Food Allergies and Intolerances: A Clinical Approach to the Diagnosis and Management of Adverse Reactions to Food

Onyimba, Frances; Crowe, Sheila E.; Johnson, Sarah; Leung, John

doi:10.1016/j.cgh.2021.01.025

Cited by 32 publications

(34 citation statements)

References 69 publications

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“…The impact of therapeutic food allergy 2 of 35 regimens on nutritional needs will therefore need to be adjusted according to this expanding spectrum [4], as this is the cornerstone of all types of food allergy prevention, from primary to tertiary [5]. This evolving landscape for immediate hypersensitivity reactions to food, as well as increased knowledge on non-IgE-or mixed IgE/non-IgE immunological responses brings increasing nutritional challenges for diseases in which long-term food elimination is a primary therapeutic strategy [6], underscoring the key role of a correct dietary approach strictly driven by appropriate diagnostics [7]. of adult-onset cases than previously appreciated [2,3].…”

Section: Introductionmentioning

confidence: 99%

Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns

et al. 2021

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Adverse food reactions include immune-mediated food allergies and non-immune-mediated intolerances. However, this distinction and the involvement of different pathogenetic mechanisms are often confused. Furthermore, there is a discrepancy between the perceived vs. actual prevalence of immune-mediated food allergies and non-immune reactions to food that are extremely common. The risk of an inappropriate approach to their correct identification can lead to inappropriate diets with severe nutritional deficiencies. This narrative review provides an outline of the pathophysiologic and clinical features of immune and non-immune adverse reactions to food—along with general diagnostic and therapeutic strategies. Special emphasis is placed on specific nutritional concerns for each of these conditions from the combined point of view of gastroenterology and immunology, in an attempt to offer a useful tool to practicing physicians in discriminating these diverging disease entities and planning their correct management. We conclude that a correct diagnostic approach and dietary control of both immune- and non-immune-mediated food-induced diseases might minimize the nutritional gaps in these patients, thus helping to improve their quality of life and reduce the economic costs of their management.

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Section: Introductionmentioning

confidence: 99%

Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns

et al. 2021

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“…Allergy tests are commonly used to determine which foods should be excluded in patients with eczema who have a history suggestive of a food allergy. Foods most likely to be tested/excluded are included in the 8 most common food allergies 4 . However, our results suggest that even in those patients with negative food allergy tests, dietitians might still advise exclusion of foods.…”

Section: N (%)mentioning

confidence: 76%

Dietary management of patients with eczema: Cross‐sectional survey of dietitians in the United Kingdom

Gilbertson

Skypala²,

Ridd

2021

Clin Experimental Allergy

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To the Editor, The association between food allergy and eczema is well recognized. 1 Food allergy is more prevalent in patients with eczema, compared with the general population, and may exacerbate symptoms, but is not thought to be the underlying cause of eczema for most patients. 2 Yet, clinicians often feel pressurized by patients with eczema or their parents to investigate food allergy, particularly in those perceived to be unresponsive to standard medical management.Investigations for IgE-mediated and non-IgE-mediated food allergy may be instigated to guide dietary exclusion(s) and reduce symptom exacerbation. However, the unwarranted exclusion of foods can compromise nutritional status and can put sensitized individuals at risk of severe IgE-mediated allergic reactions. 3 Dietitians are often asked to provide dietary advice to patients with eczema, but there is currently no universal approach to the testing and dietary management of patients with eczema and possible food allergy.We sought to establish current practices amongst UK dietitians regarding the testing and dietary management of eczema patients.Of particular interest was the basis for dietary exclusion advice, how foods to be excluded were determined, the duration of exclusion and reintroduction of foods, and the favoured approach when more than one food was suspected to be exacerbating eczema symptoms.

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“…During birch pollen season, adults with birch pollen allergy demonstrate an increase in duodenal eosinophils and IgE-carrying mast cells along with oral allergy syndrome [ 81 ]. Oral allergy syndrome is a hypersensitivity to raw plant proteins, often proteins that cross-react with pollen proteins, resulting in oropharyngeal symptoms (e.g., itching, tingling, swelling) [ 26 ]. In a separate study, birch exposure was associated with increased intestinal eosinophil and mast cell densities [ 82 ].…”

Section: Allergy and Functional Abdominal Pain Disordersmentioning

confidence: 99%

“…Food allergies are divided into two categories: IgE- mediated and non-IgE-mediated. IgE-mediated reactions are associated with more rapid onset of symptoms, while non-IgE-mediated reactions typically result in delayed onset of symptoms [ 26 , 27 ]. Food allergy in children has an estimated worldwide prevalence of 6–8%, with estimates of 10% in high-income countries [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

“…Food allergy in children has an estimated worldwide prevalence of 6–8%, with estimates of 10% in high-income countries [ 27 ]. Approximately 50% of food allergy reactions will produce systemic symptoms (e.g., wheezing, hives, anaphylaxis), and 50% will produce only or primarily gastrointestinal symptoms [ 26 ]. Multiple physiologic factors prevent immune reactions to foods, termed tolerance, including microbiome features and the intestinal barrier [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Update on the Role of Allergy in Pediatric Functional Abdominal Pain Disorders: A Clinical Perspective

2021

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Both functional abdominal pain disorders (FAPDs) and food allergies are relatively common in children and adolescents, and most studies report an association between FAPDs and allergic conditions. FAPDs share pathophysiologic processes with allergies, including both immune and psychological processes interacting with the microbiome. No conclusive data are implicating IgE-mediated reactions to foods in FAPDs; however, there may be patients who have IgE reactions localized to the gastrointestinal mucosa without systemic symptoms that are not identified by common tests. In FAPDs, the data appears stronger for aeroallergens than for foods. It also remains possible that food antigens initiate an IgG reaction that promotes mast cell activation. If a food allergen is identified, the management involves eliminating the specific food from the diet. In the absence of systemic allergic symptoms or oral allergy syndrome, it appears unlikely that allergic triggers for FAPDs can be reliably identified by standard testing. Medications used to blunt allergic reactions or symptomatically treat allergic reactions may be useful in FAPDs. The purpose of the current manuscript is to review the current literature regarding the role of allergy in FAPDs from a clinical perspective, including how allergy may fit in the current model of FAPDs.

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Food Allergies and Intolerances: A Clinical Approach to the Diagnosis and Management of Adverse Reactions to Food

Cited by 32 publications

References 69 publications

Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns

Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns

Dietary management of patients with eczema: Cross‐sectional survey of dietitians in the United Kingdom

Update on the Role of Allergy in Pediatric Functional Abdominal Pain Disorders: A Clinical Perspective

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