Food Allergies: New Research

236 Pages·2008·2.56 MB·English

by  Carrie M. Chesterton

F A :
OOD LLERGIES
NEW RESEARCH

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F A :
OOD LLERGIES
NEW RESEARCH

CARRIE M. CHESTERTON
EDITOR

Nova Science Publishers, Inc.
New York
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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Food allergies : new research / Carrie M. Chesterton, editor.
p. ; cm.
ISBN 978-1-60876-330-6 (E-Book)
1. Food allergy. I. Chesterton, Carrie M., 1959-
[DNLM: 1. Food Hypersensitivity. 2. Child. 3. Food--adverse effects. 4. Infant. WD 310
F6853 2008]
RC596.F645 2008
616.97'5--dc22 200803109

Published by Nova Science Publishers, Inc. (cid:30) New York
CONTENTS

Preface vii 
Short Comm. Clinical Features of Patients Having Oral Allergy Syndrome
Associated with Plant Food Allergens in the Kanto Region 1
Emiko Ono, Yuji Maeda, Hidenori Tanimoto, Yuma Fukutomi,
Chiyako Oshikata, Kiyoshi Sekiya, Takahiro Tsuburai,
Naomi Tsurikisawa, Mamoru Otomo, Masami Taniguchi,
Toyota Ishii, Akihiko Asahina and Kazuo Akiyama 
Chapter 1 Current Position of Atopy Patch Test in the Diagnosis of Food
Allergy in Children 9 
Milos Jesenak, Zuzana Rennerova, Eva Babusikova, Peter Banovcin,
Lubica Jakusova, Zuzana Havlicekova, Mario Barreto,
Maria Pia Villa and Roberto Ronchetti 
Chapter 2 Clinical Manifestations of Food Allergy 91 
Alexander K.C. Leung and Deepak Kamat 
Chapter 3 Food Allergies and Atopies: What Is the Evidence? 121 
Kam-lun Ellis Hon and Alexander K.C. Leung 
Chapter 4 Management of the Child with Food Allergy 135 
Alexander K.C. Leung, and Kam-lun Ellis Hon 
Chapter 5 Infantile Colic: An Update 157 
Alexander K.C. Leung 
Chapter 6 Eosinophilic Gastrointestinal Disorders 173 
Thomas P. Miller and Alexander K.C. Leung 
Chapter 7 Preventing and Responding to Food Anaphylaxis in School Settings 189 
Genevieve H. Hay, Thomas B. Harper III and Peachey M. Trudell 
Index 203

