Abstract
Food allergies are defined as adverse immune responses to food proteins that result in typical clinical symptoms involving the dermatologic, respiratory, gastrointestinal, cardiovascular, and/or neurologic systems. IgE-mediated food-allergic disease differs from non-IgE-mediated disease because the pathophysiology results from activation of the immune system, causing a T helper 2 response which results in IgE binding to Fcε receptors on effector cells like mast cells and basophils. The activation of these cells causes release of histamine and other preformed mediators, and rapid symptom onset, in contrast with non-IgE-mediated food allergy which is more delayed in onset. The diagnosis of IgE-mediated food allergy requires a history of classic clinical symptoms and evidence of food-specific IgE by either skin-prick or serum-specific IgE testing. Symptoms of IgE-mediated food allergies range from mild to severe. The severity of symptoms is not predicted by the level of specific IgE or skin test wheal size, but the likelihood of symptom onset is directly related. Diagnosis is excluded when a patient can ingest the suspected food without clinical symptoms and may require an in-office oral food challenge if testing for food-specific IgE by serum or skin testing is negative or low. Anaphylaxis is the most severe form of the clinical manifestation of IgE-mediated food allergy, and injectable epinephrine is the first-line treatment. Management of food allergies requires strict avoidance measures, counseling of the family about constant vigilance, and prompt treatment of allergic reactions with emergency medications. Guidelines have changed recently to include early introduction of peanuts at 4–6 months of life. Early introduction is recommended to prevent the development of peanut allergy. Future treatments for IgE-mediated food allergy evaluated in clinical trials include epicutaneous, sublingual, and oral immunotherapy.
Highlights
Food allergies, defined as adverse immune responses to food proteins, are becoming increasingly common conditions
Sensitization is defined as the state of having detectable food-specific IgE which can be a precursor to the development of clinical food allergy
An intact epithelial barrier is important in the maintenance of tolerance, as it prevents the entry of danger signals and subsequently prevent the production of inflammatory cytokines, in conjunction with food antigens
Summary
Food allergies, defined as adverse immune responses to food proteins, are becoming increasingly common conditions. Diseases associated with immune-mediated food allergy include acute urticaria/angioedema, oral allergy syndrome, atopic dermatitis, eosinophilic gastrointestinal. IgE-mediated food-allergic disease is associated with fatal anaphylaxis, especially with peanut, tree nuts, and Clinic Rev Allerg Immunol (2019) 57:244–260. The potential for this devastating outcome and the widespread media coverage of this epidemic has resulted in increased awareness of food allergies and fear for those affected. More people believe they have food allergies than prevalence estimates show based on physician diagnosis. This review article will address the pathophysiology, clinical manifestations, diagnostic approaches, and management of IgE-mediated food allergies
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