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World Allergy Organization Journal (2017) 10:43 DOI 10.1186/S40413-017-0174-Z

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World Allergy Organization Journal (2017) 10:43 DOI 10.1186/S40413-017-0174-Z Afify and Pali-Schöll World Allergy Organization Journal (2017) 10:43 DOI 10.1186/s40413-017-0174-z REVIEW Open Access Adverse reactions to food: the female dominance – A secondary publication and update Sheriene Moussa Afify1,2 and Isabella Pali-Schöll1,3* Abstract Gender-specific differences are evident in food intolerance and allergy. In this review, we will highlight and summarize the dissimilarities in prevalence of adverse food reactions, focusing on IgE-mediated food allergies and intolerances regarding frequency of symptoms and predisposing factors. After puberty, females suffer more frequently from food-related symptoms than males. Several factors may be responsible for this observation, for example hormonal effects, gender-specific behavior, perception of risk, or intake of medications. In this context, concrete studies related to adverse food reactions are still lacking. Keywords: Female, Food allergy, Food intolerance, Fructose, Gender, Histamine, Lactose, Women Background affected often by general atopic conditions (skin reactions Adverse food reactions affect men as well as women. against one or more allergens [1]) as well as asthma and However, for most of the associated diseases (allergies, food allergies [2] than girls. Later in life (young adult intolerances), an imbalance mainly in the direction of a group; 13–21 years), females are significantly more af- dominance of female patients is observed. In this article fected by food-induced complaints (24% vs. 14% in males) we discuss the prevalence of food intolerance conditions [3], as assessed by a questionnaire-based survey. Other and IgE-mediated food allergies, but refrain from includ- studies have confirmed this observation (Table 1), and ing non-IgE mediated allergies or sensitization (i.e., sim- show that the ratio in prevalence of food intolerance ple presence of specific IgE without correlated clinical between females and males after puberty is 60:40 [4, 5]. symptoms evaluated or reported). We used the search For instance, in a more recent report, 20,686 cases were terms “food allergy” AND gender, “food allergy” AND included in the time period between 2007 and 2010, from female, “food intolerance” AND gender, as well as “food which the prevalence of self-observed food intolerance in intolerance” AND female in PubMed. Foremost, the females was 11.1% compared to 8.21% in males with an possible factors related to the female dominance in such overall prevalence of 8.96% in the studied population [6], diseases have been extracted. and among Mexican people, basically 37.8% of female participants vs. 25.2% of male participants have reported to suffer from an adverse food reaction [7]. In this more Prevalence of adverse food reactions antigen-focused questionnaire-based survey with 1238 Allergies adult participants from Mexico, an overall prevalence of Interestingly, it was noted that in childhood and adoles- self-reported wheat or gluten intolerance of about 11.9%, cence (before puberty, till 15 years) boys are more with a significant female predominance (14.6%) compared * Correspondence: to male participants (8.0%) was revealed [7]. Interestingly, [email protected]; [email protected] females suffered equally often from hay fever as males 1Comparative Medicine, The Interuniversity Messerli Research Institute of the (about 63% of survey participants), which reflects a female University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria predominance especially in food allergies [8]. 3Institute of Pathophysiology and Allergy Research; Center of Physiology, A study from Kyoto compared only females at different Pathophysiology and Immunology, Medical University Vienna, Vienna, Austria ages regarding the prevalence of self-reported food Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Afify and Pali-Schöll World Allergy Organization Journal (2017) 10:43 Page 2 of 8 Table 1 Prevalence of food adverse reactions in women and men found in different studies Criteria Female Number of surveyed subjects Study populationa Age (years) Reference Male Food allergic patients 65.18b 17,528 Systematic search Adults (> 18 years) [64] 34.82 of PubMed literature Self-reported food adverse reactions 24c 1488 1 13–21 [3] 14 Self-reported food adverse reactions (Interview) 20.1b 1.943 1 From 14 years [65] 13.4 Norwegian