Food Allergy: From Clinical Presentation to Management and Prevention

Authors

  • Saida Rezakovic Policlinic “Eskulap” - Policlinic for Internal Medicine, Dermatovenerology, Neurology, Psychiatry, Surgery, Gynecology, Urology, Otorhinolaryngology and Physical Medicine - Rehabilitation, Havidićeva 9/11, Zagreb, Croatia
  • Marta Navratil Department of Allergy and Pulmonology, Srebrnjak Children's Hospital, Srebrnjak 100, Zagreb, Croatia
  • Kristina Žužul Medical School, University of Zagreb, Šalata 4, Zagreb, Croatia

DOI:

https://doi.org/10.6000/1929-5634.2014.03.04.7

Keywords:

Elimination diet, oral food challenge, food induced asthma, atopic dermatitis, food protein-induced enterocolitis syndrome, food protein-induced proctocolitis.

Abstract

Food allergy is an adverse immune-mediated pathological reaction directed toward proteins or glycoproteins in food. It affects the skin, gastrointestinal, respiratory and cardiovascular systems, resulting in a broad spectrum of diverse clinical presentations. Consequently, establishing a diagnosis can present a great challenge. The prevalence rate of food allergy is increasing, particularly in modern industrialized countries, and is becoming a significant public health problem. There is still no current treatment, and avoidance of suspected food allergens remains the most important treatment modality. However, in order to avoid unnecessary dietary restrictions, food hypersensitivity should be confirmed using allergy tests prior to introduction of elimination diet. In cases of validation of food allergy, avoiding suspected foods are recommended. Education of patients is the cornerstone of prevention and therapy; providing all relevant information on how to exclude specific foods from the patient's diet, as well as how to detect and manage allergic reactions, especially in severe cases like anaphylaxis. This review aims at presenting the clinical picture and diagnosis, as well as discussing current treatment and preventive strategies for different types of food allergies.

References

Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 2004; 113: 832-836. http://dx.doi.org/10.1016/j.jaci.2003.12.591 DOI: https://doi.org/10.1016/S0091-6749(04)00930-3

Wang J, Sampson HA. Food allergy: recent advances in pathophysiology and treatment. Allergy Asthma Immunol Res 2009; 1(1): 19-29. http://dx.doi.org/10.4168/aair.2009.1.1.19 DOI: https://doi.org/10.4168/aair.2009.1.1.19

Mansoor DK, Sharma HP. Clinical presentations of food allergy. Pediatr Clin North Am 2011; 58(2): 315-326. http://dx.doi.org/10.1016/j.pcl.2011.02.008 DOI: https://doi.org/10.1016/j.pcl.2011.02.008

Davis CM. Food allergies: clinical manifestations, diagnosis, and management. Curr Probl Pediatr Adolesc Health Care 2009; 39(10): 236-254. http://dx.doi.org/10.1016/j.cppeds.2009.09.003 DOI: https://doi.org/10.1016/j.cppeds.2009.09.003

Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol 2014; 133(2): 291-307. http://dx.doi.org/10.1016/j.jaci.2013.11.020 DOI: https://doi.org/10.1016/j.jaci.2013.11.020

Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol 2012; 129: 1187-1197. http://dx.doi.org/10.1016/j.jaci.2012.02.036 DOI: https://doi.org/10.1016/j.jaci.2012.02.036

Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol 2004; 114: 159-165. http://dx.doi.org/10.1016/j.jaci.2004.04.018 DOI: https://doi.org/10.1016/j.jaci.2004.04.018

Liu AH, Jaramillo R, Sicherer SH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol 2010; 126: 798-806. http://dx.doi.org/10.1016/j.jaci.2010.07.026 DOI: https://doi.org/10.1016/j.jaci.2010.07.026

Sicherer SH. Manifestations of food allergy: evaluation and management. Am Fam Physician. 1999; 59(2): 415-424, 429-430.

