Food allergy: manifestations, diagnosis and management

Abstract

Adverse reactions to food are common but only a fraction of them are due to hypersensitivity (or allergy). Of the latter, immunoglobulin (Ig)E-mediated reactions appear to be the most common and best understood. A wide variety of manifestations may affect various body systems, particularly the gastrointestinal tract, skin and respiratory tract. Diagnosis depends primarily on thorough medical history, often supplemented by skin testing or specific serum IgE antibody measurement. Verification would require appropriately designed challenge testing. At present, treatment is primarily strict avoidance of the offending food, together with crossreacting other foods. Several immunomodulatory therapeutic agents are being explored. A few studies demonstrated a potential benefit of probiotics for prophylaxis and treatment. A multicenter study is currently investigating the efficacy and safety of anti-IgE in subjects with peanut allergy. Experimental studies in mice revealed preliminary findings that promise vaccine development using novel approaches, such as modified food allergen epitopes, immunostimulatory sequence-conjugated allergens and chimeric proteins capable of complexing with IgE or its receptors.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…In infants under 6 months, the majority of allergic reactions are due to milk or soya. Over 50% of infants with cowsÕ milk allergy suffer from rhinitis (521). In adults, the most common food allergens causing severe reactions are peanuts (522), tree nuts, fish, crustacea, eggs, milk, soyabeans, sesame, celery and some fruits like apples and peaches (for review see Ref.…”

Pediatric food allergy update

“…The medical history can be very valuable in suspecting FA and, in some cases, may be convincing enough to settle the diagnosis. However, the history is often inconclusive, and selected screening tests are necessary (Table 3) [47]. Elevated total serum IgE level and eosinophilia support atopy but normal values do not exclude allergy.…”