Current Allergy and Asthma Reports

, Volume 4, Issue 4, pp 294–301 | Cite as

Common respiratory manifestations of food allergy: A critical focus on otitis media

  • John M. James


Previous investigations have established the pathogenic role of food allergy in respiratory tract symptoms, which rarely occur in isolation. Specific foods have been implicated in these reactions. The role of food allergy in otitis media is controversial, probably uncommon, and further studies are needed. Food-induced asthma is more common in young pediatric patients, especially those with atopic dermatitis. Asthma induced by food allergy is considered a risk factor for fatal and near-fatal anaphylactic reactions. Moreover, food allergy can elicit airway hyperreactivity and asthmatic responses. Therefore, evaluation for food allergy should be considered among patients with recalcitrant or otherwise unexplained acute severe asthma exacerbations; asthma triggered by ingestion of particular foods; and asthma and other manifestations of food allergy (eg, anaphylaxis, moderate to severe atopic dermatitis).


Atopic Dermatitis Food Allergy Allergy Clin Immunol Food Allergen Food Challenge 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Sampson HA: Food Allergy. Part 1: Immunopathogenesis and clinical disorders. J Allergy Clin Immnunol 1999, 103:717–728.CrossRefGoogle Scholar
  2. 2.
    Woods RK, Weiner J, Abramson M, et al.: Patients perceptions of food-induced asthma. Z J Med 1996, 26:504–512.Google Scholar
  3. 3.
    Bock SA: Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatr 1987, 79:683–688.Google Scholar
  4. 4.
    Niestijl Jansen JJ, Kardinaal AFM, Huijbers G, et al.: Prevalence of food allergy and intolerance in the adult Dutch population. J Allergy Clin Immunol 1994, 93:446–456.CrossRefGoogle Scholar
  5. 5.
    Kanny G, Moneret-Vautrin D-A, Flabbee J, et al.: Population study of food allergy in France. J Allergy Clin Immunol 2001, 108:133–140.PubMedCrossRefGoogle Scholar
  6. 6.
    Woods RK, Abramson M, Raven JM, et al.: Reported food intolerance and respiratory symptoms in young adults. Eur Respir J 1998, 11:151–155.PubMedCrossRefGoogle Scholar
  7. 7.
    Onorato J, Merland N, Terral C, et al.: Placebo-controlled double-blind food challenges in asthma. J Allergy Clin Immunol 1986, 78:1139–1146.PubMedCrossRefGoogle Scholar
  8. 8.
    Tariq SM, Matthews SM, Hakin EA, Arshad SH: Egg allergy in infancy predicts respiratory allergic disease by 4 years of age. Pediatr Allergy Immunol 2000, 11:162–167.PubMedCrossRefGoogle Scholar
  9. 9.
    Rhodes HL, Sporik R, Thomas P, et al.: Early life risk factors for adult asthma: a birth cohort study of subjects at risk. J Allergy Clin Immunol 2001, 108:720–725.PubMedCrossRefGoogle Scholar
  10. 10.
    Sicherer SH, Furlong TJ, Munoz-Furlong A, et al.: A voluntary registry for peanut and tree nut allergy: characteristics of the first 5149 registrants. J Allergy Clin Immunol 2001, 108:128–132.PubMedCrossRefGoogle Scholar
  11. 11.
    Sicherer SH: Is food allergy causing your patient’s asthma symptoms? J Respir Dis 2000, 21:127–136. This is a very practical and useful clinical review highlighting the potential link between food allergy and asthma. This review is up-to-date, contains many useful illustrations, and should be a very helpful reference for clinicians.Google Scholar
  12. 12.
    Platts-Mills TAE: The role of immunoglobulin E in allergy and asthma. Am J Respir Crit Care Med 2001, 164:S1-S5.PubMedGoogle Scholar
  13. 13.
    Bock SA, Atkins FM: Patterns of food hypersensitivity during sixteen years of double-blind placebo-controlled oral food challenges. J Pediatr 1990, 117:561–567.PubMedCrossRefGoogle Scholar
  14. 14.
    Burks AW, James JM, Hiegel A, et al.: Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998, 132:132–136.PubMedCrossRefGoogle Scholar
