Current Allergy and Asthma Reports

, Volume 12, Issue 4, pp 311–320 | Cite as

Update on Food Allergy in Adults

  • Rabia Quddus ChaudhryEmail author
  • John J. Oppenheimer


Though much has been studied and written about food allergy, the majority of the available literature focuses on food allergies in the pediatric population. Unfortunately, it is likely that in regard to food allergies, adults are not just big children, and extrapolating findings from pediatric to adult patient populations might lead to erroneous assumptions. Thus, it is important to validate the correlation between pediatric and adult data, gather data regarding adult food allergy and understand the specific nuances of subsets of adults to better treat their food allergy. This review was conducted by identifying potentially relevant studies regarding food allergies in adults through electronic databases, including PubMed, Medline, and Google Scholar. The search terms included “allergy”, “food” and “adults”. Parameters of 19+ years of age were added to search terms and all journals were written in or translated to English. From these search results, focus was placed on studies from 2010 to 2012. This systematic update on food allergy in adults found that the evidence regarding prevalence, diagnosis and management of food allergies is very limited, with the majority of data derived from children and young adults.


Food Allergy Adults Component testing Anaphylaxis IgE-mediated food allergy Prevalence Diagnosis Skin prick testing Food challenge Immunotherapy Epinephrine Management Avoidance Pregnancy Elderly 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Boyce JA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1–S58. These guidelines were formed by leading experts in the field of food allergy.PubMedGoogle Scholar
  2. 2.
    Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol. 2006;97(1):39–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Yocum MW, et al. Epidemiology of anaphylaxis in Olmsted County: a population-based study. J Allergy Clin Immunol. 1999;104(2 Pt 1):452–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Uguz A, et al. Allergic reactions in the community: a questionnaire survey of members of the anaphylaxis campaign. Clin Exp Allergy. 2005;35(6):746–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Sampson HA. Update on food allergy. J Allergy Clin Immunol. 2004;113(5):805–19. quiz 820.PubMedCrossRefGoogle Scholar
  6. 6.
    Wohrl S, Stingl G. Underestimation of allergies in elderly patients. Lancet. 2004;363(9404):249.PubMedCrossRefGoogle Scholar
  7. 7.
    Sampson HA. Update on food allergy. Journal of Allergy and Clinical Immunology. 2004;113(5):805–19.PubMedCrossRefGoogle Scholar
  8. 8.
    • Diesner SC, et al. Food allergy: only a pediatric disease? Gerontology. 2011;57(1):28–32. This study is one of the first studies to investigate food allergy in elderly patients.PubMedCrossRefGoogle Scholar
  9. 9.
    •• Burks AW, et al. ICON: Food allergy. J Allergy Clin Immunol, 2012;129(4):906–20. This review brings leading experts, from across the globe, in the field of food allergy together to review the topic in depth.Google Scholar
  10. 10.
    Rona RJ, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120(3):638–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Liu AH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005–2006. J Allergy Clin Immunol. 2010;126(4):798–806. e13.PubMedCrossRefGoogle Scholar
  12. 12.
    Vierk KA, et al. Prevalence of self-reported food allergy in American adults and use of food labels. J Allergy Clin Immunol. 2007;119(6):1504–10.PubMedCrossRefGoogle Scholar
  13. 13.
    Chafen JJ, et al. Diagnosing and managing common food allergies: a systematic review. JAMA. 2010;303(18):1848–56.PubMedCrossRefGoogle Scholar
  14. 14.
    Young E, et al. A population study of food intolerance. Lancet. 1994;343(8906):1127–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Zuberbier T, et al. Prevalence of adverse reactions to food in Germany—a population study. Allergy. 2004;59(3):338–45.PubMedCrossRefGoogle Scholar
  16. 16.
    • Skypala I. Adverse food reactions—an emerging issue for adults. J Am Diet Assoc. 2011;111(12):1877–91. This review was one of few that focused on food allergy in adults.PubMedCrossRefGoogle Scholar
  17. 17.
    Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124(6):1549–55.PubMedCrossRefGoogle Scholar
  18. 18.
    Seitz CS, et al. Food allergy in adults: an over- or underrated problem? Dtsch Arztebl Int. 2008;105(42):715–23.PubMedGoogle Scholar
  19. 19.
    American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006;96(3 Suppl 2):S1–68.Google Scholar
  20. 20.
