Non-immediate (non-IgE mediated) food allergy in infancy

Abstract

Food allergy (FA) is an immunologic adverse reaction to food exposure. The immunologic mechanism could be either IgE or non-IgE mediated or a mixed one. IgE-mediated symptoms typically develop within 20 minutes to two hours after ingestion of culprit food, while non-IgE mediated symptoms occur later, up to several days after ingestion. Non-IgE mediated food allergy encompasses a wide range of diseases affecting the gastrointestinal tract, proctocolitis and food protein induced enterocolitis syndrome (FPIES) being the most frequent in infancy. The most common food allergen in infants responsible for non-IgE mediated FA is cow’s milk, followed by soy, cereals and hen’s egg. About 5% to 10% infants with FA are reactive to more than three foods and very few to six or more. The diagnosis of non-IgE mediated disease depends on detailed history, physical examination, response to elimination diets and oral provocation challenges (OFCs), as there are no specific biomarkers. The management of FA requires avoidance of ingestion and periodic evaluation through supervised OFCs in order to determine whether the patients can tolerate other forms of offending food and/or when they are able to reintroduce it in their diet.