Food allergy

Mapping Intimacies ◽

10.1093/med/9780198759928.003.0019 ◽

2018 ◽

Author(s):

John Puntis

Keyword(s):

Food Allergy ◽

Nasal Congestion ◽

Skin Prick Testing ◽

Clinical History ◽

Specific Ige ◽

Cow Milk ◽

Severe Reaction ◽

Detailed Clinical History ◽

Food Challenges ◽

Food Specific Ige

Food allergy is an immune response to food that can be classified as immunoglobulin (Ig)-E and non-IgE mediated. Milk, egg, peanut, tree nuts, and fish are among the most prevalent causes of food allergy. Mild reactions can include itchy rash, watering eyes, and nasal congestion while a severe reaction results in anaphylaxis. A detailed clinical history is essential when making a diagnosis, and skin prick testing and quantitative measurement of food-specific IgE antibodies can be helpful. Cow milk protein allergy causes a plethora of symptoms and frequently resolves spontaneously over the first 2 years of life; diagnosis is based mainly on clinical history. Food challenges have a pivotal role in the diagnosis of food allergy. Introduction of ‘allergic’ foods at 3–6 months alongside continuing breastfeeding may prevent allergy.

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Skin Manifestations of Food Allergy

PEDIATRICS ◽

10.1542/peds.111.s3.1617 ◽

2003 ◽

Vol 111 (Supplement_3) ◽

pp. 1617-1624 ◽

Cited By ~ 3

Author(s):

Wesley Burks

Keyword(s):

Atopic Dermatitis ◽

Food Allergy ◽

Specific Ige ◽

Rational Approach ◽

Severe Atopic Dermatitis ◽

Acute Urticaria ◽

Skin Response ◽

Allergic Skin ◽

Food Challenges ◽

Food Specific Ige

The pediatrician is faced with evaluating a panoply of skin rashes, a subset of which may be induced by food allergy. Acute urticaria is a common manifestation of an allergic skin response to food, but food is rarely a cause of chronic urticaria. Approximately one third of infants/children with moderate to severe atopic dermatitis have food allergy. Although diagnosis of acute urticaria provoked by a food may be evident from a straightforward history and confirmed by diagnostic tests to detect food-specific IgE antibody, determination of the role of food allergy in patients with atopic dermatitis is more difficult and may require additional diagnostic maneuvers, including elimination diets and oral food challenges. The immunopathologic basis of food-allergic disorders that affect the skin and a rational approach to diagnosis and treatment are discussed. Additional disorders that are caused by or mimic ones caused by food allergy are reviewed.

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Food allergy and atopic dermatitis

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200018 ◽

2020 ◽

Vol 2 (1) ◽

pp. 35-38

Author(s):

Tina Banzon ◽

Donald Y.M. Leung ◽

Lynda C. Schneider

Keyword(s):

Atopic Dermatitis ◽

Food Allergy ◽

Immunoglobulin E ◽

Growth Failure ◽

Skin Barrier ◽

Clinical History ◽

Skin Inflammation ◽

Specific Ige ◽

Nutritional Deficiencies ◽

Detailed Clinical History

Atopic dermatitis (AD), characterized by intense pruritus, eczematous lesions, and a relapsing disease course, is a chronic inflammatory skin disease that affects both children and adults. AD often begins in infancy and is associated with atopic diseases in the personal or family history.1 Environmental factors may trigger AD by affecting the skin barrier and by triggering inflammation. The elicitation of T-helper type 2 cytokines further impairs the epidermal barrier and leads to the penetration of irritants and allergens into the epidermis and thereby perpetuating inflammation. The presence of AD and its severity has been shown to positively correlate with risk of developing food allergy (FA). Children with AD are estimated to be six times more likely to develop FA compared with their healthy peers. It has been reported that nearly 40% of children with moderate-to-severe AD have immunoglobulin E (IgE) mediated FA compared with only 6% in the general population. Although analysis of experimental data has linked skin inflammation in AD to FA, with food challenges reproducing symptoms and avoidance diets improving AD, elimination diets are not known to cure AD and may have unfavorable consequences, such as loss of tolerance, which leads to immediate-type allergy, including anaphylaxis, nutritional deficiencies, growth failure, and reduction of quality of life for the patient and family. Exacerbation of AD can be inaccurately attributed to foods. Individuals with AD are often sensitized to foods with positive testing results, however, able to tolerate the food. In light of widespread ordering and commercial availability of serum specific IgE for FA, testing for FA is recommended only if, from a detailed clinical history, immediate-type allergic symptoms occur with ingestion of food, or in infants with AD who do not improve with optimal skin care.

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How to interpret skin prick tests and serum-specific IgE in children and young people with food allergy

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2020-320562 ◽

2021 ◽

pp. edpract-2020-320562

Author(s):

Kathryn Ferris ◽

Marianne Cowan ◽

Christine Williams ◽

Sinead McAteer ◽

Caoimhe Glancy ◽

...

