Food Allergy

  • Onyinye I. Iweala
  • Shailesh K. Choudhary
  • Scott P. Commins
Small Intestine (D Sachar, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Small Intestine

Abstract

Purpose of Review

The goal of this review is to present an updated summary of the natural history of major childhood and adult food allergies and report recent advances in potential treatments for food allergy.

Recent Findings

The most common childhood food allergies are typically outgrown by adolescence or adulthood. However, peanut/tree nut allergies appear to more commonly persist into adulthood. Adults can develop new IgE-mediated food allergies; the most common is oral allergy syndrome. There are multiple different approaches being tried as possible treatments for food allergy.

Summary

The prevalence of food allergy appears to be increasing but the varied approaches to treatment are being actively pursued such that an approved modality may not be too far in the future.

Keywords

Food allergy Specific IgE Peanut allergy Adult food allergy Food immunotherapy 

Notes

Compliance with Ethical Standards

Conflict of Interest

Scott Commins reports personal fees as a member of the speaker’s bureau from Genentech and from Boehringer Ingelheim, and grants from NIH, outside the submitted work. Onyinye Iweala and Shailesh Coudhary declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance ••Of major importance

  1. 1.
    Sicherer SH, Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014;133:291–303.CrossRefPubMedGoogle Scholar
  2. 2.
    Osborne NJ, Koplin JJ, Martin PE, Gurrin LC, Lowe AJ, Matheson MC, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011;127:668–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Liu AH, Jaramillo R, Sicherer SH, Wood RA, Bock SA, Burks AW, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126:798–809.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124:1549–54.CrossRefPubMedGoogle Scholar
  5. 5.
    Trends in allergic conditions among children: United States, 1997–2011. http://www.cdc.gov/nchs/data/databriefs/db121.pdf. Accessed 25 Feb 2018.
  6. 6.
    Skripak JM, Matsui EC, Mudd K, Wood RA. The natural history of IgE-mediated cow’s milk allergy. J Allergy Clin Immunol. 2007;120:1172–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. 2007;120:1413–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Nickel R, Kulig M, Forster J, Bergmann R, Bauer CP, Lau S, et al. Sensitization to hen’s egg at the age of twelve months is predictive for allergic sensitization to common indoor and outdoor allergens at the age of three years. J Allergy Clin Immunol. 1997;99:613–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Clark A, Islam S, King Y, Deighton J, Szun S, Anagnostou K, et al. A longitudinal study of resolution of allergy to well-cooked and uncooked egg. Clin Exp Allergy. 2011;41:706–12.CrossRefPubMedGoogle Scholar
  10. 10.
    Sicherer SH, Muñoz-Furlong A, Burks AW, Sampson HA. Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey. J Allergy Clin Immunol. 1999;103:559–65.CrossRefPubMedGoogle Scholar
  11. 11.
    Sicherer SH, Muñoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol. 2003;112:1203–10.CrossRefPubMedGoogle Scholar
  12. 12.
    Skolnick HS, Conover-Walker MK, Koerner CB, Sampson HA, Burks W, Wood RA. The natural history of peanut allergy. J Allergy Clin Immunol. 2001;107:367–76.CrossRefPubMedGoogle Scholar
  13. 13.
    Fleischer DM, Conover-Walker MK, Christie L, Burks AW, Wood RA. The natural progression of peanut allergy: resolution and the possibility of recurrence. J Allergy Clin Immunol. 2003;112:183–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol. 2005;116:1087–94.CrossRefPubMedGoogle Scholar
  15. 15.
    Keet CA, Matsui EC, Dhillon G, Lenehan P, Paterakis M, Wood RA. The natural history of wheat allergy. Ann Allergy Asthma Immunol. 2009;102:410–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Lack G. Clinical practice. Food allergy. N Engl J Med. 2008;359:1252–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Kotaniemi-Syrjänen A, Palosuo K, Jartti T, Kuitunen M, Pelkonen AS, Mäkelä MJ. The prognosis of wheat hypersensitivity in children. Pediatr Allergy Immunol. 2010;21:e421–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PA, Ebisawa M, et al. ICON: food allergy. J Allergy Clin Immunol. 2012;129:906–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Werfel T. Food allergy in adulthood. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59:737–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Moneret-Vautrin DA, Morisset M. Adult food allergy. Curr Allergy Asthma Rep. 2005;5:80–92.CrossRefPubMedGoogle Scholar