  15. 15.
    Sampson HA, McCaskill CM: Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985, 107:669–675.PubMedCrossRefGoogle Scholar
  16. 16.
    James JM: Anaphylactic reactions to foods. Immunol Allergy Clin North Am 2001, 21:653–667.Google Scholar
  17. 17.
    Sampson HA, Mendelson L, Rosen JP: Fatal and near-fatal food anaphylaxis reactions in children. N Engl J Med 1992, 327:380–384.PubMedCrossRefGoogle Scholar
  18. 18.
    Yunginger JY, Sweeney KG, Sturner WQ, et al.: Fatal foodinduced anaphylaxis. J Am Med Assoc 1988, 260:1450–1452.CrossRefGoogle Scholar
  19. 19.
    Baur X, Posch A: Characterized allergens causing bakers’ asthma. Allergy 1998, 53:562–566.PubMedCrossRefGoogle Scholar
  20. 20.
    Crespo JF, Rodriguez J, Vives R, et al.: Occupational IgEmediated allergy after exposure to lupine seed flour. J Allergy Clin Immunol 2001, 108:295–297.PubMedCrossRefGoogle Scholar
  21. 21.
    Crespo JF, Pascual C, Dominguez C, et al.: Allergic reactions associated with airborne fish particles in IgE-mediated fish hypersensitive patients. Allergy 1995, 50:257–261.PubMedCrossRefGoogle Scholar
  22. 22.
    Sicherer DH, Furlong TJ, DeSimone J, Sampson HA:Self-reported peanut allergic reactions on commercial airlines. J Allergy Clin Immunol 1999, 103:186–189.CrossRefGoogle Scholar
  23. 23.
    Novembre E, de Martino M, Vierucci A: Foods and respiratory allergy. J Allergy Clin Immunol 1988, 81:1059–1065.PubMedCrossRefGoogle Scholar
  24. 24.
    Oehling A, Baena Cagnani CE: Food allergy and child asthma. Allergol Immunopathol 1980, 8:7–14.Google Scholar
  25. 25.
    Businco L, Falconieri P, Giampietro P, et al.: Food allergy and asthma. Pediatr Pulmonary Suppl 1995, 11:59–60.CrossRefGoogle Scholar
  26. 26.
    Hill DJ, Firer MA, Shelton MJ, et al.: Manifestations of milk allergy in infancy: clinical and immunological findings. J Pediatr 1986, 109:270–276.PubMedCrossRefGoogle Scholar
  27. 27.
    Bock SA: Respiratory reactions induced by food challenges in children with pulmonary disease. Pediatr Allergy Immunol 1992, 3:188–194.Google Scholar
  28. 28.
    James JM, Bernhisel-Broadbent J, Sampson HA: Respiratory reactions provoked by double-blind food challenges in children. Am J Respir Crit Care Med 1994, 149:59–64.PubMedGoogle Scholar
  29. 29.
    James JM, Eigenmann PA, Eggleston PA, et al.: Airway reactivity changes in asthmatic patients undergoing blinded food challenges. Am J Respir Crit Care Med 1996, 153:597–603.PubMedGoogle Scholar
  30. 30.
    Zwetchkenbawn JF, Skufca R, Nelson HS: An examination of food hypersensitivity as a cause of increased bronchial responsiveness to inhaled methacholine. J Allergy Clin Immunol 1991, 88:360–364.CrossRefGoogle Scholar
  31. 31.
    Pinnock CB, Graham NM, Mylvaganam A, Douglas RM:Relationship between milk intake and mucus production in adult volunteers challenged with rhinovirus-2. Am Rev Respir Dis 1990, 141:352–356.PubMedGoogle Scholar
  32. 32.
    Woods RK, Weiner JM, Abramson M, et al.: Do dairy products induce bronchoconstriction in adults with asthma? J Allergy Clin Immunol 1998, 101:45–50.PubMedCrossRefGoogle Scholar
  33. 33.
    Nsouli TM, Nsouli SM, Linde RE, et al.: Role of food allergy in serous otitis media. Ann Allergy 1994, 73:215–219.PubMedGoogle Scholar
  34. 34.
    Bernstein JM: The role of IgE-mediated hypersensitivity in the development of otitis media with effusion: a review. Otolaryngol Head Neck Surg 1993, 109:611–620.PubMedGoogle Scholar
  35. 35.
    Juntti H, Tikkanen S, Kokkonen J, et al.: Cow’s milk allergy is associated with recurrent otitis media during childhood. Acta Otolaryngol 1999, 119:867–873.PubMedCrossRefGoogle Scholar
  36. 36.
    Heiner DC, Sears JW: Chronic respiratory disease associated with multiple circulation precipitins to cow’s milk. Am J Dis Child 1960, 100:500–502.Google Scholar
  37. 37.
