Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects
Abstract
:1. Introduction
1.1. Food Allergy Prevalence
1.2. Food Allergens
2. Physiopathology
3. Classification of Food Allergic Reactions
3.1. Neonatal and Infantile Gastrointestinal Allergy
3.2. Infantile Atopic Dermatitis Associated with and Aggravated by Food Allergies
3.3. FA with Immediate Manifestation
3.4. Special Type
4. Clinical Manifestations
4.1. The Cutaneous Manifestations Translate into Urticaria, Pruritus, Rash, and Accentuation of the Symptoms of Atopic Dermatitis. Depending on the Severity of the Lesions, We Can Classify the Symptoms in Three Degrees of Severity
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- Grade I: skin manifestations such as erythema, urticaria, and pruritus are localized.
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- Grade II: generalized skin manifestations of moderate intensity.
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- Grade III: generalized skin manifestations of high intensity.
4.2. Ocular Manifestations
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- Conjunctival Erythema.
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- Pruritus.
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- Tear Hypersecretion.
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- Periorbital Edema.
4.3. Gastrointestinal Manifestations Are Bloating, Abdominal Cramps, Nausea, Vomiting, and Diarrhea. Recent Studies Introduced Three Other Degrees of Severity
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- Grade I: Feeling of discomfort in the oral cavity and throat, mild abdominal pain, nausea. These manifestations are localized and of low intensity.
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- Grade II: Moderate abdominal pain, sore throat, and recurrent diarrhea with vomiting.
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- Grade III: Severe abdominal pain, vomiting, and uncontrollable diarrhea.
4.4. Cardiovascular Manifestations: Hypotension, Palpitations, Tachyarrhythmias, or Rhythm Disorders. They Can Be Divided into Two Degrees of Severity
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- Medium form: Hypotension tachycardia.
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- Severe form: Dysrhythmia, hypotension, severe bradycardia.
4.5. Respiratory Manifestations: Rhinorrhea, Nasal Congestion, Sneezing, Wheezing, Dyspnea, Sometimes Even Glottic Edema, Cough. They Can Be Divided into Three Degrees of Severity
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- Grade I: intermittent cough, rhinorrhea, nasal congestion and sneezing, lack of wheezing, and dyspnea.
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- Grade II: Repetitive cough, accentuated wheezing.
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- Grade III: Persistent cough, wheezing, and dyspnea with SaO2 below 92%.
4.6. Neurological Disorders: Headache, Drowsiness, Vertigo, Anxiety, Incontinence, Loss of Consciousness. These Were Divided According to Severity into Three Degrees
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- Grade I: changes in daily behavior.
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- Grade II: moderate and drowsy headache.
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- Grade III: fatigue, anxiety, loss of consciousness.
4.7. Systemic Manifestation
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- Anaphylactic Shock with a Feeling of Weakness.
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- Headaches.
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- Visual Disturbances.
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- Ear Noises, Sometimes.
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- Vascular Collapse.
5. Association with Other Diseases
6. Diagnosis of Food Allergies
6.1. Medical History
6.2. Skin Prick Tests (SPT)
6.3. Antigen-Specific Ige(S-Ige) Antibodies in the Blood
6.4. Patch Testing
6.5. Basophil Activation Test
6.6. Elimination Diets
6.7. OFC Test
- 1.
- Open food challenge. This test involves ingesting the food in its natural form. It is used in cases where anamnesis and laboratory explorations suggest that there is a small probability that the incriminated food is the one responsible for the symptoms. However, supervision is recommended for 1–2 h after the test. Given that the patient expects an allergic reaction, the results may be influenced by them having this knowledge and thus exhibiting the symptoms unconsciously.
- 2.
- Single-blind placebo-controlled food challenge. The test provides more objective results compared to the previous one because the food is not served in its natural form, it is hidden in a capsule [46,47,48]. The control food (placebo) is chosen so that it is as similar as possible in taste, smell, and texture. In this way, the patient cannot distinguish whether or not the administered substance contains the allergenic food.
- 3.
- Double-blind placebo-controlled food challenge. This consists of the administration of the incriminated food and a placebo. The difference between a single-blind placebo-controlled food challenge and this test is that the examiner does not know the difference between placebo and allergen [46]. It is the gold standard in the diagnosis of FAs. The test is used more frequently in specialized studies and less often in current practice due to the complexity of its execution.
