Internal and Emergency Medicine

, Volume 4, Issue 1, pp 11–24 | Cite as

Food allergy and food intolerance: diagnosis and treatment

  • Giampiero Patriarca
  • Domenico Schiavino
  • Valentina Pecora
  • Carla Lombardo
  • Emanuela Pollastrini
  • Arianna Aruanno
  • Vito Sabato
  • Amira Colagiovanni
  • Angela Rizzi
  • Tiziana De Pasquale
  • Chiara Roncallo
  • Marzia Decinti
  • Sonia Musumeci
  • Giovanni Gasbarrini
  • Alessandro Buonomo
  • Eleonora Nucera
IM - Review


Food allergy is a matter of concern because it affects about 0.5–3.8% of the paediatric population and 0.1–1% of adults, and as well may cause life-threatening reactions. Skin prick testing with food extracts and with fresh foods, the measurement of food-specific IgE, elimination diets and a double-blind, placebo-controlled food challenge are the main diagnostic procedures; many non-validated procedures are available, creating confusion among patients and physicians. The treatment of food allergy is still a matter of debate. Antihistamines, corticosteroids and, if necessary (in case of anaphylaxis), epinephrine, are the drugs of choice for the treatment of symptoms of food allergy. Sodium cromolyn may be used prophylactically even though there are no controlled studies certifying its efficacy. The only etiologic treatment of food allergy is specific desensitization. Sublingual-oral-specific desensitization has been used by our group for the treatment of food-allergic patients with a high percentage of success.


Food allergy Food intolerance Skin prick test Double-blind placebo-controlled food challenge Oral specific desensitization 


