Food Allergy: Opportunities and Challenges in the Clinical Practice of Allergy and Immunology

  • Julie Wang
  • Hugh A. Sampson
Part of the Allergy Frontiers book series (ALLERGY, volume 5)

Food allergy affects up to 6% of children and 3–4% of adults in the United States (1), and remains the leading cause of outpatient anaphylaxis in most surveys (2). The prevalence of food allergy is greatest in the first 2 years of life and decreases with age. The most common food allergens causing reactions in children include milk, egg, wheat, soy, peanuts, tree nuts, fish, and shellfish. While the majority of children outgrow their allergy to milk, egg, wheat and soy, allergies to peanut, tree nuts, fish and shellfish are often life-long. Although any food can cause anaphylaxis, the most commonly implicated foods for severe allergic reactions are peanuts, tree nuts, fish, and shellfish (3).

Currently, there are no treatments that can cure or provide long-term remission from food allergy. The mainstay of management consists of avoidance and education as well as providing emergency medications for the treatment of allergic reactions. This approach is generally effective; however, avoidance can be quite difficult as several of these food allergens are ubiquitous in our diets; thus, patients and their families experience a significant negative impact on their quality of life. Therefore, there are several new strategies currently being investigated with the aim of long-term treatment and possible cure.


Food Allergy Allergy Clin Immunol Birch Pollen Peanut Allergy Sublingual Immunotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol, 2006; 117 (2 Suppl):S470–S475CrossRefPubMedGoogle Scholar
  2. 2.
    Yocum MW, Butterfield JH, Klein JS, Volcheck GW, Schroeder DR, Silverstein MD. Epidemiology of anaphylaxis in Olmsted County: A population-based study. J Allergy Clin Immunol, 1999; 104 (2 Pt 1):452–456CrossRefPubMedGoogle Scholar
  3. 3.
    Burks W, Bannon GA, Sicherer S, Sampson HA. Peanut-induced anaphylactic reactions. Int Arch Allergy Immunol, 1999; 119 (3):165–172CrossRefPubMedGoogle Scholar
  4. 4.
    Joint Task Force on Practice Parameters, American Academy of Alllergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol 2003;90:1–40Google Scholar
  5. 5.
    Freeman J. “Rush” inoculation. Lancet, 1930; 1:744CrossRefGoogle Scholar
  6. 6.
    Oppenheimer JJ, Nelson HS, Bock SA, Christensen F, Leung DYM. Treatment of peanut allergy with rush immunotherapy. J Allergy Clin Immunol, 1992; 90:256–262CrossRefPubMedGoogle Scholar
  7. 7.
    Nelson HS, Lahr J, Rule R, Bock A, Leung D. Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol, 1997; 99 (6 Pt 1):744–751CrossRefPubMedGoogle Scholar
  8. 8.
    Bullock RJ, Barnett D, Howden ME. Immunologic and clinical responses to parenteral immu-notherapy in peanut anaphylaxis — a study using IgE and IgG4 immunoblot monitoring. Allergol Immunopathol (Madr), 2005; 33 (5):250–256CrossRefGoogle Scholar
  9. 9.
    Asero R. Effects of birch pollen-specific immunotherapy on apple allergy in birch pollen-hypersensitive patients. Clin Exp Allergy, 1998; 28 (11):1368–1373CrossRefPubMedGoogle Scholar
  10. 10.
    Bolhaar ST, Tiemessen MM, Zuidmeer L, van Leeuwen A, Hoffmann-Sommergruber K, Bruijnzeel-Koomen CA, et al. Efficacy of birch pollen immunotherapy on cross-reactive food allergy confirmed by skin tests and double-blind food challenges. Clin Exp Allergy, 2004; 34 (5):761–769CrossRefPubMedGoogle Scholar
  11. 11.
    Asero R. Fennel, cucumber, and melon allergy successfully treated with pollen-specific injection immunotherapy. Ann Allergy Asthma Immunol, 2000; 84 (4):460–462PubMedCrossRefGoogle Scholar
  12. 12.
    Bucher X, Pichler WJ, Dahinden CA, Helbling A. Effect of tree pollen-specific, subcutaneous immu-notherapy on the oral allergy syndrome to apple and hazelnut. Allergy, 2004; 59 (12):1272–1276CrossRefPubMedGoogle Scholar
  13. 13.
    Skamstrup Hansen K, Sondergaard KM, Stahl SP, et al. Food allergy to apple and specific immunotherapy with birch pollen. Mol Nutr Food Res, 2004; 48:441–448CrossRefGoogle Scholar
