PETALING JAYA: Going by the numbers, the picture isn’t pretty.
An estimated 33 million Americans have to put up with at least one food allergy, says the American Pharmacists Association.
Closer to home, Singapore has found that food allergies in children are on the rise, with more cases of adverse reactions to food such as egg and peanut.
The National University Hospital attended to an increasing number of children with food allergies – from about 300 in 2014 to 10,000 in 2022, according to a report in The Straits Times.
In Malaysia, doctors say that food allergy is no longer just a childhood “phase” or a minor rash after a meal.
As an increasing number of cases is identified in clinics, medical professionals believe that Malaysia must enhance public awareness and improve food labelling to better protect individuals who are at risk.
Malaysian Medical Association (MMA) president Datuk Dr Thirunavukarasu Rajoo said the global direction is clear, even if Malaysia’s local numbers are not.
“Internationally, there is strong evidence that food allergies are increasing, and Malaysia is likely experiencing a similar trend,” he said, adding that more awareness and diagnoses led to the identification of more cases.
But the country still lacks solid epidemiological data.
“Unfortunately, local epidemiological data remains limited, highlighting the need for more research in this area,” he said.
Dr Thirunavukarasu acknowledged that Malaysia has evidence-based guidance for doctors, including the Malaysian Allergy Prevention (MAP) Guidelines for Healthcare Professionals (second edition) and the Guidelines for the Diagnosis and Management of Cow’s Milk Protein Allergy (CMPA) in Children 2024 (second edition).
“These evidence-based guidelines are widely used by doctors in both public and private healthcare settings,” he said.
Tracking severe reactions, however, remains a major gap.
“There is currently no comprehensive national data on the frequency of severe allergic reactions or anaphylaxis triggered by food in Malaysia. The absence of a formal reporting or registry system makes it difficult to determine trends,” he said.
In daily practice, doctors see common triggers that mirror international patterns.
“Common food allergens include peanuts and tree nuts, eggs, milk, wheat- or gluten-containing products, fish, shellfish and other seafood,” he said.
On the consumer side, Dr Thirunavukarasu said Malaysia has allergen labelling requirements under the Food Act and Food Regulations 1985, and established manufacturers generally comply.
The challenge, he said, is consistency across the wider market.
He said MMA would like to see stronger public education on recognising food allergies and early symptoms of severe reactions, as well as better awareness among food manufacturers.
“In schools, standardised policies for managing children with food allergies, staff training and emergency preparedness are important,” he said.
In response to a question, Dr Thirunavukarasu said doctors and allied health professionals are trained to recognise and manage allergic reactions, including severe ones, and that early action can be lifesaving.
“Prompt recognition and appropriate emergency management are part of standard medical training,” he said.
Consultant allergist and immunologist Prof Datuk Dr Kent Woo of Gleneagles Kuala Lumpur said clinicians are seeing food allergy as part of a broader rise in allergic disease, including eczema, asthma and allergic rhinitis.
One early marker, he said, is eczema, which should not be dismissed as “just skin”.
“When the skin barrier is damaged, it’s like a house with the gate open, the doors open, and the windows open. All can enter,” he said.
There is a lack of nationally representative studies on food allergy prevalence in Malaysia, but going by the Asia-Pacific benchmarks and local clinical patterns, Dr Woo estimates around 5% of Malaysian children have food allergies, with the risk higher among children with moderate to severe eczema at about one in 10.
“Around 5% of Malaysian children have food allergies, but in children with eczema, that risk doubles to one in 10,” he said.
Egg and cow’s milk, he said, remain common triggers in younger children, while peanut allergy is being seen more often than in the past.
In older children and adults, seafood, especially shellfish and prawns, is a prominent trigger.
Prevention advice has also shifted, Dr Woo said.
“Early introduction of allergenic foods, even in high-risk infants, helps train the immune system toward tolerance rather than allergy,” he said.
He cautioned against broad testing and unnecessary food avoidance, especially in children with persistent eczema.
“Indiscriminate allergy testing can lead to false positives, unnecessary food avoidance, and increased risk of new food allergies,” he said.
For those with confirmed allergies, Dr Woo said avoidance remains essential, along with an emergency plan and knowing when to use an adrenaline auto-injector.
