Food allergy. Part 2: Diagnosis and management☆,☆☆
Section snippets
DIAGNOSING ADVERSE FOOD REACTIONS
The diagnostic approach to suspected adverse food reactions begins with the medical history and physical examination. The goal of this exercise is to determine whether the patient is likely to have experienced an adverse reaction to food and whether it is likely to involve an immunologic (allergic) mechanism. If an allergic mechanism is suspected, it is useful to categorize reactions mechanistically (ie, IgE-mediated or non-IgE-mediated) because subsequent laboratory evaluations and oral
THERAPY FOR FOOD-INDUCED ALLERGIC DISORDERS
Once the diagnosis of food hypersensitivity is established, the only proven therapy is strict elimination of the offending allergen. Prescribing therapeutic elimination diets should be undertaken with the same consideration given to prescribing medications; both may result in unwanted side effects. Elimination diets may lead to malnutrition and/or eating disorders, especially if they include a large number of foods and/or are used for extended periods of time.44, 45 Patients and their families
NATURAL HISTORY OF FOOD HYPERSENSITIVITY
The prevalence of food hypersensitivity is greatest in the first few years of life, affecting about 6% to 8% of infants in the first year.74 Most young children “outgrow” (become tolerant of) their food hypersensitivity within a few years, except in most cases of peanut, tree nut, and seafood allergy. In a prospective study of adverse reactions to foods in infants, 80% of confirmed symptoms developed in the first year of life.74 In a prospective study of milk hypersensitivity in children
CONCLUSION
About 2% of the population is affected by various food-induced allergic disorders. A number of well-characterized food-induced allergic disorders have been delineated. Patients afflicted with these disorders may be accurately diagnosed by using a systematic evaluation, including medical history, laboratory studies, diagnostic elimination diets, and food challenges. Once the appropriate diagnosis has been made, patients must be educated to avoid the specific food allergen or allergens and to
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