FOOD ALLERGY IN ADULTS AND ADOLESCENTS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The natural history of food allergy after early childhood remains largely undefined. Prior studies have suggested that the great majority of individuals acquire food allergy in infancy and early childhood and outgrow most of these allergies by school-age. Clinical observation, however, suggests that there may be an increasing number of children who fail to outgrow their allergies or who acquire new sensitivities in adolescence or adulthood. Furthermore, food-allergic adolescents and young adults appear to have more severe, life-threatening reactions for reasons that have yet to be elucidated. In clinical practice, food allergy in adults is generally presumed to be a lifelong condition, and patients are advised to practice strict avoidance indefinitely. There is little formal evidence to guide these practices, and the applicability of pediatric RAST cutoff levels to adolescents and adults has yet to be confirmed. We hypothesize that individuals with persistent childhood food allergy and individuals who acquire allergy in later years are clinically and immunologically distinguishable from those who outgrow food allergy by school-age. To test this hypothesis, we propose establishing a cohort of adolescents and adults with food allergy and characterizing these individuals by clinical history, RAST measurements, skin tests, and when clinically indicated, oral food challenges. Specifically, we will address the predictive value of RAST measurements in adolescents and adults in comparison to younger children. In addition, we will evaluate potential predictors of disease persistence and severity, such as specific epitope recognition patterns and cell mediator releasability. We will focus on peanut, milk, egg, soy, tree nuts, and shellfish allergy, some of the most common food allergies in both children and adults. Our long-term goal is to characterize the natural history of food allergy in adolescence and adulthood for the purpose of developing more effective disease management and identifying potential therapeutic targets in this relatively unstudied population.