certain e.g., apple Mal d 1 and Birch bet v 1). Rhinitis, asthma Symptoms may accompany a reaction but rarely an isolated or chronic symptom. May also be triggered by inhalation of aerosolized food protein. Infant/child > adult except for occupational disease (e.g., Baker’s asthma) Generally: allergens. Occupational: egg, seafood, etc. Depending upon food. SPT and/or sIgE Immediate GI symptoms Immediate isolated vomiting (more often, gastrointestinal symptoms are associated with anaphylaxis); nausea, emesis, abdominal pain Major food allergens Depends on food SPT and/or sIgE Anaphylaxis Rapidly progressive, multiple organ system reaction can include cardiovascular collapse. Massive release of mediators such as histamine, though mast cell tryptase not always elevated. Key role of platelet Any Any but more commonly peanut, tree nuts, shellfish, fish, milk and egg. Depending upon food SPT and/or sIgE allergic
activating factor. Delayed food anaphylaxis to mammalian meats Several hour delay following ingestion Related to antibodies to carbohydrate moiety (see text) Related to tick Beef, pork, lamb Uncertain Serum test for IgE to alpha-gal SPT and/or sIgE anaphylaxis Food triggers anaphylaxis only if ingestion followed temporally by exercise. Exercise is presumed to alter gut absorption and or allergen digestion. Onset more commonly later childhood/adult Wheat, shellfish celery most described. Presumed persistent SPT and/or sIgE Component testing Exercise test (may be poorly reproducible) IgE antibody mediated Atopic dermatitis Associated with food in ~35% of children with moderate-severe rash. May relate to homing of T-cells to the skin. Major allergens, particularly egg, milk. Typically resolves SPT and/or sIgE APT not generally recommended induced
Eosinophilic Symptoms vary upon site(s)/degree of eosinophilic inflammation. Esophageal: dysphagia, pain. Generalized: ascites, weight loss, edema, obstruction. Mediators that home and activate eosinophils play a role, e.g., eotaxin, IL-5. Any Multiple Likely persistent Empiric diets Endoscopy SPT and/or sIgE APT not generally recommended Non-IgE mediated Food protein enterocolitis syndrome Primarily affects infants. Chronic exposure: emesis, diarrhea, poor growth, lethargy. after restriction: emesis, diarrhea, hypotension (15%) 2 hours following ingestion. Increased TNF-alpha response, decreased response to TGF-beta. Infancy Cow’s milk, soy, rice, oat. Multiple other solids have been identified Usually resolves SPT and/or sIgE are typically negative, but may become positive APT not helpful Food protein induced proctocolitis Mucus laden, bloody stools in infants. Eosinophilic inflammation Infancy Milk (via breast feeding) Usually resolves Empiric diets Heiner syndrome Rare disorder. Pulmonary infiltrates, upper respiratory symptoms, failure to thrive, iron deficiency anemia. Infant Milk Undefined No evidence of IgE. May have precipitating IgG antibodies.
Celiac Disease An autoimmune disorder leading to enteropathy and malabsorption. Occurs in persons with a genetic disposition and is triggered by gliadin, a gluten protein found in wheat and related grains. Often not categorized as a food allergy May include anemia, poor growth, symptoms, bone IgA deficiency, dermatitis herpetiformis, malignancy risk. May be asymptomatic or present at any age. Gluten (i.e., wheat, rye, barley) Lifelong Serologies (while ingesting wheat including IgA against tissue transglutaminase, gliadin), HLA typing (for DQ2/DQ8), and biopsies. Allergic contact dermatitis A form of eczema to chemical haptens that are additives or naturally occurring in foods Similar to other forms of contact dermatitis, subtype includes systemic contact dermatitis (rare) and possibly “fixed food eruptions” Adult Metals Patch testing Fixed food eruption Localized hive or maculopapular rash following ingestion IgE is usually not demonstrated by skin test, SIgE Case reports, mostly adults Varied Uncertain Unknown