Leung A.S.y.Estrada-Reyes E.Goto K.Huang C.H.Li J.M.Nagarajan S.A.Ranasinghe T.Sato S.Srisuwatchari W.Zepeda-Ortega B.Tham E.H.Mahidol University2025-12-112025-12-112025-12-01Pediatric Allergy and Immunology Vol.36 No.12 (2025)09056157https://repository.li.mahidol.ac.th/handle/123456789/113452This review examines the evolving global landscape of food-induced anaphylaxis (FIA), revealing critical epidemiological shifts that challenge traditional allergen management paradigms. As the leading cause of anaphylaxis worldwide, FIA demonstrates striking geographic, age-specific, and temporal patterns that reflect broader changes in dietary practices, environmental exposures, and food production systems. Emerging trends reveal novel allergen sources that evade current regulatory frameworks, including non-priority legumes, edible insects and galacto-oligosaccharides with distinct cross-reactivity patterns and the expanding prevalence of buckwheat, tree nut and seeds anaphylaxis. Complex syndromes such as lipid transfer protein syndrome, tick-borne α-Gal syndrome and food-dependent exercise-induced anaphylaxis represent diagnostic challenges requiring heightened clinical suspicion. Critical knowledge gaps remain in certain regions where limited surveillance, inadequate adrenaline access, and uncharacterized regional allergens create substantial management disparities. The review emphasizes urgent needs for comprehensive global surveillance networks, precision diagnostic tools for atypical presentations, expanded allergen labeling policies encompassing novel proteins, and equity-centered interventions addressing geographic disparities in emergency treatment access. (Figure presented.).MedicineMedicineImmunology and MicrobiologyReviewSCOPUS10.1111/pai.702462-s2.0-1050235930311399303841332221