  21. 21.
    Kamdar TA, Peterson S, Lau CH, Saltoun CA, Gupta RS, Bryce PJ. Prevalence and characteristics of adult-onset food allergy. J Allergy Clin Immunol Pract. 2015;3:114–21.CrossRefPubMedGoogle Scholar
  22. 22.
    Kleine-Tebbe J, Herold DA. Cross-reactive allergen clusters in pollen-associated food allergy. Hautarzt. 2003;54:130–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Sicherer SH, Muñoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol. 2004;114:159–63.CrossRefPubMedGoogle Scholar
  24. 24.
    Moscato G, Pala G, Crivellaro M, Siracusa A. Anaphylaxis as occupational risk. Curr Opin Allergy Clin Immunol. 2014;14:328–33.CrossRefPubMedGoogle Scholar
  25. 25.
    Inomata N, Nagashima M, Hakuta A, Aihara M. Food allergy preceded by contact urticaria due to the same food: involvement of epicutaneous sensitization in food allergy. Allergol Int. 2015;64:73–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Lukács J, Schliemann S, Elsner P. Occupational contact urticaria caused by food—a systematic clinical review. Contact Dermatitis. 2016;75:195–202.CrossRefPubMedGoogle Scholar
  27. 27.
    Doutre MS. Occupational contact urticaria and protein contact dermatitis. Eur J Dermatol. 2005;15:419–21.PubMedGoogle Scholar
  28. 28.
    Commins SP, Satinover SM, Hosen J. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol. 2009;123:426–33.CrossRefPubMedGoogle Scholar
  29. 29.
    Nuñez R, Carballada F, Gonzalez-Quintela A, Gomez-Rial J, Boquete M, Vidal C. Delayed mammalian meat-induced anaphylaxis due to galactose-α-1,3-galactose in 5 European patients. J Allergy Clin Immunol. 2011;128:1122–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Van Nunen SA, O'Connor KS, Clarke LR. An association between tick bite reactions and red meat allergy in humans. Med J Aust. 2009;190:510.PubMedGoogle Scholar
  31. 31.
    Grönlund H, Adédoyin J, Commins SP. The carbohydrate galactose-alpha-1,3-galactose is a major IgE-binding epitope on cat IgA. J Allergy Clin Immunol. 2009;123:1189–95.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Hamsten C, Starkhammar M, Tran TA, Johansson M, Bengtsson U, Ahlén G, et al. Identification of galactose-α-1,3-galactose in the gastrointestinal tract of the tick Ixodes ricinus; possible relationship with red meat allergy. Allergy. 2013;68:549–54.CrossRefPubMedGoogle Scholar
  33. 33.
    Commins SP, James HR, Kelly LA. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J Allergy Clin Immunol. 2011;127:1286–92.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Vickery BP, Burks W. Oral immunotherapy for food allergy. Curr Opin Pediatr. 2010;22:765–77.CrossRefPubMedGoogle Scholar
  35. 35.
    • Ko J, Mayer L. Oral tolerance: lessons on treatment of food allergy. Eur J Gastroenterol Hepatol. 2005;17:1299–310. This review is a classic paper on the development of tolerance.CrossRefPubMedGoogle Scholar
  36. 36.
    •• Vickery BP, Berglund JP, Burk CM, Fine JP, Kim EH, Kim JI, et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017;139:173–81. This important study reported 78% of children aged 9 to 36 months in the intent-to-treat analysis achieved sustained unresponsiveness and this effect was not dependent on high dose OIT (300-mg arm, 85%; 3000 mg, 71%). These results demonstrated that OIT could be initiated at young ages and that low dose was sufficient.CrossRefPubMedGoogle Scholar
  37. 37.
    • Wright BL, Kulis M, Orgel KA, Burks AW, Dawson P, Henning AK, et al. Component-resolved analysis of IgA, IgE, and IgG4 during egg OIT identifies markers associated with sustained unresponsiveness. Allergy. 2016;71:1552–8. This excellent work shows that increased IgG4 to egg white parallels the increase seen in IgA and IgA2 to egg white during early OIT are associated with clinical response to OIT. These observations begin to suggest a foundation for possible biomarkers in food OIT.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Lucendo AJ, Arias A, Tenias JM. Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis. Ann Allergy Asthma Immunol. 2014;113:624–30.CrossRefPubMedGoogle Scholar
  39. 39.
    Frati F, Moingeon P, Marcucci F, Puccinelli P, Sensi L, Di Cara G, et al. Mucosal immunization application to allergic disease: sublingual immunotherapy. Allergy Asthma Proc. 2007;28:35–40.CrossRefPubMedGoogle Scholar
