Food Allergy in Adults: An Over- or Underrated Problem? Stringent Elimination Diet

Abstract

Seitz et al conducted a retrospective analysis of more than 400 patients with suspected allergies and rightly emphasize that a comprehensive allergological evaluation can protect patients from the negative consequences of over- or underestimating the allergy (1). In 66 cases they describe oral provocation tests—following a medical history and standardized skin tests—whose results were negative. The authors diagnose a allergy in more than 50% of their patients—but we don’t know whether in case the situation was not obvious, oral provocation tests were conducted in these patients too. In everyday practice, the proportion of patients with unclear constellations after a medical history has been taken, skin tests have been conducted, or IgE concentrations were measured is high (for example, existing differential diagnoses to allergies and sensitization to several foodstuffs in unequivocal symptoms after a composite meal). The allergy working group of the three German allergy societies (the German Society for Allergology and Clinical Immunology [DGAKI], the Medical Association of German Allergologists [ADA,], and the Society of Pediatric Allergology [GPA]) have compiled position papers and guidelines relevant to clinical practice that can be found at http://www.leitlinien.net by searching for food allergy. The specialist societies are particularly concerned that institutions with allergological experience should extensively offer the option of oral provocation tests for patients whose constellation is unclear. Targeted oral provocation tests can be sufficiently reproduced in hospitals under DRG conditions and are often the only option to confirm a suspected diagnosis of allergy (2, 3). Food allergies can have harmless outcomes but they can also be fatal, albeit rarely. Neither the degree of sensitization nor the extent of a previous systemic reaction are predictive of the outcome of life threatening reactions to foodstuffs. Hence even patients with mild confirmed systemic reactions to foodstuffs should stringently adhere to a strict elimination diet after dietary advice and should carry an emergency kit (adrenaline auto injector, antihistamine, steroid) on their person.