Sicherer SH: Clinical aspects of gastrointestinal food allergy in childhood. Pediatrics 2003; 111: 1609-1616. DOI: https://doi.org/10.1542/peds.111.S3.1609

Dupont C. Food allergy: recent advances in pathophysiology and diagnosis. Ann Nutr Metab 2011; 59: 8-18. http://dx.doi.org/10.1159/000334145 DOI: https://doi.org/10.1159/000334145

Morita H, Nomura I, Matsuda A, Saito H, Matsumoto K. Gastrointestinal food allergy in infants. Allergol Int 2013; 62(3): 297-307. http://dx.doi.org/10.2332/allergolint.13-RA-0542 DOI: https://doi.org/10.2332/allergolint.13-RA-0542

Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract 2013; 1(1): 22-28. http://dx.doi.org/10.1016/j.jaip.2012.11.005 DOI: https://doi.org/10.1016/j.jaip.2012.11.005

Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow’s milk allergy. J Allergy Clin Immunol 2007; 120: 1172-1177. http://dx.doi.org/10.1016/j.jaci.2007.08.023 DOI: https://doi.org/10.1016/j.jaci.2007.08.023

Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol 2007; 120: 1413-1417. http://dx.doi.org/10.1016/j.jaci.2007.09.040 DOI: https://doi.org/10.1016/j.jaci.2007.09.040

Skolnick HS, Conover-Walker MK, Koerner CB, Sampson HA, Burks W, Wood RA. The natural history of peanut allergy. J Allergy Clin Immunol 2001; 107: 367-374. http://dx.doi.org/10.1067/mai.2001.112129 DOI: https://doi.org/10.1067/mai.2001.112129

Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol 2005; 116: 1087-1093. http://dx.doi.org/10.1016/j.jaci.2005.09.002 DOI: https://doi.org/10.1016/j.jaci.2005.09.002

Neuman-Sunshine DL, Eckman JA, Keet CA, et al. The natural history of persistent peanut allergy. Ann Allergy Asthma Immunol 2012; 108: 326-331. http://dx.doi.org/10.1016/j.anai.2011.11.010 DOI: https://doi.org/10.1016/j.anai.2011.11.010

Resnick ES, Pieretti MM, Maloney J, Noone S, Munoz-Furlong A, Sicherer SH. Development of a questionnaire to measure quality of life in adolescents with food allergy: the FAQL-teen. Ann Allergy Asthma Immunol 2010; 105: 364-368. http://dx.doi.org/10.1016/j.anai.2010.09.006 DOI: https://doi.org/10.1016/j.anai.2010.09.006

Guandalini S, Setty M. Celiac disease. Curr Opin Gastroenterol 2008; 24(6): 707-712. http://dx.doi.org/10.1097/MOG.0b013e32830f4527 DOI: https://doi.org/10.1097/MOG.0b013e32830f4527

Caubet JC, Ford LS, Sickles L, et al. Clinical features and resolution of food protein-induced enterocolitis syndrome: 10-year experience. J Allergy Clin Immunol 2014; 134(2): 382-389. http://dx.doi.org/10.1016/j.jaci.2014.04.008 DOI: https://doi.org/10.1016/j.jaci.2014.04.008

Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol 2005; 115(1): 149-156. http://dx.doi.org/10.1016/j.jaci.2004.09.033 DOI: https://doi.org/10.1016/j.jaci.2004.09.033

Levy Y, Danon YL. Food protein-induced enterocolitis syndrome—not only due to cow's milk and soy. Pediatr Allergy Immunol 2003; 14: 325-329. http://dx.doi.org/10.1034/j.1399-3038.2003.00039.x DOI: https://doi.org/10.1034/j.1399-3038.2003.00039.x

Bruijnzeel KC, Ortolani C, Aas K et al. Adverse reactions to food. European academy of allergology and clinical immunology subcommittee. Allergy 1995; 50: 623-635. http://dx.doi.org/10.1111/j.1398-9995.1995.tb02579.x DOI: https://doi.org/10.1111/j.1398-9995.1995.tb02579.x

Nowak-Wegrzyn A, Muraro A. Food protein-induced enterocolitis syndrome. Curr Opin Allergy Clin Immunol 2009; 9: 371-377. http://dx.doi.org/10.1097/ACI.0b013e32832d6315 DOI: https://doi.org/10.1097/ACI.0b013e32832d6315

Lake AM. Food-induced eosinophilic proctocolitis. J Pediatr Gastroenterol Nutr 2000; 30: 58-60. http://dx.doi.org/10.1097/00005176-200001001-00009 DOI: https://doi.org/10.1002/j.1536-4801.2000.tb02682.x

