ICON: Food allergy

doi:10.1016/j.jaci.2012.02.001

Journal of Allergy and Clinical Immunology

Volume 129, Issue 4, April 2012, Pages 906-920

https://doi.org/10.1016/j.jaci.2012.02.001 Get rights and content

Food allergies can result in life-threatening reactions and diminish quality of life. In the last several decades, the prevalence of food allergies has increased in several regions throughout the world. Although more than 170 foods have been identified as being potentially allergenic, a minority of these foods cause the majority of reactions, and common food allergens vary between geographic regions. Treatment of food allergy involves strict avoidance of the trigger food. Medications manage symptoms of disease, but currently, there is no cure for food allergy. In light of the increasing burden of allergic diseases, the American Academy of Allergy, Asthma & Immunology; European Academy of Allergy and Clinical Immunology; World Allergy Organization; and American College of Allergy, Asthma & Immunology have come together to increase the communication of information about allergies and asthma at a global level. Within the framework of this collaboration, termed the International Collaboration in Asthma, Allergy and Immunology, a series of consensus documents called International Consensus ON (ICON) are being developed to serve as an important resource and support physicians in managing different allergic diseases. An author group was formed to describe the natural history, prevalence, diagnosis, and treatment of food allergies in the context of the global community.

Section snippets

Food allergy

The term food allergy refers to an immune response directed toward food.¹ As defined in the 2010 US National Institutes of Allergy and Infectious Diseases (NIAID)–sponsored guidelines, food allergy is an “adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.”² This definition encompasses immune responses that are IgE mediated, non–IgE mediated, or a combination of both and is in agreement with other international guidelines.3, 4, 5

Prevalence

Determining the prevalence of food allergy is challenging. The double-blind, placebo-controlled food challenge (DBPCFC) is the most reliable indicator of allergy to a food, but using DBPCFCs in prevalence studies is difficult because the format is time-consuming and not all foods are easily masked. Prevalence rates determined on the basis of patient self-reporting are in general higher than those determined on the basis of medical history and clinical testing. A 2010 systematic review

Clinical manifestations and diagnosis

Because data from multiple studies suggest more than half of presumed food allergies are not allergies,² careful diagnosis is important to prevent unnecessary food avoidance.

Food allergy symptoms usually develop consistently after ingestion of a trigger food. However, smaller subthreshold quantities of a food allergen or extensively baked, heat-denatured, or fermented foods (eg, milk, egg, and soybean) are often ingested without inducing symptoms, and this must be taken into account when

Conditions associated with the disease

On the basis of survey data in the United States, children with food allergy have a 4-fold increased likelihood of having asthma, a 2.4-fold increased likelihood of atopic dermatitis, and a 3.6-fold increased likelihood of respiratory allergies compared with children without food allergy.³⁸ Other studies have similarly reported an increased co-occurrence of atopic dermatitis, allergic rhinitis, or asthma in patients with food allergy to peanut, tree nuts, or milk.21, 62, 63 Specific rates of

Treatment options and prevention

The primary therapy for food allergy is strict avoidance of the causal food or foods. This is true for IgE-mediated, non–IgE-mediated, and mixed IgE- and non–IgE-mediated food allergy syndromes. Although allergen avoidance is unproved in randomized controlled trials, it is the safest strategy for managing food allergy. Patients should be educated on how to read ingredient labels to avoid their allergens. In the United States, European Union, Australia, Japan, and Singapore, food-labeling laws

Diagnostic assays and evaluations

Oral food challenges are accurate and sensitive, but they put patients at risk for allergic reactions. They also require extensive resources to conduct and monitor. SPTs and measurement of sIgE antibodies are safer than food challenge but have poor specificity and do not always correlate with clinical reactivity. Standardization of food challenge procedures and interpretation should be promoted. New approaches to improve the diagnosis of clinical allergy without the need for a food challenge

References (104)

A. Urisu et al.
Japanese guideline for food allergy
Allergol Int
(2011)
S.H. Sicherer et al.
Food allergy
J Allergy Clin Immunol
(2010)
H. Akiyama et al.
Japan food allergen labeling regulation-history and evaluation
Adv Food Nutr Res
(2011)
T.K. Vander Leek et al.
The natural history of peanut allergy in young children and its association with serum peanut-specific IgE
J Pediatr
(2000)
P.W. Ewan et al.
Long-term prospective observational study of patients with peanut and nut allergy after participation in a management plan
Lancet
(2001)
H.A. Sampson et al.
Symposium on the definition and management of anaphylaxis: summary report
J Allergy Clin Immunol
(2005)
R.S.H. Pumphrey et al.
Further fatal allergic reactions to food in the United Kingdom, 1999-2006
J Allergy Clin Immunol
(2007)
S.A. Bock et al.
Fatalities due to anaphylactic reactions to foods
J Allergy Clin Immunol
(2001)
W.K. Liew et al.
Anaphylaxis fatalities and admissions in Australia
J Allergy Clin Immunol
(2009)
R.J. Rona et al.
The prevalence of food allergy: a meta-analysis
J Allergy Clin Immunol
(2007)

S.H. Sicherer et al.

