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Community Perspectives Toward Food Allergies
Albandari Bin Ammar1, Khalid ME Eltalib2, Mohamed Ahmed Agab Ahmed Agab2, Hussain Gadelkarim Ahmed3
1Department of Clinical Nutrition, College of applied Medical Sciences, University of Hail, Saudi Arabia.
2Department of Medicine, Faculty of Medicine, Kordofan University, El-Obeid, Sudan. Coronary Care Unit, El-Obeid Teaching
Hospital, El-Obeid, Sudan.
3Department of Histopathology and Cytology, FMLS, University of Khartoum, Sudan.
ABSTRACT
Background: Food allergy is a widespread condition with multiple manifestations across the globe. The
purpose of this study was to analyze the community's knowledge of techniques to improving food allergy
awareness in Saudi Arabia. Methodology: This cross-sectional poll includes 15141 Saudi residents between
December 2020 and January 2021. The data was gathered using convenience/snowball sampling via an online
poll. The questionnaire was created using the verified design by Gupta et al. [12]. The survey was marketed
on social media and by e-mail. Results: In this study, 15142 individuals had been surveyed. This population's
average overall knowledge was 57.1%. Approximately 12% of participants claimed food allergies and had
previously been diagnosed with an IgE test, with 11.7% males and 12% females. Contacting a person with FA
calmed about 11% of people, including 8.4% of men and 11.6% of women. Conclusion: The Saudi population
has a low level of overall understanding about FA allergy. FA proportions are higher among those aged 36 to
45. The knowledge level of FA does not appear to be affected by gender, financial situation, or education
level. In this study, FA prevalence rates were lower in nations with lower rates.
Keywords: food allergy, Saudi Arabia, IgE, Allergic reactions.
Correspondence to: Dr. Khalid ME, Email: Eisa.khalid1@gmail.com
Cite this article: Ammar AB, Eltalib KME, Agab MAAA, Ahmed HG. Medical Research Updates 2023;1(1): 10-22. DOI: 0000
INTRODUCTION
Food Allergy (FA) is a serious global health issue that
is becoming more prevalent in the urbanized
community. FA has an impact on the quality of life of
many allergy patients and their families due to
increased costs [1,2]. FA prevalence rates are quickly
increasing in several parts of the world, necessitating
the need for improved prevention, diagnosis, and
treatment measures. Significant progress has been
made in understanding the causes and mechanisms
underlying FA in recent years. This resulted in the
implementation of several guidelines and the
promotion of continuous upgrades [3]. Investigations
understanding the risk factors that have contributed
to the growth in FA consequences, as well as their
core immunological mechanisms, may help to define
ways for FA therapy and prevention [1]. The most
common FA-associated foods include soybeans, milk,
eggs, groundnuts, shellfishes, tree nuts, cereals, and
fish (Big Eight) [4,5].
FA is defined as unfavorable immune responses to
dietary proteins that result in conventional clinical
manifestations such as dermatologic, respiratory,
gastrointestinal, cardiovascular, and/or neurologic
symptoms. Immunoglobulin (Ig) E-mediated allergy
disorder differs from non-IgE-mediated allergy
disorder in that the pathophysiology originates from
immune system activation, activating a T helper 2
response, which leads to IgE binding to Fc receptors
on effector cells such as mast cells and basophils. In
contrast to non-IgE-mediated FA, this activation
commences the release of histamine and other
comparable inflammatory mediators, and symptoms
begin immediately [6].
Ig E-mediated allergy symptoms can range from
moderate to severe, and life-threatening anaphylaxis
can occur. Skin prick testing, allergen-specific serum
IgE, and/or oral meal challenges are currently
recommended for diagnosis. Management entails
allergen avoidance and appropriate medication for
allergic reactions when accidental ingestions occur.
Recently, immunotherapy, biological treatments, and
new vaccinations have been introduced [7-9].
However, there is a scarcity of data on FA from Saudi
Arabia. The few relevant studies refer to food
consumed outside the home, such as fast food or
dining out [10,11]. As a result, the current study
sought to assess the community's understanding of
measures to increase understanding of food allergies
in Saudi Arabia.
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MATERIALS AND METHODS
This cross-sectional poll includes 15141 Saudi
residents between December 2020 and January 2021.
The data was gathered using convenience/snowball
sampling via an online poll. The questioner was
created using the verified design by Gupta et al. [13].
The survey was marketed on social media and by e-
mail.