National Reporting System and Register 60d Ca. 6500 health care 2 Adolescents [4] 40 professionals/year report cases Food-dependent exercise-induced anaphylaxis 2e 199 1 15–35 [30] 1 Self-observed food adverse reactions 11.1c 20,686 1 Adults [6] 8.21 Self-reported food adverse reactions 37.8c 1238 1 Adults [7] 25.2 Self-reported food adverse reactions; 27.5c 1537 1 Adults [5] Positive skin-test with at least 1 allergen 14; 27.5c 22.7 Self-reported food adverse reactions 2e 1253 1 18–25 [66] 1 Physician-diagnosed food allergy in parents of 13.3c 1.252 mothers, 1.225 fathers 1 and 2 30–39 [67] food allergic children 8.9 Electronic health record data for food allergy 4.2c 2,714,851 2 No limitation [12] and intolerances, validated for peanut allergy 2.9 by RAST and ImmunoCAP aStudy population: 1 = population based/community setting, 2 = hospital based bPercentage among allergic patients cPercentage among study population dPercent eRatio intolerance [9]. This study has shown nearly the same whereas paternal allergy increased the risk in boys results for adolescent (18–24 years) and elder women [8]. This has implications for childhood allergy pre- (< 50 years), with a prevalence of 8.2% and 8.9%, diction and prevention, because if there is a greater respectively. This was confirmed by other data about prevalence of female allergy with higher impact on occurrence of food allergy in an adult population, girls, the effect might be multiplied. Ideally, this ob- which showed that both, adolescent (18–29 years; servation may facilitate some pattern of preventing al- 28.4%) and elderly people (70–79 years; 21.1%) were lergy. However, more multigenerational studies are sensitized against food allergens ([10], review [11]). needed to assess this effect and whether there are In a recent paper, using data from an electronic health epigenetic effects regarding the risk of allergy and records (EHR) allergy module from the Greater Boston asthma in subsequent generations, which may also area, which is composed of multiple community and depend on the sex of the child [13]. specialty hospitals, food allergy and intolerance data were analyzed among 2,714,851 patients [12]. Also here, Intolerances among the overall 3.6% patients affected by adverse food Intolerances also clearly showed gender-specific varia- reactions, female sex dominated significantly with 4.2% tions with females more affected than males. The most over male with 2.9%. important examples are histamine intolerance (about 1% This female dominance might have more far-reaching of population, from which 80% were females [14]) and implications for further generations, because Arshad et fructose intolerance [15]. Yet, in lactose intolerance, the al., revealed in their paper that in the Isle of Wight Birth available data are not conclusive about whether females Cohort, maternal allergy increased the risk for asthma, are more affected than males [16], or whether they are eczema, atopy and total IgE in girls but not in boys, equally affected [17]. Afify and Pali-Schöll World Allergy Organization Journal (2017) 10:43 Page 3 of 8 Pathophysiology small study described an association between lactose in- Adverse food reactions are divided according to their tolerance and premenstrual tension syndrome, as well as pathophysiology into immune-mediated conditions (for mental depression especially in females. A possible the- example, IgE-mediated allergy or coeliac disease) and ory is that high concentrations of lactose interfere with non-immune-mediated conditions (mainly intolerances tryptophan and serotonin metabolism, which are crucial due to enzyme- or transporter deficiency) [18]. for mood control [24]. Similar symptoms could occur in fructose intolerance, Allergies in which fructose transporter (Glucose-Transporter-5, Food allergy — genetically predetermined, but not dir- GLUT-5) is absent or deficient. This leads to inability of ectly inherited — is best described as an immediate IgE- the small intestine to take up fructose, as a result fruc- mediated reaction [19, 20], dominated by a Th2-milieu. tose accumulates in the large intestinal lumen. Patients These cells are characterized by the liberation of cyto- in such condition suffer from similar symptoms like in kines IL-4, IL-13 and IL-5, which consequently stimulate lactose intolerance, however, depression is more likely to class switching in B-cells in the direction of IgE- occur in association with fructose intolerance because of antibodies production [21]. IgE-antibodies bind through tryptophan
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