Food allergy

Food allergy appears to be increasing in prevalence and is estimated to affect >2% and possibly up to 10% of the population. Food allergies are defined by an immune response triggered by food proteins. Emerging data suggest that carbohydrate moieties on food proteins, specifically mammalian meats, may also elicit allergic responses. Food is the most common trigger of anaphylaxis in the community, which can be fatal. The underlying mechanisms of food allergy usually involve food-specific immunoglobulin E antibodies, but cell-mediated disorders account for a variety of chronic or subacute skin and gastrointestinal reactions. Eosinophilic esophagitis is an emerging food-related chronic disorder. The diagnosis of food allergy is complicated by the observation that detection of food-specific immunoglobulin E (sensitization) does not necessarily indicate clinical allergy. Diagnosis requires a careful medical history, laboratory studies, and, in many cases, oral food challenges to confirm a diagnosis. Novel diagnostic methods, many of which rely upon evaluating immune responses to specific food proteins or epitopes, may improve diagnosis and prognosis in the future. Current management relies upon allergen avoidance and preparation to promptly treat severe reactions with epinephrine. Studies suggest that some children with milk or egg allergy might tolerate extensively heated forms, for example milk or egg baked into muffins, without symptoms and possibly with some immunotherapeutic benefits. Novel therapeutic strategies are under study, including oral and sublingual immunotherapy, Chinese herbal medicine, anti-immunoglobulin E antibodies, and modified vaccines.