  1. 1.
    Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Dreborg S, Haahtela T, Kowalski ML, Mygind N, Ring J, van Cauwenberge P, van Hage-Hamsten M, Wuthrich B, EAACI (the European Academy of Allergology, Cinical Immunology) nomenclature task force (2001) A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 56:813–824PubMedCrossRefGoogle Scholar
  2. 2.
    Mills EN, Mackie AR, Burney P, Beyer K, Frewer L, Madsen C, Botjes E, Crevel RW, van Ree R (2007) The prevalence, cost and basis of food allergy across Europe. Allergy 62:717–722PubMedGoogle Scholar
  3. 3.
    Sampson HA (1999) Food allergy. Part 1: Immunopathogenesis and clinical disorders. J Allergy Clin Immunol 103:717–728PubMedCrossRefGoogle Scholar
  4. 4.
    Sampson HA (1999) Food allergy. Part 2: diagnosis and management. J Allergy Clin Immunol 103:981–989PubMedCrossRefGoogle Scholar
  5. 5.
    Hill DJ, Heine RG, Hosking CS (2004) The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol 15:435–441PubMedCrossRefGoogle Scholar
  6. 6.
    Verstege A, Mehl A, Rolinck-Werninghaus C, Staden U, Nocon M, Beyer K, Niggemann B (2005) The predictive value of the skin prick test wheal size for the outcome of oral food challenges. Clin Exp Allergy 35:1220–1226PubMedCrossRefGoogle Scholar
  7. 7.
    Sampson HA (2001) Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 107:891–896PubMedCrossRefGoogle Scholar
  8. 8.
    Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, Niggemann B (2005) The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 35:268–273PubMedCrossRefGoogle Scholar
  9. 9.
    Panzani RC, Schiavino D, Nucera G, Pellegrino S, Fais G, Schinco G, Patriarca G (1995) Oral hyposensitization to nickel allergy: preliminary clinical results. Int Arch Allergy Immunol 107:251–254PubMedGoogle Scholar
  10. 10.
    Nucera E, Pollastrini E, Buonomo A, Roncallo C, De Pasquale T, Lombardo C, Schiavino D, Patriarca G (2003) Chronic urticaria in latex allergic patients: two case reports. Allergy 58:1199–1200PubMedCrossRefGoogle Scholar
  11. 11.
    Bindslev-Jensen C, Poulsen LK (1997) Hazards of unintentional/intentional introduction of allergens into foods. Allergy 52:1184–1186PubMedCrossRefGoogle Scholar
  12. 12.
    Niggeman B, Beyer K (2007) Diagnosis of food allergy: toward a standardization of food challenge. J Pediatr Gastroenterol Nutr 45:399–404Google Scholar
  13. 13.
    Patriarca G, Nucera E, Roncallo C, Pollastrini E, Bartolozzi F, De Pasquale T, Buonomo A, Gasbarrini G, Di Campli C, Schiavino D (2003) Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther 17:459–465PubMedCrossRefGoogle Scholar
  14. 14.
    Patriarca G, Nucera E, Pollastrini E, Roncallo C, Pasquale TD, Lombardo C, Pedone C, Gasbarrini G, Buonomo A, Schiavino D (2007) Oral specific desensitization in food-allergic children. Dig Dis Sci 52:1662–1672PubMedCrossRefGoogle Scholar
  15. 15.
    Niggemann B, Beyer K (2007) Pitfalls in double-blind, placebo-controlled oral food challenges. Allergy 62:729–732PubMedCrossRefGoogle Scholar
  16. 16.
    Sampson HA (2004) Update on food allergy. J Allergy Clin Immunol 113:805–819PubMedCrossRefGoogle Scholar
  17. 17.
    Shreffler WG (2006) Evaluation of basophil activation in food allergy: present and future applications. Curr Opin Allergy Clin Immunol 6:226–233PubMedCrossRefGoogle Scholar
  18. 18.
    de Weck AL, Sanz ML, Gamboa PM, Aberer W, Bienvenu J, Blanca M, Demoly P, Ebo DG, Mayorga L, Monneret G, Sainte-Laudi J (2008) Diagnostic tests based on human basophils: more potentials and perspectives than pitfalls. Int Arch Allergy Immunol 146:177–179PubMedCrossRefGoogle Scholar
  19. 19.
    Turjanmaa K, Darsow U, Niggemann B, Rance F, Vanto T, Werfel T (2006) EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy 61:1377–1384PubMedCrossRefGoogle Scholar
  20. 20.
    Canani RB, Ruotolo S, Auricchio L, Caldore M, Porcaro F, Manguso F, Terrin G, Troncone R (2007) Diagnostic accuracy of the atopy patch test in children with food allergy-related gastrointestinal symptoms. Allergy 62:738–743PubMedCrossRefGoogle Scholar
  21. 21.
    Stapel SO, Asero R, Ballmer-Weber BK, Knol EF, Strobel S, Vieths S, Kleine-Tebbe J (2008) Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy 63:793–796PubMedCrossRefGoogle Scholar
  22. 22.
    Wilkinson DS, Fregert S, Magnusson B, Bandmann HJ, Calnan CD, Cronin E, Hjorth N, Maibach HJ, Malalten KE, Meneghini CL, Pirila V (1970) Terminology of contact dermatitis. Acta Derm Venereol 50:287–292PubMedGoogle Scholar