Ethical Considerations
The participants in this study gave their consent
voluntarily, since they would not be forced or
encouraged to take part. The survey results were not
coupled with any personal data, and the study
participants remained anonymous. On the participant
information sheet, which was the first page of the
online survey, participants were asked to confirm that
they were willing to participate in this study.
Consent was secured by including a mandatory
response question that required their agreement in
order to participate. Only those who actively clicked
to consent may view the subsequent sections of the
survey.
Statistical Analysis
The Statistical Package for the Social Sciences (SPSS)
version 23 was used for the statistical analyses.
Descriptive data reported as frequencies and
percentages were included in the statistical analysis.
RESULTS
The awareness level of food allergies was tested in
this study for 15142 participants, 3350 (22%) males
and 11792 (78%) females, aged 18 to 80 years, with a
mean age of 28.5 years. The majority of participants
were between the ages of 21 and 35, and the vast
majority were Saudi (96%). The majority of
contributors had a Batchelor degree BSc level of
education, followed by high school and diploma,
accounting for 62%, 23%, and 9%, respectively. As
shown in Table 1, Figure 1, the majority of
participants have a monthly income of 3000 SAR
(52%), followed by 3000 to 6000 SAR (15%).
Table 1. Distribution of study population by demographical data
Category
Variable
Males
(n=3350)
Females (n=11792)
Total (n=15142)
Nationality
Saudi
3166
11095
14261
Non-Saudi
184
697
881
Age
20-18 years
483
2493
2976
21-25 years
872
4270
5142
26-35 years
1010
2682
3692
36-45 years
523
1598
2121
46+ years
462
749
1211
Education
Illiterate
35
62
97
High school
741
2732
3473
Diploma
515
883
1398
BSc
1777
7578
9355
MSc
223
400
623
PhD
59
137
196
Income in Saudi Riyals (SAR)
< 3,000 SAR
1119
6736
7855
3000-6000
443
1785
2228
6000-8000
278
689
967
8000-10000
336
821
1157
10000-15000
487
1026
1513
15000-20000
322
369
691
20000-25000
162
128
290
More than 25000
203
238
441
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Figure 1. proportions of the study population by demographical data
Around 1796/15142 (12%) participants claimed to
have food allergies and had previously been identified
with an IgE test, including 391/3350 (11.7%) males
and 1405/11792 (12%) females. Furthermore, as
indicated in Figure 2, around 1445/13246 (11%)
calmed contacting a person with FA, including
247/2928 (8.4%) males and 1198/10318 (11.6%)
females.
Figure 2. Description of the study population prevalence rates of FA
This population's average overall knowledge was
57.1%.
Table 2 and Figure 2 show the gender distribution of
the study population as well as various FA knowledge-
related categories. When asked if "FA is an allergic
reaction that happens when the body considers a
food to be harmful," 7004/13270 (52.8%) said "Ture,"
including 1550/2929 (53%) males and 5454/10341
(52.7%) females.
In response to the question "Is a family history of FA
considered a risk factor for having FA?" 8466/13270
94% 6% 20%34%24%14% 8% 1% 23% 9% 62% 4% 1% 52%15% 6% 8% 10% 5% 2% 3% 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Total (n=15142) Males (n=3350) Females (n=11792)
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(63.8%) said "Ture," including 17772/2929 (60%)
males and 6694/10341 (64.7%) females.
4710/13270 (35.5%) responded "Ture" to the
question "Asthma is an important risk factor for
severe anaphylaxis," with 1033/2929 (35.3%) males
and 3677/10341 (35.6%) females.
In response to the question "whether FA is an
infectious condition," 10430/13270 (78.6%) said
"False," including 2111/2929 (72%) males and
8319/10341 (80%) females.
The question reads: "Hives (red bumps or blotches on
the skin that can be itchy) are a common symptom of
an FA reaction" 10440/13270 (78.7%) said "Ture,"
with 2117/2929 (72.2%) males and 8323/10341
(80.5%) females responding.
When asked if "people with food allergies can have an
allergic reaction after touching a food," 5034/13270
(38%) said "Ture," with 1026/2929 (35%) males and
4008/10341 (38.8%) females responding.
In response to the question "Is FA more common in
children than in adults?" 6822/13270 (51.4%) said
"Ture," including 1297/2929 (44.3%) males and
5525/10341 (53.4%) females.
When asked if a person could die as a result of an FA
reaction, 7693/13270 (58%) said "Ture," including
1401/2929 (47.8%) males and 6292/10341 (60.8%)
females.
Table 2. Distribution of the study population by sex and some FA knowledge-related domains.
