What do allergists in practice need to know about non–IgE-mediated food allergies

Mehr, Sam; Brown‐Whitehorn, Terri

doi:10.1016/j.anai.2019.03.025

Cited by 13 publications

(6 citation statements)

References 87 publications

(214 reference statements)

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“…Food allergy reactions are mediated by IgE-or non-IgEmediated mechanisms (4) with an increasingly recognized spectrum of disorders because of their diverse and heterogeneous manifestations in different organs and their potential for significant morbidity (3). The most challenging food allergies to diagnose are non-IgE-mediated allergies, which are commonly misdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

A Demographics Analysis of IgE- and Non-IgE-mediated Food Allergies in Children

Norolahi

Hematyar

Pouyanfar

et al. 2022

J Kermanshah Univ Med Sci

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Background: There are three broad types of food allergies, including IgE-mediated reactions, non-IgE-mediated reactions, and mixed reactions. The onset of IgE-mediated food allergies is usually rapid and can sometimes lead to serious illness. Non-IgE-mediated and mixed types of food allergies can cause significant morbidity as a result of chronic disease. Objectives: This study aimed to compare various types of food allergies and discuss the basis of their different presentations. Methods: This study was conducted on children aged 2 - 12 years old with signs or symptoms of food allergy in the allergy clinics of Azad University Hospitals, Tehran, Iran, from January 2019 to January 2020. Food allergy was evaluated in these patients by careful history, physical exam, skin prick test, and atopy patch test. Results: A positive family history of atopy was detected in the first-degree relatives of 82 (63%) patients. All the children were exclusively breastfed at the beginning. A total of 61 patients had positive skin prick test (SPT), and 68 patients had positive atopy patch test (APT) results. Among food allergens, a significant correlation was detected between positive atopic patch test results and hypersensitivity reactions to cow’s milk (P value = 0.001), beef (0.002), and tomato (0.04). There was the same significant correlation between positive skin prick test results, allergens, and wheat (P value = 0.01). Conclusions: Although skin prick and atopy patch tests may help identify the culprit foods, oral food challenges are the mainstay of the diagnosis.

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Section: Discussionmentioning

confidence: 99%

A Demographics Analysis of IgE- and Non-IgE-mediated Food Allergies in Children

Norolahi

Hematyar

Pouyanfar

et al. 2022

J Kermanshah Univ Med Sci

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“…77,78 Most infants outgrow FPIAP by 1 year and can ingest food without restriction. 79 Infants with uncomplicated FPIAP may not require an allergy referral. However, further evaluation may be warranted if the trigger cannot be identified, or symptoms do not resolve with trigger elimination.…”

Section: Dovepressmentioning

confidence: 99%

Perspectives on Non-IgE-Mediated Gastrointestinal Food Allergy in Pediatrics: A Review of Current Evidence and Guidelines

Al-Iede¹,

Sarhan²,

Alshrouf³

et al. 2023

JAA

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Food allergy is an immune-mediated disease that can result in considerable morbidity and even mortality, with a significant negative impact on patients' quality of life. It is characterized by allergic symptoms that can occur shortly after a relevant food allergen ingestion, or can be delayed or chronic, which make it more difficult for diagnosis. The symptoms of this disease can range from mild to severe, and rarely can cause anaphylaxis, a life-threatening allergic reaction. The prevalence of non-immunoglobulin E (IgE)mediated food allergy is poorly established outside of cow's milk allergy, with an adjusted incidence ranging between 0.13% and 0.72%. Several disorders are classified as non-immunoglobulin E (IgE)-mediated food allergies that predominantly affect the gastrointestinal tract including food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), food protein-induced allergic enteropathy (FPE), and food protein-induced dysmotility disorders (GORD and constipation). Eosinophilic esophagitis (EoE) is listed in this group, even though it considered by some authorities to be mixed reaction with both IgE and cell-mediated immune response to be involved in the reaction. The most common types of non-IgE-mediated food allergy are food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). These disorders typically present in infancy and are often triggered by cow's milk protein. Patients with FPIES present with profuse emesis and dehydration, while FPIAP patients present with hematochezia in otherwise healthy infants. Since there are no specific confirmatory non-invasive diagnostic laboratory tests, the diagnosis is usually made clinically when typical symptoms improve upon the removal of the culprit food. Food reintroduction should be attempted, when possible, with documentation of symptoms of relapse to confirm the diagnosis. The management includes dietary avoidance, supportive treatment in the case of accidental exposure, and nutritional counseling. This review focuses on the clinical manifestations, epidemiology, management, and recent guidelines of the most common non-IgEmediated food hypersensitivity disorders (FPIES, FPIAP, and FPE).

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“…Food antigens may precipitate gastrointestinal symptoms through cell-mediated processes (type IV hypersensitivity reactions [ 84 ]. The classic examples include food protein-induced allergic proctocolitis (FPIAP), a benign condition generally presenting in early infancy, and food protein-induced enterocolitis syndrome (FPIES), generally presenting with severe symptoms within the first 6 months of life [ 85 ]. While not completely characterized, FPIES results from food-induced immune activation, including activation of the innate immune system limited to the gastrointestinal tract [ 86 , 87 ].…”

Section: Allergy and Functional Abdominal Pain Disordersmentioning

confidence: 99%

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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What do allergists in practice need to know about non–IgE-mediated food allergies

Cited by 13 publications

References 87 publications

A Demographics Analysis of IgE- and Non-IgE-mediated Food Allergies in Children

A Demographics Analysis of IgE- and Non-IgE-mediated Food Allergies in Children

Perspectives on Non-IgE-Mediated Gastrointestinal Food Allergy in Pediatrics: A Review of Current Evidence and Guidelines

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

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