  23. 23.
    Schiavino D, Nucera E, Alonzi C, Buonomo A, Pollastrini E, Roncallo C, De Pasquale T, Lombardo C, La Torre G, Sabato V, Pecora V, Patriarca G (2006) A clinical trial of oral hyposensitization in systemic allergy to nickel. Int J Immunopathol Pharmacol 19:593–600PubMedGoogle Scholar
  24. 24.
    Pastorello EA, Incorvaia C, Pravettoni V, Farioli L, Conti A, Vigano G, Rivolta F, Ispano M, Rotondo F, Ortolani C (1998) New allergens in fruits and vegetables. Allergy 53(46 Suppl):48–51PubMedCrossRefGoogle Scholar
  25. 25.
    Blanco C, Carrillo T, Castillo R, Quiralte J, Cuevas M (1994) Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy 73:309–314PubMedGoogle Scholar
  26. 26.
    Sanchez-Monge R, Blanco C, Lopez-Torrejon G, Cumplido J, Recas M, Figueroa J, Carrillo T, Salcedo G (2006) Differential allergen sensitization patterns in chestnut allergy with or without associated latex-fruit syndrome. J Allergy Clin Immunol 118:705–710PubMedCrossRefGoogle Scholar
  27. 27.
    Patriarca G, Nucera E, Buonomo A, Roncallo C, De Pasquale T, Pollastrini E, Schiavino D (2002) New insights on latex allergy diagnosis and treatment. J Investig Allergol Clin Immunol 12:169–176PubMedGoogle Scholar
  28. 28.
    Green PHR, Cellier C (2007) Celiac disease. N Engl J Med 357:1731–1743PubMedCrossRefGoogle Scholar
  29. 29.
    Leung DYM, Sampson HA, Yunginger JW, Schneider LC, Wortel CH, Davis FM, Hyun JD, Shanahan WR, for the TNX-901 Peanut Allergy Study Group (2003) Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med 348:986–993Google Scholar
  30. 30.
    Chipps B (2006) Systemic reaction to omalizumab. Ann Allergy Asthma Immunol 97:267PubMedCrossRefGoogle Scholar
  31. 31.
    Rackal JM, Vender RB (2004) The treatment of atopic dermatitis and other dermatoses with leukotriene antagonists. Skin Therapy Lett 9:1–5PubMedGoogle Scholar
  32. 32.
    Pacor ML, Di Lorenzo G, Corrocher R (2001) Efficacy of leukotriene receptor antagonist in chronic urticaria. A double-blind, placebo-controlled comparison of treatment with montelukast and cetirizine in patients with chronic urticaria with intolerance to food additive and/or acetylsalicylic acid. Clin Exp Allergy 31:1607–1614PubMedCrossRefGoogle Scholar
  33. 33.
    Geiger RS (2000) Dietary aspects of food allergy prevention in infants and children. J Ped Gastroenterol Nutr 30:577–786Google Scholar
  34. 34.
    Bock SA (1982) The natural history of food sensitivity. J Allergy Clin Immunol 69:173–177PubMedCrossRefGoogle Scholar
  35. 35.
    Boyano MT, Martin Esteban M, Pascual C, Ojeda J (1987) Food allergy in children. Prognostic factors and long-term development. An Esp Pediatr 26:241–245PubMedGoogle Scholar
  36. 36.
    Host A, Halken S (1990) A Prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Allergy 45:587–596PubMedCrossRefGoogle Scholar
  37. 37.
    Host A, Halken S, Jacobsen H, Christensen A, Herskind A, Plesner K (2002) Clinical course of cow’s milk protein allergy/intolerance ad atopic diseases in childhood. Pediatr Allergy Immunol 13:23–28PubMedCrossRefGoogle Scholar
  38. 38.
    Bishop J, Hill D, Hosking C (1990) Natural History of cow milk allergy: clinical outcome. J Pediatr 116:862–867PubMedCrossRefGoogle Scholar
  39. 39.
    Sampson H (2004) Update on food allergy. J Allergy Clin Immunol 113:815–819CrossRefGoogle Scholar
  40. 40.
    Boyano MT, Garcia-Ara C, Diaz-Pena J, Martin Esteban M (2002) Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. J Allergy Clin Immunol 110:304–309CrossRefGoogle Scholar
  41. 41.
    Nelson HS, Lahr J, Rule R, Bock A, Leung D (1997) Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 99:744–751PubMedCrossRefGoogle Scholar
  42. 42.
    Bucher C, Wüthrich B (2000) Oral desensitisation in cow’s milk allergy. Ital J Allergy Clin Immunol 10(suppl. 1):119–120Google Scholar
  43. 43.
    Nucera E, Schiavino D, D’Ambrosio C, Stabile A, Rumi C, Gasbarrini G, Patriarca G (2000) Immunological aspects of oral desenstization in food allergy. Dig Dis Sci 45:637–641PubMedCrossRefGoogle Scholar
  44. 44.
    Meglio P, Bartone E, Plantamura M, Arabito E, Giampietro PG (2004) A protocol for oral desensitization in children with IgE-mediated cow’s milk allergy. Allergy 59:980–987PubMedCrossRefGoogle Scholar
  45. 45.
