[Management of food allergy (Food allergy management 2005 by National Food Allergy Research Group)].
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Anaphylaxis↗
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[Parabirch allergy. Food allergy related to birch pollen].
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Adult↗
Food allergies, food intolerance and food-related anaphylaxis.
The incidence and complexity of allergic disease has increased dramatically in the UK in recent years. Existing services are inadequate and need to be expanded so that patients with complex allergic conditions can be treated by allergy specialists and members of the primary health care team can be given training to enable them to teat non-complex cases.
Anaphylaxis↗
Pediatric drug information: food allergies, food additives, and the Feingold diet.
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Child↗
In vitro testing in pediatric food allergy.
Food allergies are an important cause of morbidity in the pediatric population. We used a questionnaire to assess the value of in vitro testing in evaluating children for food allergy. The patient population was divided into two groups: those who tested positive (Class I or greater) for food allergy (combined food/inhalant allergy or food allergy alone) and those who tested negative for food allergy (inhalant only or negative test). Although we recognize that a significant proportion of food allergies may not be IgE-mediated, for the purposes of this study we considered a patient food allergy--positive if in vitro testing was positive and food allergy--negative if testing was negative. Thirty-eight of 77 patients tested (49%) were positive for food allergies. Those with food allergies did not have pretreatment scores significantly different from those of patients negative for food allergies (55 vs. 65, p = 0.11). Similarly, we detected no statistically significant difference between the symptom-improvement scores of the two groups (37 vs. 40, p = 0.57). We conclude that in vitro testing for food allergies is warranted in children with allergic symptoms, for several reasons: The prevalence of IgE-mediated food allergy in children may be higher than previously thought, and children with food allergies experience the same severity of symptoms as those without. It must be remembered that in vitro testing only detects IgE levels, and therefore a negative test does not mean that the patient does not have food allergies. However, when positive, in vitro testing gives the physician the opportunity to modify the treatment plan, helping avoid time-consuming and demanding oral food challenges. Our questionnaire also showed that food allergy and non-food allergy patients had similar pretreatment and posttreatment symptom scores.
Adolescent↗
[Food allergies].
Food allergies are not a phenomenon of our time. The public and published opinion characterize food allergies as an accompanying symptom of our modern industrial society. However, many years before our time, Hippocrates (400 B.C.) and Lucrezius (1. Century A.D.) had described symptoms of illness which seemed to be due to food-allergies and intolerances. Today, allergies (especially food allergies) are often depicted as having increased excessively and that this increase seems to result from harmful substances in the environment, residues, food additives or may even be due to food manufacturing processes. It is estimated that the frequency of all types of allergic illnesses at this time in West-Germany is between 10-20 percent. Taking into consideration all degrees of difficulty, the number of people with food allergies lies under 10 percent of the population, although exact numbers in this area are missing. It is undisputed that food allergies are induced as a result of some of the foreign substances mentioned. However, the predominant share of food allergies occur as a result of natural food substances. The trend towards less processed foods has especially increased the risk of food allergies, since for example unmodified protein may contain more possible allergens than the corresponding protein which has been denatured by heating. The wide distribution of "new" foods from exotic countries and the enormous expansion in the variety of seasonings is also thought of as a cause for many allergies. One cause for more allergens reaching our abundantly set tables is the increased distribution and range of products resulting from expansion of national and international trade. Allergy, which to some extent is due to a malfunctioning immune system, activates certain defense mechanisms in the body. Food or more precisely its contents, then becomes an alien substance or antigen for the body against which it builds certain antibodies to "stay in a good state of health". These antibodies cause typical allergic reaction such as nausea, vomiting, diarrhea, urticaria and difficulty in breathing, after a certain food has been eaten. We must differentiate between food allergies and incompatibility (food intolerances). The body does not produce antibodies for the latter. Unlike food allergies, intolerances can disappear with time.
Food Hypersensitivity↗
[Food allergies].