PREFACE

A food allergy is an exaggerated immune response triggered by eggs, peanuts, milk, or
some other specific food. Normally, your body's immune system defends against potentially
harmful substances, such as bacteria, viruses, and toxins. In some people, an immune
response is triggered by a substance that is generally harmless, such as a specific food. The
cause of food allergies is not fully understood. A food allergy frequently starts in childhood,
but it can begin at any age. Fortunately, many children will outgrow their allergy to milk, egg,
wheat, and soy by the time they are 5 years old if they avoid the offending foods when they
are young. Allergies to peanuts, tree nuts, and shellfish tend to be lifelong. This new book
presents recent significant research in this field.
Short Communication - Background and Objective: Recently, the number of patients
having oral allergy syndrome (OAS) associated with fruits has been increasing. We
investigated the background, characteristics, and severity of the symptoms of such patients.
Subject and Methods: A questionnaire survey was conducted on the patients living in the
Kanto region who visited the authors’ hospital in the past 5 years and were suspected of
having allergies to foods of plant origin.
Results: The subjects were 42 patients, 8 males and 34 females, whose mean age was 36
years. The complicating allergic diseases were allergic rhinitis in 35 patients (83%), asthma
in 34 patients (81%), and atopic dermatitis in 14 patients (33%). The suspected causes of the
OAS symptoms were rose family fruits in 31 patients, non-rose family fruits in 34 patients,
vegetables in 14 patients, beans and nuts in 11 patients, and grains in 2 patients. As for the
symptoms, oral and pharynx symptoms alone were observed in 12 patients, systemic
symptoms were observed in 29 patients, and anaphylaxis was observed in 11 patients.
Allergic rhinitis preceded OAS in 80% of the patients, which was a high incidence, but 20%
of the patients did not experience this complication.
Conclusion: Rhinitic symptoms preceded OAS in many of the patients having oral
allergies to foods of plant origin in the Kanto region. Moreover, the findings that there were
patients who did not experience black alder pollinosis and that the symptoms were also
caused at a high rate by non-rose family fruits suggests the presence of broad cross reactivity
among pollens other those that of black alder and food of plant origin.
Chapter 1 - Food allergy (FA) represents one of the most important problems of pediatric
allergology and immunology. FA diagnosing is very challenging and not as easy as it seems
at first sight. It requires close cooperation among immunoallergologist, gastroenterologist,
dermatologist and pediatrician. Diagnostic algorithm consists of detailed personal and family
viii Carrie M. Chesterton
history, physical examination, tests for IgE mediated reactions (quantification of food-specific
IgE and skin prick test), elimination diet and the “gold standard” – double-blind, placebo-
controlled oral food challenge. However, all these methods and tests may be sometimes
misleading. Additional test in the diagnosis of FA is atopy patch test (APT), which is aimed
at the diagnosis of late clinical symptoms induced by special foods and can significantly
contribute to the final outcome. The standardized method for APT testing has been published
recently. APT has left experimental grounds and is increasingly used as a standard diagnostic
procedure for characterizing patients with aeroallergen- and food-triggered disorders.
Although APT seems a valuable additional tool in the diagnostic work-up of food allergy,
especially in children with atopic eczema, the immunopathology and some technical aspects
of testing remain controversial. There are still some points waiting to be answered, e.g.,
epidemiology of this tests in an unselected population, prevalence of side effects and safety of
this test, possibility of sensitization through skin during testing, reproducibility in the same
time and over-time, suitability of some new APT testing sets available on the market (e.g.
plastic cups on tape), and especially optimal and good available testing substances.
For better understanding these unsolved aspects of this new diagnostic method, the
authors performed the study in an unselected population of schoolchildren of two different
nations (all together 900 children), where they examined the prevalence of positive APT with
food and inhalant allergens. The authors evaluated the link between positive APT reactions
and skin prick tests, circulating eosinophils, histamine skin reactivity, and questionnaire-
derived frequencies of various atopic and non-atopic symptoms and diseases. The authors
also investigated the right versus left and over-time reproducibility of duplicate APT with
native and commercially available food and with inhalant allergens.
In this chapter, the authors review current knowledge about atopy patch test and to
compare their results with already published studies. Despite some unresolved questions
about APT, this test seems to be useful as an additional method in management of food-
induced symptoms and disorders, but its results should be evaluated in the context with other
