Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

Abstract

This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.

Alergija na hranu u dečjoj dobi – klinički aspekt

“…Alergija predstavlja čest i kontinuirano rastući oblik nepodnošenja hrane u dečjoj dobi [1][2][3][4][5]. Znatno je učestalija u razvijenim u odnosu na zemlje u razvoju [6,7].…”

“…Znatno je učestalija u razvijenim u odnosu na zemlje u razvoju [6,7]. Generalno gledano, sreće se kod 2-8% dece i to uglavnom u dobi odojčeta i malog deteta [4][5][6][8][9][10]. Poremećaj je najčešće prolaznog karaktera i primarno pogađa nasledno predisponiranu decu, a posebno odojčad u prvom polugođu po rođenju i na veštačkoj ishrani ili dohrani [6,[11][12][13].…”

Evidence for a Role of TGF-β-Activated Kinase 1 and MAP3K7 Binding Protein 3 in Peanut-Specific T-Cell Responses

“…Especially children are in danger of anaphylaxis to low amounts of allergen. They contribute significantly to the frequent attendance at the emergency rooms due to unintentional ingestion of foods contaminated by hidden allergens [4-6]. The pathomechanisms that contribute to the development and maintenance of PA involve antigen-presenting cells, mast cells, T cells, and B cells [7, 8].…”

Ara h 1 and Ara h 6 Sensitization Causes Clinical Peanut Allergy in Ara h 2-Negative Individuals

“…Peanut allergy is one of the most common food allergies, with a prevalence of approximately 1% in the general population, and recent studies have suggested that its prevalence is on the rise [1]. Peanut allergy is more persistent than other food allergies, and resolution is only seen in 20% of cases, unlike many other food allergies that are usually outgrown by the age of 16 years [2–5].…”