Food allergy must have an immunological background. Till recently it was restricted only to the IgE mechanism, today we include also non-atopical reactions (in particular type III and IV according to Coombs and Gell). We speak of probable and possible food allergies. By differential diagnosis we must differentiate food allergies from food intolerance (e.g. enzyme deficiencies), food aversions (psychic factor) as well as toxic and pharmacological effects. There are more than 10% undesirable reactions in humans after ingestion of food but only every fifth (some 2% of the population have food allergies. The diagnosis is based above all on the case-history, subsequent elimination and exposure tests and examination by allergological tests, or examination of specific immunoglobulins E (IgE). The diagnosis is not always unequivocal--it is influenced among others by a different specificity and sensitivity of food antigens (allergens). The manifestations of food allergy are found at the site of action (mouth, GIT) or are systemic (respiration, cardiovascular system, skin etc.). A special type of food allergy is the oral alimentary syndrome, i.e. food allergy crossed with pollen hypersensitivity, described in the great majority of subjects sensitive to pollen. Food allergy has its specific age-conditioned and geographical features. In childhood sensitivity to the protein of cows milk, egg white but also soya or flour predominates, with advancing age allergies to nuts, fruit, vegetables, spices, cheese, sea foods increase. Food allergy can be a very early allergy (manifested already in infant age) but it is one of the few allergies which can also recede (incl. laboratory tests). Treatment is dietetic, the period of dietetic treatment depends on the type of food and the patient's age, not infrequently it must be lifelong. If diet does not suffice, preventive medication is used (sodium cromoglycate) or symptomatic (antihistamine preparations, corticosteroids, external agents etc.), in some countries specific immunotherapy is being tested.
Food Hypersensitivity↗
[Food allergy].
Food allergy (hypersensitivity) is a form of adverse food reaction in which the reaction is caused by an immunological response to a food. The majority of immediate allergic reactions to food are IgE-mediated. Although the true prevalence of food allergy is unknown, it is said to be higher in children than in adults. Data suggest that the prevalence in the general population is about 1%. In children the most common foods eliciting an allergic reaction are cow's milk, eggs, fish, peanuts and soy. In adults celery, fish, nuts, peanuts and shrimp are the major source of food allergy. Usually, food-allergic adults are sensitized to pollen, e.g. in the frame of the celery-carrot-mugwort-spice syndrome. There is some evidence that antigenic similarity exists between pollen and food proteins. Clinical signs and symptoms due to food allergy are cutaneous, respiratory, gastrointestinal reactions such as urticaria, laryngeal edema, asthma or diarrhea. Food anaphylaxis is the most severe generalized and sometimes fatal reaction. History, physical examination, skin tests and laboratory tests (RAST) provide the basic tools for identifying a food allergy. However, the "gold standard" for diagnosing allergic food reactions is the double-blind, placebo-controlled food challenge. The predictive accuracy of positive skin tests is less than 50%, as demonstrated by double-blind, placebo-controlled food challenges. The only proven form of management in food allergy is strict elimination of the offending food. Food-allergic individuals must be provided with an emergency kit containing an oral antihistamine of the second generation and a corticosteroid.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Proliferative responses of lymphocytes to food antigens are useful for detection of allergens in nonimmediate types of food allergy.
Food allergy is clinically classified into two types, immediate and nonimmediate. Radioallergosorbent test (RAST) is a sensitive procedure for the diagnosis of IgE-mediated hypersensitivity but not for other types of hypersensitivity. There is not yet a sensitive blood examination for detection of allergens in nonimmediate types of food allergy. Of the total number of subjects in our study, twenty-two children had nonimmediate types of food allergy (hen's egg, cow's milk, soybean, or buckwheat flour), atopic dermatitis, allergic tension fatigue syndrome or pulmonary hemosiderosis. For these children, manifestations of the allergy did not appear earlier than 2 hours after ingestion of the offending food. Eighteen children in the study developed acute urticaria, angioedema, or bronchial asthma appearing within 2 hours of the challenge. Fifteen nonatopic healthy children were selected as controls. Proliferative responses of peripheral blood mononuclear cells (PBMCs) to food antigens were measured in nonimmediate types of food allergy. The proliferative responses of PBMCs to each offending food antigen in patients with nonimmediate types of food allergy were significantly higher than those of healthy controls and patients with immediate types of food allergy, respectively. Moreover, in each case with nonimmediate type, the proliferative responses to food antigens other than the offending food were not detected. When PBMCs were twice stimulated with the offending food antigen, the same results were obtained. These results indicate that the proliferative response of PBMCs to food antigens is specific to each offending food antigen in nonimmediate types of food allergy. Taken together, proliferative responses of PBMCs to each food antigen are useful for detection of allergens in nonimmediate types of food allergy.
Adolescent↗
[Food allergy].