    Bindslev-Jensen C, et al. Standardization of food challenges in patients with immediate reactions to foods—position paper from the European Academy of Allergology and Clinical Immunology. Allergy. 2004;59(7):690–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Fogg MI, Spergel JM. Management of food allergies. Expert Opin Pharmacother. 2003;4(7):1025–37.PubMedCrossRefGoogle Scholar
  22. 22.
    Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol. 1997;100(4):444–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Rudeschko O, et al. Investigation of the stability of apple allergen extracts. Allergy. 1995;50(7):575–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Rance F, et al. Correlations between skin prick tests using commercial extracts and fresh foods, specific IgE, and food challenges. Allergy. 1997;52(10):1031–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Ortolani C, et al. Comparison of results of skin prick tests (with fresh foods and commercial food extracts) and RAST in 100 patients with oral allergy syndrome. J Allergy Clin Immunol. 1989;83(3):683–90.PubMedCrossRefGoogle Scholar
  26. 26.
    Devenney I, Falth-Magnusson K. Skin prick test in duplicate: is it necessary? Ann Allergy Asthma Immunol. 2001;87(5):386–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Codreanu F, et al. The risk of systemic reactions to skin prick-tests using food allergens: CICBAA data and literature review. Eur Ann Allergy Clin Immunol. 2006;38(2):52–4.PubMedGoogle Scholar
  28. 28.
    Asero R, et al. IgE-Mediated food allergy diagnosis: current status and new perspectives. Mol Nutr Food Res. 2007;51(1):135–47.PubMedCrossRefGoogle Scholar
  29. 29.
    Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001;107(5):891–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Bernstein IL, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 Suppl 3):S1–S148.Google Scholar
  31. 31.
    Pongracic JA, et al. Associations of prick skin tests and allergen specific IgE in children and adults. J Allergy Clin Immunol. 2007;119(1 Suppl):S121.CrossRefGoogle Scholar
  32. 32.
    • Webber CM, England RW. Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge. Ann Allergy Asthma Immunol. 2010;104(2):101–8. quiz 109–10, 117. This study focused on the significance of differentiating oral allergy syndrome from other food allergies.PubMedCrossRefGoogle Scholar
  33. 33.
    Roehr CC, et al. Food allergy and non-allergic food hypersensitivity in children and adolescents. Clin Exp Allergy. 2004;34(10):1534–41.PubMedCrossRefGoogle Scholar
  34. 34.
    • Moverare R, et al. Evaluation of IgE antibodies to recombinant peanut allergens in patients with reported reactions to peanut. Int Arch Allergy Immunol. 2011;156(3):282–90. This study was one of the first to evaluate the clinical importance of component testing.PubMedCrossRefGoogle Scholar
  35. 35.
    Perry TT, et al. Risk of oral food challenges. J Allergy Clin Immunol. 2004;114(5):1164–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Caffarelli C, Petroccione T. False-negative food challenges in children with suspected food allergy. Lancet. 2001;358(9296):1871–2.PubMedCrossRefGoogle Scholar
  37. 37.
    Nowak-Wegrzyn A, et al. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123(6 Suppl):S365–83.PubMedCrossRefGoogle Scholar
  38. 38.
    • DunnGalvin A, et al. Highly accurate prediction of food challenge outcome using routinely available clinical data. J Allergy Clin Immunol. 2011;127(3):633–9. e1-3. This study is the first of its kind to evaluate alternate methods of confirming food allergy.PubMedCrossRefGoogle Scholar
  39. 39.
    Mehl A, Wahn U, Niggemann B. Anaphylactic reactions in children–a questionnaire-based survey in Germany. Allergy. 2005;60(11):1440–5.PubMedCrossRefGoogle Scholar
  40. 40.
    • Hostetler TL, et al. The ability of adults and children to visually identify peanuts and tree nuts. Ann Allergy Asthma Immunol. 2012;108(1):25–9. This study is one of the first to confirm difficulty patients have in identifying peanuts and tree nuts.PubMedCrossRefGoogle Scholar
  41. 41.
    Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S116–25.PubMedCrossRefGoogle Scholar
  42. 42.
    Center for Food Safety and Applied Nutrition (U.S.), Food Allergen Labeling and Consumer Protection Act of 2004, Public Law 108–282 report to the Committee on Health, Education, Labor, and Pensions, United States Senate, and the Committee on Energy and Commerce, United States House of Representatives, 2006, Dept. of Health and Human Services, Food and Drug Administration, Center for Food Safety and Applied Nutrition,: College Park, MD. p. 33.Google Scholar
  43. 43.
    Sicherer SH, Burks AW, Sampson HA. Clinical features of acute allergic reactions to peanut and tree nuts in children. Pediatrics. 1998;102(1):e6.PubMedCrossRefGoogle Scholar
