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Food allergy is a condition characterized by both skin and general symptoms that appear after eating certain foods. Allergy can affect both children and adults, but it is most common in patients with AD. The diagnosis of the disease is based, inter alia, on skin prick tests.
What is a food allergy?
Food allergy is a set of undesirable symptoms, both skin and general, resulting from immune reactions occurring after eating certain foods. According to the EAACI definition, the term food allergy is used in the case of an allergic background, while the term IgE-dependent food allergy is used in the case of a confirmed participation of IgE antibodies. The other types of food reactions should be referred to as non-allergic food hypersensitivity rather than food intolerance. For generalized allergic reactions, the term anaphylaxis is used.
Food allergy affects 3-5% of children and 2-4% of adults. It often occurs in patients with atopic dermatitis, mainly in children.
The causes of food allergy
They play an important role in the development of food allergy IgE-dependent immune mechanisms responsible for immediate reactions as well IgG-dependent mechanisms and delayed-type cellular responsible for the chronic nature of the lesions. The delayed reaction is associated with the activation of T lymphocytes, mainly Th1, which leads to the activation of pro-inflammatory cytokines, macrophage proliferation and the release of lysosomal enzymes, which in turn causes damage to the gastrointestinal tract.
Food allergy – a list of products that cause allergies
Food allergens play an important role in the pathogenesis of atopic dermatitis, mainly in children under 5 years of age, but are never the only cause of it. Food allergy is associated with a higher risk of airborne allergy later in life. The products that most often lead to food allergy are:
- eggs – they are found in many products, including pasta, sauces and dumplings – so it is very difficult to fight this allergen. Moreover, in children, allergy to egg white is very common;
- milk – the most common cause of food allergy, usually the problem occurs in children. It should be emphasized that it is not always a good idea to replace cow’s milk with soy, as soy is also a strong allergen. The same is true of sheep’s and goat’s milk, so you should look for other sources of calcium, e.g. in the meat. IMPORTANT! Usually, allergy to milk passes with age;
- fish – surprisingly, sometimes the smell of the fish or touching it can trigger an allergic reaction (especially herring or mackerel). Similarly, an allergy may occur after eating, for example, animal meat that has been previously fed with meat products with the addition of fish or fish meal;
- nuts – allergy occurs most often after eating peanuts, which are a very strong allergen (even a minimal amount of them can lead to anaphylactic shock). Fortunately, many foods nowadays carry information about the presence of peanuts. Unfortunately, during a meal in a restaurant – you should ask if there is a specific allergen in the ordered food. Apart from peanuts, they can also sensitize walnuts, cashews and almonds;
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- fruit – usually citrus is the most sensitive (even citrus juices should be avoided) and strawberries containing histamine. In some people, food allergies are triggered by the consumption of kiwi or mango;
- cereals – children and adults may be allergic to proteins found in rye or wheat. Unfortunately, it is difficult to diagnose this type of allergy, because in wheat we can find up to 20 types of proteins responsible for food allergy or celiac disease.
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Food allergy – symptoms of the disease
The clinical manifestation of food allergy may be multi-organ. The clinical picture and the location of the lesions vary depending on the patient’s age.
In infants, the most common symptoms include:
- gastrointestinal tract: regurgitation and regurgitation, gastroesophageal reflux disease, intestinal colic, proctitis / colitis, enteropathy, enterocolitis;
- Skin: onset or worsening of atopic dermatitis.
In infants and older children, symptoms of:
- gastrointestinal tract: characterized by abdominal pain, nausea, diarrhea, vomiting and eosinophilic inflammation of the esophagus, stomach and intestines;
- skin: exacerbation of atopic dermatitis – less clinically significant over 5 years of age
After infancy, symptoms of:
- gastrointestinal tract: nausea, vomiting, diarrhea, constipation, celiac disease, oral allergy syndrome;
- skin: urticaria, angioedema, oral allergy syndrome.
Clinical symptoms occurring in the course of an immediate reaction include:
- skin: urticaria, angioedema, oral allergy syndrome;
- respiratory system: oral allergy syndrome, runny nose;
- gastrointestinal tract: nausea, vomiting, diarrhea, abdominal pain;
- systemic: anaphylactic reaction.
The clinical symptoms of a delayed reaction concern:
- gastrointestinal tract: colitis, proctitis, enteropathy, celiac disease.
Clinical signs of mixed reaction include:
- skin: atopic dermatitis;
- respiratory system: asthma;
- digestive tract: eosinophilic gastroenteropathy.
