Food Allergy-practical Approach

Year : 2024 | Volume :14 | Issue : 01 | Page : 32-53
By

    P.C Kathuria

  1. Manisha Rai

  1. Senior Consultant, BLK Super Speciality Hospital, New Delhi, India
  2. Associate Consultant, National Allergy Centre, New Delhi, India

Abstract

There is a consistent increase in prevalence of food allergy (FA). The diagnosis of FA is based on thorough history supported by positive skin test, specific IgE (extract-and component-based), Basophil activation test (BAT) to reduce the need for Oral food challenge (OFC). OFC procedures may be conducted in cases of diagnostic uncertainty or to assess the presence or development of tolerance. Effective management of food allergy involves a comprehensive three-pronged strategy. Firstly, it includes implementing measures for avoidance and diet elimination to minimize exposure to allergens. Secondly, an emergency action plan, often involving the use of an Epipen autoinjector, is crucial for immediate response to accidental allergen exposure. Finally, the approach incorporates strategies to induce tolerance through a combination of oral immunotherapy (OIT) and the use of biological agents like Omalizumab etc.. This updated review provides a practical and comprehensive approach to the diagnosis and management of food allergies

Keywords: Food allergy, Oral immunotherapy (OIT), Allergen immunotherapy (AIT), Subcutaneous immunotherapy (SCIT), Sublingual immunotherapy (SLIT), omalizumab, anti-IgE IgE-mediated food allergy, Non-IgE-mediated food allergy, Eosinophilic esophagitis (EoE) and Non EoE (EG-Eosinophilic gastritis, EGE- Eosinophilic gastroenteritis

[This article belongs to Research & Reviews : A Journal of Immunology(rrjoi)]

How to cite this article: P.C Kathuria, Manisha Rai.Food Allergy-practical Approach.Research & Reviews : A Journal of Immunology.2024; 14(01):32-53.
How to cite this URL: P.C Kathuria, Manisha Rai , Food Allergy-practical Approach rrjoi 2024 {cited 2024 Apr 24};14:32-53. Available from: https://journals.stmjournals.com/rrjoi/article=2024/view=144225


