For children who were ≤5 years old as of the end of the year, only 3 major food allergens (eggs, milk, and wheat) and foods for which there was a previous history of FA were evaluated. All kinds of foods which were suspicious for FA or had not been eaten yet were evaluated in children who were ≥6 years old as of the end of the year. The secondary survey consisted of a detailed medical interview by doctors located on the islands. The secondary and third surveys were conducted between August 2014 and February 2015. Children with positive responses regarding current reactions and avoiding foods proceeded to the secondary survey. The primary questions included those regarding the history of FA, foods to which there were current reactions, and foods currently avoided. The questionnaire collected information regarding the number of older siblings, length of time living in the islands, history of exclusive breast-feeding, history of infantile eczema, history of other allergic diseases, and family history of allergic diseases. The parents completed the questionnaire when the parents might not have been aware of their child's FA symptoms, the child was consulted.
The distribution, response, and collection of the questionnaires occurred in July 2014 at each institution or by mail for children younger than preschool age. To determine patients with suspected FA, a primary survey was conducted via a questionnaire among all children aged 0-18 years (high school students and younger) in Niijima village. Therefore, this study aimed to identify the prevalence of FA and to determine the proportion of children who unnecessarily eliminate food in Niijima village. Because the movement of the population on these islands is relatively limited, the authors believed that identification of the true prevalence of FA, based on a census survey, was possible.
Of the approximately 3,000 people living in Niijima village, 12.9% are younger than 18 years old. Because essential food items are transported from the mainland to the islands by ship, the foods and daily eating habits are similar to those of the mainland. Niijima village, which consists of uninhabited islands and 2 inhabited islands named Niijima and Shikinejima, respectively, is located 160 km south of mainland Japan and accessed primarily by a daily ship or airplane.
The first author of this article, who worked as a physician in Niijima village from 2014 to 2016, was under the impression that food might be unnecessarily avoided by children. 4 reported that many studies of the prevalence of FA have been based only on perception of food reactions, and compared with studies that include objective diagnostic tools, most of these studies seem to have overestimated the prevalence of FA. 1, 2 However, the true prevalence of FA, as based on an oral food challenge test (OFC), is relatively unknown. An increasing prevalence of food allergy (FA) has recently been reported among children.
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