Interdisciplinary Significance of Food-Related Adverse Reactions in Adulthood

Background: Adults frequently interpret food-associated adverse reactions as indicators of a food allergy. However, the public perception of food allergy may differ from a clinician’s point of view. The prevalence of patient-reported food allergy tends to be higher than physician-confirmed cases. Dermatological manifestations (urticaria, pruritus, dermatitis, and edema) are frequently reported by patients. Objective: The aim of this study was to describe patient-reported symptoms related to suspected food allergies and particularly to characterize and highlight the volume of patients who visit Budapest allergy clinics with suspected food allergies. Methods: In this prospective study, adult (≥18 years) patients were examined at the Allergology Outpatient Unit of the Dept. of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest. The examination included a detailed medical history; physical examination; and when necessary the measurement of allergen-specific serum immunoglobulin E (IgE) levels. Results: Data from 501 patients (393 women, 108 men) were analyzed. Intolerance to dietary biogenic amines occurred in 250 cases (250/501, 50%). Oral allergy syndrome was confirmed in 71 patients (71/501, 14%). Allergy to food preservatives was diagnosed in 14 (14/501, 3%) cases by a dermatologist-allergist specialist. Five individuals (5/501, 1%) were diagnosed with IgE-mediated food allergy. In some cases (28/501, 6%), edema-inducing/enhancing side effects of drugs were observed which patients had misattributed to various foods. Among the food groups considered to be provoking factors, the most frequently mentioned were fruits (198/501, 40%), milk/dairy products (174/501, 35%), and nuts/oilseeds (144/501, 29%). Overwhelmingly, urticaria (47%) was the most common dermatological diagnosis, followed by dermatitis (20%) and allergic contact dermatitis (8%). Conclusion: Improvement is needed in food allergy, food intolerance, and general nutritional knowledge among the general public. According to our data, perceived/self-reported food allergies were overestimated by adults when compared against physician-confirmed food allergies; however, other diseases potentially responsible for food-related problems were underestimated. The prevalence of oral allergy syndrome was high in the cohort. Intolerance to dietary biogenic amines was common, and although the role of dietary histamine and biogenic amine is not entirely understood in eliciting patients’ symptoms, improvements in complaints were reported during the control visits.

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Food Allergies

10.2310/im.1077 ◽

2018 ◽

Author(s):

Matthew Greenhawt

Keyword(s):

United States ◽

Adverse Reaction ◽

Food Allergy ◽

Eosinophilic Esophagitis ◽

Adverse Reactions ◽

Action Plan ◽

The United States ◽

Oral Allergy Syndrome ◽

Food Allergies ◽

Food Protein

Food allergy represents a rapidly growing public health problem in the United States and other westernized nations. Adverse reactions to foods are categorized as either immunologic or nonimmunologic reactions. This distinction is highly important but often confusing to patients and physicians unfamiliar with allergy, who may simply describe any adverse reaction to a food as an “allergy.” A food allergy is an immune-mediated, adverse reaction to one or more protein allergens in a particular food item involving recognition of that protein by specifically targeted IgE or allergen-specific T cells. This chapter discusses the definition, pathophysiology, epidemiology, testing, management, prognosis, and natural history of food allergy. Clinical manifestations are systematically covered, including cutaneous, respiratory, cardiovascular, and gastrointestinal reactions, as well as eosinophilic esophagitis, food protein–induced enterocolitis syndrome, and oral allergy syndrome. Emerging treatments such as food oral immunotherapy are also reviewed. Tables outline signs and symptoms of immediate hypersensitivity reactions to food, the prevalence of major food allergens in the United States, common patterns of cross-reactivity among foods, clinical criteria for the diagnosis of anaphylaxis, and clinical studies involving treatment for food allergies. Figures illustrate the classification of adverse reactions to food, esophageal histology, visual and radiographic features of eosinophilic esophagitis, and a food allergy action plan. This review contains 4 figures, 8 tables, and 64 references. KeyWords: Food allergy, Hypersensitivity, IgE-mediated allergy, Eosinophilic esophagitis, Anaphylaxis

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Immunoglobulin E (IgE)-Mediated Food Allergy in Children: Epidemiology, Pathogenesis, Diagnosis, Prevention, and Management

Medicina ◽

10.3390/medicina56030111 ◽

2020 ◽

Vol 56 (3) ◽

pp. 111 ◽

Cited By ~ 1

Author(s):

Simona Barni ◽

Giulia Liccioli ◽

Lucrezia Sarti ◽

Mattia Giovannini ◽

Elio Novembre ◽

...