  44. 44.
    • Campbell RL, et al. Anaphylaxis in emergency department patients 50 or 65 years or older. Ann Allergy Asthma Immunol. 2011;106(5):401–6. This study was one of the first to evaluate anaphylaxis in selective group of adults.PubMedCrossRefGoogle Scholar
  45. 45.
    • Jarvinen KM. Food-induced anaphylaxis. Curr Opin Allergy Clin Immunol. 2011;11(3):255–61. This article reviews the anaphylaxis specifically secondary to food.PubMedCrossRefGoogle Scholar
  46. 46.
    Sampson MA, Munoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol. 2006;117(6):1440–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Pumphrey R. Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol. 2004;4(4):285–90.PubMedCrossRefGoogle Scholar
  48. 48.
    Lee JM, Greenes DS. Biphasic anaphylactic reactions in pediatrics. Pediatrics. 2000;106(4):762–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Simons FE. Lack of worldwide availability of epinephrine autoinjectors for outpatients at risk of anaphylaxis. Ann Allergy Asthma Immunol. 2005;94(5):534–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Gold MS, Sainsbury R. First aid anaphylaxis management in children who were prescribed an epinephrine autoinjector device (EpiPen). J Allergy Clin Immunol. 2000;106(1 Pt 1):171–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Song TT, et al. Adequacy of the epinephrine autoinjector needle length in delivering epinephrine to the intramuscular tissues. Ann Allergy Asthma Immunol. 2005;94(5):539–42.PubMedCrossRefGoogle Scholar
  52. 52.
    Scurlock AM, Burks AW, Jones SM. Oral immunotherapy for food allergy. Curr Allergy Asthma Rep. 2009;9(3):186–93.PubMedCrossRefGoogle Scholar
  53. 53.
    Buchanan AD, et al. Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol. 2007;119(1):199–205.PubMedCrossRefGoogle Scholar
  54. 54.
    Jones SM, et al. Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol. 2009;124(2):300 e1–97.CrossRefGoogle Scholar
  55. 55.
    • Kim EH, et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. J Allergy Clin Immunol. 2011;127(3):640–6. e1. This study is one of the first to evaluate the role of sublingual immunotherapy in peanut allergy.PubMedCrossRefGoogle Scholar
  56. 56.
    • Keet CA, et al. The safety and efficacy of sublingual and oral immunotherapy for milk allergy. J Allergy Clin Immunol. 2012;129(2):448–55. 455 e1-5. This study is one of the first to evaluate the role of sublingual and oral immunotherapy in milk allergy.PubMedCrossRefGoogle Scholar
  57. 57.
    Leung DY, et al. Effect of anti-IgE therapy in patients with peanut allergy. N Engl J Med. 2003;348(11):986–93.PubMedCrossRefGoogle Scholar
  58. 58.
    Nicklas RA, Chowdhury BA. Effect of anti-IgE therapy in patients with food allergy. Ann Allergy Asthma Immunol. 2003;91(2):119–20.PubMedCrossRefGoogle Scholar
  59. 59.
    • Nadeau KC, et al. Rapid oral desensitization in combination with omalizumab therapy in patients with cow’s milk allergy. J Allergy Clin Immunol. 2011;127(6):1622–4. This study is one of the first to evaluate the role omalizumab may play as an additive agent during immunotherapy for a milk allergy.PubMedCrossRefGoogle Scholar
  60. 60.
    Li XM, et al. The potential use of Chinese herbal medicines in treating allergic asthma. Ann Allergy Asthma Immunol. 2004;93(2 Suppl 1):S35–44.PubMedCrossRefGoogle Scholar
  61. 61.
    • Srivastava K, et al. Efficacy, safety and immunological actions of butanol-extracted Food Allergy Herbal Formula-2 on peanut anaphylaxis. Clin Exp Allergy. 2011;41(4):582–91. This is one of the first studies to find a possible alternative treatment to food allergy.PubMedCrossRefGoogle Scholar
  62. 62.
    • Patil SP, et al. Clinical safety of Food Allergy Herbal Formula-2 (FAHF-2) and inhibitory effect on basophils from patients with food allergy: extended phase I study. J Allergy Clin Immunol. 2011;128(6):1259–65. e2. This is one of the first studies to find a possible alternative treatment to food allergy.PubMedCrossRefGoogle Scholar
  63. 63.
    Sicherer SH, et al. Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants. J Allergy Clin Immunol. 2010;126(6):1191–7.PubMedCrossRefGoogle Scholar
  64. 64.
    DesRoches A, et al. Peanut allergy: is maternal transmission of antigens during pregnancy and breastfeeding a risk factor? J Investig Allergol Clin Immunol. 2010;20(4):289–94.PubMedGoogle Scholar
  65. 65.
    Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev. 2006;3:CD000133.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.University of Medicine and Dentistry of New Jersey/New Jersey Medical SchoolNewarkUSA
  2. 2.University of Medicine and Dentistry of New JerseySummitUSA

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