Food allergies: clinical manifestations, diagnosis, and management.
Food allergies: clinical manifestations, diagnosis, and management.
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DOI：
10.1016/j.cppeds.2009.09.003
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发表时间：
2009-11
影响因子：
1.6
通讯作者：
C. Davis
中科院分区：
文献类型：
--
作者：
C. Davis
R eactions to foods are extremely common and the etiology of these reactions determines their correct management. Adverse food reactions are not all allergic. The management of food adverse reactions ranges from complete avoidance of minute amounts of food to ingesting milk after lactase supplementation. It is, therefore, important to accurately classify reactions to foods. Adverse food reactions can be categorized into the 2 following groups: nonimmunologic and immunologic. Immunologic reactions to food are mediated by the immune system, while all other reactions fall into the nonimmunologic category. Nonimmunologic reactions are grouped into either toxic or nontoxic reactions. A toxic reaction results from the pharmacologic actions of a substance within a food. These reactions can occur in anyone who is exposed to the food and do not depend on host factors. These substances may be enzymes or any agent that could cause reactions in the body. Examples of toxic reactions include nausea from bacterial food poisoning, heavy metal poisoning, and itching and flushing from histamine ingestion as seen in scombroid fish poisoning. The consumption of foods containing caffeine, such as coffee or tea, can cause jitteriness. Tyramine in aged cheeses can cause migraine headaches and alcohol ingestion is associated with a variety of well-known symptoms. 1 All other nonimmunologic reactions to foods can be characterized as food intolerances. These are dependent on the host and the host-environment interaction. The nomenclature of the World Allergy Organization uses the term “hypersensitivity” to refer to a reproducible symptom or sign to a stimulus tolerated at the same dose by normal persons apart from an immunologic basis. Food intolerances are not mediated by the immune system (Table 1). Enzyme deficiencies such as lactase deficiency and galactosemia are examples of food intolerances. Pancreatic insufficiency, gallbladder or liver disease, hiatal hernia, and gustatory rhinitis are all conditions that can be associated with adverse events following food ingestion. Psychiatric illnesses, like anorexia nervosa with vomiting or the auriculotemporal syndrome, can also mimic food intolerance. Food intolerances, by definition, are nonallergic food hypersensitivities. The remainder of this review focuses on the immunologic responses to food. Immunologic reactions to food are mediated by the immune system and these disorders are induced by 2 major mechanisms: IgE-mediated and/or non-IgE-mediated. It is most practical to classify immunologic reactions to food into the 3 following groups: IgE-mediated, non-IgE-mediated, and mixed disorders (Table 1). 2 Classically, IgE-mediated disorders occur when food-specific IgE antibodies on the surface of mast cells and basophils bind to circulating ingested food allergens, and activate the cells to release cytokines and other potent mediators, such as histamine. Typically, symptoms occur immediately after food ingestion, resulting in urticaria, angioedema, wheezing, cough, nausea, vomiting, and, in some cases, hypotension. This is the mechanism that mediates anaphylaxis after food ingestion. Most food-induced, IgE-mediated allergic reactions occur within minutes to a few hours after ingestion. IgE-mediated food allergy is excluded if symptoms occur 4 hours after ingestion. The non-IgE-mediated food allergies result from T cell activation, which produces cytokines like IL-4, IL-5, and IL-13 (called TH2 cytokines), which further the allergic response. Eosinophilic inflammation can also result from this cascade of events. These reactions are generally slower in onset (greater than 4 hours after ingestion …