    Morisset M, Moneret-Vautrin DA, Guenard L, Cuny JM, Frentz P, Hatahet R, Hanss C, Beaudouin E, Petit N, Kanny G (2007) Oral desensitization in children with milk and egg allergies obtains recovery in a significant proportion of cases. A randomized study in 60 children with cow’s milk allergy and 90 children with egg allergy. Eur Ann Allergy Clin Immunol 39:12–19PubMedGoogle Scholar
  46. 46.
    Chatchatee P, Jarvinen KM, Bardina L, Beyer K, Sampson HA (2001) Identification of IgE- and IgG-binding epitopes on alpha(s1)-casein: differences in patients with persistent and transient cow’s milk allergy. J Allergy Clin Immunol 107:379–383PubMedCrossRefGoogle Scholar
  47. 47.
    WHO Position Paper (1997) Allergen immunotherapy: therapeutic vaccines for allergic diseases. Allergy 53(Suppl. 44):20–23Google Scholar
  48. 48.
    Enrique E, Pineda F, Malek T, Bartra J, Basagana M, Tella R, Castello JV, Alonso R, de Mateo JA, Cerda-Trias T, San Miguel-Moncin Mdel M, Monzon S, Garcia M, Palacios R, Cistero-Bahima A (2005) Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. J Allergy Clin Immunol 116:1073–1079PubMedCrossRefGoogle Scholar
  49. 49.
    Staden U, Rolinck-Werninghaus C, Brewe F, Wahn U, Niggemann B, Beyer K (2007) Specific oral tolerance induction in food allergy in children: efficacy and clinical patterns of reaction. Allergy 62:1261–1269PubMedCrossRefGoogle Scholar
  50. 50.
    Patriarca G, Nucera E, Pollastrini E, De Pasquale T, Lombardo C, Buonomo A, Roncallo C, Pecora V, Musumeci S, Altomonte G, Alonzi C, Schiavino D, Gasbarrini G (2006) Oral rush desensitization in peanut allergy: a case report. Dig Dis Sci 51:471–473PubMedCrossRefGoogle Scholar
  51. 51.
    Bauer A, Ekanayake Mudiyanselage S, Wigger-Alberti W, Elsner P (1999) Oral rush desensitization to milk. Allergy 54:894–895PubMedCrossRefGoogle Scholar
  52. 52.
    Asero R (1998) Effects of birch pollen-specific immunotherapy on apple allergy in birch pollen-hypersensitivity patients. Clin Exp Allergy 28:1368–1373PubMedCrossRefGoogle Scholar
  53. 53.
    Nucera E, Schiavino D, Buonomo A, Roncallo C, Pollastrini E, Lombardo C, Alonzi C, Pecora V, De Pasquale T, Patriarca G (2006) Oral rush desensitization with tomato: a case report. J Investig Allergol Clin Immunol 16:214–217PubMedGoogle Scholar
  54. 54.
    Patriarca G, Nucera E, Pollastrini E, Roncallo C, Buonomo A, Bartolozzi F, De Pasquale T, Gasbarrini G, Schiavino D (2002) Sublingual desensitization: a new approach to latex allergy problem. Anesth Analg 95:956–960PubMedCrossRefGoogle Scholar
  55. 55.
    Patriarca G, Pogna N, Cammarota G, Schiavino D, Lombardo C, Pollastrini E, De Pasquale T, Buonomo A, Nocente F, Gazza L, Pietrini D, Miele L, Nucera E, Gasbarrini G (2005) An attempt of specific desensitising treatment with gliadin in celiac disease. Int J Immunopathol Pharmacol 18:709–714PubMedGoogle Scholar
  56. 56.
    Huang CK, Schofield BH, Burks AW et al (1999) Strain-dependent protection from allergic reactions by peanut allergen plasmid DNA immunization in mice (Abstract). J Allergy Clin Immunol 103:S238CrossRefGoogle Scholar
  57. 57.
    Majamaa H, Isolauri E (1997) Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 99:179–185PubMedCrossRefGoogle Scholar
  58. 58.
    Frick OL, Bachanan BB, Delval G, Umetsu DT (2001) Allergen immunotherapy with heat-killed Listeria monocytogenes (HKL) as adjuvant prevents allergic reactions in highly food sensitized dogs [Abstract]. J Allergy Clin Immunol 107:S232Google Scholar
  59. 59.
    Li XM, Zhang TF, Huang CK, Srivastava K, Teper AA, Zhang L, Schofield BH, Sampson HA (2001) Food allergy herbal formula-1 (FAHF-1) blocks peanut-induced anaphylaxis in a murine model. J Allergy Clin Immunol 108:639–646PubMedCrossRefGoogle Scholar

Copyright information

© SIMI 2008

Authors and Affiliations

  • Giampiero Patriarca
    • 1
  • Domenico Schiavino
    • 1
  • Valentina Pecora
    • 1
  • Carla Lombardo
    • 1
  • Emanuela Pollastrini
    • 1
  • Arianna Aruanno
    • 1
  • Vito Sabato
    • 1
  • Amira Colagiovanni
    • 1
  • Angela Rizzi
    • 1
  • Tiziana De Pasquale
    • 1
  • Chiara Roncallo
    • 1
  • Marzia Decinti
    • 1
  • Sonia Musumeci
    • 1
  • Giovanni Gasbarrini
    • 2
  • Alessandro Buonomo
    • 1
  • Eleonora Nucera
    • 1
  1. 1.Department of AllergologyCatholic University Policlinico “A. Gemelli”RomeItaly
  2. 2.Institute of Internal MedicineCatholic UniversityRomeItaly

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