Food anaphylaxis: data from the French Allergy-Vigilance Network, 2002–2022

• In a series of 2842 cases, AVN data provide epidemiological information on food anaphylaxis, and highlights rare and new allergens. • Peanut an tree nuts accounted for 34,4% allergens involved, followed by fruits (8.7%) and legumes other than peanut (6.6%). • Food allergens involved were different by age groups. • Management of severe food anaphylaxis is a major public health issue and is studied through AVN data. Adrenaline was administered in less than 25% of food anaphylaxis cases. • Near-fatal and fatal (grade 4) anaphylaxis cases induced by foods were reported in 54 (1.9%) patients. Peanut, cow’s milk and goat or sheep’s milk were the most frequent triggers in the 18 deaths. The number of hospitalizations for food-induced anaphylaxis is rising in industrialized countries. Our aim was to give an overview of food-induced anaphylaxis cases recorded in the Allergy-Vigilance Network (AVN) database focusing on the type of allergens, particularities according to elderly people, severity, cofactors, and management. Food-induced anaphylaxis cases recorded in the AVN database from 2002 to 2022 were analysed retrospectively. Of the 4282 cases of anaphylaxis registered by the AVN, 2842 (66.4%) cases involved food. Of these, 1591 (52.4%) were children (< 18 years), 1062 (37.3%) adults (18-59 years) and 189 (6.6%) people aged ≥ 60 years. 18 fatalities have been reported. Tree nuts and peanut together accounted for 34.4% of allergens, followed by fruits (8.7%) and legumes (other than peanut) (6.6%). The most frequent cofactor was physical exercise reported in 57% of cases in children and 38% in adults. Adrenaline was administered in 24.4% of cases. Several allergens should be subject to specific mandatory labeling, particularly goat's and sheep's milk responsible for two deaths. In our database, foods, mainly peanut and tree nuts, represent the most common anaphylaxis triggers and children are involved in more than half of cases. Our data highlight a room for improvement in the management of anaphylaxis, particularly the use of adrenaline. New technological tools, such as artificial intelligence, collaboration with health authorities and other registries are required to address knowledge gaps regarding severe anaphylaxis.