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Public Health Problem ◽

Elimination Diet ◽

Food Allergies ◽

Major Public Health Problem ◽

Double Blind ◽

Detailed Medical History ◽

Ige Mediated

A food allergy is an immunoglobulin E (IgE)-mediated hypersensitive reaction to food, which consists in the appearance of allergic symptoms; it can vary from common urticaria to even fatal anaphylaxis. The prevalence of food allergies has been increasing in the past twenty years and it represents a major public health problem in industrialized countries. The mechanism that leads to food allergies is the lack of immunologic and clinical tolerance to food allergens. The diagnosis of IgE-mediated food allergies is based on the combined use of a detailed medical history, in-vivo, and in-vitro research of specific IgE, the elimination diet, and the double-blind placebo-controlled food challenge. The only currently available treatment for allergies is the strict elimination diet. This type of attitude, which we could define as “passive”, does not overcome the risk of accidental reactions due to involuntary intake of the culprit food. For food allergy management, an “active” approach is urgently needed, such as specific allergen immunotherapy, which is currently under development and only used for research purposes. This article aims to give an updated review of IgE-mediated food allergies in pediatric populations in terms of epidemiology, pathogenesis, prevention, diagnosis, and management.

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Biologic therapy for food allergy

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200004 ◽

2020 ◽

Vol 2 (1) ◽

pp. 86-90

Author(s):

Meng Chen ◽

Wenming Zhang ◽

Lisa Lee ◽

Jamie Saxena ◽

Sayantani Sindher ◽

...

Keyword(s):

Food Allergy ◽

Molecular Mechanisms ◽

Adverse Reactions ◽

Biologic Therapy ◽

Immunoglobulin E ◽

Oral Immunotherapy ◽

Food Allergies ◽

Dna Plasmid ◽

Global Population ◽

Significant Health

With the rising prevalence, food allergies have become a significant health burden that affects 6% to 13% of the global population. Although oral immunotherapy (OIT) has been promising for food allergies, this therapy has limitations, including high rates of adverse reactions and long treatment periods. Biologics may address these limitations by increasing the safety and tolerability of OIT and decreasing treatment periods. The use of biologics and vaccines are actively being explored as monotherapy as well as adjunctive therapy in combination with allergen specific OIT. A number of biologics that target key molecules known to be involved in food allergy are under investigation, including anti‐immunoglobulin E therapy (omalizumab), anti‐interleukin (IL) 4 receptor α (dupilumab), anti‐IL-5 (mepolizumab and reslizumab), and anti‐IL-5R (benralizumab), anti‐IL-33 (etokimab), and peanut DNA plasmid vaccines. In the era of precision medicine, the future of food allergy looks promising, and biologics will provide treatment as well as further insights into the molecular mechanisms associated with food allergy.

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Food Allergies

10.2310/fm.1077 ◽

2018 ◽

Author(s):

Matthew Greenhawt

Keyword(s):

United States ◽

Adverse Reaction ◽

Food Allergy ◽

Eosinophilic Esophagitis ◽

Adverse Reactions ◽

Action Plan ◽

The United States ◽

Oral Allergy Syndrome ◽

Food Allergies ◽

Food Protein

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A Review on Identified Major Food Allergens: Characteristics and Role in Food Allergy

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2017.54.3.11626 ◽

2017 ◽

Vol 54 (3) ◽

pp. 346

Author(s):

Chhavi Arya ◽

Chetna Jantwal

Keyword(s):

