suggests that non disease causing organisms, such as helminths, could protect against allergy. therefore, reduced exposure to these organisms, particularly in developed countries, could have contributed towards the increase. children of east asian or african descent who live in westernized countries were reported to be at significantly higher risk of food allergy compared to caucasian children. several studies predict that asia and africa may experience a growth in food allergy prevalence as the lifestyles there become more westernized. the prevalence of certain food allergies is suggested to depend partly on the geographical area and country. for instance, allergy to buckwheat flour, used for soba noodles, is more common in japan than peanuts, tree nuts or foods made from soy beans. also, shellfish allergy is the most common cause of anaphylaxis in adults and adolescents particularly in east asian countries like hong kong, taiwan, singapore, and thailand. individuals in east asia have further developed an allergy to rice, which forms a large part of their diet. another example is that, out of 9 european countries, egg allergy was found to be most prevalent in the uk and least prevalent in greece. special population: children about 75% of children who have allergies to milk protein are able to tolerate baked-in milk products, i.e., muffins, cookies, cake, and hydrolyzed formulas. about 50% of children with allergies to milk, egg, soy, peanuts, tree nuts, and wheat will outgrow their allergy by the age of 6. those who are still allergic by the age of 12 or so have less than an 8% chance of outgrowing the allergy. united states in the united states, food allergy affects as many as 5% of infants less than three years of age and 3% to 4% of adults. the prevalence of food allergies is rising. food allergies cause roughly 30,000 emergency room visits and 150 deaths per year. regulation whether rates of food allergy are increasing or not, food allergy awareness has definitely increased, with impacts on the quality of life for children, their parents and their caregivers. in the united states, the food allergen labeling and consumer protection act of 2004 causes people to be reminded of allergy problems every time they handle a food package, and restaurants have added allergen warnings to menus. the culinary institute of america, a premier school for chef training, has courses in allergen-free cooking and a separate teaching kitchen. school systems have protocols about what foods can be brought into the school. despite all these precautions, people with serious allergies are aware that accidental exposure can easily occur at other peoples' houses, at school or in restaurants. regulation of labelling an example of a list of allergens in a food item in response to the risk that certain foods pose to those with food allergies, some countries have responded by instituting labeling laws that require food products to clearly inform consumers if their products contain priority allergens or byproducts of major allergens among the ingredients intentionally added to foods. the priority allergens vary by country. food allergens prioritized in labeling laws by country food us canada uk australia eu peanuts yes yes yes yes yes tree nuts yes yes yes yes yes milk yes yes yes yes yes eggs yes yes yes yes yes fish yes yes yes yes yes shellfish crustaceans only crustaceans and molluscs crustaceans and molluscs yes crustaceans and molluscs soy yes yes yes yes yes wheat yes includes triticale included under gluten yes included under gluten sesame seeds yes as of 2023 yes yes yes yes mustard no yes yes no yes sulphites (not a true allergy) no yes yes no yes, >10 mg/kg gluten (not a true allergy) no yes yes no yes celery no no yes no yes lupin no no yes yes yes there are no labeling laws mandating declaration of the presence of trace amounts in the final product as a consequence of cross-contamination, except in brazil. ingredients intentionally added in the united states, the food allergen labeling and consumer protection act of 2004 requires companies to disclose on the label whether a packaged food product contains any of these eight major food allergens, added intentionally: cow's milk, peanuts, eggs, shellfish, fish, tree nuts, soy and wheat. the eight-ingredient is list originated in 1999 from the world health organisation codex alimentarius commission. to meet labeling requirements, if an ingredient is derived from one of the required-label allergens, then it must either have its "food sourced name" in parentheses, for example, "casein (milk)," or as an alternative, there must be a statement separate but adjacent to the ingredients list: "contains milk" (and any other of the allergens with mandatory labeling). the european union requires listing for those eight major allergens plus molluscs, celery, mustard, lupin, sesame and sulfites. in 2018, the us fda issued a request for information for the consideration of labeling for sesame to help protect people who have sesame allergies. a decision was reached in november 2020 that food manufacturers voluntarily declare that when powdered sesame seeds are used as a previously unspecified spice or flavor, the label be changed to "spice (sesame)" or "flavor (sesame)." congress and the president passed a law in april 2021, the "faster act", stipulating that labeling be mandatory, to be effect january 1, 2023, making it the ninth required food ingredient label. the food allergen labeling and consumer protection act of 2004 applies to packaged foods regulated by the fda, which does not include poultry, most meats, certain egg products, and most alcoholic beverages. however, some meat, poultry, and egg processed products may contain allergenic ingredients. these products are regulated by the food safety and inspection service, which requires that any ingredient be declared in the labeling only by its common or usual name. neither the identification of the source of a specific ingredient in a parenthetical statement nor the use of statements to alert for the presence of specific ingredients, like "contains: milk", are mandatory. the act also does not apply to food prepared in restaurants. the eu food information for consumers regulation 1169/2011 – requires food businesses to provide allergy information on food sold unpackaged, for example, in catering outlets, deli counters, bakeries and sandwich bars. in the united states, there is no federal mandate to address the presence of allergens in drug products, medicines, or cosmetics. trace amounts as a result of cross-contamination the value of allergen labeling other than