  40. 40.
    Kim EH, Bird JA, Kulis M, Laubach S, Pons L, Shreffler W, et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol. 2011;127:640–50.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Narisety SD, Frischmeyer-Guerrerio PA, Keet CA, Gorelik M, Schroeder J, Hamilton RG, et al. A randomized, double-blind, placebo-controlled pilot study of sublingual versus oral immunotherapy for the treatment of peanut allergy. J Allergy Clin Immunol. 2015;135:1275–81.CrossRefPubMedGoogle Scholar
  42. 42.
    Fleischer DM, Burks AW, Vickery BP, Scurlock AM, Wood RA, Jones SM, et al. Sublingual immunotherapy for peanut allergy: a randomized, double-blind, placebo-controlled multicenter trial. J Allergy Clin Immunol. 2013;131:119–26.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    • Burks AW, Wood RA, Jones SM, Sicherer SH, Fleischer DM, Scurlock AM, et al. Sublingual immunotherapy for peanut allergy: Long-term follow-up of a randomized multicenter trial. J Allergy Clin Immunol. 2015;135:1240–50. This multi-center study reported that over 10% of SLIT-treated participants were fully desensitized to 10 g of peanut powder, which represents a significant effect of the lower dose SLIT approach to food immunotherapy.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Enrique E, Pineda F, Malek T, Bartra J, Basagaña M, Tella R, et al. Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol. 2005;116:1073–80.CrossRefPubMedGoogle Scholar
  45. 45.
    Enrique E, Malek T, Pineda F, Bartra J, Basagaña M, Tella R, et al. Sublingual immunotherapy for hazelnut food allergy: a follow-up study. Ann Allergy Asthma Immunol. 2008;100:283–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Keet CA, Frischmeyer-Guerrerio PA, Thyagarajan A, Schroeder JT, Hamilton RG, Boden S, et al. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol. 2012;129:448–54.CrossRefPubMedGoogle Scholar
  47. 47.
    de Boissieu D, Dupont C. Sublingual immunotherapy for cow’s milk protein allergy: a preliminary report. Allergy. 2006;61:1238–43.CrossRefPubMedGoogle Scholar
  48. 48.
    Mempel M, Rakoski J, Ring J, Ollert M. Severe anaphylaxis to kiwi fruit: immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol. 2003;111:1406–11.CrossRefPubMedGoogle Scholar
  49. 49.
    Kerzl R, Simonowa A, Ring J. Life-threatening anaphylaxis to kiwi fruit: protective sublingual allergen immunotherapy effect persists even after discontinuation. J Allergy Clin Immunol. 2007;119:507–12.CrossRefPubMedGoogle Scholar
  50. 50.
    Dupont C, Kalach N, Soulaines P, Legoué-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;125:1165–72.CrossRefPubMedGoogle Scholar
  51. 51.
    Jones SM, Agbotounou WK, Fleischer DM, Burks AW, Pesek RD, Harris MW, et al. Safety of epicutaneous immunotherapy for the treatment of peanut allergy: a phase 1 study using the Viaskin patch. J Allergy Clin Immunol. 2016;137:1258–66.CrossRefPubMedGoogle Scholar
  52. 52.
    Sampson HA, Agbotounou W, Thebault C. Epicutaneous immunotherapy (EPIT) is effective and safe to treat peanut allergy: a multi-national double-blind placebo-controlled randomized phase IIb trial. J Allergy Clin Immunol. 2015;135:AB390.CrossRefGoogle Scholar
  53. 53.
    Jones SM, Sicherer SH, Burks AW, Leung DY, Lindblad RW, Dawson P, et al. Epicutaneous immunotherapy for the treatment of peanut allergy in children and young adults. J Allergy Clin Immunol. 2017;139:1242–50.CrossRefPubMedGoogle Scholar
  54. 54.
    •• Sampson HA, Shreffler WG, Yang WH, Sussman GL, Brown-Whitehorn TF, Nadeau KC, et al. Effect of varying doses of epicutaneous immunotherapy vs placebo on reaction to peanut protein exposure among patients with peanut sensitivity: a randomized clinical trial. JAMA. 2017;318:1798–804. Demonstrates the effect of epicutaneous treatment may be better performed in younger patients.CrossRefPubMedGoogle Scholar
  55. 55.
    Mondoulet L, Dioszeghy V, Ligouis M, Dhelft V, Dupont C, Benhamou PH. Epicutaneous immunotherapy on intact skin using a new delivery system in a murine model of allergy. Clin Exp Allergy. 2010;40:659–64.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Onyinye I. Iweala
    • 1
    • 2
  • Shailesh K. Choudhary
    • 1
  • Scott P. Commins
    • 1
    • 2
  1. 1.Department of Medicine and PediatricsUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.Thurston Research Center, Division of Allergy, Immunology and RheumatologyUniversity of North CarolinaChapel HillUSA

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