Background
There are increasing global data relating to prevalence of food allergy and food-induced anaphylaxis, however this is often based on surrogate measures of sensitization rather than objective symptoms at food challenge. In terms of protecting food-allergic consumers from reactions, there has been no global survey assessing geographical differences in the proportion of anaphylaxis triggered by specific foods.

Objective
To identify common triggers for food-induced anaphylaxis, and how these vary from country to country.

Methods
Systematic review of relevant reports published between January 2010 and November 2020. Results were reported following PRISMA guidelines. Publications were screened and data extracted by two independent reviewers, and risk of bias assessed.

Results
Sixty-five studies (encompassing 41 countries and all 6 regions as defined by the Food & Agriculture Organization of the United Nations) were included. Significant regional variations in the most common triggers of food-anaphylaxis were seen, however, in general there was good agreement between local legislative requirements for allergen disclosure and the commonest allergens for each region/nation.

Conclusions
Local legislation for allergen disclosure generally reflect those allergens commonly responsible for food-anaphylaxis. Cow’s milk and crustacea appear to be cause a higher proportion of anaphylaxis compared to peanut in some regions.