Journal of asthma, allergy and clinical immunology (천식및알레르기)

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
권호 표지

Food Allergy: Diagnosis and Management

식품알레르기: 진단과 관리

  • Ahn, Kang-Mo (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 안강모 (성균관대학교 의과대학 삼성서울병원 소아과학교실)
  • Published : 2011.09.25
⟨ Previous Next ⟩

Abstract

Food allergy is an adverse food reaction as a result of immune mechanisms and is a key component in food safety issue. The prevalence of food allergy is known to be up to 6% of children and 3~4% of adults. A nationwide cross-sectional questionnaire survey of Korean children in 1995 and 2000 revealed that there was a tendency of the prevalence of food allergy to increase. The most common allergen was egg, followed by milk, fish, and seafoods, such as crab, lobster and shellfish. However, this does not seem to reflect the true prevalence because diagnosis of food allergy was based on questionnaires but not food challenge tests but. Various symptoms are manifested in patients with food allergy depending on whether IgE- or non-IgE-mediated mechanisms are involved. The gold standard for diagnosing food allergy is double-blind placebo-controlled food challenge test (DBPCFC), which is both time- and effort-consuming. In clinical practice, a convincing history and positive specific IgE are very important for the diagnosis of IgE-mediated food allergy, and quantification of food-specific IgE is considered a useful test in some foods, such as egg, milk, peanut and fish in the pediatric population. The patients and their caregivers need to be educated about the way to avoid exposure to food allergens. However, recent progress in understanding of the immunopathogenesis of food allergy will lead to novel therapeutic approaches in the future.