Keyword(s):

Food Allergy ◽

Skin Prick Testing ◽

Clinical History ◽

Specific Ige ◽

Children And Young People ◽

Subsequent Investigation ◽

Targeted Testing ◽

Important Diagnostic Tool ◽

Skin Prick Tests

Food allergy is common, it can lead to significant morbidity andnegatively impacts on quality of life; therefore, it is vitally important we get the diagnosis right. However, making the diagnosis can be complex. Clinical history is the most important diagnostic tool and subsequent investigation may help confirm the diagnosis. The investigations available to most paediatric departments are skin prick testing and specific IgE so we will focus on these. Within this article we explore the evidence related to targeted testing and how to interpret these within the clinical context.

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Oral Food Challenge

Medicina ◽

10.3390/medicina55100651 ◽

2019 ◽

Vol 55 (10) ◽

pp. 651

Author(s):

Calvani ◽

Bianchi ◽

Reginelli ◽

Peresso ◽

Testa

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Clinical History ◽

Specific Ige ◽

Oral Food Challenge ◽

Food Allergies ◽

Pediatric Allergy ◽

Expert Review ◽

Ige Mediated ◽

Food Specific Ige

: Oral food challenge (OFC) is the gold standard for diagnosis of IgE-mediated and non-IgE mediated food allergy. It is usually conducted to make diagnosis, to monitor for resolution of a food allergy, or to identify the threshold of responsiveness. Clinical history and lab tests have poor diagnostic accuracy and they are not sufficient to make a strict diagnosis of food allergy. Higher concentrations of food-specific IgE or larger allergy prick skin test wheal sizes correlate with an increased likelihood of a reaction upon ingestion. Several cut-off values, to make a diagnosis of some food allergies (e.g., milk, egg, peanut, etc.) without performing an OFC, have been suggested, but their use is still debated. The oral food challenge should be carried out by experienced physicians in a proper environment equipped for emergency, in order to carefully assess symptoms and signs and correctly manage any possible allergic reaction. This review does not intend to analyse comprehensively all the issues related to the diagnosis of food allergies, but to summarize some practical information on the OFC procedure, as reported in a recent issue by The Expert Review of Food Allergy Committee of Italian Society of Pediatric Allergy and Immunology (SIAIP)

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Food Allergy: Unproven diagnostics and therapeutics

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200013 ◽

2020 ◽

Vol 2 (1) ◽

pp. 91-94

Author(s):

Megan F. Patterson ◽

Stacy L. Dorris

Keyword(s):

Food Allergy ◽

Adverse Reactions ◽

Immunoglobulin E ◽

Skin Prick Testing ◽

Scientific Evidence ◽

Food Challenge ◽

Clinical History ◽

Specific Ige ◽

Therapeutic Modalities ◽

Diagnostic Modalities

Food allergy or intolerance is often attributed by patients as the cause of many symptoms unknown to be directly related to food ingestion. For immunoglobulin E (IgE) mediated food allergy, diagnostic modalities are currently limited to the combination of clinical history, evidence of sensitization with food-specific IgE testing and skin-prick testing, and oral food challenge. Many patients find an appeal in the promise of identification of the etiology of their symptoms through alternative food allergy or intolerance diagnostic modalities. These patients may seek guidance from allergists or their general providers as to the legitimacy of these tests or interpretation of results. These tests include food-specific serum IgG or IgG4 testing, flow cytometry to measure the change in leukocyte volume after exposure to food, intradermal or sublingual provocation-neutralization, electrodermal testing, applied kinesiology, hair analysis, and iridology. In addition, there are some unconventional therapeutic modalities for adverse reactions to foods, including rotary diets. None of these have been supported by scientific evidence, and some even carry the risk of severe adverse reactions. It is important that we offer our patients evidence-based, accurate counseling of these unproven modalities by understanding their methods, their paucity of credible scientific support, and their associated risks.

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Addressing Common Misconceptions in Food Allergy: A Review

Children ◽

10.3390/children8060497 ◽

2021 ◽

Vol 8 (6) ◽

pp. 497

Author(s):

Aikaterini Anagnostou

Keyword(s):

Food Allergy ◽

The United States ◽

Specific Ige ◽

Oral Immunotherapy ◽

Food Allergies ◽

Allergy Prevention ◽

Diagnosis And Management ◽

Skin Prick Tests ◽

Food Specific Ige ◽

Common Misconceptions

Background: Food allergies are common, affecting 1 in 13 school children in the United States and their prevalence is increasing. Many misconceptions exist with regards to food allergy prevention, diagnosis and management. Objective: The main objective of this review is to address misconceptions with regards to food allergies and discuss the optimal, evidence-based approach for patients who carry this diagnosis. Observations: Common misconceptions in terms of food allergy prevention include beliefs that breastfeeding and delayed introduction of allergenic foods prevent the development of food allergies. In terms of diagnosis, statements such as ‘larger skin prick tests or/and higher levels of food-specific IgE can predict the severity of food-induced allergic reactions’, or ‘Tryptase is always elevated in food-induced anaphylaxis’ are inaccurate. Additionally, egg allergy is not a contraindication for receiving the influenza vaccine, food-allergy related fatalities are rare and peanut oral immunotherapy, despite reported benefits, is not a cure for food allergies. Finally, not all infants with eczema will develop food allergies and epinephrine auto-injectors may unfortunately be both unavailable and underused in food-triggered anaphylaxis. Conclusions and relevance: Healthcare professionals must be familiar with recent evidence in the food allergy field and avoid common misunderstandings that may negatively affect prevention, diagnosis and management of this chronic disease.

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