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Jan Hed, Clin Immunologist, MD, PhD
Karolinska Institutet, IMPI, Div of Clin Immunology
Huddinge University Hospital, Sweden
 
The statements below are based on conclusions from selected publications. Their intention is to highlight recent research and information that could be beneficial in allergy in vitro testing. They can include seemingly contradictory statements due to differences in selecting patient populations as well as in the study design.
  • The skin is the most frequently affected target organ in allergy or intolerance of food and food additives (1, 2).
     
  • The continual ingestion of food allergen in an allergic patient appears to induce partial desensitization of mast cells, resulting in less pronounced gastrointestinal symptoms (for review, see 3).
     
  • Several subclinical, physiological changes have been shown in the gastrointestinal tract following ingestion of food allergen both in animal models and in humans (for review, see 3).
     
  • Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal and cardiovascular ones in anaphylaxis in children (4).
     
  • In children with history and symptoms suggestive of food allergy, only 6% had diarrhea (5).
     
  • In 544 children with food allergy confirmed by food challenge, the most common symptoms are skin symptoms, whereas only 2% had gastrointestinal symptoms (6).
     
  • In children with peanut hypersensitivity confirmed by food challenge, the most common symptoms was atopic dermatitis and only 1.5% had gastrointestinal symptoms (7,8).
     
  • Recent laboratory-based studies have identified three groups of infants with reactions to cow´s milk, where children with gastrointestinal symptoms belong to a non-IgE sensitized group (for review, see 9).
     
  • In 229 predominantly adult patients who showed an immediate-type allergy to one or more specific food allergen, 21.8% had gastrointestinal symptoms (10).
     
  • Although sensitization to food allergens is not uncommon in adults, the correlation to specific symptoms of food intolerance is weak (11).
     
  • In children with atopic dermatitis and peanut sensitization, 32% developed gastrointestinal symptoms and 97% skin symptoms after peanut challenge (12).
     
  • In 113 children with severe atopic dermatitis, 52% developed gastrointestinal symptoms and 84% skin symptoms after food challenge (13).

References:

    1. Wuthrich B. Food-induced cutaneous adverse reactions. Allergy 1998;53(46 Suppl):131-5.
    2. Oehling A, Fernandez M, Cordoba H, Sanz ML. Skin manifestations and immunological parameters in childhood food allergy. J Investig Allergol Clin Immunol 1997;7:155-9.
    3. Sampson HA. Food Allergy. In: Kay AB, editor. Allergy and allergic diseases. Oxford: Blackwell Science Ltd. 1997:1517-49.
    4. Novembre E, Cianferoni A, Bernardini R, Mugnaini L, Caffarelli C, Cavagni G et al.. Anaphylaxis in children: clinical and allergologic features. Pediatrics 1998;101:E8.
    5. Giampietro PG, Ragno V, Daniele S, Cantani A, Ferrara M, Businco L. Soy hypersensitivity in children with food allergy. Ann Allergy 1992;69:143-6.
    6. Rance F, Kanny G, Dutau G, Moneret-Vautrin DA. Food hypersensitivity in children: clinical aspects and distribution of allergens. Pediatr Allergy Immunol 1999;10:33-8.
    7. Rance F, Dutau G. Peanut hypersensitivity in children. Pediatr Pulmonol Suppl 1999;18:165-7.
    8. Moneret-Vautrin DA, Rance F, Kanny G, Olsewski A, Gueant JL, Dutau G et al. Food allergy to peanuts in France – evaluation of 142 observations. Clin Exp Allergy 1998;28:1113-9.
    9. Hill DJ, Hosking CS. The cow milk allergy complex: overlapping disease profiles in infancy. Eur J Clin Nutr 1995;49(Suppl 1):S1-12.
    10. Muhlemann RJ, Wuthrich B. (Food allergies 1983-1987). Schweiz Med Wochenschr 1991;121:1696-700.
    11. Björnsson E, Janson C, Plaschke P, Norrman E, Sjöberg O. Prevalence of sensitization to food allergens in adult Swedes. Ann Allergy Asthma Immunol 1996;77:327-32.
    12. Burks AW, Williams LW, Mallory SB, Shirrell MA, Williams C. Peanut protein as a major cause of adverse food reactions in patients with atopic dermatitis. Allergy Proc 1989;104:265-9.
    13. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985;107:669-75.