  14. 14.
    Moller C. Effect of pollen immunotherapy on food hypersensitivity in children with birch pollinosis. Ann Allergy, 1989; 62 (4):343–345PubMedGoogle Scholar
  15. 15.
    Patriarca G, Nucera E, Pollastrini E, Roncallo C, De Pasquale T, Lombardo C, Pedone C, Gasbarrini G, Buonomo A, Schiavino D. Oral specific desensitization in food-allergic children. Dig Dis Sci, 2007; 52(7):1662–1672CrossRefPubMedGoogle Scholar
  16. 16.
    Patriarca G, Nucera E, Roncallo C, Pollastrini E, Bartolozzi F, De Pasquale T et al. Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther, 2003; 17(3):459–465CrossRefPubMedGoogle Scholar
  17. 17.
    Meglio P, Bartone E, Plantamura M, Arabito E, Giampietro PG. A protocol for oral desensi-tization in children with IgE-mediated cow's milk allergy. Allergy, 2004; 59 (9):980–987CrossRefPubMedGoogle Scholar
  18. 18.
    Buchanan AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA, Steele PH, Pons L, Helm RM, Lee LA, Burks AW. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol, 2007; 119 (1):199–205CrossRefPubMedGoogle Scholar
  19. 19.
    Patriarca G, Nucera E, Pollastrini E, Roncallo C, De Pasquale T, Lombardo C, Pedone C, Gasbarrini G, Buonomo A, Schiavino D. Oral specific desensitization in food-allergic children. Dig Dis Sci, 2007; 52:1662–1672CrossRefPubMedGoogle Scholar
  20. 20.
    Morisset M, Moneret-Vautrin DA, Guenard L, Cuny JM, Frentz P, Hatahet R, Hanss Ch, Beaudouin E, Petit N, Kanny G. Oral desensitization in children with milk and egg allergies obtains recovery in a significant proportion of cases. A randomized study in 60 children with cow's milk allergy and 90 children with egg allergy. Allerg Immunol (Paris), 2007; 39 (1):12–19Google Scholar
  21. 21.
    Staden U, Rolnick-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K. Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy, 2007; 62(11):1261–1269CrossRefPubMedGoogle Scholar
  22. 22.
    Mempel M, Rakoski J, Ring J, Ollert M. Severe anaphylaxis to kivi fruit: immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol, 2003; 111 (6):1406–1409CrossRefPubMedGoogle Scholar
  23. 23.
    Enrique E, Pineda F, Malek T, Bartra J, Basagana 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 (5):1073–1079CrossRefPubMedGoogle Scholar
  24. 24.
    King N, Helm R, Stanley JS, et al. Allergenic characteristics of a modified peanut allergen. Mol Nutr Food Res, 2005; 49 (10):963–971CrossRefPubMedGoogle Scholar
  25. 25.
    Bannon GA, Cockrell G, Connaughton C, et al. Engineering, characterization and in vitro efficacy of the major peanut allergens for use in immunotherapy. Int Arch Allergy Immunol, 2001; 124 (1–3):70–72CrossRefPubMedGoogle Scholar
  26. 26.
    Li XM, Srivastava K, Grishin A, et al. Persistent protective effect of heat-killed Escherichia coli producing “engineered,” recombinant peanut proteins in a murine model of peanut allergy. J Allergy Clin Immunol, 2003; 112 (1):159–167CrossRefPubMedGoogle Scholar
  27. 27.
    Bissonnette E Y, Befus AD. Inhibition of mast cell-mediated cytotoxicity by IFN-alpha/beta and -gamma. J Immunol, 1990; 145 (10):3385–3390PubMedGoogle Scholar
  28. 28.
    Pierkes M, Bellinghausen I, Hultsch T, Metz G, Knop J, Saloga J. Decreased release of histamine and sulfidoleukotrienes by human peripheral blood leukocytes after wasp venom immu-notherapy is partially due to induction of IL-10 and IFN-gamma production of T cells. J Allergy Clin Immunol, 1999; 103 (2 Pt 1):326–332CrossRefPubMedGoogle Scholar
  29. 29.
    Hong SJ, Michael JG, Fehringer A, Leung DY. Pepsin-digested peanut contains T-cell epitopes but no IgE epitopes. J Allergy Clin Immunol, 1999; 104 (2 Pt 1):473–478CrossRefPubMedGoogle Scholar
  30. 30.
    Li S, Li XM, Burks AW, Bannon GA, Sampson HA. Modulation of peanut allergy by peptide-based immunotherapy. J Allergy Clin Immunol, 2001; 107 (2):S233Google Scholar
  31. 31.
    Chu RS, Targoni OS, Krieg AM, Lehmann P V, Harding CV. CpG oligodeoxynucleotides act as adjuvants that switch on T helper 1 (Th1) immunity. J Exp Med, 1997; 186 (10):1623–1631CrossRefPubMedGoogle Scholar