methods and clinical status. Further studies are necessary for better understanding all the
clinical characteristics and applications of atopy patch test.
Chapter 2 - Food allergy is defined as an adverse reaction because of an abnormal
immunological response to food protein. The immune pathogenesis is, in the majority of
cases, IgE-mediated although it may also be cell-mediated (non-IgE) or mixed IgE/cell-
mediated. Food allergy affects as many as 2 to 8% of young children and the presentation can
be highly variable. There is usually a clear temporal relationship between food exposure and
the development of allergic symptoms. At times, symptoms may develop hours or days after
food exposure making the diagnosis difficult.
Food allergy usually presents as multi-system involvement, most commonly
gastrointestinal symptoms which occur with a frequency of 50 to 80% of cases. These are
followed by cutaneous symptoms and respiratory symptoms, occurring in 20 to 40%, and 4 to
25% of cases, respectively. Gastrointestinal manifestations include oral allergy syndrome,
gastrointestinal anaphylaxis, allergic eosinophilic esophagitis, allergic eosinophilic
gastroenteropathy, food protein-induced enteropathy, food protein-induced enterocolitis
syndrome, food protein-induced proctocolitis, gluten-sensitive enteropathy, infantile colic,
irritable bowel syndrome, and constipation. Cutaneous manifestations are
urticaria/angioedema, atopic dermatitis, contact dermatitis, and dermatitis herpetiformis.
Rhinitis/rhinoconjunctivitis, asthma, Heiner syndrome, and serous otitis media are the
Preface ix
respiratory manifestations of food allergy. Other manifestations include systemic anaphylaxis,
food-dependent exercise-induced anaphylaxis, migraine, epilepsy, diabetes mellitus,
nephrotic syndrome, nocturnal enuresis, anemia, thrombocytopenia, vasculitis, and
arthropathy/arthritis. This chapter discusses the various clinical manifestations of food
allergy.
Chapter 3 - Genuine food allergy affects approximately 5% of children and less than 1%
of adults. The underlying mechanism is complex and involves immediate (type I) or delayed
(type IV) sensitization to food proteins. The gold standard for the diagnosis of genuine food
allergies is by double-blind placebo-controlled food challenge test. The literature gives
ambiguous data on the association between food allergies and atopic diseases. In asthma,
aeroallergens such as house dust, mites, and pollens are well known allergens. Apart from
type I hypersensitivity reaction precipitating acute anaphylactic and asthmatic attacks by
peanuts, egg or crustacean seafood, the association with food allergens is probably less
prevalent. Allergic rhinitis/allergic rhinoconjunctivitis as the sole manifestation of food
allergy is quite uncommon. Food allergy plays an immunopathogenic role in 30 to 50% of
children with moderate to severe atopic dermatitis.
Chapter 4 - The definitive treatment of food allergy is strict elimination of the offending
food from the diet. Symptomatic reactivity to food allergens is generally very specific, and
patients rarely react to more than one food in a botanical or animal species. If elimination
diets are prescribed, care must be taken to ensure that they are palatable and nutritionally
adequate. Patients must have a good knowledge of food containing the allergen and must be
taught to scrutinize the labels of all packaged food carefully.
Formula-fed infants with cow’s milk allergy should be fed an elemental or extensively
hydrolysed hypoallergenic formula. Soy formulas are inappropriate alternatives as a
significant number of infants who are allergic to cow’s milk are also allergic to soy. Most
children outgrow their food hypersensitivity. As such, rechallenge testing for food allergy
should be performed; the interval between rechallenges should be dictated by the specific
food allergen in question, the age of the child, and the degree of difficulty in avoiding the
food in question
Emergency treatment of food-induced anaphylaxis should follow the basic life support
ABC principles, with the simultaneous intramuscular injection of adrenaline. A fast-acting H
1
antihistamine should be considered for the child with progressive or generalized urticaria or
disturbing pruritus. Pharmacological therapies such as mast cell stabilizers have very little
role to play in the treatment of gastrointestinal manifestations of food allergy.
In high-risk infants, exclusive breastfeeding with introduction of solid foods not earlier
than 6 months of age may delay or possibly prevent the onset of food allergy in some
children. Avoidance of allergenic foods by lactating mothers is often recommended. When
breastfeeding is not possible, the use of a partially or extensively hydrolysed hypoallergenic
formula is desirable. Prophylactic medications have not been shown to be consistently
effective in the prevention of life-threatening reactions to food. Their use may mask a less
severe reaction to a culprit food, knowledge of which might prevent a more severe reaction to
that food in the future.
Chapter 5 - Infantile colic is characterized by paroxysms of uncontrollable crying or
fussing in an otherwise healthy and well-fed infant less than 3 months of age. The duration of
crying is more than 3 hours per day and more than 3 days per week for at least 3 weeks.