References

  1. Abril AG, Carrera M, Sánchez-Pérez Á, Villa TG. Gut Microbiome Proteomics in Food Allergies. International Journal of Molecular Sciences. 2023 Jan 23;24(3):2234.
  2. Satitsuksanoa P, Jansen K, Głobińska A, Van de Veen W, Akdis M. Regulatory immune mechanisms in tolerance to food allergy. Frontiers in immunology. 2018 Dec 12;9:2939.
  3. Nwaru BI, Hickstein L, Panesar SS, Muraro A, Werfel T, Cardona V, Dubois AE, Halken S, Hoffmann‐Sommergruber K, Poulsen LK, Roberts G. The epidemiology of food allergy in Europe: a systematic review and meta‐analysis. Allergy. 2014 Jan;69(1):62-75.
  4. Özdemir PG, Sato S, Yanagida N, Ebisawa M. Oral Immunotherapy in Food Allergy: Where Are We Now?. Allergy, Asthma & Immunology Research. 2023 Mar;15(2):125.
  5. Hwang DW, Nagler CR, Ciaccio CE. New and emerging concepts and therapies for the treatment of food allergy. Immunotherapy Advances. 2022 Jan 1;2(1):ltac006.
  6. Nance CL, Deniskin R, Diaz VC, Paul M, Anvari S, Anagnostou A. The role of the microbiome in food allergy: a review. Children. 2020 May 26;7(6):50.
  7. Anagnostou A, Lieberman J, Greenhawt M, Mack DP, Santos AF, Venter C, Stukus D, Turner PJ, Brough HA. The Future of Food Allergy: Challenging Existing Paradigms of Clinical Practice. Allergy. 2023 May 2.
  8. Asero R, Pravettoni V, Scala E, Villalta D. Lipid transfer protein allergy: A review of current controversies. Clinical & Experimental Allergy. 2022 Feb;52(2):222-30.
  9. Mahesh PA, Kaleem Ullah M, Parthasarathi A. Allergic sensitization to foods in India and other Low–Middle‐income countries. Clinical & Experimental Allergy. 2023 Feb 24.
  10. Yamada Y. Recent topics on gastrointestinal allergic disorders. Clinical and Experimental Pediatrics. 2023 Jun;66(6):240.
  11. Onyimba F, Crowe SE, Johnson S, Leung J. Food allergies and intolerances: a clinical approach to the diagnosis and management of adverse reactions to food. Clinical Gastroenterology and Hepatology. 2021 Nov 1;19(11):2230-40.
  12. Boman HG. Innate immunity and the normal microflora. Immunological reviews. 2000 Feb 1;173:5-16.
  13. Kuchroo VK. B7-1 and B7-2 co-stimulator molecules activate differentially the Th1/Th2 developmental pathways: application to autoimmune disease therapy. Cell. 1995;80:1.
  14. Steinbrink K, Wölfl M, Jonuleit H, Knop J, Enk AH. Pillars Article: Induction of Tolerance by IL-10-Treated Dendritic Cells. J. Immunol. 1997. 159: 4772–4780. The Journal of Immunology. 2016 Sep 1;197(5):1547-55.
  15. Bellou A, Schaub B, Ting L, Finn PW. Toll receptors modulate allergic responses: interaction with dendritic cells, T cells and mast cells. Current Opinion in Allergy and Clinical Immunology. 2003 Dec 1;3(6):487-94.
  16. Hussain M, Borcard L, Walsh KP, et al. Basophil-derived IL-4 promotes epicutaneous antigen sensitization concomitant with the development of food allergy. J Allergy Clin Immunol 2018; 141:223–234.e5.
  17. Rivas MN, Burton OT, Oettgen HC, Chatila T. IL-4 production by group 2 innate lymphoid cells promotes food allergy by blocking regulatory T-cell function. Journal of Allergy and Clinical Immunology. 2016 Sep 1;138(3):801-11.
  18. Galli SJ, Tsai M. IgE and mast cells in allergic disease. Nature medicine. 2012 May;18(5):693-704.
  19. De Angelis, Elisabetta & Bavaro, Simona Lucia & Pilolli, Rosa & Monaci, Linda. (2018). Allergenic Ingredients in Food. 10.1016/B978-0-12-409547-2.13957-5.
  20. Waserman S, Watson W. Food allergy. Allergy, Asthma & Clinical Immunology. 2011 Dec;7:1-7.
  21. Freeman HJ, Chopra A, Clandinin MT, Thomson AB. Recent advances in celiac disease. World journal of gastroenterology: WJG. 2011 May 5;17(18):2259.
  22. Scherf KA, Koehler P,Wieser H. Gluten and wheat sensitivities – an overview. J Cereal Sci. (2016) 67:2–11.
  23. Sh, Sicherer. “Food allergy.” J Allergy Clin immunol 125.2 (2010): S116-S125.
  24. Riggioni C, Agache I, Akdis M, Alvarez‐perea A, Alvaro‐lozano M, Ballmer‐weber B, Barni S, Beyer K, Bindslev‐jensen C, Buyuktiryaki B, Chu D. EAACI guidelines on the diagnosis of IgE‐mediated food allergy. Allergy. 2023 Oct 10.
  25. Hill DJ, Heine RG, Hosking CS. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol. 2004 Oct;15(5):435-41.
  26. Foong RX, Dantzer JA, Wood RA, Santos AF. Improving Diagnostic Accuracy in Food Allergy. J Allergy Clin Immunol Pract. 2021 Jan;9(1):71-80.
  27. Roberts G., Lack G. Food allergy—getting more out of your skin prick tests. Clin Exp Allergy. 2000;30:1495–1498.
  28. Sindher S., Long A.J., Purington N., Chollet M., Slatkin S., Andorf S. Analysis of a large standardized food challenge data set to determine predictors of positive outcome across multiple allergens. Front Immunol. 2018;9:2689.
  29. Santos AF, Kulis MD, Sampson HA. Bringing the Next Generation of Food Allergy Diagnostics Into the Clinic. J Allergy Clin Immunol Pract. 2022 Jan;10(1):1-9.
  30. Flores Kim J, McCleary N, Nwaru BI, Stoddart A, Sheikh A. Diagnostic accuracy, risk assessment, and cost-effectiveness of component-resolved diagnostics for food allergy: A systematic review. Allergy. 2018 Aug;73(8):1609-1621.