7. Prevention and Treatment of FAs
7.1. Prevention
7.2. Emergency Treatment
7.3. Immunotherapy
7.3.1. Oral Immunotherapy (OIT)
7.3.2. Sublingual Immunotherapy (SLIT)
7.3.3. Epicutaneous Immunotherapy (EPIT)
7.4. Pharmacological Treatment
7.5. Omalizumab
7.6. Dupilimumab
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Food | Usual Age at Onset of Allergy | Cross Reactivity | Usual Age at Resolution |
---|---|---|---|
Hen’s egg white | 0–1 years | Other avian eggs | 7 years (75% of cases resolve) |
Cow’s milk | 0–1 years | Goat’s milk, sheep’s milk, buffalo milk | 5 years (76% of cases resolve) |
Peanuts | 1–2 years | Other legumes, peas, lentils; core activity with tree nuts | Persistent (20% of cases resolve) |
Tree nuts | 1–2 years; in adults, onset occurs after cross-reactivity to birch pollen | Other tree nuts; co-reactivity with peanuts | Persistent (9% of cases resolve) |
Fish | Late childhood and adulthood | Other fish (low cross-reactivity with tuna and swordfish) | Persistent |
Shellfish | Adulthood (in 60% of patients with this allergy) | Other shellfish | Persistent |
Wheat | 6–24 months | Other grains containing gluten (rye, barley) | 5 years (80% of cases resolve) |
Soybeans | 6–24 month | Other legumes | 2 years (67% of cases resolve) |
Immunopathology | Disorder | Clinical Features | Typical Age Group | Prognosis |
---|---|---|---|---|
IgE-mediated | Pollen food allergy | Pruritus, mild edema confined to oral cavity Triggered by ingestion or direct contact | Onset after pollen allergy established (adult > young child) Children > adults | May be persistent and may vary by season Depends on the food |
Syndrome Urticaria/angioedema | ||||
Rhinoconjunctivitis/asthma | Accompanies food-induced allergic reaction but rarely isolated symptoms It may be triggered by the inhalation of aerosolized food protein | Infant/child > adult, | Depends on food | |
except for occupational disease | ||||
Gastrointestinal symptoms | Symptoms such as nausea, emesis, abdominal pain, and diarrhea triggered by food ingestion | Any age | Depends on food | |
Anaphylaxis | Rapid progressive, multisystem reaction | Any age | Depends on food | |
Food-dependent, exercise-induced anaphylaxis | Food triggers anaphylaxis only if ingestion is followed | Onset in late childhood/adulthood | Presumed persistent | |
Mixed IgE and cell-mediated | Atopic eczema/dermatitis | temporally by exercise Associated with food in 30–40% of children with moderate/severe eczema | Infant > child > adult | Usually resolves |
Eosinophilic gastrointestinal disorders | Symptoms vary depending on the site of the intestinal tract involved and degree of eosinophilic inflammation | Any age | Likely persistent | |
Cell mediated | Dietary protein-induced proctitis/proctocolitis | Mucus-laden, bloody stools in infants | Infancy | Usually resolves |
Food protein-induced enterocolitis syndrome | Chronic exposure: emesis, diarrhea, poor growth, lethargy | Infancy | Usually resolves | |
Celiac disease | Re-exposure after restriction: emesis, diarrhea, hypotension a couple of an hour after ingestion | |||
Lactose intolerance | ||||
Scombroid syndrome |
The Class of Medicines | Time Required from the Last Dose |
---|---|
Histamine H1 receptor antagonists | 72 h |
Leukotriene receptor antagonists | 24 h |
β2 stimulant | 12 h |
Th2 cytokine inhibitors | 12 h |
Theophylline | 48 h |
Oral steroids | 7–14 days |
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Sur, L.M.; Armat, I.; Duca, E.; Sur, G.; Lupan, I.; Sur, D.; Samasca, G.; Lazea, C.; Lazar, C. Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects. Life 2021, 11, 1204. https://doi.org/10.3390/life11111204
Sur LM, Armat I, Duca E, Sur G, Lupan I, Sur D, Samasca G, Lazea C, Lazar C. Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects. Life. 2021; 11(11):1204. https://doi.org/10.3390/life11111204
Chicago/Turabian StyleSur, Lucia M., Ionel Armat, Emanuela Duca, Genel Sur, Iulia Lupan, Daniel Sur, Gabriel Samasca, Cecilia Lazea, and Calin Lazar. 2021. "Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects" Life 11, no. 11: 1204. https://doi.org/10.3390/life11111204