Food Allergy ◽

Food Allergies ◽

Allergic Reactions ◽

Food Allergens ◽

Food Groups ◽

Consumer Protection Act ◽

Major Food ◽

Life Threatening ◽

Major Allergens ◽

Allergen Labeling

Food allergens are the substances present in food that cause food allergy. Human body reactions to food allergens range from mild to severe life threatening anaphylactic shock. At least seventy different foods have been reported to cause allergic reactions and several other foods have been identified which have the potential to provoke allergic reactions. Majority of the identified food allergens are proteins. The Food Allergen Labeling and Consumer Protection Act (FALCPA) identifies eight major food groups i.e. milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans as major allergy causing foods. These eight foods are believed to account for 90 per cent of food allergies and are responsible for most serious reactions to foods. Several studies have been done which identify the major allergens in various foods. The present paper attempts to review the major allergens present in various food.

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In vitro testing for immunoglobulin E-mediated food allergies

Otolaryngology ◽

10.1016/s0194-5998(96)70044-x ◽

1996 ◽

Vol 115 (4) ◽

pp. 312-318 ◽

Cited By ~ 6

Author(s):

Jacquelynne P. Corey ◽

Anil Gungor

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Diagnostic Methods ◽

Food Allergies ◽

Vitro Assay ◽

Positive Screen ◽

Specific Immunoglobulin E ◽

Radioallergosorbent Test ◽

Specific Immunoglobulin

The role of immunoglobulin E-mediated food allergy in subjects with allergic disorders, especially in patients with rhinitis and sinusitis, is underestimated by clinicians because of the initial attribution of these disorders to immediate-type hypersensitivity reactions. The difficulties of diagnosing food-related reactions have caused further delay in their recognition and incorporation into the daily practice of diagnosing food allergy. Two of the diagnostic methods for food allergy are the in vitro assay of total immunoglobulin E and the measurement of food-specific immunoglobulin E levels in serum with the radioallergosorbent test. Measurement of specific immunoglobulin E level is the most commonly used but also one of the most controversial techniques. We examined 123 patients with rhinitis who were referred to our otolaryngology/allergy clinic between January and April 1995. All patients received an initial radioallergosorbent test screen, which included milk. We determined the positive predictive value of this positive screen and, in particular, of a positive test for milk in the diagnosis of immunoglobulin E-mediated food allergies in these patients. Conclusions were based on comparison with the result of an additional radioallergosorbent test food panel consisting of eight common and two investigational food allergens. (Otolaryngol Head Neck Surg 1996;115:312-8.)

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Future Approaches to Food Allergy

PEDIATRICS ◽

10.1542/peds.111.s3.1672 ◽

2003 ◽

Vol 111 (Supplement_3) ◽

pp. 1672-1680

Author(s):

Anna Nowak-Wegrzyn

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Fatal Outcome ◽

Diagnostic Methods ◽

Food Allergies ◽

In Vitro Assays ◽

Activation Markers ◽

Treatment Of Food Allergy

Food allergy affects ∼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.

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Food Allergies: Current and Future Treatments

Medicina ◽

10.3390/medicina55050120 ◽

2019 ◽

Vol 55 (5) ◽

pp. 120 ◽

Cited By ~ 5

Author(s):

Amelia Licari ◽

Sara Manti ◽

Alessia Marseglia ◽

Ilaria Brambilla ◽

Martina Votto ◽

...

Keyword(s):

Food Allergy ◽

Adverse Reactions ◽

Public Health Problem ◽

Food Allergies ◽

Dietary Restrictions ◽

Related Risk ◽

Promising Therapeutic Approach ◽

Significant Burden ◽

Allergy Treatment

Food allergies are an increasingly public health problem, affecting up to 10% of children and causing a significant burden on affected patients, resulting in dietary restrictions, fear of accidental ingestion and related risk of severe reactions, as well as a reduced quality of life. Currently, there is no specific cure for a food allergy, so the only available management is limited to strict dietary avoidance, education on prompt recognition of symptoms, and emergency treatment of adverse reactions. Several allergen specific- and nonspecific-therapies, aiming to acquire a persistent food tolerance, are under investigation as potential treatments; however, to date, only immunotherapy has been identified as the most promising therapeutic approach for food allergy treatment. The aim of this review is to provide an updated overview on changes in the treatment landscape for food allergies.

