	42	9	51
2023 November	41	9	50
2023 October	55	13	68
2023 September	34	11	45
2023 August	31	6	37
2023 July	36	7	43
2023 June	62	5	67
2023 May	78	5	83
2023 April	106	3	109
2023 March	20	2	22
2023 February	27	10	37
2023 January	10	6	16
2022 December	15	6	21
2022 November	20	7	27
2022 October	13	16	29
2022 September	14	12	26
2022 August	12	10	22
2022 July	12	19	31
2022 June	17	8	25
2022 May	21	9	30
2022 April	18	18	36
2022 March	7	4	11
2022 February	9	11	20
2022 January	21	9	30
2021 December	15	10	25
2021 November	19	10	29
2021 October	21	12	33
2021 September	17	18	35
2021 August	54	15	69
2021 July	12	19	31
2021 June	12	10	22
2021 May	15	17	32
2021 April	34	20	54
2021 March	10	14	24
2021 February	13	10	23
2021 January	11	6	17
2020 December	2	0	2
2020 November	0	1	1
2020 September	0	1	1
2020 August	0	1	1
2020 July	0	1	1
2020 May	0	2	2
2020 April	0	2	2
2020 March	0	1	1
2020 February	0	1	1
2020 January	0	2	2
2019 December	0	1	1
2019 September	0	3	3
2019 July	0	3	3
2019 June	0	3	3
2019 February	1	2	3
2018 February	10	2	12
2018 January	12	2	14
2017 December	11	1	12
2017 November	17	2	19
2017 October	16	5	21
2017 September	14	3	17
2017 August	25	3	28
2017 July	26	8	34
2017 June	23	15	38
2017 May	36	8	44
2017 April	26	2	28
2017 March	37	2	39
2017 February	48	0	48
2017 January	40	2	42
2016 December	39	4	43
2016 November	33	6	39
2016 October	51	5	56
2016 September	49	7	56
2016 August	38	4	42
2016 July	18	3	21
2016 June	27	4	31
2016 May	21	10	31
2016 April	26	9	35
2016 March	22	15	37
2016 February	24	13	37
2016 January	16	9	25
2015 December	23	9	32
2015 November	25	6	31
2015 October	23	9	32
2015 September	17	5	22
2015 August	38	5	43
2015 July	50	5	55
2015 June	25	0	25
2015 May	28	3	31
2015 April	16	8	24
2015 March	9	5	14
2015 February	10	4	14
2015 January	16	4	20
2014 December	25	12	37
2014 November	13	1	14
2014 October	1	0	1
2014 September	0	1	1
2014 August	1	2	3
2014 July	0	3	3
2014 May	0	1	1
2014 April	0	4	4
2014 March	46	15	61
2014 February	48	8	56
2014 January	27	10	37
2013 December	19	9	28

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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