Keywords

References

  1. Sampson HA. Update on food allergy. J Allergy Clin Immunol. 2004;113:805-19. https://doi.org/10.1016/j.jaci.2004.03.014
  2. Eller E, Kjaer HF, Host A, Andersen KE, Bindslev-Jensen C. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy. 2009;64:1023-9. https://doi.org/10.1111/j.1398-9995.2009.01952.x
  3. Luccioli S, Ross M, Labiner-Wolfe J, Fein SB. Maternally reported food allergies and other food-related health problems in infants: characteristics and associated factors. Pediatrics. 2008;122(Suppl 2):S105-12. https://doi.org/10.1542/peds.2008-1315n
  4. Venter C, Pereira B, Voigt K, Grundy J, Clayton CB, Higgins B, et al. Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life. Allergy. 2008;63:354-9.
  5. Oh JW, Pyun BY, Choung JT, Ahn KM, Kim CH, Song SW, et al. Epidemiological change of atopic dermatitis and food allergy in school-aged children in Korea between 1995 and 2000. J Korean Med Sci. 2004;19:716-23. https://doi.org/10.3346/jkms.2004.19.5.716
  6. Kim J, Chang E, Han Y, Ahn K, Lee SI. The incidence and risk factors of immediate type food allergy during the first year of life in Korean infants: a birth cohort study. Pediatr Allergy Immunol. 2011 May 4. Epub.
  7. Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010;125:1322-6. https://doi.org/10.1016/j.jaci.2010.03.029
  8. Sampson HA. Food allergy. Part 1: immunopathogenesis and clinical disorders. J Allergy Clin Immunol. 1999;103:717-28. https://doi.org/10.1016/S0091-6749(99)70411-2
  9. Hill DJ, Hosking CS, Heine RG. Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment. Ann Med. 1999;31:272-81. https://doi.org/10.3109/07853899908995890
  10. Beyer K, Morrow E, Li XM, Bardina L, Bannon GA, Burks AW, et al. Effects of cooking methods on peanut allergenicity. J Allergy Clin Immunol. 2001;107:1077-81. https://doi.org/10.1067/mai.2001.115480
  11. Ben-Shoshan M, Harrington DW, Soller L, Fragapane J, Joseph L, St Pierre Y, et al. A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. J Allergy Clin Immunol. 2010;125:1327-35. https://doi.org/10.1016/j.jaci.2010.03.015
  12. Shek LP, Cabrera-Morales EA, Soh SE, Gerez I, Ng PZ, Yi FC, et al. A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations. J Allergy Clin Immunol. 2010;126:324-31. https://doi.org/10.1016/j.jaci.2010.06.003
  13. Dalal I, Binson I, Reifen R, Amitai Z, Shohat T, Rahmani S, et al. Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. Allergy. 2002;57:362-5. https://doi.org/10.1034/j.1398-9995.2002.1s3412.x
  14. Wieslander G, Norback D. Buckwheat allergy. Allergy. 2001;56:703-4. https://doi.org/10.1034/j.1398-9995.2001.056008703.x
  15. Egger M, Mutschlechner S, Wopfner N, Gadermaier G, Briza P, Ferreira F. Pollen-food syndromes associated with weed pollinosis: an update from the molecular point of view. Allergy. 2006;61:461-76. https://doi.org/10.1111/j.1398-9995.2006.00994.x
  16. Valenta R, Kraft D. Recombinant allergen molecules: tools to study effector cell activation. Immunol Rev. 2001;179:119-27. https://doi.org/10.1034/j.1600-065X.2001.790112.x
  17. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001;107:891-6. https://doi.org/10.1067/mai.2001.114708
  18. van Nieuwaal NH, Lasfar W, Meijer Y, Kentie PA, Flinterman AE, Pasmans SG, et al. Utility of peanut-specific IgE levels in predicting the outcome of double-blind, placebo-controlled food challenges. J Allergy Clin Immunol. 2010;125:1391-2. https://doi.org/10.1016/j.jaci.2010.01.057
  19. Sampson HA. Food allergy. Part 2: diagnosis and management. J Allergy Clin Immunol. 1999;103:981-9. https://doi.org/10.1016/S0091-6749(99)70167-3
  20. Valenta R, Lidholm J, Niederberger V, Hayek B, Kraft D, Gronlund H. The recombinant allergen-based concept of component-resolved diagnostics and immunotherapy (CRD and CRIT). Clin Exp Allergy. 1999;29:896-904. https://doi.org/10.1046/j.1365-2222.1999.00653.x
  21. Lidholm J, Ballmer-Weber BK, Mari A, Vieths S. Component-resolved diagnostics in food allergy. Curr Opin Allergy Clin Immunol. 2006;6:234-40. https://doi.org/10.1097/01.all.0000225166.90768.d6
  22. Nicolaou N, Poorafshar M, Murray C, Simpson A, Winell H, Kerry G, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol. 2010;125:191-7. https://doi.org/10.1016/j.jaci.2009.10.008
  23. Boyano-Martinez T, Garcia-Ara C, Diaz-Pena JM, Martin-Esteban M. Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. J Allergy Clin Immunol. 2002;110:304-9. https://doi.org/10.1067/mai.2002.126081
  24. Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. 2007;120:1413-7. https://doi.org/10.1016/j.jaci.2007.09.040
