Big-time sensitization rates in young Germans: big numbers--big risks--big confusion?

(e.g. the extent of indoor/outdoor living, pets and eating habits). The number of underlying variables is constantly growing, and this hampers comparisons between epidemiological studies on different regions. Even more important, employing diagnostic extracts as tools for detecting allergic sensitizations (by skin prick test or serum IgE) carries inherent problems and can create misleading results: (1) The peanut sensitization rate of 10.6% in the whole German cohort (age 3–17 years) is mainly driven by prevalent Bet v 1-related cross sensitizations to peanut allergen Ara h 8. This is presumably far beyond the much lower sensitization rate to ‘classical’, stable peanut allergens like Ara h 1, 2, 3 and 6 being associated with severe systemic symptoms. The same applies to soy (sensitization rate 6.3%) due to its Bet v 1 homologue Gly m 4 and the well-defined Bet v 1-cross-reactive foods like raw carrots, apples and potatoes with impressive sensitization rates of 9.7, 9.2 and 8.4%, respectively. (2) Rates of high sensitization to rye (21.2%), wheat (9.9%) and rice (7.2%) are potentially misleading and are probably due to cross-reactive grass pollen allergens (e.g. Timothy grass pollen 22.7%), including cross-reactive carbohydrate determinants. (3) Pollen sensitization rates (e.g. Timothy grass 22.7%, birch 14.1% and mugwort 10.9%) can be disputed for as Welcome to well-powered data from wealthy Germany: almost 13,000 children and adolescents have been screened for serum IgE to 20 common inhalants and foods [1] . The nonselective design, a truly representative cohort, its huge sample size and appropriate statistics generated robust results. Sensitization rates based on allergen-specific serum IgE ≥ 0.35 kU A /l to one or more allergen sources range from 29% in the youngest group (i.e. age 3–6 years) to 46.5% in the oldest group (14–17 years), this latter group being composed of 42% atopic girls and 51% atopic boys. Extrapolate this into the future beyond adolescence – Yes, these are big numbers! What are they good for? (1) They can provide trustworthy population-based information for everybody: doctors, scientists, the media, the general population, health-care stakeholders and politicians. (2) Allergen manufacturers, diagnostic companies and industry will also be keen to dig into this data pool. (3) Epidemiologists wanting to compare these statistics will look for similar cohorts or age groups and comment on these truly ‘epidemic’ results from Middle Europe. However, extrapolations of any kind are not without some risks. There are major geographical differences due to variations in climate, natural allergen exposure (pollen, outdoor molds and food availability) and lifestyle factors Published online: November 16, 2013