Food for thought: progress in understanding the causes and mechanisms of food allergy.

Abstract

The community burden of food allergy appears to be rising, yet the causes and mechanisms are not completely understood. The purpose of this review is to provide a snapshot of the state of play of IgE food allergies, with a focus on recent advances. There are still wide discrepancies regarding measures and definitions of food allergy. Even recent studies still rely on food sensitization, self-reporting, or parent-reporting rather than more robust measures. Population-based sampling strategies using objective measures are underway in some countries. Emerging data suggest substantial geographical and ethnic differences in food sensitization and allergy. Trans-cutaneous sensitization, particularly in those with eczema or filaggrin mutations, has been posited as a potential mechanism, as well as gut microbiota and genetics/epigenetics. Treatments for food allergy are still lacking, yet progress is being made, and immunotherapy appears more effective than dietary avoidance. Non-IgE food allergy remains drastically under-explored. Food allergy is a complex immune-mediated disease consisting of numerous environmental/genetic/epigenetic risk factors; yet interventions are likely to be simple and cost-effective.