Childhood Food Allergies: Current Diagnosis, Treatment, and Management Strategies

Abstract

Food allergy is a growing public health concern in the United States that affects an estimated 8% of children. Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a specific food. Nearly 40% of children with food allergy have a history of severe reactions that if not treated immediately with proper medication can lead to hospitalization or even death. The National Institute of Allergy and Infectious Diseases (NIAID) convened an expert panel in 2010 to develop guidelines outlining evidence-based practices in diagnosing and managing food allergy. The purpose of this review is to aid clinicians in translating the NIAID guidelines into primary care practice and includes the following content domains: (1) the definition and mechanism of childhood food allergy, (2) differences between food allergy and food intolerance, (3) the epidemiology of childhood food allergy in the United States, (4) best practices derived from the NIAID guidelines focused on primary care clinicians' management of childhood food allergy, (5) emerging food allergy treatments, and (6) future directions in food allergy research and practice. Articles focused on childhood food allergy were considered for inclusion in this review. Studies were restricted to the English language and to those published within the past 40 years. A cross-listed combination of the following words, phrases, and MeSH terms was searched in PubMed and Google Scholar to identify relevant articles: food allergy, food hypersensitivity, child, pediatric, prevalence, and epidemiology. Additional sources were identified through the bibliographies of the retrieved articles.

Determination of Crucial Immunogenic Epitopes in Major Peanut Allergy Protein, Ara h2, via Novel Nanoallergen Platform

“…Type I hypersensitivity is caused when an allergen binds multivalently to allergen specific IgEs bound to Fc epsilon receptors (FcεRIs) present on the surface of mast cells or basophils, causing receptor clustering and culminating in degranulation. While only 3% percent of adults suffer from food allergies, 8% percent of children under four years of age have a food allergy 1, 2 . Consequently, food allergies are a rapidly growing problem in developed nations, resulting in a dire need for more accurate and information-rich diagnostic testing and therapeutic options 3, 4 .…”

The Molecular Basis of Peanut Allergy

“…In fact, approximately 50 % of peanut-allergic patients have positive skin prick tests to other legumes, but less than 5 % are clinically symptomatic upon ingestion of legumes [35]. Without a good medical history and a food challenge, it is increasingly difficult to assign accurate food avoidance diets and often leads to unnecessary blanket elimination diets [36]. These types of widespread dietary avoidance are very difficult for the patient and their families [36].…”

“…Without a good medical history and a food challenge, it is increasingly difficult to assign accurate food avoidance diets and often leads to unnecessary blanket elimination diets [36]. These types of widespread dietary avoidance are very difficult for the patient and their families [36]. …”

Diagnosis of food allergy: History, examination and in vivo and in vitro tests

“…[12] Blind testing without sus picion of a reaction to a specific allergen is not advocated -findings are often misleading as they indicate asymptomatic sensitisation alone. [13] Tests for sensitisation to foods should not be performed when history indicates that those foods are tolerated.…”

“…Cut-off values for the 95% positive predictive values of a clinical reaction to common food allergens are given in Table 3, but may be population specific. [13] Purified recombinant allergen-specific IgE tests against individual major allergen components in food may improve the diagnosis of clinical allergy and differentiate true food allergy from cross-reactivity. Certain component allergens are correlated with persistence of food allergy (e.g.…”