Kim J, Kwon J, Noh G, Lee SS. The effects of elimination diet on nutritional status in subjects with atopic dermatitis. Nutr Res Pract 2013; 7(6): 488-494. http://dx.doi.org/10.4162/nrp.2013.7.6.488 DOI: https://doi.org/10.4162/nrp.2013.7.6.488

Kim JS. Pediatric atopic dermatitis: the importance of food allergens. Semin Cutan Med Surg 2008; 27(2): 156-160. http://dx.doi.org/10.1016/j.sder.2008.05.003 DOI: https://doi.org/10.1016/j.sder.2008.05.003

Breuer K, Wulf A, Constien A, Tetau D, Kapp A, Werfel T. Birch pollen related food as a provocation factor of allergic symptoms in children with atopic eczema/dermatitis syndrome. Allergy 2004; 59: 988-994. http://dx.doi.org/10.1111/j.1398-9995.2004.00493.x DOI: https://doi.org/10.1111/j.1398-9995.2004.00493.x

Sampson HA. The evaluation and management of food allergy in atopic dermatitis. Clin Dermatol 2003; 21: 183-192. http://dx.doi.org/10.1016/S0738-081X(02)00363-2 DOI: https://doi.org/10.1016/S0738-081X(02)00363-2

Sampson HA, Mendelson LM, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992; 327: 380-384. http://dx.doi.org/10.1056/NEJM199208063270603 DOI: https://doi.org/10.1056/NEJM199208063270603

Barg W, Medrala W, Wolanczyk-Medrala A. Exercise-induced anaphylaxis: an update on diagnosis and treatment. Curr Allergy Asthma Rep 2011; 11(1): 45-51. http://dx.doi.org/10.1007/s11882-010-0150-y DOI: https://doi.org/10.1007/s11882-010-0150-y

Kelava N, Lugović-Mihić L, Duvancić T, Romić R, Situm M. Oral allergy syndrome - the need of a multidisciplinary approach. Acta Clin Croat 2014; 53(2): 210-219.

Blanco C, Carrillo T, Castillo R, Quiralte J, Cuevas M. Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy 1994; 73: 309-314.

Brehler R, Theissen U, Mohr C, Luger T. Latex-fruit syndrome: frequency of cross-reacting IgE antibodies. Allergy 1997; 52(4): 404-410. http://dx.doi.org/10.1111/j.1398-9995.1997.tb01019.x DOI: https://doi.org/10.1111/j.1398-9995.1997.tb01019.x

Beezhold DH, Sussman GL, Liss, GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy 1996; 26: 416-422. http://dx.doi.org/10.1046/j.1365-2222.1996.d01-334.x DOI: https://doi.org/10.1111/j.1365-2222.1996.tb00557.x

Lee SS, Noh G, Lee KY. Clinical application of histamine prick test for food challenge in atopic dermatitis. Journal of Korean Medical Science 2001; 16: 276-282. http://dx.doi.org/10.3346/jkms.2001.16.3.276 DOI: https://doi.org/10.3346/jkms.2001.16.3.276

Perry TT, Matsui EC, Kay Conover-Walker M, Wood RA. The relationship of allergen-specific IgE levels and oral food challenge outcome. J Allergy Clin Immunol 2004; 114: 144-149. http://dx.doi.org/10.1016/j.jaci.2004.04.009 DOI: https://doi.org/10.1016/j.jaci.2004.04.009

Boyano Martinez T, Garcia-Ara C, Diaz-Pena JM, Munoz FM, Garcia Sanchez G, Esteban MM. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy 2001; 31: 1464-1469. http://dx.doi.org/10.1046/j.1365-2222.2001.01175.x DOI: https://doi.org/10.1046/j.1365-2222.2001.01175.x

Hill DJ, Heine RG, Hosking CS. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol 2004; 15: 435-441. http://dx.doi.org/10.1111/j.1399-3038.2004.00188.x DOI: https://doi.org/10.1111/j.1399-3038.2004.00188.x

Nomura I, Morita H, Hosokawa S, et al. Four distinct subtypes of non-IgE-mediated gastrointestinal food allergies in neonates and infants, distinguished by their initial symptoms. J Allergy Clin Immunol 2011; 127: 685-688. http://dx.doi.org/10.1016/j.jaci.2011.01.019 DOI: https://doi.org/10.1016/j.jaci.2011.01.019