    Sicherer DH, Burks AW, Sampson HA: Clinical features of acute allergic reactions to peanut and tree nuts in children. Immunol Allergy Clin North Am 1998, 102:e6.Google Scholar
  38. 38.
    Cianferoni A, Novembre E, Mugnaini L, et al.: Clinical features of acute anaphylaxis in patients admitted to a university hospital: an 11-year retrospective review (1985-1996). Ann Allergy Asthma Immunol 2001, 87:27–32.PubMedCrossRefGoogle Scholar
  39. 39.
    James JM, Burks AW: Foods. Immunol Clin North Am 1995, 15:477–488.Google Scholar
  40. 40.
    Sampson HA: Food allergy. Part 2: Diagnosis and management. J Allergy Clin Immunol 1999, 103:981–989. This reference provides an excellent foundation for the diagnosis and management of food allergy. A special emphasis is placed on appropriate skin testing, interpretation of laboratory studies, and performing food challenges that can be utilized in the diagnosis of food allergy. The fundamentals of safe and effective management strategies are also discussed.PubMedCrossRefGoogle Scholar
  41. 41.
    Bock SA, Buckley J, Holst A, et al.: Proper use of skin tests with food extracts in diagnosis of food hypersensitivity. Clin Allergy 1978, 8:559–564.PubMedCrossRefGoogle Scholar
  42. 42.
    Price GW, Hogan AD, Farris AH, et al.: Sensitization (IgE antibody) to food allergens in wheezing infants and children. J Allergy Clin Immunol 1995, 96:266–270.PubMedCrossRefGoogle Scholar
  43. 43.
    Sampson HA, Ho D: Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997, 100:444–451.PubMedCrossRefGoogle Scholar
  44. 44.
    Sampson HA: Utility of food specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001, 107:891–896.PubMedCrossRefGoogle Scholar
  45. 45.
    Sporik R, Hill DJ, Hoskins 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.PubMedCrossRefGoogle Scholar
  46. 46.
    Hill DJ, Hosking CS, Reyes-Benito LV: Reducing the need for food allergen challenges in young children: comparison of in vitro with in vivo tests. Clin Exp Allergy 2001, 31:1031–1035.PubMedCrossRefGoogle Scholar
  47. 47.
    James JM, Sampson HA: An overview of food hypersensitivity. Ped Allergy Immunol 1992, 3:67–78.Google Scholar
  48. 48.
    James JM: Unproven diagnostic and therapeutic techniques. Curr Allergy Asthma Rep 2002, 2:87–91. There have been a variety of diagnostic and therapeutic techniques used in the diagnosis and management of food allergy. Most of these techniques have not been substantiated with reliable, well-controlled investigations. This brief overview provides a useful critique of these different techniques.PubMedCrossRefGoogle Scholar
  49. 49.
    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.PubMedCrossRefGoogle Scholar
  50. 50.
    David TJ, Waddington E, Stanton RHJ: Nutritional hazards of elimination diets in children with atopic dermatitis. Arch Dis Child 1984, 59:323–325.PubMedCrossRefGoogle Scholar
  51. 51.
    McGowan M, Gibney MJ: Calcium intakes in individuals on diets for the management of cow’s milk allergy: a case control study. Eur J Clin Nutr 1993, 47:609–616.PubMedGoogle Scholar
  52. 52.
    Barnes-Koerner C, Sampson HA: Diets and nutrition. In Food Allergy: Adverse Reactions to Foods and Food Additives, edn 3. Edited by Metcalfe DD, Sampson HA, Simon RA. Malden, MA: Blackwell; 2003:438–460. The foundation to the effective management of food allergy remains an appropriate elimination diet. This chapter is a must read for clinicians who are evaluating and managing patients with food allergy. There is an enormous amount of practical, clinical information in this reference, including numerous tables that effectively supplement the text.Google Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • John M. James
    • 1
  1. 1.Colorado Allergy and Asthma CentersFort CollinsUSA

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