  31. Masthoff LJN, Pasmans SGMA, van Doorn H, et al. Major hazelnut and peanut allergens are potent in basophil activation and cross-react at T-cell level. Allergy. 2018;73(10):2080-2082.
  32. Kamath SD, Bublin M, Kitamura K, Matsui T, Ito K, Lopata AL. Cross-reactive epitopes, and their role in food allergy. J Allergy Clin Immunol. 2023 May;151(5):1178-1190.
  33. Cañas, J.A.; Pérez-Sánchez, N.; Lopera-Doblas, L.; Palomares, F.; Molina, A.; Bartra, J.; Torres, M.J.; Gómez, F.; Mayorga, C. Basophil Activation Test Utility as a Diagnostic Tool in LTP Allergy. J. Mol. Sci. 2022, 23, 4979. h
  34. Muraro A, Worm M, Alviani C, Cardona V, DunnGalvin A, Garvey LH, et al; European Academy of Allergy and Clinical Immunology, Food Allergy, Anaphylaxis Guidelines Group. EAACI guidelines: Anaphylaxis (2021 update). Allergy. 2022 Feb;77(2):357-377.
  35. . Mauro M, Russello M, Incorvaia C, Gazzola G, Frati F, Moingeon P, Passalacqua G. Birch-apple syndrome treated with birch pollen immunotherapy. International archives of allergy and immunology. 2011 Aug 10;156(4):416-22.
  36. . Fleischer DM, Burks AW, Vickery BP, Scurlock AM, Wood RA, Jones SM, Sicherer SH, Liu AH, Stablein D, Henning AK, Mayer L. Sublingual immunotherapy for peanut allergy: a randomized, double-blind, placebo-controlled multicenter trial. Journal of allergy and clinical immunology. 2013 Jan 1;131(1):119-27.
  37. Burks AW, Jones SM, Wood RA, Fleischer DM, Sicherer SH, Lindblad RW et al. Oral immunotherapy for treatment of egg allergy in children. N Engl J Med 2012;367:233–43
  38. Larché M. T cell epitope-based allergy vaccines. Vaccines against Allergies. 2011 May 13:107-19.
  39. Linhart B., Valenta R. Mechanisms underlying allergy vaccination with recombinant hypoallergenic allergen derivatives. 2012;30:4328–4335.
  40. Focke-Tejkl M., Valenta R. Safety of engineered allergen-specific immunotherapy vaccines. Curr Opin Allergy Clin Immunol. 2012;12:555–563.
  41. Brown KR, Baker J, Vereda A, et al. Safety of peanut (Arachis hypogaea) allergen powder-dnfp in children and teenagers with peanut allergy: pooled summary of phase 3 and extension trials. J Allergy Clin Immunol. 2022 Jun;149(6):2043–2052.
  42. Pouessel G, Lezmi G. Oral immunotherapy for food allergy: Translation from studies to clinical practice? World Allergy Organ J. 2023 Feb 3;16(2):100747.
  43. De Silva D, Rodríguez Del Río P, de Jong NW, et al. GA2LEN Food Allergy Guidelines Group. Allergen immunotherapy and/or biologicals for IgE-mediated food allergy: a systematic review and meta-analysis. Allergy. 2022 Jun;77(6):1852–1862.
  44. Nurmatov U, Dhami S, Arasi S, et al. Allergen immunotherapy for IgE-mediated food allergy: a systematic review and metaanalysis. Allergy. 2017;72(8):1133–1147.
  45. Romantsik O, Tosca MA, Zappettini S, Calevo MG. Oral and sublingual immunotherapy for egg allergy. Cochrane Database Syst Rev. 2018 Apr 20;4(4):CD01
  46. Yeung JP, Kloda LA, McDevitt J, Ben-Shoshan M, Alizadehfar R. Oral immunotherapy for milk allergy. Cochrane Database Syst Rev. 2012 Nov 14;11(11):CD009542.
  47. Chu DK, Wood RA, French S, et al. Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety. Lancet. 2019; 393:2222–2232.
  48. Nachshon L, Goldberg MR, Levy MB, et al. Efficacy and safety of sesame oral immunotherapy-A real-world, single-center study. J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2775– 2781.e2.
  49. 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 Dec;113(6):624–629.
  50. Jin H, Trogen B, Nowak-Wegrzyn A. Eosinophilic esophagitis as a complication of food oral immunotherapy. Curr Opin Allergy Clin Immunol. 2020 Dec;20(6):616–623.
  51. Hill DA, Dudley JW, Spergel JM. The prevalence of eosinophilic esophagitis in pediatric patients with IgE-mediated food allergy. J Allergy Clin Immunol Pract. 2017 Mar-Apr;5(2):369–375.
  52. Vickery BP, Berglund JP, Burk CM, et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017;139(1):173–181.e8
  53. Finley A, Atkinson E. Subcutaneous Immunotherapy for Pollen Food Allergy Syndrome: A Systematic Review. Journal of Allergy and Clinical Immunology. 2021 Feb 1;147(2):AB107.
  54. Kathuria PC, Rai M. Pollen-food allergy syndrome and lipid transfer protein syndrome: Clinical relevance. Indian Journal of Allergy Asthma & Immunology. 2021 Jul 1;35(2).
  55. Kathuria PC, Rai M. Wheat and peanut food allergy in mugwort (Artemesia vulgaris) sensitized patients: A case series of four cases. Indian Journal of Case Reports. 2020 Jun 25:292-5.
  56. Kathuria PC, Rai M. Case series of seven cases of urticaria, angioedema, and anaphylaxis (LTP syndrome) due to foods (nuts, lentils, and citrus foods) related to tree pollen (Prosopis juliflora and Holoptelea integrifolia) sensitization. Indian Journal of Case Reports. 2021 Aug 28:319-23.
Regular Issue Subscription Review Article
Volume 14
Issue 01
Received January 20, 2024
Accepted January 21, 2024
Published April 24, 2024
Views: 18