Food allergy is an important public health problem. The prevalence of IgE-mediated food allergy is estimated at 3.24% of French population. Clinical pictures are varied: atopic dermatitis, urticaria and oedema, asthma, rhinitis, anaphylactic shock. Their comparative frequencies change with age. The risk of fatal anaphylactic reactions (acute asthma, anaphylactic shock, laryngeal oedema) is underlined. The role of risk factors on expression of food allergy is important: exercise, concomitant intake of alcohol, aspirin NAIDS, beta-blockers or converting enzyme inhibitors. The modifications of food habits and of food allergenicity by agro-alimentary technology, the consumption of novel foods and masked allergens explain the present aspects of food allergy. The role of intestinal flora and early diversification of food influence the acquisition of tolerance. The diagnosis of food allergy depends of the expert appraisement of the allergologist. Oral challenge tests distinguish sensitisation from true food allergy. Treatment is based on targeted eviction diet. Contact with food allergen must be avoided by other way: skin (cosmetic), respiratory tract and drug intake. The control of risk factors is essential.
Allergens↗
Future approaches to food allergy.
Food allergy affects approximately 2% of the general US population, and its prevalence seems to be increasing. Despite the potential for a fatal outcome, no definitive therapies are available for food allergy. This article reviews novel approaches for the diagnosis and treatment of food allergy. Improved diagnostic methods include more precise in vitro and in vivo tests for immunoglobulin E-mediated food allergies, in vitro assays for predicting development of oral tolerance, and novel noninvasive tests for cell-mediated food allergies such as patch testing, cytokine assays, and detection of eosinophil activation markers. Several promising novel immunomodulatory approaches to food allergy are discussed, including monoclonal anti-immunoglobulin E; probiotics; traditional Chinese medicine; and immunotherapy with modified food proteins, peptides, bacterial adjuvants, and immunostimulatory sequences.
Animals↗
Respiratory manifestations of food allergy.
Food allergy may present with a variety of respiratory tract symptoms that generally involve immunoglobulin E antibody-mediated responses. Exposure is typically through ingestion, but in some cases, inhalation of airborne food particles may trigger these reactions. Upper and lower respiratory tract reactions are often a significant component of multisystem, anaphylactic reactions. However, chronic or isolated asthma or rhinitis induced by food is unusual. It is important to recognize that food allergy in early childhood is a marker indicating an increased risk to develop respiratory allergy. The role of food allergy in otitis media is controversial and probably is extremely rare. Likewise, asthmatic responses to food additives can occur but are uncommon. Studies using blinded oral food challenges have demonstrated that foods can elicit airway hyperreactivity and asthmatic responses. Therefore, an evaluation for food allergy should be considered in patients who are at risk, including those with recalcitrant or otherwise unexplained acute, severe asthma exacerbations, asthma triggered after ingestion of particular foods, and asthma that is accompanied by other manifestations of food allergy (e.g., anaphylaxis, moderate to severe atopic dermatitis).
Animals↗
Clinical aspects of food allergy.
Food allergy affects 2.5% of adults and 6-8% of children, and is a leading cause of life-threatening anaphylactic episodes. Food allergy is defined as an adverse reaction to foods that is mediated immunologically and involves specific IgE or non-IgE mechanisms. In this review only IgE-related food allergy will be considered. Many food allergens are glycoproteins, but they do not share any striking biochemical similarities. The definition of many food proteins at the molecular level has tremendously facilitated our understanding of clinical syndromes and seemingly bizarre observations. Clinical manifestations of food allergy include symptoms of the gastrointestinal, cutaneous and respiratory systems, as well as systemic anaphylaxis. The diagnosis of food allergy involves a stepwise approach, including medical history taking, demonstration of specific IgE and confirmation by oral food challenge. The management of the food-allergic patient at present consists of avoidance of the culprit food and education, while future advances may include specific immunotherapy with modified allergens or DNA vaccination.
Animals↗
Risk factors for food allergy.
Food allergy is a common problem that often affects young children. Numerous factors affect the development of food allergy both prenatally and postnatally. These factors are genetic and environmental. Although little can be done post-conception to alter a child's genetic risk for developing food allergy, early identification may permit alterations of the environment in which food allergy develops. Environmental factors operate both prenatally and postnatally. By understanding how these factors affect development of food allergy, it may be possible for parents to modulate the development of this difficult problem in their children.