Hill P, Austin A, Forsyth J, Holmes G. British Society of Gastroenterology guidelines on the diagnosis and management of coeliac disease. Gut 2014. http://dx.doi.org/10.1136/gutjnl-2014-308420 DOI: https://doi.org/10.1136/gutjnl-2014-308420

Rothenberg ME: Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004; 113(1): 11-28. http://dx.doi.org/10.1016/j.jaci.2003.10.047 DOI: https://doi.org/10.1016/j.jaci.2003.10.047

Turjanmaa K, Darsow U, Niggemann B, Rance F, Vanto T, Werfel T. EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy 2006; 61: 1377-1384. http://dx.doi.org/10.1111/j.1398-9995.2006.01136.x DOI: https://doi.org/10.1111/j.1398-9995.2006.01136.x

Darsow U, Laifaoui J, Kerschenlohr K, et al. The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study. Allergy 2004; 59: 1318-1325. http://dx.doi.org/10.1111/j.1398-9995.2004.00556.x DOI: https://doi.org/10.1111/j.1398-9995.2004.00556.x

Bloom KA, Huang FR, Bencharitiwong R, et al. Effect of Heat Treatment on Milk and Egg Proteins Allergenicity. Pediatr Allergy Immunol 2014. http://dx.doi.org/10.1111/pai.12283 DOI: https://doi.org/10.1111/pai.12283

Bock SA, Lee WY, Remigio L, Holst A, May CD. Appraisal of skin tests with food extracts for diagnosis of food hypersensitivity. Clin Allergy 1978; 8: 559-564. http://dx.doi.org/10.1111/j.1365-2222.1978.tb01509.x DOI: https://doi.org/10.1111/j.1365-2222.1978.tb01509.x

Sampson HA, Albergo R. Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol 1984; 74: 26-33. http://dx.doi.org/10.1016/0091-6749(84)90083-6 DOI: https://doi.org/10.1016/0091-6749(84)90083-6

Jones SM, Burks AW. The changing CARE for patients with food allergy. J Allergy Clin Immunol 2013; 131: 3-11. http://dx.doi.org/10.1016/j.jaci.2012.11.012 DOI: https://doi.org/10.1016/j.jaci.2012.11.012

Sicherer SH, Simons FE. Self-injectable epinephrine for first-aid management of anaphylaxis. Pediatrics 2007; 119: 638-646. http://dx.doi.org/10.1542/peds.2006-3689 DOI: https://doi.org/10.1542/peds.2006-3689

Yu JW, Kagan R, Verreault N, et al. A. Accidental ingestions in children with peanut allergy. J Allergy Clin Immunol 2006; 118: 466-472. http://dx.doi.org/10.1016/j.jaci.2006.04.024 DOI: https://doi.org/10.1016/j.jaci.2006.04.024

Nowak-Wegrzyn A, Sampson HA. Future therapies for food allergies. J Allergy Clin Immunol 2011; 127: 558-573. http://dx.doi.org/10.1016/j.jaci.2010.12.1098 DOI: https://doi.org/10.1016/j.jaci.2010.12.1098

Maleki SJ, Hurlburt BK. Structural and functional alterations in major peanut allergens caused by thermal processing. J AOAC Int 2004; 87: 1475-1479.

Gruber P, Becker WM, Hofmann T. Influence of the maillard reaction on the allergenicity of rAra h 2, a recombinant major allergen from peanut (Arachis hypogaea), its major epitopes, and peanut agglutinin. J Agric Food Chem 2005; 53: 2289-2296. http://dx.doi.org/10.1021/jf048398w DOI: https://doi.org/10.1021/jf048398w

Pfefferle PI, Prescott SL, Kopp M. Microbial influence on tolerance and opportunities for intervention with prebiotics/probiotics and bacterial lysates. J Allergy Clin Immunol 2013; 131: 1453-1463. http://dx.doi.org/10.1016/j.jaci.2013.03.020 DOI: https://doi.org/10.1016/j.jaci.2013.03.020

Downloads

Published

2014-12-22

How to Cite

Rezakovic, S., Navratil, M., & Žužul, K. (2014). Food Allergy: From Clinical Presentation to Management and Prevention. Journal of Nutritional Therapeutics, 3(4), 183–190. https://doi.org/10.6000/1929-5634.2014.03.04.7

Issue

Section

Articles

Most read articles by the same author(s)