Posted by: Indonesian Children | April 23, 2010

Food allergy in childhood

Food allergy in childhood

Katrina J Allen, David J Hill and Ralf G Heine
MJA 2006; 185 (7): 394-400

SERIES EDITORS: Andrew Kemp, Raymond Mullins, John Weiner

ABSTRACT

  • Symptoms usually begin in the first 2 years of life, often after the first known exposure to the food.
  • Immediate reactions (occurring between several minutes and 2 hours after ingestion) are likely to be IgE-mediated and can usually be detected by skin prick testing (SPT) or measuring food-specific serum IgE antibody levels.
  • Over 90% of IgE-mediated food allergies in childhood are caused by eight foods: cows milk, hens egg, soy, peanuts, tree nuts (and seeds), wheat, fish and shellfish. Anaphylaxis is a severe and potentially life-threatening form of IgE-mediated food allergy that requires prescription of self-injectable adrenaline.
  • Delayed-onset reactions (occurring within several hours to days after ingestion) are often difficult to diagnose. They are usually SPT negative, and elimination or challenge protocols are required to make a definitive diagnosis. These forms of food allergy are not usually associated with anaphylaxis.
  • The mainstay of diagnosis and management of food allergies is correct identification and avoidance of the offending antigen.
  • Children often develop tolerance to cows milk, egg, soy and wheat by school age, whereas allergies to nuts and shellfish are more likely to be lifelong.
References
  1. Hill DJ, Hosking CS, Heine RG. Clinical spectrum of food allergy in children in Australia and South-East Asia: identification and targets for treatment. Ann Med 1999; 31: 272-281. <PubMed>
  2. Heine RG. Gastroesophageal reflux disease, colic and constipation in infants with food allergy. Curr Opin Allergy Clin Immunol 2006; 6: 220-225. <PubMed>
  3. Sampson HA. 9. Food allergy. J Allergy Clin Immunol 2003; 111 (2 Suppl): S540-S547.
  4. Grundy J, Matthews S, Bateman B, et al. Rising prevalence of allergy to peanut in children: data from 2 sequential cohorts. J Allergy Clin Immunol 2002; 110: 784-789. <PubMed>
  5. Schafer T, Bohler E, Ruhdorfer S, et al. Epidemiology of food allergy/food intolerance in adults: associations with other manifestations of atopy. Allergy 2001; 56: 1172-1179. <PubMed>
  6. Vila L, Beyer K, Jarvinen KM, et al. Role of conformational and linear epitopes in the achievement of tolerance in cow’s milk allergy. Clin Exp Allergy 2001; 31: 1599-1606. <PubMed>
  7. American Gastroenterological Association medical position statement: guidelines for the evaluation of food allergies. Gastroenterology 2001; 120: 1023-1025. <PubMed>
  8. Host A, Halken S, Jacobsen HP, et al. Clinical course of cow’s milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol 2002; 13 Suppl 15: 23-28.
  9. Saarinen KM, Pelkonen AS, Makela MJ, Savilahti E. Clinical course and prognosis of cow’s milk allergy are dependent on milk-specific IgE status. J Allergy Clin Immunol 2005; 116: 869-875. <PubMed>
  10. Chang JW, Wu TC, Wang KS, et al. Colon mucosal pathology in infants under three months of age with diarrhea disorders. J Pediatr Gastroenterol Nutr 2002; 35: 387-390. <PubMed>
  11. Lake AM. Dietary protein enterocolitis. Curr Allergy Rep 2001; 1: 76-79. <PubMed>
  12. Nowak-Wegrzyn A, Sampson HA, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics 2003; 111 (4 Pt 1): 829-835.
  13. Kakakios A, Heine RG. Eosinophilic oesophagitis. Med J Aust 2006; 185: 401. <eMJA full text>
  14. Hill DJ, Hosking CS. Infantile colic and food hypersensitivity. J Pediatr Gastroenterol Nutr 2000; 30 Suppl: S67-S76.
  15. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy 2000; 30: 1540-1546. <PubMed>
  16. Verstege A, Mehl A, Rolinck-Werninghaus C, et al. The predictive value of the skin prick test weal size for the outcome of oral food challenges. Clin Exp Allergy 2005; 35: 1220-1226. <PubMed>
  17. Roehr CC, Reibel S, Ziegert M, et al. Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. J Allergy Clin Immunol 2001; 107: 548-553. <PubMed>
  18. Garcia-Ara C, Boyano-Martinez T, Diaz-Pena JM, et al. Specific IgE levels in the diagnosis of immediate hypersensitivity to cows’ milk protein in the infant. J Allergy Clin Immunol 2001; 107: 185-190. <PubMed>
