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Pathophysiology and Symptoms of Food Allergy and Anaphylaxis

  • Alicia T. Widge
  • Hemant P. SharmaEmail author
Chapter
  • 44 Downloads

Abstract

Food allergies are increasing in prevalence, have a highly variable clinical presentation, and can result in life-threatening reactions. In order for clinicians to accurately diagnose and manage food allergies, they must have a clear understanding of the symptoms and underlying pathophysiology. Food allergies by definition are immune-mediated responses that occur reproducibly on food ingestion, which differentiates them from non-immunologic adverse food reactions like lactose intolerance or food poisoning. Food allergies can be IgE mediated, non-IgE/cell mediated, or mixed IgE and non-IgE mediated with varying clinical presentations depending on the underlying immune mechanisms. IgE-mediated food allergies produce symptoms that affect the cutaneous (hives, pruritus, angioedema), gastrointestinal (abdominal pain, vomiting, diarrhea), respiratory (rhinorrhea, dyspnea, wheezing), and cardiovascular (hypotension, syncope) systems. IgE-mediated food allergies can progress to anaphylaxis, which is a severe and potentially fatal systemic reaction that requires timely recognition and treatment. Non-IgE- or cell-mediated reactions are typically delayed or chronic, and include food protein-induced allergic proctocolitis (FPIAP), food protein-induced enterocolitis syndrome (FPIES), celiac disease, and food-induced pulmonary hemosiderosis (Heiner syndrome). Mixed IgE- and non-IgE-mediated reactions occur in eosinophilic esophagitis or eosinophilic gastroenteritis, which present with symptoms of dysphagia, vomiting, reflux, and abdominal pain related to eosinophilic infiltrates in the GI tract. This chapter describes the clinical manifestations of food allergies with an emphasis on anaphylaxis and the pathophysiology behind these reactions.

Keywords

Food allergy Anaphylaxis Mechanism Symptoms Presentation Gastrointestinal Pathophysiology 

Abbreviations

CD

Celiac disease

DCs

Dendritic cells

EG

Eosinophilic gastroenteritis

EOE

Eosinophilic esophagitis

FA

Food allergy

FPIAP

Food protein-induced allergic proctocolitis

FPIES

Food protein-induced enterocolitis syndrome

HLA

Human leukocyte antigen

MSG

Monosodium glutamate

OAS

Oral allergy syndrome

PFS

Pollen-food allergy syndrome

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.National Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaUSA
  2. 2.Division of Allergy and ImmunologyChildren’s National Health SystemWashington, DCUSA
  3. 3.George Washington University School of Medicine and Health SciencesWashington, DCUSA

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