Landmark four-year joint study led by NUH and NUS Medicine, in collaboration with KKH, NUP and SSHSPH, is the first and largest to involve over 2,000 children in addressing food allergies

SINGAPORE (26 June 2025) - A group of clinicians and researchers from the National University Hospital (NUH), Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), KK Women’s and Children’s Hospital (KKH), National University Polyclinics (NUP) and NUS Saw Swee Hock School of Public Health (SSHSPH) are embarking on a four-year joint study to determine the prevalence and impact of food allergies in Singaporean children this year.

Rising burden of food allergies

Food allergy is a condition with no definitive cure apart from natural outgrowing. Parents of children with food allergies may face significant challenges, including anxiety, hyper-vigilance, and stress. Accidental exposure to allergens is common and may lead to life-threatening reactions.

NUH and KKH have reported a steady rise in paediatric food allergy cases seen at their clinics, with common allergens being eggs, milk, and peanuts in younger children, and shellfish in adolescents and young adults. In both NUH and KKH, the number of day therapy sessions (food challenges¹) performed in children has risen by 60 per cent in 2022 to 2024. While this may reflect increasing awareness and concern among parents, it potentially highlights food allergy as an emerging condition in Singapore.   

The Singapore Food Allergy Story: A two-phase study

The Singapore Food Allergy Story will be the first and largest study to provide a holistic overview of the burden of food allergies in Singapore. It aims to determine the current prevalence among Singaporean children, as well as the impact on nutrition, growth, metabolic and mental health outcomes, providing insights into the nutritional and psychosocial burden of food allergy.

This study will provide an update to existing data on food allergy prevalence, and for the first time, evaluate the impact, as well as the social and economic burden, of food allergies in Singapore. With these new insights, the hope is to bring greater social and infrastructural support for affected children and families. The study consists of two years of recruitment and two years of data analysis.

The first phase, which began in February 2025, will survey at least 2,000 parents and caregivers of children aged 12 to 24 months attending routine developmental and immunisation visits at polyclinics under NUP. Parents will be asked to complete questionnaires and those reporting possible allergic reactions to food will be referred to NUH or KKH for further evaluation.

The second phase, beginning in July 2025, will involve approximately 400 children aged 0 to 18 years with diagnosed allergies to milk, egg, peanut and shellfish for at least six months. Participants from the first phase of the study and existing NUH and KKH patients will be invited to take part in this study phase, which will include questionnaires, growth and nutritional assessments, as well as blood and stool collection.

The study findings will help to identify nutrient deficiencies, growth and metabolic abnormalities, and feeding behavioural issues, which will inform future guidelines and educational materials on nutrition, dietary management, as well as mental health support for affected families.

The team is also working with parent support groups like the Singapore Parents of Eczema and Allergy Kids (SPEAK) to prioritise patient-relevant outcomes.

Creating a safer environment for individuals with food allergies

Associate Professor Elizabeth Tham, Lead Principal Investigator, said: “With this research, we hope to deepen our understanding of food allergies and their broader impact. Our goal is to create a safer environment for children with food allergies, enabling them to reach their fullest potential at school and work. Additionally, we aim to improve mental health and overall well-being, especially for older children and adolescents.” A/Prof Tham is the Head & Senior Consultant, Division of Paediatric Allergy, Immunology & Rheumatology, Department of Paediatrics, Khoo Teck Puat – National University Children's Medical Institute, NUH.

Co-Investigator Dr Chong Kok Wee, Head and Senior Consultant, Allergy Service, Department of Paediatric Medicine, KKH, said: “At KKH, we have seen a concerning upward trend in food allergy cases in recent years, making this research a critical step to address the issue. As the first and largest study of its kind in Singapore, this study marks a significant milestone in our nation’s approach towards understanding and managing the impact of food allergies in children. By examining the medical and psychosocial aspects of food allergies, the findings from this research will serve as an instrumental guide for us to establish evidence-based strategies to enhance the quality of life for children living with food allergies and provide better guidance for healthcare professionals managing these allergies.”

Dr Abiramy D/O Anathan, Clinician Lead, Paediatrics, and Consultant, Family Physician, NUP, said: “As NUP embarks on this important research initiative with NUH and KKH, we are optimistic that the outcomes from the Singapore Food Allergy Story will play a crucial role in exploring viable solutions and ultimately improving the quality of life for children suffering from food allergies. The increased number of food challenge sessions we have witnessed in NUP reflects a growing recognition of the importance of effective management strategies. I believe that the findings from this study will be invaluable in shaping our approach to management, support, and education for families navigating the complexities of this chronic condition. We look 3 forward to seeing positive changes through our collective efforts in enhancing safety and support for these children.” Dr Abiramy is also Head of Clementi Polyclinic.

This research is supported by the Singapore Ministry of Health through the National Medical Research Council (NMRC) Office, MOH Holdings Pte Ltd, under the NMRC Population Health Research Grant (MOH-001637).

Annex A – Background on the prevalence of food allergies in Singapore

Previous clinical cohort studies in Singapore established more than 10 years ago indicated that food allergy prevalence was low at that time. One of the earliest studies in 2008 found that peanut anaphylaxis was mostly seen only in expatriate patients in Singapore, and that adrenaline autoinjectors prescribed for anaphylaxis was very uncommon (0.01%).² Bird’s nest was also the top trigger for food anaphylaxis in Singapore and peanut/treenut allergies were extremely uncommon.³ There were no population studies on FA prevalence during that period.

Subsequently, the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study (recruited between 2009 to 2011) reported an overall prevalence of parent-reported food allergies of 2.9% (26 of 902) at 12 months and 2.7% at 18 months. Egg was the predominant allergen below 2 years and peanut allergy was still uncommon. Another cross-sectional study of 4,115 children aged 11 to 30 months recruited from polyclinics and well-baby clinics between 2011-2013 (completed data collection in 2015) showed that the self-reported prevalence of cow’s milk, hen’s egg, and peanut allergy were 0.51%, 1.43%, and 0.27% respectively at that time.⁴

In a 2016 KKH study, food triggers were found to be the most common cause of anaphylaxis across all age groups, but particularly in children.⁵   

Annex B – Posters on the Singapore Food Allergy Story

Poster for patients and public information regarding first phase of the study

Poster for patients and public information regarding second phase of the study

¹ Oral food challenges are clinical evaluations of food allergy status, where patients are exposed to specific allergens under the supervision of clinically trained staff.
² Tham EH, Tay SY, Lim DL, et al. Epinephrine auto-injector prescriptions as a reflection of the pattern of anaphylaxis in an Asian population. Allergy Asthma Proc 2008; 29: 211-215. 2008/04/24. DOI: 10.2500/aap.2008.29.3102.
³ Shek LP and Lee BW. Food allergy in children-the Singapore story. Asian Pac J Allergy Immunol 1999; 17: 203-206. 2000/03/04.
⁴ Lee AJ, Tham EH, Goh AEN, et al. Prevalence of IgE-mediated cow milk, egg, and peanut allergy in young Singapore children. Asia Pac Allergy 2022; 12: e31. 2022/08/16. DOI: 10.5415/apallergy.2022.12.e31.
⁵ Ganapathy S, Lwin Z, Ting DH, et al. Anaphylaxis in Children: Experience of 485 Episodes in 1,272,482 Patient Attendances at a Tertiary Paediatric Emergency Department from 2007 to 2014. Ann Acad Med Singap 2016; 45: 542-548. 2017/01/08.