Category
Variable
Males n=2929
Females n=10341
Total n=13270
FA is an allergic reaction that happens when the body considers a food to be harmful.
True
1550
5454
7004
False
815
3164
3979
Don’t know
564
1723
2287
A family history of FA is considered a risk factor for having FA.
True
1772
6694
8466
False
419
1259
1678
Don’t know
738
2388
3126
Asthma is a significant risk factor for severe anaphylaxis.
True
1033
3677
4710
False
764
2419
3183
Don’t know
1132
4245
5377
FA is an infectious condition
True
297
688
985
False
2111
8319
10430
Don’t know
521
1334
1855
Hives (red bumps or blotches on the skin that can be itchy) are a common symptom of a FA reaction.
True
2117
8323
10440
False
218
529
747
Don’t know
594
1489
2083
People with food allergies can have an allergic reaction after touching a food.
True
1026
4008
5034
False
1046
3610
4656
Don’t know
857
2723
3580
FA is more common in children than in adults
True
1297
5525
6822
False
587
1403
1990
Don’t know
1045
3413
4458
A person can die from having a FA reaction
True
1401
6292
7693
False
644
1492
2136
Don’t know
884
2557
3441
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Figure 3. Study population by proportions of knowledge levels
Table 3 and Figure 3 show the gender distribution of
the study participants as well as their awareness of
frequent allergy foods. "Lactose intolerance (difficulty
digesting dairy products) is the same as having a milk
allergy," 6275/13270 (47.3%), followed by "Foods
eaten by a mother can cause an FA by passing to her
child through her breast milk," 5875/13270 (44.3%),
"Acidic foods (like lemons, oranges, and tomatoes)
are not commonly causing FA," 4649/13270 (35%),
and and A person with a milk allergy can still drink
low-fat milk without having an allergic reaction
1269/13270(9.6%).
Table 3. Distribution of the study population by sex and knowledge related to common allergic food.
Category
Variable
Males n=2929
Females n=10341
Total n=13270
Lactose intolerance (trouble digesting dairy products) is the same as having a milk allergy.
True
1185
5090
6275
False
533
1843
2376
Don’t know
1211
3408
4619
Acidic foods (like lemons, oranges, and tomatoes) commonly cause FA.
True
577
2640
3217
False
1137
3512
4649
Don’t know
1215
4189
5404
A person with a milk allergy can still drink low-fat milk without having an allergic reaction.
True
358
911
1269
False
1340
5582
6922
Don’t know
1231
3848
5079
Foods eaten by a mother can cause a FA by passing to her child through her breast milk.
True
994
4881
5875
False
671
1776
2447
Don’t know
1264
3684
4948
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Figure 3. Proportions of knowledge levels by some allergies
Table 4 summarizes the study subjects by sex and
some concepts about preventive measures. On
querying the participants "whether Food allergies can
go away as a person gets older," 3193(24%) answered
"YES," of whom 691(23.6%) were males and
2502(24.2%) were females.
In the query "The only way to prevent an allergic
reaction is to stay away from food that causes an
allergic reaction," 10407(78.4%) answered "YES," of
whom 2170 (74%) were males and 8237 (79.6%) were
females.
In the query "There is a cure for food allergies," 2895
(21.8%) answered "NO," of whom 603 (20.6%) were
males, and 2292 (22%) were females.
Table 4. Study subjects by sex and some judgments about preventive measures.
Category
Variable
Males n=2929
Females n=10341
Total n=13270
Food allergies can go away as a person gets older
YES
691
2502
3193
NO
891
3085
3976
DON’T KNOW
1347
4754
6101
The only way to prevent an allergic reaction is to stay away from food that causes an allergic reaction
YES
2170
8237
10407
NO
312
871
1183
DON’T KNOW
447
1233
1680
There is a cure for food allergies
YES
1171
3662
4833
NO
603
2292
2895
DON’T KNOW
1155
4387
5542
On asking the participants about the quick symptoms
of FA reactions, about 3590/13270(27%) answered,
"Immediately his tongue swells, and he will have
trouble breathing," comprising 615(21%) males and
2975(28.8%) females. About 7924 (60%) participants
indicated that "After 15 minutes, he gets hives on his
face and chest," including 1753(60%) males and
6171(60%) females. When asking the contributors,
"Where is the best place to use an EpiPen (injectable
epinephrine)?” 1480/13270(11%) answered
Buttock," as indicated in Table 5
Table 5. Descriptions of the study subjects by symptoms and management.