Prevalence of seafood allergy in the United States determined by a random telephone survey

J Allergy Clin Immunol

(2004)

K. Pyziak et al.

Natural history of IgE-dependent food allergy diagnosed in children during the first three years of life

Adv Med Sci

(2011)

L.P.C. Shek et al.

Determination of food specific IgE levels over time can predict the development of tolerance in cow’s milk and hen’s egg allergy

J Allergy Clin Immunol

(2004)

J.M. Skripak et al.

The natural history of IgE-mediated cow’s milk allergy

J Allergy Clin Immunol

(2007)

J.H. Savage et al.

The natural history of soy allergy

J Allergy Clin Immunol

(2010)

C.A. Keet et al.

The natural history of wheat allergy

Ann Allergy Asthma Immunol

(2009)

J.H. Savage et al.

The natural history of egg allergy

J Allergy Clin Immunol

(2007)

A. Fiocchi et al.

Incremental prognostic factors associated with cow’s milk allergy outcomes in infant and child referrals: the Milan Cow’s Milk Allergy Cohort study

Ann Allergy Asthma Immunol

(2008)

A. Vereda et al.

Peanut allergy: clinical and immunologic differences among patients from 3 different geographic regions

J Allergy Clin Immunol

(2011)

S.H. Sicherer et al.

US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up

J Allergy Clin Immunol

(2010)

M. Ben-Shoshan et al.

Is the prevalence of peanut allergy increasing? A 5-year follow-up study in children in Montreal

J Allergy Clin Immunol

(2009)

A.K. Knight et al.

Skin prick test to egg white provides additional diagnostic utility to serum egg white-specific IgE antibody concentration in children

J Allergy Clin Immunol

(2006)

S.H. Sicherer et al.

9. Food allergy

J Allergy Clin Immunol

(2006)

H.A. Sampson

Utility of food-specific IgE concentrations in predicting symptomatic food allergy

J Allergy Clin Immunol

(2001)

G. Roberts et al.

Diagnosing peanut allergy with skin prick and specific IgE testing

J Allergy Clin Immunol

(2005)

T. Boyano-Martínez et al.

Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy

J Allergy Clin Immunol

(2002)

C. García-Ara et al.

Specific IgE levels in the diagnosis of immediate hypersensitivity to cows’ milk protein in the infant

J Allergy Clin Immunol

(2001)

M. Osterballe et al.

Threshold levels in food challenge and specific IgE in patients with egg allergy: is there a relationship?

J Allergy Clin Immunol

(2003)

T.T. Perry et al.

The relationship of allergen-specific IgE levels and oral food challenge outcome

J Allergy Clin Immunol

(2004)

A. Nowak-Wegrzyn et al.

Work Group report: oral food challenge testing

J Allergy Clin Immunol

(2009)

K. Ito et al.

Diagnosis of food allergy based on oral food challenge test

Allergol Int

(2009)

S.H. Sicherer et al.

A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants

J Allergy Clin Immunol

(2001)

H.S. Skolnick et al.

The natural history of peanut allergy

J Allergy Clin Immunol

(2001)

H. Agata et al.

Effect of elimination diets on food-specific IgE antibodies and lymphocyte proliferative responses to food antigens in atopic dermatitis patients exhibiting sensitivity to food allergens

J Allergy Clin Immunol

(1993)

S.A. Bock et al.

Further fatalities caused by anaphylactic reactions to food, 2001-2006

J Allergy Clin Immunol

(2007)

L. Christie et al.

Food allergies in children affect nutrient intake and growth

J Am Diet Assoc

(2002)

S.A. Bock et al.

The natural history of peanut allergy

J Allergy Clin Immunol

(1989)

M.L.K. Tang et al.

Prevention and treatment of anaphylaxis

Paediatr Child Health

(2008)

M.H.K. Ho et al.

Early clinical predictors of remission of peanut allergy in children

J Allergy Clin Immunol

(2008)

R.S.H. Pumphrey

Fatal posture in anaphylactic shock

J Allergy Clin Immunol

(2003)

J.W. Tole et al.

Biphasic anaphylaxis: review of incidence, clinical predictors, and observation recommendations

Immunol Allergy Clin North Am

(2007)

H.A. Sampson et al.

Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

J Allergy Clin Immunol

(2006)

S.H. Sicherer et al.

Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants

J Allergy Clin Immunol

(2010)

G. Du Toit et al.

Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy

J Allergy Clin Immunol

(2008)

A.T. Fox et al.

