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When all birch allergic subjects are excluded from the population (Table?3), hazelnut and peach remain among the four most common food sensitizations and in Italy, where sensitization to birch is relatively rare, ALK the prevalence of apple sensitization is still the third highest of the 11 countries studied. For any form of sensitization, the main potential drivers can be broadly classified as genetic susceptibility, exposure to the allergen and exposure to other environmental factors that make people more or less likely to become sensitized to a food that they are exposed to. There is little evidence on the genetic determinants of sensitization to foods, although there have been some analyses (16). It is unlikely that these will have a major impact on local prevalence of disease. Risk ratios for individual polymorphisms are typically small, and although variation in genotypes between populations is well recognized, such variation would have to be large to have a major impact on local prevalence. In addition, the large increase in sensitization to common aeroallergens over the last 50?years (5, 6) suggests that the genotype of most populations is permissive Pazopanib datasheet of the sensitization of a large part of the population given conductive environmental circumstances. The role of allergen exposure has been much less emphasized in recent years as it is clearly possible for large parts of the population to remain unsensitized in the presence of large quantities of allergen. The clearest example is presented by children Regorafenib clinical trial brought up on farms with very high exposure to grass pollen allergens, who are nevertheless less likely to be sensitized to grass pollen (17). However, in those who are exposed, the allergens that people are sensitized to will be those that they are more likely to encounter, at least in moderate doses. In places where house dust mites are rare, such as most of Sweden, sensitization to house dust mites also tends to be rare. In the data reported here, there is a similarity in the rankings of the foods within each country that is greater than would be expected by chance (P?