  19. Boyano-Martinez T, Garcia-Ara C, Diaz-Pena JM, et al. Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy 2001; 31: 1464-1469. <PubMed>
  20. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107: 891-896. <PubMed>
  21. Celik-Bilgili S, Mehl A, Verstege A, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005; 35: 268-273. <PubMed>
  22. Bock SA, Sampson HA, Atkins FM, et al. Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual. J Allergy Clin Immunol 1988; 82: 986-997. <PubMed>
  23. Bischoff S, Crowe SE. Gastrointestinal food allergy: new insights into pathophysiology and clinical perspectives. Gastroenterology 2005; 128: 1089-1113. <PubMed>
  24. Hill DJ, Sporik R, Thorburn J, Hosking CS. The association of atopic dermatitis in infancy with immunoglobulin E food sensitization. J Pediatr 2000; 137: 475-479. <PubMed>
  25. Prescott SL, Tang ML. The Australasian Society of Clinical Immunology and Allergy position statement: summary of allergy prevention in children. Med J Aust 2005; 182: 464-467. <eMJA full text> <PubMed>
  26. National Health and Medical Research Council. How to use the evidence: assessment and application of scientific evidence. Canberra: NHMRC, 2000. http://www.nhmrc.gov.au/publications/_files/cp69.pdf (accessed Jul 2006).
  27. ESPGHAN Committee on Nutrition; Agostoni C, Axelsson I, Goulet O, et al. Soy protein infant formulae and follow-on formulae: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2006; 42: 352-361. <PubMed>
  28. Hill DJ, Heine RG, Cameron DJ, et al. The natural history of intolerance to soy and extensively hydrolyzed formula in infants with multiple food protein intolerance. J Pediatr 1999; 135: 118-121. <PubMed>
  29. Bock SA, Munoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001; 107: 191-193. <PubMed>
  30. Kemp AS. EpiPen epidemic: suggestions for rational prescribing in childhood food allergy. J Paediatr Child Health 2003; 39: 372-375. <PubMed>
  31. Baumgart K, Brown S, Gold M, et al; Australasian Society of Clinical Immunology and Allergy Anaphylaxis Working Party. ASCIA guidelines for prevention of food anaphylactic reactions in schools, preschools and child-care centres. J Paediatr Child Health 2004; 40: 669-671. <PubMed>
  32. Bailey M, Haverson K, Inman C, et al. The development of the mucosal immune system pre- and post-weaning: balancing regulatory and effector function. Proc Nutr Soc 2005; 64: 451-457. <PubMed>
  33. Brandtzaeg PE. Current understanding of gastrointestinal immunoregulation and its relation to food allergy. Ann N Y Acad Sci 2002; 964: 13-45. <PubMed>
  34. Bashir MEH, Louie S, Shi HN, Nagler-Anderson C. Toll-like receptor 4 signaling by intestinal microbes influences susceptibility to food allergy. J Immunol 2004; 172: 6978-6987. <PubMed>
  35. Kalliomaki M, Kirjavainen P, Eerola E, et al. Distinct patterns of neonatal gut microflora in infants in whom atopy was and was not developing. J Allergy Clin Immunol 2001; 107: 129-134. <PubMed>
  36. Zutavern A, Brockow I, Schaaf B, et al. Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization: results from a prospective birth cohort study. Pediatrics 2006; 117: 401-411. <PubMed>
  37. Halken S, Host A. Prevention. Curr Opin Allergy Clin Immunol 2001; 1: 229-236. <PubMed>
  38. Weiner JM. Allergen injection immunotherapy. Med J Aust 2006; 185: 234. <eMJA full text> <PubMed>
  39. Leung DY, Sampson HA, Yunginger JW, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med 2003; 348: 986-993. <PubMed>
  40. Lehrer SB. Genetic modification of food allergens. Ann Allergy Asthma Immunol 2004; 93 (5 Suppl 3): S19-S25.

 

source : http://www.mja.com.au

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PHONE : (021) 70081995 – 5703646

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Copyright © 2009, Children Allergy Center Information Education Network. All rights reserved.

Food allergies in children present with a wide spectrum of clinical manifestations, including anaphylaxis, urticaria, angioedema, atopic dermatitis and gastrointestinal symptoms (such as vomiting, diarrhoea and failure to thrive).

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Responses

  1. It’s so common nowadays with all the pollutions for kids to have allergies


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