Household peanut consumption as a risk factor for the development of peanut allergy

J Allergy Clin Immunol

(2009)

G. Lack

Epidemiologic risks for food allergy

J Allergy Clin Immunol

(2008)

J.J. Koplin et al.

Can early introduction of egg prevent egg allergy in infants? A population-based study

J Allergy Clin Immunol

(2010)

J.J.S. Chafen et al.

Diagnosing and managing common food allergies: a systematic review

JAMA

(2010)

J.A. Boyce et al.

Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel

J Allergy Clin Immunol

(2010)

A. Sackeyfio et al.

Diagnosis and assessment of food allergy in children and young people: summary of NICE guidance

BMJ

(2011)

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Food allergy is an increasing public health problem in children and adults. In addition to the risk of potentially severe reactions, food allergy can have a significant burden on quality of life, nutrition, cost of living, and social activities. Traditionally, treatment has primarily included strict food allergen avoidance and use of emergency medications to treat an allergic reaction. However, in recent years, there have been significant strides in the advancement of food allergy treatment, including the approval of the first and only approved therapy (peanut oral immunotherapy) for food allergy in 2020. Clinical trials have primarily focused on food allergen immunotherapy (oral, epicutaneous, sublingual). Building off of a foundation of promising data supporting the efficacy of food oral immunotherapy and our greater understanding of the underlying mechanism of immunotherapy, newer approaches, including alternative routes of delivery, adjuncts to therapy, modified allergens, and utilization in younger patients, aim to provide safer and more effective treatment approaches to the millions of patients burdened by food allergy.
Clinically and industrially relevant incurred reference materials to improve analysis of food allergens, milk, egg, almond, hazelnut and walnut
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Measurement of food allergen protein concentrations against thresholds can improve allergen risk management and precautionary allergen labelling. Such measurement suffers well known problems which could be ameliorated by well characterised reference materials (RMs) providing meaningful information for risk assessors. We investigated the preparation and characterisation of the first consensus informed industrially and clinically relevant multi-allergen matrix RM kit for five priority allergens. It is a medium analytical difficulty processed food chocolate paste matrix (a) devoid of allergens, and (b) incurred with five allergens at the clinically relevant concentration of 10 mg kg⁻¹ expressed as protein. The allergen raw materials: hens’ egg white powder, skimmed cows’ milk powder, almond powder (full fat), hazelnut powder (partially defatted), and walnut powder (partially defatted), are also available as RMs. The preparation, gravimetric traceability to the SI, homogeneity, and stability were found to be fit-for-purpose and the RMs are now available to the analytical community.
Preparation of poly(caffeic acid)-coated epitope molecularly imprinted polymers and investigation of adsorption performance toward ovalbumin
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Food allergy can lead to severe allergic reactions that are potentially fatal for human, hence the detection of food allergens such as ovalbumin (OVA) is important. In this study, a poly(caffeic acid)-coated epitope molecularly imprinted polymer (EMIP) was prepared by chelation and autoxidation of caffeic acid with hexamethylenediamine. EMIP has not only imprinted cavities highly matched with OVA in size and spatial structure, but also externally abundant hydrophilic groups, resulting in few non-specific binding and good hydrophilicity. With high specificity, significant paramagnetism, and great reusability, EMIP can distinguish OVA from other proteins and selectively enrich OVA in egg white samples, which opens up a promising route to the determination of allergens in food products.
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A mouse model of food allergy permitting skin and nasal symptoms
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Developing experimental animal models that show clinical symptoms and methods for quantitative and objective evaluation are important for understanding food allergies. Therefore, this study aimed to develop an ovalbumin (OVA)-induced mouse model of food allergy and a useful method to evaluate the symptoms of food allergy.
Mice were sensitized via intraperitoneal injection of OVA. Subsequently, local sensitization was performed once weekly by oral administration of OVA. Itching and nasal symptoms were observed after oral administration of the antigen. First, we examined the dose-dependency of the antigen. Symptoms were checked weekly. In order to confirm food allergy symptoms, the effect of histamine H₁ receptor antagonist was examined. Finally, we measured antigen-specific IgE antibody levels in the serum.
Scratching behavior, sneezing and nasal rubbing were increased. Both itching and rhinitis symptoms increased steadily, after which, the number of symptoms remained almost constant. No difference was observed between the results of 3- and 5-week-old mice. Cetirizine inhibited these symptoms in a dose-dependent manner. In addition, antigen-specific IgE antibodies were produced in both 3- and 5-week-old mice.
This method may be useful for evaluating the symptoms of skin and rhinitis that could not be assessed in the conventional food allergy model and could be induced with a low dose of antigen. In particular, the developed method, which measures the number of itching and nasal symptoms, may enable quantitative, objective, and noninvasive evaluation of food allergy severity.
Qualitative and quantitative prediction of food allergen epitopes based on machine learning combined with in vitro experimental validation
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An allergen epitope is a part of molecules that can specifically bind to immunoglobulin E (IgE), causing an allergic reactions. To predict protein epitopes and their binding ability to IgE, quantitative structure–activity relationship (QSAR) models were established using four algorithms combined with the selected chemical descriptors. The model predicted the binding capabilities of the epitopes to IgE with the R² and root mean squared error (RMSE) as 0.7494 and 0.2375, respectively. The model’s performance was validated using an enzyme-linked immunosorbent assay (ELISA). The results showed that the established QSAR model could efficiently and accurately predict the allergic reaction of food protein epitopes. The prediction results of the model and the experimental results were consistent, with a Pearson correlation coefficient of 0.8956. The results from both the QSAR model and in vitro experiments indicated that amino acid sequence 116–130 was a novel IgE-binding epitope of β-LG.

