Allergies have been around for what it seems like forever. Most of our patients suffer from environmental or seasonal allergy. Most of the patients with on-going gastrointestinal symptoms self-diagnose with a food allergy, and they start avoiding the food in the matter. Therefore, the exact number of people with a food allergy is unknown, but it’s estimated that the prevalence rate is 3% and less than 10% of adults worldwide.
Several adverse gastrointestinal symptoms, reproducible or not reproducible, can be caused by the ingestion of different foods. Adverse food reactions can be immune derived or non-immune conditions. Food allergy is considered an immune-derived reaction.
Institute of Allergy and Infectious Diseases defined as food allergy
as ‘‘an adverse health effect arising from a specific immune
response that occurs reproducibly on exposure to a given food’’
Food allergies are adverse immunologic IgE-mediated reactions related to food hypersensitivity. The risk factors can be varied:
|Sex (male sex children)||Timing in the exposure to food (weaning)|
|Race/ ethnicity (Asian and black children)||Environmental sensitization|
|Vitamin D deficiency||Probiotics|
|Omega 3 PUFA’s deficiency|
|Antioxidant deficient diet|
The reproducible adverse food reaction called food allergy is associated with the ingestion of different foods, and these can vary depending on the patient’s life stage:
|Childhood (can be resolved)||Adult (persistent)|
Testing for food allergy can be tricky; false positives or cross-reactions between foods can easily take place. The best approaches are currently regulated by the Expert Panel Guidelines and should be accompanied by a physical examination.
Considered the gold standard.
It can be easily reproduced, but cross-reactions to different foods can appear if the test is not properly prepared.
Not appropriate for patients that have a high risk of anaphylaxis or using steroids, antihistamines, dermatitis.
Useful but not diagnostic
The adverse food reaction should appear within minutes or 2-4 hours after the test. Is considered to be time consuming and risky.
THE CROSS REACTORS
|Environmental allergen||Fruits||Vegetables||Nuts||Spices||Other foods|
|Pollen||Apple, cherry, fig, kiwi, lychee, nectarine, pear, plum, peach, apricot.||Beans, carrot, celery, potato, tomato, peas.||Almond, hazelnut, walnut.||Anise, basil, dill, chicory.||Lentils, peanuts, soybean, sunflower.|
|Grass||Date, kiwi, melons, orange, tomato, watermelon.||Peas, potato.||Peanut|
|Ragweed||Banana, melons, watermelon.||Cucumbers, Zucchini|
An allergy is considered a systemic disease and may be presented with diverse manifestations. Food allergy can have the following adverse reactions.
FOOD ALLERGY MANIFESTATIONS
|Immediate gastrointestinal hypersensitivity: IgE mediated reaction, often accompanied by effects in the skin and the lungs. Symptoms: |
· pyloric spams
|Cutaneous manifestations: |
· atopic dermatitis
· exercise-induced urticaria
· contact urticaria
|Oral allergy syndrome: the presence of itching and swelling of oral tissues.||Respiratory: |
· Heiner syndrome
· coughing or rhinitis
|Eosinophilic esophagitis and gastritis: IgE mediated and non-IgE mediated, the first involves dysphagia, vomiting, abdominal pain, and irritability. Eosinophilic gastritis is associated with vomiting, abdominal pain, hematemesis, and poor weight gain.||Systemic manifestations: anaphylaxis.|
|Dietary protein enterocolitis: In the first months of life, babies may present vomiting and diarrhea, leading to dehydration.|
|Celiac disease: an increased transglutaminase activity is found in this disease.|
|Irritable bowel syndrome and food allergy.|
Sicherer, Scott H., and Hugh A. Sampson. “Food allergy: epidemiology, pathogenesis, diagnosis, and treatment.” Journal of Allergy and Clinical Immunology 133.2 (2014): 291-307.
Olivier, C. E. “Food allergy.” J Aller Ther S 3 (2013): 2.
Flores Kim, J., et al. “Diagnostic accuracy, risk assessment, and cost‐effectiveness of component‐resolved diagnostics for food allergy: a systematic review.” Allergy 73.8 (2018): 1609-1621.
Allergic Living, Charts, Food Allergy, Fruit & Vegetable August 30, 2010. https://www.allergicliving.com/2010/08/30/the-cross-reactors/
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