Food Allergy

Abstract

Food allergy has recently become more common. There is no curative treatment for food allergy and management relies on allergen avoidance and emergency treatment of accidental allergic reactions. Food allergy can have a significant impact on the lives of patients and their families and an accurate diagnosis is, therefore, of utmost importance. A food allergy‐focused clinical history, together with evidence of allergen‐specific IgE, can be enough to confirm or exclude the diagnosis of food allergy; however, in the equivocal cases, exposure to the allergen in a controlled environment in hospital, called oral food challenge (OFC), is required. New tests are being developed to reduce the number of patients that need OFCs. Allergen‐specific immunotherapy has shown to reduce patients' sensitivity to the allergen but the majority of treated patients still remain food allergic. In the absence of a definitive treatment, prevention of food allergy is key. Key Concepts Food allergy prevalence is increasing, affecting about 7% of children and 2% of adults, with cow's milk, egg, peanut, tree nuts, sesame, fish and shellfish constituting more than 90% of food allergies in children. Risk factors for food allergy are atopic eczema, family history of atopic diseases, black or Asian ethnicity, less diverse diet, low serum vitamin D and filaggrin loss‐of‐function mutations. The diagnosis of food allergy is usually based on a combination of clinical history and evidence of allergen‐specific IgE, with oral food challenges being reserved for the equivocal cases. There is no curative treatment for food allergy; management consists of allergen avoidance and emergency treatment plan for accidental allergic reactions. Allergenic foods should be introduced in the diet at the time of weaning. Early peanut consumption in the first year of life can prevent the development of peanut allergy at school age.

Allergen immunotherapy for food allergy: Evidence and outlook

“…Oral immunotherapy (OIT) involves administering increasing doses of an allergenic food via the oral route with the aim to increase the threshold of reaction in patients with persistent food allergies [ 6 , 9 ]. However, the ability of OIT to induce sustained tolerance when the treatment is stopped seems limited at present.…”

“…SLIT involves administering increasing doses of an allergenic food via the sublingual route [ 6 ]. Data on SLIT effectiveness and safety in the literature are scarce.…”

“…This practice was reported for the first time in 1908 for hen’s egg allergy [ 5 ]; however, since then, several routes of food allergen administration have been investigated (e.g., oral, sublingual, epicutaneous, and subcutaneous). It is apparent that the different amount of allergen utilized, depending on the administration route, is associated with different effectiveness and rate of adverse events [ 6 ] ( Table 1 ).…”

Netherton Syndrome in Children: Management and Future Perspectives

“…NS can be associated with food allergies, which may be severe (71,72) and need proper management (73)(74)(75)(76). Specific oral tolerance induction could be used with an improved outcome in these patients in which an allergy is included in a broader genetic disorder (77,78).…”

Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

“…The worldwide prevalence of allergic disease has increased over the last decades (1,2). Among allergic diseases, food allergy (FA) represents a major public health concern as the leading cause of anaphylaxis in the pediatric population (3)(4)(5)(6) and and being associated to a higher risk of severe forms in asthmatic children (7).…”