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: This article is a product of an international coalition between the American Academy of Allergy, Asthma & Immunology; European Academy of Allergy and Clinical Immunology; World Allergy Organization; and American College of Allergy, Asthma & Immunology on food allergy.

: Disclosure of potential conflict of interest: A. W. Burks is a minority stockholder in Allertein and Mast Cell, Inc; is on an advisory board or expert panel for Dannon Co Probiotics and Nutricia; has consulted for Exploramed Development, LLC, Intelliject, McNeil Nutritionals, Merck & Co, Novartis, Pfizer, Portola Pharmaceuticals, and Schering-Plough; has received research support from the National Institutes of Health (NIH), the Food Allergy and Anaphylaxis Network (FAAN), the Food Allergy Initiative (FAI), the National Peanut Board, SHS, and the Wallace Research Foundation; has provided legal consultation or expert witness testimony on the topic of food allergy; and is on the medical board of directors of FAAN. M. Tang has received study products from Nestlé Research Institute; has been an invited speaker on food allergy and anaphylaxis for Link Pharmaceuticals, Alphapharm, Nutricia, Wyeth, and Nestlé Nutrition Institute; and has served on advisory boards for Nestlé Nutrition Institute and Nutricia. S. Sicherer has consulted for, and received grants from FAI; has served as an advisor to FAAN; and has received grants from the National Institute of Allergy and Infectious Diseases (NIAID). P. A. Eigenmann is an ex-committee member of the European Academy of Allergy and Clinical Immunology. A. Fiocchi has received research support from Allegria Onlus. K. Beyer has received consulting fees and honoraria from Danone and Novartis; has received honoraria from Phadia, Infectopharm, Hipp, UCB, and Meda Pharma; and has received research support from the German Research Foundation, the European Union, Danone, and the Foundation for the Treatment of Peanut Allergy. R. Wood has consulted for the Asthma and Allergy Foundation of America, has received research support from the NIH, and is on the medical advisory board for FAAN. J. O. Hourihane has received research support from the Children's Research Foundation (Ireland), Danone, the Food Standards Agency (United Kingdom), and Stallergenes; in addition, his employer, University College Cork, holds a patent on challenge outcome predictor software. S. M. Jones has received research support from the NIH/NIAID, the National Peanut Board, and FAAN; in addition, she serves on an advisory board for FAAN. G. Lack has received sponsorship from Sodilac, Novartis, the Spanish Society of Allergy and Clinical Immunology, Danone Nutricia, and Nestlé; has received research support from the Immune Tolerance Network/NIH, National Peanut Board, Food Standards Agency, Medical Research Council, FAI, Action Medical Research, ALK Abelló, and Guy's & St Thomas' Charity; is a voluntary scientific advisor for the Anaphylaxis Campaign and National Peanut Board; and is scientific advisor for DBV Technologies. H. A. Sampson has consulted for Allertein Therapeutics, LLC; has served on advisory boards for ImmusanT and Novartis; has received research support from the NIH/NIAID and FAI; has served as a consultant or advisor to FAI, FAAN, and the University of Nebraska–FARRP; and is a part-owner of Herb Springs, LLC. The rest of the authors declare that they have no relevant conflicts of interest.

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Reviews and feature articleICON: Food allergy

Section snippets

Food allergy

Prevalence

Clinical manifestations and diagnosis

Conditions associated with the disease

Treatment options and prevention

Diagnostic assays and evaluations

Allergol Int

J Allergy Clin Immunol

Adv Food Nutr Res

J Pediatr

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Adv Med Sci

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Allergol Int

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Am Diet Assoc

J Allergy Clin Immunol

Paediatr Child Health

J Allergy Clin Immunol

J Allergy Clin Immunol

Immunol Allergy Clin North Am

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Diagnosing and managing common food allergies: a systematic review

JAMA

Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel

J Allergy Clin Immunol

Diagnosis and assessment of food allergy in children and young people: summary of NICE guidance

BMJ

Reviews and feature article
ICON: Food allergy