  25. Kim J, Chung Y, Han Y, Ahn K, Lee SI. The natural history and prognostic factors of egg allergy in Korean infants with atopic dermatitis. Asian Pac J Allergy Immunol. 2009;27:107-14.
  26. Skolnick HS, Conover-Walker MK, Koerner CB, Sampson HA, Burks W, Wood RA. The natural history of peanut allergy. J Allergy Clin Immunol. 2001;107:367-74. https://doi.org/10.1067/mai.2001.112129
  27. Sampson HA, Scanlon SM. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr. 1989;115:23-7. https://doi.org/10.1016/S0022-3476(89)80323-3
  28. Savage JH, Kaeding AJ, Matsui EC, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol. 2010;125:683-6. https://doi.org/10.1016/j.jaci.2009.12.994
  29. van der Gugten AC, den Otter M, Meijer Y, Pasmans SG, Knulst AC, Hoekstra MO. Usefulness of specific IgE levels in predicting cow's milk allergy. J Allergy Clin Immunol. 2008;121:531-3. https://doi.org/10.1016/j.jaci.2007.10.042
  30. Shek LP, Soderstrom L, Ahlstedt S, Beyer K, Sampson HA. Determination of food specific IgE levels over time can predict the development of tolerance in cow's milk and hen's egg allergy. J Allergy Clin Immunol. 2004;114:387-91. https://doi.org/10.1016/j.jaci.2004.04.032
  31. Vila L, Beyer K, Jarvinen KM, Chatchatee P, Bardina L, Sampson HA. Role of conformational and linear epitopes in the achievement of tolerance in cow's milk allergy. Clin Exp Allergy. 2001;31:1599-606. https://doi.org/10.1046/j.1365-2222.2001.01218.x
  32. Jarvinen KM, Beyer K, Vila L, Chatchatee P, Busse PJ, Sampson HA. B-cell epitopes as a screening instrument for persistent cow's milk allergy. J Allergy Clin Immunol. 2002;110:293-7. https://doi.org/10.1067/mai.2002.126080
  33. Bernhisel-Broadbent J, Dintzis HM, Dintzis RZ, Sampson HA. Allergenicity and antigenicity of chicken egg ovomucoid (Gal d III) compared with ovalbumin (Gal d I) in children with egg allergy and in mice. J Allergy Clin Immunol. 1994;93:1047-59. https://doi.org/10.1016/S0091-6749(94)70054-0
  34. Urisu A, Yamada K, Tokuda R, Ando H, Wada E, Kondo Y, et al. Clinical significance of IgE-binding activity to enzymatic digests of ovomucoid in the diagnosis and the prediction of the outgrowing of egg white hypersensitivity. Int Arch Allergy Immunol. 1999;120:192-8. https://doi.org/10.1159/000024267
  35. Takagi K, Teshima R, Okunuki H, Itoh S, Kawasaki N, Kawanishi T, et al. Kinetic analysis of pepsin digestion of chicken egg white ovomucoid and allergenic potential of pepsin fragments. Int Arch Allergy Immunol. 2005;136:23-32. https://doi.org/10.1159/000082581
  36. Jarvinen KM, Beyer K, Vila L, Bardina L, Mishoe M, Sampson HA. Specificity of IgE antibodies to sequential epitopes of hen's egg ovomucoid as a marker for persistence of egg allergy. Allergy. 2007;62:758-65. https://doi.org/10.1111/j.1398-9995.2007.01332.x
  37. Wang J, Lin J, Bardina L, Goldis M, Nowak-Wegrzyn A, Shreffler WG, et al. Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy. J Allergy Clin Immunol. 2010;125:695-702. https://doi.org/10.1016/j.jaci.2009.12.017
  38. Muraro MA, Giampietro PG, Galli E. Soy formulas and nonbovine milk. Ann Allergy Asthma Immunol. 2002;89(6 Suppl 1):97-101. https://doi.org/10.1016/S1081-1206(10)62132-1
  39. Nowak-Wegrzyn A. Future approaches to food allergy. Pediatrics. 2003;111(6 Pt 3):1672-80.
  40. Thyagarajan A, Varshney P, Jones SM, Sicherer S, Wood R, Vickery BP, et al. Peanut oral immunotherapy is not ready for clinical use. J Allergy Clin Immunol. 2010;126:31-2. https://doi.org/10.1016/j.jaci.2010.05.012
  41. Dupont C, Kalach N, Soulaines P, Legoue-Morillon S, Piloquet H, Benhamou PH. Cow's milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity. J Allergy Clin Immunol. 2010;125:1165-7. https://doi.org/10.1016/j.jaci.2010.02.029
  42. American Academy of Pediatrics. Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics. 2000;106(2 Pt 1):346-9. https://doi.org/10.1542/peds.106.2.346
  43. Host A, Koletzko B, Dreborg S, Muraro A, Wahn U, Aggett P, et al. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child. 1999;81:80-4. https://doi.org/10.1136/adc.81.1.80
  44. Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183-91. https://doi.org/10.1542/peds.2007-3022
  45. Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001;357:1076-9. https://doi.org/10.1016/S0140-6736(00)04259-8
  46. Kim JY, Kwon JH, Ahn SH, Lee SI, Han YS, Choi YO, et al. Effect of probiotic mix (Bifidobacterium bifidum, Bifidobacterium lactis, Lactobacillus acidophilus) in the primary prevention of eczema: a double-blind, randomized, placebo-controlled trial. Pediatr Allergy Immunol. 2010;21(2 Pt 2):e386-9. https://doi.org/10.1111/j.1399-3038.2009.00958.x