Reviews and feature articlesUpdate on food allergy☆
Section snippets
Immunopathogenesis and clinical disorders
In the 5 years since the Journal's previous review on food allergy,1., 2. our understanding of food-induced allergic reactions has increased dramatically, especially in the area of diagnosis and management. Investigation of allergenic food proteins and immunologic responses has moved to the molecular level, and this newfound knowledge now provides novel strategies for the laboratory diagnosis and immunomodulatory control of IgE-mediated food hypersensitivity. Food allergy is now recognized as a
Prevalence of food hypersensitivity
The prevalence of food hypersensitivities is greatest in the first few years of life, affecting about 6% of infants less than 3 years of age5 and decreasing over the first decade. Virtually all infants who have cow's milk allergy have it in the first year of life, with clinical tolerance developing in about 80% by their fifth birthday.1 About 60% of infants with cow's milk allergy experience IgE-mediated reactions, and about 25% of these infants retain their sensitivity into the second decade
Gut barrier
Food allergy represents an abnormal response of the mucosal immune system to antigens delivered through the oral route. Unlike the systemic immune system, which sees relatively small quantities of antigen and mounts a brisk inflammatory response, the mucosal immune system encounters enormous quantities of antigen on a daily basis and generally suppresses immune reactivity to harmless foreign antigens (eg, food proteins and commensal organisms), although it is fully capable of mounting a brisk
Clinical disorders
Food hypersensitivities develop in genetically predisposed individuals,34 presumably when oral tolerance fails to develop normally or breaks down. IgE-mediated reactions develop when food-specific IgE antibodies residing on mast cells and basophils come in contact with and bind circulating food allergens and activate the cells to release potent mediators and cytokines. As depicted in Table II, a number of IgE-, cellular-, and mixed IgE– and cell-mediated food hypersensitivity disorders have
Diagnosing adverse food reactions
The approach to diagnosing adverse food reactions has changed little over the past 5 years,2 as recently reviewed,89., 90. although new laboratory approaches are proving useful for the diagnosis of IgE-mediated food allergy. The medical history continues to be a mainstay in the diagnostic process, attempting to establish whether a food-induced allergic reaction occurred, which food was involved, and what allergic mechanism was likely involved. Diet diaries can be a useful supplement to a
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Disclosure of potential conflict of interest: H. Sampson has consultant arrangements with Seer Pharmaceuticals and receives grants/research support from Pharmacia Diagnostics.