Category
Variable
Males
Females
Total
A boy with a milk allergy accidentally drank some milk which of the following could be a symptom of FA reaction
After 2 days, he gets hyperactive and cranky and has headaches
385
794
1179
After 15 minutes, he gets hives on his face and chest
1753
6171
7924
Immediately his tongue swells, and he will have trouble breathing
615
2975
3590
He has a stuffy nose that won't go away for weeks
176
401
577
Total
2929
10341
13270
Lactose
intolerance
Mother milk
Acidic food (Not)
Low fat milk
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Where is the best place to use an EpiPen (injectable epinephrine)?
Upper arm
646
2220
2866
Buttock
434
1046
1480
Outer thigh
526
1817
2343
I don’t know
1323
5258
6581
Total
2929
10341
13270
As indicated in Table 6, Figure 4, FA was increasingly
diagnosed in age groups (36-45 & 46+) followed by
26-35 years, and (18-20& 21-25), representing 14%,
13%, and 11%, respectively.
Table 6. Distribution of FA by age.
Variable
18-20 years
21-25
26-35
36-45
46+
Total
Do you suffer from FA, and have you been diagnosed with an IgE test?
Yes
333
559
472
266
166
1796
No
2643
4583
3220
1855
1045
13346
Total
2976
5142
3692
2121
1211
15142
Do you take care of people with food allergies?
Yes
225
401
388
303
128
1445
No
2386
4147
2813
1542
913
11801
Total
2611
4548
3201
1845
1041
13246
Figure 4. Proportions of FA by age
Table 7. Distribution of FA by monthly income.
Variable
<3000SAR
3000-6000
6000-8000
8000-10000
10000-
15000
15000-
20000
20000-
25000
>25000
Do you suffer from FA, and have you been diagnosed with an IgE test?
Yes
884
279
124
153
164
93
41
58
No
6971
1949
843
1004
1349
598
249
383
Total
7855
2228
967
1157
1513
691
290
441
Do you take care of people with food allergies?
Yes
676
244
94
106
179
66
25
55
No
6239
1698
744
887
1161
528
222
322
Total
6915
1942
838
993
1340
594
247
377
0%
2%
4%
6%
8%
10%
12%
14%
18-20
Y E A R S 21-25Y R S 26-35Y R S 36-45Y R S 46+ Y R S
11%11%
13%14%14%
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Figure 5. Proportions of FA by monthly income.
Regarding the proportions of FA and monthly income,
the most affected people were those with 20000 to
25000 SAR, followed by 15000-20000, and 8000 to
10000, representing 14.1%, 13.5%, and 13.2%, in this
order, as indicated in Table 7, Figure 5.
Table 8, Figure 6, describe the proportions of overall
knowledge levels of FA by the level of education. High
ratios of knowledge levels were observed: For "FA is
an allergic reaction," seen illiterate followed by Ph.D.,
and high school, representing 64%, 57%, and 55%,
correspondingly. For family history, high knowledge
levels were revealed in MSc (73%), followed by Ph.D.
(69%) and illiterate & BSc) (66%). For hives, mostly
MSc 985%) followed by BSc (81%) and high school
(74%).
For FA, more in children increased percentage seen within illiterate (61%), followed by MSc (57%) and Ph.D. (55%).
Table 8. Level of knowledge of FA by education
Variable
illiterate
High school
Diploma
BSc
MSc
PhD
Total
FA is an allergic reaction that happens when the body considers a food to be harmful
Yes
51
1638
643
4266
302
104
7004
False
14
755
282
2689
184
55
3979
Don’t know
15
589
268
1317
76
22
2287
Total
80
2982
1193
8272
562
181
13270
A family history of FA is considered a risk factor for having FA.
Yes
53
1733
669
5474
412
125
8466
False
17
400
176
1002
62
21
1678
Don’t know
10
849
348
1796
88
35
3126
Total
80
2982
1193
8272
562
181
13270
Asthma is a significant risk factor for severe anaphylaxis
Yes
45
976
426
2967
224
72
4710
False
16
743
314
1937
129
44
3183
Don’t know
19
1263
453
3368
209
65
5377
Total
80
2982
1193
8272
562
181
13270
FA is an infectious condition
Yes
32
284
124
501
28
16
985
False
30
2223
860
6687
483
147
10430
Don’t know
18
475
209
1084
51
18
1855
Total
80
2982
1193
8272
562
181
13270
Hives (red bumps or blotches on the skin that can be itchy) are a common symptom of a FA reaction
Yes
49
2210
871
6689
476
145
10440
False
11
191
76
431
28
10
747
Don’t know
20
581
246
1152
58
26
2083
Total
80
2982
1193
8272
562
181
13270
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FA is more common in children than in adults
Yes
49
1479
592
4282
320
100
6822
False
14
459
207
1204
78
28
1990
Don’t know
17
1044
394
2786
164
53
4458
Total
80
2982
1193
8272
562
181
13270
Figure 6. Proportions of overall knowledge levels of FA by the level of education.