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Using oral food challenges to provide clarity and confidence when diagnosing food allergies

Journal of Food Allergy ◽

10.2500/jfa.2021.3.210002 ◽

2021 ◽

Vol 3 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Justin Greiwe

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Food Challenge ◽

Clinical History ◽

The United States ◽

Oral Immunotherapy ◽

Food Allergies ◽

Ige Mediated ◽

Challenge Education ◽

Food Challenges

A verified food allergy can be an impactful life event that leads to increased anxiety and measurable effects on quality of life. Allergists play a key role in framing this discussion and can help alleviate underlying fears by promoting confidence and clarifying safety concerns. Correctly diagnosing a patient with an immunoglobulin E (IgE) mediated food allergy remains a nuanced process fraught with the potential for error and confusion. This is especially true in situations in which the clinical history is not classic, and allergists rely too heavily on food allergy testing to provide a confirmatory diagnosis. A comprehensive medical history is critical in the diagnosis of food allergy and should be used to determine subsequent testing and interpretation of the results. Oral food challenge (OFC) is a critical procedure to identify patients with an IgE-mediated food allergy when the history and testing are not specific enough to confirm the diagnosis and can be a powerful teaching tool regardless of outcome. Although the safety and feasibility of performing OFC in a busy allergy office have always been a concern, in the hands of an experienced and trained provider, OFC is a safe and reliable procedure for patients of any age. With food allergy rates increasing and analysis of recent data that suggests that allergists across the United States are not providing this resource consistently to their patients, more emphasis needs to be placed on food challenge education and hands-on experience. The demand for OFCs will only continue to increase, especially with the growing popularity of oral immunotherapy programs; therefore, it is essential that allergists become familiar with the merits and limitations of current testing modalities and open their doors to using OFCs in the office.

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Caregiver perceptions and attitudes associated with oral immunotherapy on social media

Allergy and Asthma Proceedings ◽

10.2500/aap.2021.42.210050 ◽

2021 ◽

Vol 42 (5) ◽

pp. 432-438 ◽

Cited By ~ 1

Author(s):

Suzanne Kochis ◽

Corinne Keet ◽

Lauren E. Claus ◽

Tai Hairston ◽

Annie R. Links ◽

...

Keyword(s):

Decision Making ◽

Social Media ◽

Food Allergy ◽

Immunoglobulin E ◽

Oral Immunotherapy ◽

Food Allergies ◽

Perceptions And Attitudes ◽

Lay Perspectives ◽

Treatment Of Food Allergy ◽

Meta Analyses

Background: Caregiver values and preferences with regard to oral immunotherapy (OIT) for treatment of food allergies are not widely reported. Understanding caregiver perspectives is integral to establishing shared decision-making in the treatment of food allergy. Objective: We aimed to understand caregiver opinions that may influence caregivers in their decisions about OIT through social media. Methods: We searched a popular parenting web site for posts related to OIT from December 2008 to September 2019. We applied a Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to review posts for inclusion, performed thematic content analysis to determine common themes, and calculated frequencies for each theme and subtheme. Posts and comments were included if they contained discussions about OIT for immunoglobulin E‐mediated food allergy and were excluded if they were duplicates, comments from an original post from the original user, or comments on a nonrelevant original post. Results: Of 1300 posts and comments retrieved, 174 were included (13%). Most were excluded because they did not directly address OIT for food allergy. Relevant posts could fall into multiple themes and were categorized under three main themes: attitudes (n = 128, “I am scared to do OIT but scared not to!”), logistics (n = 168, “We will be doing this once LO [little one] is a little older”), and questions (n = 32, “How does it work?”). Conclusion: Caregivers communicate with each other through social media, expressing attitudes, logistics, and questions about OIT. Understanding these lay perspectives may help guide clinicians in counseling and engage caregivers in decision-making.

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