for intentional ingredients is controversial. this concerns labeling for ingredients present unintentionally as a consequence of cross-contact or cross-contamination at any point along the food chain (during raw material transportation, storage or handling, due to shared equipment for processing and packaging, etc.). experts in this field propose that if allergen labeling is to be useful to consumers, and healthcare professionals who advise and treat those consumers, ideally there should be agreement on which foods require labeling, threshold quantities below which labeling may be of no purpose, and validation of allergen detection methods to test and potentially recall foods that were deliberately or inadvertently contaminated. labeling regulations have been modified to provide for mandatory labeling of ingredients plus voluntary labeling, termed precautionary allergen labeling, also known as "may contain" statements, for possible, inadvertent, trace amount, cross-contamination during production. precautionary allergen labeling can be confusing to consumers, especially as there can be many variations on the wording of the warning. precautionary allergen labeling is optional in the united states. as of 2014, precautionary allergen labeling is regulated only in switzerland, japan, argentina, and south africa. argentina decided to prohibit precautionary allergen labeling since 2010 and instead puts the onus on the manufacturer to control the manufacturing process and label only those allergenic ingredients known to be in the products. south africa does not permit the use of precautionary allergen labeling, except when manufacturers demonstrate the potential presence of allergen due to cross-contamination through a documented risk assessment and despite adherence to good manufacturing practice. in australia and new zealand there is a recommendation that precautionary allergen labeling be replaced by guidance from vital 2.0 (vital incidental trace allergen labeling). a review identified "the eliciting dose for an allergic reaction in 1% of the population" as the threshold reference dose for certain foods (such as cow's milk, egg, peanut and other proteins) to provide food manufacturers with guidance for developing precautionary labeling and give consumers a better idea of what might be accidentally in a food product beyond "may contain." vital 2.0 was developed by the allergen bureau, a food industry sponsored, non-government organization. the european union has initiated a process to create labeling regulations for unintentional contamination but is not expected to publish such before 2024. in brazil, since april 2016, the declaration of the possibility of cross-contamination is mandatory when the product does not intentionally add any allergenic food or its derivatives, but the good manufacturing practices and allergen control measures adopted are not sufficient to prevent the presence of accidental trace amounts. these allergens include wheat, rye, barley, oats and their hybrids, crustaceans, eggs, fish, peanuts, soybean, milk of all species of mammalians, almonds, hazelnuts, cashew nuts, brazil nuts, macadamia nuts, walnuts, pecan nuts, pistachios, pine nuts, and chestnuts. genetically modified food although there is a scientific consensus that available food derived from genetically modified crops poses no greater risk to human health than conventional food, and a 2016 u.s. national academy of sciences report concluded that there is no relationship between consumption of genetically modified foods and the increase in prevalence of food allergies, there are concerns that genetically modified foods, also described as foods sourced from genetically modified organisms, could be responsible for allergic reactions, and that the widespread acceptance of these types of foods may be responsible for what is a real or perceived increase in the percentage of people with allergies. one concern is that genetic engineering could make an allergy-provoking food more allergic, meaning that smaller portions would suffice to set off a reaction. of the food currently in widespread use of genetically modified organisms, only soybeans are identified as a common allergen. however, for the soybean proteins known to trigger allergic reactions, there is more variation from strain to strain than between those and the genetically modified varieties. another concern is that genes transferred from one species to another could introduce an allergen in a food not thought of as particularly allergenic. research on an attempt to enhance the quality of soybean protein by adding genes from brazil nuts was terminated when human volunteers known to have tree nut allergy reacted to the modified soybeans. prior to a new genetically modified food receiving government approval, certain criteria need to be met. these include: is the donor species known to be allergenic? does the amino acid sequence of the transferred proteins resemble the sequence of known allergenic proteins? are the transferred proteins resistant to digestion - a trait shared by many allergenic proteins? genes approved for animal use can be restricted from human consumption due to potential for allergic reactions. in 1998 starlink brand corn restricted to animals was detected in the human food supply, leading to first a voluntary and then a fda mandated recall. there are requirements in some countries and recommendations in others that all foods containing genetically modified ingredients be so labeled, and that there be a post-launch monitoring system to report adverse effects (similar to the requirements in some countries for drug and dietary supplement reporting). restaurants in the us, the fda food code states that the person in charge in restaurants should have knowledge about major food allergens, cross-contacts, and symptoms of food allergy reactions. restaurant staff, including wait staff and kitchen staff, may not be adequately informed about allergenic ingredients, or the risk of cross-contact when kitchen utensils used to prepare food may have been in previous contact with an allergenic food. the problem may be compounded when customers have a hard time describing their food allergies or when wait staff have a hard time understanding those with food allergies when taking an order. diagnosing issues there exists both over-reporting and under-reporting of the prevalence of food allergies. self-diagnosed perceptions of food allergy are greater than the rates of true food allergy because people confuse non-allergic intolerance with allergy, and also attribute non-allergy symptoms to an allergic response.