Food allergy: manifestations, diagnosis and management

Adverse reactions to food are common but only a fraction of them are due to hypersensitivity (or allergy). Of the latter, immunoglobulin (Ig)E-mediated reactions appear to be the most common and best understood. A wide variety of manifestations may affect various body systems, particularly the gastrointestinal tract, skin and respiratory tract. Diagnosis depends primarily on thorough medical history, often supplemented by skin testing or specific serum IgE antibody measurement. Verification would require appropriately designed challenge testing. At present, treatment is primarily strict avoidance of the offending food, together with crossreacting other foods. Several immunomodulatory therapeutic agents are being explored. A few studies demonstrated a potential benefit of probiotics for prophylaxis and treatment. A multicenter study is currently investigating the efficacy and safety of anti-IgE in subjects with peanut allergy. Experimental studies in mice revealed preliminary findings that promise vaccine development using novel approaches, such as modified food allergen epitopes, immunostimulatory sequence-conjugated allergens and chimeric proteins capable of complexing with IgE or its receptors.