DISCUSSION
FA is a widespread disorder that has varying loads
depending on geographical location. This variation
may be related to nutritional choices and level of
awareness of prevalent allergy foods. Because there
is a scarcity of literature in this field from Saudi
Arabia, the purpose of this study was to assess the
community's understanding of the techniques to raise
awareness of food allergies in Saudi Arabia.
The current study's findings revealed that
approximately 12% of the individuals had FA, with
prevalence rates being roughly similar between males
and females. To the best of our knowledge, no
epidemiological studies have been conducted in Saudi
Arabia to determine the actual prevalence of FA. FA is
said to affect up to 10% of youngsters in wealthy
countries [14]. However, the prevalence of FA allergy
varies widely depending on a number of factors,
including age and other demographic features. Some
investigations found incidence rates ranging from
5.7% to 61.6% [15-17].
The overall level of knowledge metrics presented in
this study (57.1%) was average. In this context, there
were just two studies from Saudi Arabia available at
the time. A study looked at the timing of introducing
potentially allergenic foods into children's diets, as
well as the level of maternal understanding and
compliance with existing recommendations.
Approximately 25% of the youngsters in the research
were identified as high risk. Most moms overlook or
disagree that the timing of the introduction of
allergenic foods may help to prevent FA. Only 15.9%
of mothers received adequate information from their
health care providers [10]. Evaluated the allergen-
labeling (AL) knowledge, practices, preferences, and
perceptions regarding the latest Saudi Food and Drug
Authority (SFDA) AL legislation among consumers
with FA in Saudi Arabia. Only 28.1% declared
knowledge about food allergen labeling and the
related legislation in Saudi Arabia. Around 67% used
to check labels in food packages. About 84% preferred
food carrying safety statements. About 94% of
participants supported SFDA legislation and like to eat
in restaurants with available food allergen
information [11].
The majority of participants (78.7%) were aware that
"Hives (red bumps or blotches on the skin that can be
itchy) are a common symptom of an FA reaction," and
similar numbers were able to distinguish Food allergy
reactions from infectious illnesses. Only 27% of the
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FA is an allergic
reaction
Family history Asthma Hives Children
Illiterate High school Diploma BSc MSc PhD
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participants were able to identify the earliest signs of
FA. However, people with FA have a wide range of
symptoms that can interact with other non-FA
symptoms. However, irritation of the lips or tongue,
as well as urticaria, are noteworthy characteristics
[17]. Although the females' participants were much
more than the males in the present study, no
knowledge levels differences were noticed when
calculating statistical metrics within each entire
group.
Regarding age, most patients that experienced
previous food allergic conditions were within the age
range 36 45 years. This opposes the reports that FA
is more common among the younger population and
children [18]. This might be related to the increased
number of participants in this study within the age
group 36-45 years.
In the present study, monthly income didn't show any
significant value with FA. Social and financial status
and differences in prevalence rates of FA were
previously reported [19]. In Saudi Arabia, though
there is a wide range of monthly income, the life
pattern and food intake are relatively similar.
In conclusion, The Saudi population has a low general
level of awareness of FA allergies. There is an increase
in FA proportions in the 3645 age group. The degree
of schooling, socioeconomic standing, or sex does not
appear to have an impact on FA's knowledge. The
study's FA prevalence percentages were found in
comparatively poorer nations. All facets of the Saudi
population, irrespective of age, socioeconomic
standing, or educational attainment, are considered
to benefit from health education regarding FA.
ACKNOWLEDGMENT
The authors would like to express their gratitude to all
participants for their kind cooperation.
AUTHORS CONTRIBUTION
ABA: Conceptual, consultation, funding, and approval
of the final version
KEME: Conceptual, data analysis, funding, and
approval of the final version
MAA: conceptual, manuscript drafting, and approval
of the final version
HGA: conceptual, administration, funding, and
approval of the final version
FUNDING:
Self-funded.
DATA AVAILABILITY:
The data presented in this study are available on
request to the corresponding author.
DISCLOSURE OF INTEREST
No interest to declare
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