Food Allergy Overview in Children

Abstract

Food allergies have increased significantly in the past decade. An accurate history is crucial in approaching the management. At the outset, food intolerance must be distinguished from food allergies and, furthermore, these allergies should be classified into either an IgE, Non-IgE, or a mixed response. The clinical features vary from life-threatening anaphylaxis to milder IgE-mediated responses, atopic dermatitis, and gastrointestinal symptoms. The severity of the reaction and the potential risk for anaphylaxis on reexposure should be assessed. Milk, soy, egg, wheat, and peanut allergies are common in children, whereas peanut, tree nut, fish, shell fish allergies, and allergies to fruits and vegetables are common in adults. Structural proteins are important determinants of the severity of the reactions and may often predict the natural history and cross reactivity. Diagnostic work up must be guided by the clinical history. Skin testing and food-specific IgE done by standard methods are very useful, whereas oral challenges may be indicated in some situations. Majority of the patients outgrow their allergies to milk, soy, egg, and wheat, and some to peanut also, therefore, patients should be periodically reassessed. Novel diagnostic techniques which detect specific allergenic epitopes have been developed. Several newer therapies are promising.

Potential, pitfalls, and prospects of food allergy diagnostics with recombinant allergens or synthetic sequential epitopes

“…This might be exemplified by the observation that high sIgE titers to recombinant lipid transfer protein in combination with low or absent reactivity to Bet v 1 homologues are clearly correlated with systemic reactions in apple, peach, cherry, and hazelnut allergy, whereas the opposite is true for patients with oral allergy syndrome at consumption of these foods. [31], [33], [111] and [112] 113 Early RAST studies suggested a correlation of sIgE titers and the pace of tolerance development. 114 Further studies with crude allergen extracts mostly verified a general trend of a correlation between high sIgE titers and slow outgrowth of cow's milk or hen's egg allergy.…”

Food Allergy: Always a Threat, How do We Treat it?

“…Children lose their sensitivity to egg around the age of 5 years. Patients with egg allergy during childhood are more likely to develop sensitivity to aeroallergens later [3].…”

“…Immune responses are IgE-mediated, non-IgE mediated, or combination of both. Food allergy should be distinguished from food intolerance, which is not an immunologically mediated reaction [2][3][4].…”

“…Skin tests and food-specific IgE are useful for identifying food allergy. In some cases, oral challenges may be indicated [3,4].…”

“…Avoiding food allergens, therapy of symptoms and administration of epinephrine in anaphylaxis are included in the management of food allergies [3][4][5].…”