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Food allergy – three types of reactions in adults
1. Immediate allergic reaction – symptoms in the form of hives or anaphylactic shock appear only minutes after eating the allergenic food.
2. Cytotoxic reaction – when cells are destroyed (eg purpura).
3. Allergic reaction of the immune complex type – the first symptoms of allergy may appear only after several hours or days – after eating the sensitizing product.
Food allergy – types
1. Oral allergy – occurs in connection with allergy to inhaled allergens and food. Most often it concerns patients allergic to birch pollen, who develop unbearable itching and swelling in the mouth a few minutes after eating, for example, peaches. In people allergic to grass pollen, after eating tomatoes, for example, similar symptoms occur.
2. Food allergy can cause inflammation of the gastrointestinal mucosa, eg of the intestines, stomach, esophagus.
3. Anaphylactic shock – is a very dangerous consequence of food allergy, which may occur in patients with asthma. The foods that most commonly cause this condition are celery, peanuts, sesame, shrimp or fish.
4. Toxins and microorganisms in products can also lead to food allergy. These are various types of preservatives or dyes added to food, and even natural ingredients in the form of, for example, histamine or tyramine. Consuming a large amount of fish or cheese that contain histamine can lead to vomiting, diarrhea, and even fainting in the case of allergy sufferers. In turn, tyramine in red meat, herring and chocolate can cause high blood pressure, palpitations and headaches.
Food allergy – diagnosis
In the diagnosis of food allergy, the medical interview with the patient plays a significant role, during which the specialist obtains information about the symptoms and the time after which the reaction to the consumed food appeared. It is also important whether the patient’s relatives suffer from any allergic diseases.
Laboratory diagnosis of food allergy is:
- skin prick tests,
- determination of the levels of total and antigen-specific IgE antibodies in the serum,
- atopic patch tests,
- immediate exposure food tests (SAFT),
- specific challenge tests with suspect food.
The provocation test is the most important test in the diagnosis of food allergy. During the examination, the patient is given allergic food under the supervision of a doctor and monitored for any symptoms. In addition, another diagnostic method is the elimination diet, which is based on the removal of the allergenic allergen from the daily diet. Evidence of the presence of allergies is the disappearance of symptoms after discontinuation of a given food and its reappearance after reintroducing it into the diet.
Treatment of food allergy
Avoiding allergenic products plays the most important role in the treatment of food allergy. The specialist should select the patient’s diet in such a way that it meets the needs of the most important nutrients. In the case of allergies of infants and children to milk, various, special mixtures are recommended, including: Bebilon pepti 1 and 2 or Nutramigen. Thanks to the correct diet, the proper development of the child is possible. In addition, an elimination diet allows you to rebuild the intestinal walls and gain (over time) tolerance to allergenic foods.
Apart from the diet, it is recommended to use pharmacological agents (as a support), especially in the presence of other types of allergies. Antihistamines are used in skin lesions. However, in the case of severe symptoms of gastroenteritis, glucocorticosteroids (in the form of intravenous or tablets) are administered. It is recommended that adrenaline pre-filled syringes be carried in patients at risk of anaphylactic shock.
After treatment, patients should avoid allergenic products and those containing artificial preservatives and biogenic amines! For people who are allergic, it is better to prepare meals at home instead of eating them in a restaurant where there is an unconscious risk of eating the allergenic product.
Can you completely heal yourself?
It was noticed that about 30 percent. patients who stopped their allergic foods for two years, the food allergy was reverted. This is especially true of young children who, colloquially speaking, “outgrow” this ailment, for example, if they are allergic to cow’s milk. Unfortunately, many people have to avoid allergenic products for the rest of their lives.
Ways to prevent food allergy
There is actually no single and effective way to avoid food allergy, but breastfeeding for at least four months can help you avoid this unpleasant ailment. You should introduce new foods into your baby’s diet very slowly, especially eggs and milk. It is worth starting with smaller amounts and increasing it over time and observe how the baby reacts to the food.
For people who are aware of the products that sensitize them, it is important to avoid allergens in the daily diet.
Lit .: [1] Juchet A., Broué-Chabbert A.: Food allergy: relations with asthma. Arch Pediatr 2009, 16(6); 606-8. [2] Kanagawa Y., Matsumoto S., Koike S., Imamura T.: Association analysis of food allergens. Pediatr Allergy Immunol 2009, 20(4); 347-52. [3] Lin J., Sampson H.A.: The role of immunoglobulin E-binding epitopes in characterization of food allergy. Curr Opin Allergy Clin Immunol 2009, 9(4); 357-63.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House