The EPIFA study investigated the epidemiology of pediatric food allergy (FA) in Italy from 2009 to 2021. A retrospective cohort study was conducted with family pediatricians in the Campania region, involving 105,151 children aged 0-14 years. Data from 752 FA patients were analyzed, showing a significant increase in both incidence and prevalence of FA over the study period, with a relative increase of 34% and 113.6%, respectively. The most frequent allergens were cow's milk, hen's egg, and nuts. The prevalence of FA was highest in children aged ≤3 years, with a relative increase of 120.8%. The study highlights the need for new strategies to prevent and manage FA, as the results indicate a growing trend in FA among Italian children. The study also found that 51.9% of children achieved immune tolerance, suggesting a need for longer follow-up. The results are consistent with other studies showing an increase in FA prevalence globally. The study's limitations include the focus on a single region and potential selection bias. Overall, the EPIFA study provides important data on the epidemiology of FA in Italy, emphasizing the importance of updated public health strategies for FA prevention and management.The EPIFA study investigated the epidemiology of pediatric food allergy (FA) in Italy from 2009 to 2021. A retrospective cohort study was conducted with family pediatricians in the Campania region, involving 105,151 children aged 0-14 years. Data from 752 FA patients were analyzed, showing a significant increase in both incidence and prevalence of FA over the study period, with a relative increase of 34% and 113.6%, respectively. The most frequent allergens were cow's milk, hen's egg, and nuts. The prevalence of FA was highest in children aged ≤3 years, with a relative increase of 120.8%. The study highlights the need for new strategies to prevent and manage FA, as the results indicate a growing trend in FA among Italian children. The study also found that 51.9% of children achieved immune tolerance, suggesting a need for longer follow-up. The results are consistent with other studies showing an increase in FA prevalence globally. The study's limitations include the focus on a single region and potential selection bias. Overall, the EPIFA study provides important data on the epidemiology of FA in Italy, emphasizing the importance of updated public health strategies for FA prevention and management.