Adult↗
[Food allergy. Most often conceals an inhalational allergy].
Food allergy (hypersensitivity) is a form of adverse food reaction in which the reaction is caused by an immunological response to a food. Most immediate allergic reactions to food are IgE-mediated. The prevalence of food allergy in the general population without the oral allergy syndrome is about 1-2%. Although many foods have been described to cause an allergic reaction, only a few are responsible for the majority of hypersensitivity symptoms. Based on continuous studies by B. Wüthrich, Allergy Unit of the Dermatology Department, University Hospital, Zurich, celery (42%) followed by dairy products (16%), carrot (13%), hen's egg (12%) and fish (7%) is by far the major source of food allergy in Switzerland. In adults food hypersensitivity is mainly due to cross-reactivity between inhalative and food allergens. Pathophysiologically, IgE antibodies induced by aeroallergens recognize structurally similar components in certain foods even from taxonomically unrelated plants. Following an accurate allergological examination, oral provocation tests are considered the most conclusive procedures to establish diagnosis. The only proven form of management in food allergy is strict elimination of the offending food. Food-allergic patients must be provided with emergency medications. Identification of allergens and their characterization finally will improve our understanding for pathophysiologic mechanisms of food allergy.
Adult↗
Psychological aspects of food allergy.
Food allergies may impact the emotions of patients through both direct and indirect mechanisms. Direct mechanisms include the effects on the central nervous system from biologic mediators released during an allergic reaction to food. Indirect mechanisms include the stress of coping with a food allergy--for example, food preparation and avoidance--as well as managing the fear of the potential consequences of ingesting the food. Indirect effects may also be mediated through family members--for example, the impact of a parent's stress on the child. These relationships are difficult to study, in part because many patients who report food allergy symptoms do not have objective symptoms when challenged with the offending food. Symptoms may be misinterpreted as food allergy more often by patients with certain psychological profiles. In this paper, relevant literature is reviewed, and clinical treatment designed to minimize the emotional suffering of patients and their families is presented through the description of a case vignette.
Cross Reactions↗
Nonmurine animal models of food allergy.
Food allergy can present as immediate hypersensitivity [manifestations mediated by immunoglobulin (Ig)E], delayed-type hypersensitivity (reactions associated with specific T lymphocytes), and inflammatory reactions caused by immune complexes. For reasons of ethics and efficacy, investigations in humans to determine sensitization and allergic responses of IgE production to innocuous food proteins are not feasible. Therefore, animal models are used a) to bypass the innate tendency to develop tolerance to food proteins and induce specific IgE antibody of sufficient avidity/affinity to cause sensitization and upon reexposure to induce an allergic response, b) to predict allergenicity of novel proteins using characteristics of known food allergens, and c) to treat food allergy by using immunotherapeutic strategies to alleviate life-threatening reactions. The predominant hypothesis for IgE-mediated food allergy is that there is an adverse reaction to exogenous food proteins or food protein fragments, which escape lumen hydrolysis, and in a polarized helper T cell subset 2 (Th2) environment, immunoglobulin class switching to allergen-specific IgE is generated in the immune system of the gastrointestinal-associated lymphoid tissues. Traditionally, the immunologic characterization and toxicologic studies of small laboratory animals have provided the basis for development of animal models of food allergy; however, the natural allergic response in large animals, which closely mimic allergic diseases in humans, can also be useful as models for investigations involving food allergy.
Allergens↗
9. Food allergy.
Food allergy, defined as an adverse immune response to food proteins, affects as many as 6% of young children and 3% to 4% of adults. Food-induced allergic reactions are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract and might be caused by IgE-mediated and non-IgE-mediated (cellular) mechanisms. Our understanding of how food allergy represents an abrogation of normal oral tolerance is evolving. Although any food can provoke a reaction, relatively few foods are responsible for the vast majority of significant food-induced allergic reactions: milk, egg, peanuts, tree nuts, fish, and shellfish. A systematic approach to diagnosis includes a careful history, followed by laboratory studies, elimination diets, and often food challenges to confirm a diagnosis. Many food allergens have been characterized at a molecular level, which has increased our understanding of the immunopathogenesis of food allergy and might soon lead to novel diagnostic and therapeutic approaches. Currently, management of food allergies consists of educating the patient to avoid ingesting the responsible allergen and to initiate therapy in case of an unintended ingestion.
Adult↗