  32. 32.
    Tighe H, Takabayashi K, Schwartz D, et al. Conjugation of immunostimulatory DNA to the short ragweed allergen amb a 1 enhances its immunogenicity and reduces its allergenicity. J Allergy Clin Immunol, 2000; 106 (1 Pt 1):124–134CrossRefPubMedGoogle Scholar
  33. 33.
    Horner AA, Nguyen MD, Ronaghy A, Cinman N, Verbeek S, Raz E. DNA-based vaccination reduces the risk of lethal anaphylactic hypersensitivity in mice. J Allergy Clin Immunol, 2000; 106 (2):349–356CrossRefPubMedGoogle Scholar
  34. 34.
    Srivastava K, Li XM, Bannon GA, Burks AW, Eiden J, Vannest G, Tuck R, Rodriguez R, Sampson HA. Investigation of the use of Iss-linked Ara h2 for the treatment of peanut-induced allergy. J Allergy Clin Immunol, 2001; 107 (2):S233Google Scholar
  35. 35.
    Roy K, Mao HQ, Huang SK, Leong KW. Oral gene delivery with chitosan–DNA nanoparti-cles generates immunologic protection in a murine model of peanut allergy [see comments]. Nat Med, 1999; 5 (4):387–391CrossRefPubMedGoogle Scholar
  36. 36.
    Leung D Y, Sampson HA, Yunginger JW, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med, 2003; 348 (11):986–993CrossRefPubMedGoogle Scholar
  37. 37.
    Sampson HA, Leung DYM, Burks AW, Lack G, Bahna SL, Jones SM, et al. A phase II, randomized, double-blind, parallel group, placebo-controlled oral food challenge trial of Xolair (omalizumab) in peanut allergy. J Allergy Clin Immun, 2007; 119 (1): S117CrossRefGoogle Scholar
  38. 38.
    Srivastava KD, Kattan JD, Zou ZM, et al. The Chinese herbal medicine formula FAHF-2 completely blocks anaphylactic reactions in a murine model of peanut allergy. J Allergy Clin Immunol, 2005; 115 (1):171–178CrossRefPubMedGoogle Scholar
  39. 39.
    Srivastava KD, Zhang T, Qu C, Sampson HA, Li XM. Silencing peanut allergy: A Chinese Herbal Formula, Fahf-2, completely blocks peanut-induced anaphylaxis for up to 6 months following therapy in a murine model of peanut allergy. J Allergy Clin Immunol, 2006; 117 (2):S328CrossRefGoogle Scholar
  40. 40.
    Qu C, Srivastava K, Ko J, Zhang TF, Sampson HA, Li XM. Induction of tolerance after establishment of peanut allergy by the food allergy herbal formula-2 is associated with up-regulation of interferon-gamma. Clin Exp Allergy, 2007; 37 (6):846–855CrossRefPubMedGoogle Scholar
  41. 41.
    Ko J, Busse PJ, Shek L, Noone SA, Sampson HA, Li XM. J Allergy Clin Immunol, 2005; 115 (2), S34CrossRefGoogle Scholar
  42. 42.
    Skripak JM, Nash SD, Rowley H, Brereton NH, Oh S, Hamilton RG, et al. A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow's milk allergy. J Allergy Clin Immunol 2008; 122(6):1154–1160CrossRefPubMedGoogle Scholar
  43. 43.
    Longo G, Barbi E, Berti I, Meneghetti R, Pittalis A, Ronfani L, Ventura A. Specific oral tolerance induction in children with very severe cow's milk-induced reactions. J Allergy Clin Immunol 2008; 121(2):343–347CrossRefPubMedGoogle Scholar
  44. 44.
    Jones SM, Pons L, Roberts JL, Scurlock AM, Perry TT, Kulis M, Shreffler WG, Steele P, Henry KA, Adair M, Francis JM, Durham S, Vickery BP, Zhong X, Burks AW. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol. 2009; 124(2):292–300CrossRefPubMedGoogle Scholar
  45. 45.
    Fernández-Rivas M, Garrido Fernández S, Nadal JA, Díaz de Durana MD, García BE, González-Mancebo E, Martín S, Barber D, Rico P, Tabar AI. Randomized double-blind, placebo-controlled trial of sublingual immunotherapy with a Pru p 3 quantified peach extract. Allergy. 2009; 64(6):876–883CrossRefPubMedGoogle Scholar
  46. 46.
    Kinaciyan T, Jahn-Schmid B, Radakovics A, Zwolfer B, Schreiber C, Francis JN, et al. Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1. J Allergy Clin Immunol 2007; 119(4):937–943CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Julie Wang
    • 1
  • Hugh A. Sampson
    • 1
  1. 1.Division of Allergy and Immunology, Department of PediatricsJaffe Food Allergy Institute, Mount Sinai School of MedicineNew YorkUSA

Personalised recommendations