An experience estimating food allergy prevalence in Mexican adults: Going beyond self-report

Dear Editor, We appreciate the response from Morales-Romero and colleagues to our correspondence. We agree that cross-sectional surveys, supported by strict definitions, are a cornerstone for epidemiological studies of immediate-type food allergy (FA). In our opinion, well-designed surveys not only serve as the first line for highlighting the magnitude and relevance of the problem in areas where FA testing and diagnosis are not feasible at the population level but also lay the groundwork for epidemiological studies based on objective diagnostic criteria 1–4. In this context, it should be acknowledged that achieving clinical confirmation of the suspected FA cases remains a fundamental goal to bridge the gap between perceived and confirmed FA prevalence, a challenge observed globally 5,6. Consistent with our previous statement, we would like to clarify that, although Morales-Romero et al. 7 addressed adverse food reactions as a broad category, our research focused specifically on immediate-type reactions, aiming to confirm sensitization to the suspected foods through objective clinical criteria. The findings regarding skin prick testing, outlined in our previous communication, represent our research group’s first attempt to move beyond cross-sectional surveys and highlight the significant methodological and logistical barriers encountered when transitioning from self-reported data to confirmed clinical outcomes in our region. Certainly, evaluating all adverse events covered under the adverse food reaction umbrella in future research will provide a more comprehensive view of the FA burden in Mexican populations. This task represents a significant challenge that will require the use of validated instruments based on strict definitions. Finally, our previous communication highlights the need to implement effective strategies to reduce attrition rates during confirmatory diagnostic phases in FA prevalence studies. While surveys generate valuable population-level insights, FA prevalence estimates based on objective diagnostic criteria are needed in Mexico and other countries. Such evidence is essential for driving public policy changes for the benefit of those who live with FA or are responsible for food-allergic individuals. Conflicts of interest The authors have no financial conflicts of interest. Author contributions Conceptualization: Jesús G. Arámburo-Gálvez and Noé Ontiveros. Investigation: Lizbeth Vizcarra-Olguin, Oscar G. Figueroa-Salcido, and Juancarlos M. Velásquez-Rodríguez. Methodology: Lizbeth Vizcarra-Olguin and Oscar G. Figueroa-Salcido. Validation: Juancarlos M. Velásquez-Rodríguez. Project administration: Noé Ontiveros. Supervision: Jesús G. Arámburo-Gálvez. Writing—original draft: Jesús G. Arámburo-Gálvez and Noé Ontiveros. Writing—review and editing: Lizbeth Vizcarra-Olguin, Juancarlos M. Velásquez-Rodríguez, and Oscar G. Figueroa-Salcido.