Pathogenesis of Food Allergy in the Pediatric Patient

Abstract

In the US and other developed countries, food allergy is a growing epidemic in pediatric populations with a substantial impact on health-related quality of life. As such, there are great efforts underway to unravel the mechanisms of oral mucosal tolerance and to better define the factors related to host and allergen exposure that contribute to the aberrant immune response leading to sensitization and clinical food allergy. Although more research is needed to eventually develop targeted treatment and prevention strategies, this review highlights our current understanding of the pathogenesis of IgE-mediated food allergy.

Food Components and the Immune System: From Tonic Agents to Allergens

“…These molecules may induce the expression of chemokines and inflammatory cytokines resulting in the recruitment of neutrophils, monocytes, and DC precursors from the circulation. The homeostatic balance in the gut can be altered by several factors in the intestine and when disrupted can result in a breach in oral tolerance and consequently in allergic sensitization to food proteins (Chin and Vickery, 2012). …”

“…Genetic factors play a significant role in the predisposition to food allergy. It is demonstrated the occurrence of family history in food allergic patients, high rates of peanut allergy among monozygotic twins, and racial/ethnic determined predispositions (Chin and Vickery, 2012; Kumar et al, 2012). Although the genetic susceptibility clearly participates in the development of food allergy, environmental factors also contribute to the rapid increase in the prevalence of this disease.…”

“…It is known that the food allergens present structural and functional characteristics that play a significant role in determining their ability to trigger allergic responses. Among these characteristics we can mention the small molecular weight, presence of glycosylation residues, lipid binding, and resistance to heat and digestion which ensure the maintenance of the allergenic potential of the protein upon reaching the small intestine (Chin and Vickery, 2012). …”

Patterns of allergen sensitization and self-reported allergic disease in parents of food allergic children

“…1,2 While the cause for this increase in food allergy has not yet been elucidated, an interaction between genetic and environmental factors including the timing and route of allergen exposure has been implicated. 3-7 Sensitization, or presence of allergic antibody, is a prerequisite for development of an allergic response to an allergen. Patterns of sensitization to environmental and food allergens have previously been studied in children in an effort to better understand allergy development.…”

Food Allergy Diagnosis and Therapy: Where are we Now?

“…Defined as an immune response to a given food that occurs reproducibly upon exposure [1], FA affects anywhere from 1 to 10% of the population, with greater prevalence in children (4–6% in the USA vs ~2% in adults) [2]. This prevalence has been increasing at a rapid rate, as has been demonstrated by data from the USA [3], UK [4], Australia [5] and China [6]. Despite this burden, the only currently accepted treatment for FA is complete avoidance of the offending allergen, with epinephrine delivered in the case of accidental ingestions – which occur frequently, even in the most careful patients, and are often undertreated [7,8].…”