Food Allergy in Children: An Overview

  • Jaidev M. Devdas
  • Christopher Mckie
  • Adam T. Fox
  • Vinod H. Ratageri
Review Article

Abstract

The estimated prevalence of food allergy amongst children in the west is around 6–8% but there is paucity of data in the Indian population. There is a complex interplay of environmental influences and genetic factors in the immuno-pathogenesis and manifestations of food allergy. A reliable thorough clinical history, combined with positive skin prick tests or food-specific IgE, is essential for a more precise diagnosis of food allergy. Currently there is no cure for food allergy. The management of food allergy usually includes strict avoidance, patient education and provision of emergency medication (adrenaline-autoinjectors). Emerging therapies based on evolving research are focused on a more active approach to management which includes early introduction of potentially allergenic foods, anticipatory testing and desensitisation to food allergens. Lack of food labelling policy and non availability of adrenaline auto-injectors is a huge limiting factor for effective management of food allergy among children in India. The present review focuses on IgE mediated food allergy.

Keywords

Food allergy Children Diet Anaphylaxis Food labelling Adrenaline auto-injectors 

Notes

Contributions

JMD: Designed, reviewed the literature, wrote the manuscript; CM: Reviewed the literature and helped in writing the manuscript; ATF: Helped in designing and critically reviewed the manuscript; VHR: Helped in designing, review and will act as guarantor for the paper.

Compliance with Ethical Standards

Conflict of Interest

None.

Source of Funding

None.

References

  1. 1.
    Sicherer SH, Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis and treatment. J Allergy Clin Immunol. 2014;133:291–307.CrossRefPubMedGoogle Scholar
  2. 2.
    Shek LP, Lee BW. Food allergy in Asia. Curr Opin Allergy Clin Immunol. 2006;6:197–201.CrossRefPubMedGoogle Scholar
  3. 3.
    Mahesh PA, Wong GW, Ogorodova L, et al. Prevalence of food sensitization and probable food allergy among adults in India: the EuroPrevall INCO study. Allergy. 2016;71:1010–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee BW, Chew FT, Goh DYT. Changing prevalence of childhood allergic diseases in Singapore. 5th West-Pacific Allergy Symposium & 7th Korea- Japan Joint Allergy Symposium; 11–14 June, 1997; Seoul, South Korea; 1997. p. 17–22.Google Scholar
  5. 5.
    Lee SI, Shin MH, Lee HB, et al. Prevalences of symptoms of asthma and other allergic diseases in Korean children: a nationwide questionnaire survey. J Korean Med Sci. 2001;16:155–64.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wang Z. An allergy prevalence survey in population of 10,144 people [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 1990;11:100–2.PubMedGoogle Scholar
  7. 7.
    Iikura Y, Imai Y, Imai T, et al. Frequency of immediate-type food allergy in children in Japan. Int Arch Allergy Immunol. 1999;118:251–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Hu Y, Chen J, Li H. Comparison of food allergy prevalence among Chinese infants in Chongquing, 2009 versus 1999. Pediatr Int. 2010;52:820–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Wang XS, Tan TN, Shek LP, et al. The prevalence of asthma and allergies in Singapore; data from two ISAAC surveys seven years apart. Arch Dis Child. 2004;89:423–6.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Tanihara S, Nakamura Y, Oki I, et al. Trends in asthma morbidity and mortality in Japan between 1984 and 1996. J Epidemiol. 2002;12:217–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Chandra RK. Food hypersensitivity and allergic disease: a new threat in India. Indian Pediatr. 2003;40:99–101.PubMedGoogle Scholar
  12. 12.
    Walker-Smith J. An eye witness perspective of the changing patterns of food allergy. Eur J Gastroenterol Hepatol. 2005;17:1313–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Pereira B, Venter C, Grundy J, et al. Prevalence of sensitization to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. J Allergy Clin Immunol. 2005;116:884–92.CrossRefPubMedGoogle Scholar
  14. 14.
    Venter C, Hasan Arshad S, Grundy J, et al. Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK. Allergy. 2010;65:103–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128:e9–17.CrossRefPubMedGoogle Scholar
  16. 16.
    McGowan EC, Keet CA. Prevalence of self-reported food allergy in the National Health and nutrition examination survey (NHANES) 2007-2010. J Allergy Clin Immunol. 2013;132:1216–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Soller L, Ben Shoshan M, Harrington DW, et al. Overall prevalence of self-reported food allergy in Canada. J Allergy Clin Immunol. 2012;130:986–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Osborne NJ, Koplin JJ, Martin PE, et al. Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants. J Allergy Clin Immunol. 2011;127:668–76.CrossRefPubMedGoogle Scholar
  19. 19.
    Prescott S, Allen KJ. Food allergy: riding the second wave of allergy epidemic. Pediatr Allergy Immunol. 2011;22:155–60.CrossRefPubMedGoogle Scholar
  20. 20.
    Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010;125:S116–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Patil SP, Niphadkar PV, Bapat MM. Chickpea: a major food allergen in the Indian subcontinent and its clinical and immunochemical correlation. Ann Allergy Asthma Immunol. 2001;87:140–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Niphadkar PV, Patil SP, Bapat MM. Chickpea-induced anaphylaxis. Allergy. 1997;52:115–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Litonjua AA, Celedon JC. Hausmann, et al. variation in total and specific IgE, effects of ethnicity and socioeconomic status. J Allergy Clin Immunol. 2005;115:751–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Dias RP, Summerfield A, Khakoo GA. Food hypersensitivity among Caucasian and non-caucasion children. Pediatr Allergy Immunol. 2008;19:86–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Liu AH, Jaramillo R, Sicherer SH, 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;126:798–806.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009;124:1549–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol. 2012;129:1187–97.CrossRefPubMedGoogle Scholar
  28. 28.
    Visness CM, London SJ, Daniels JL, et al. Association of obesity with IgE levels and allergy symptoms in children and adolescents: results from the National Health and nutrition examination survey 2005-2006. J Allergy Clin Immunol. 2009;123:1163–9.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Untersmayr E, Jensen-Jarolim E. The role of protein digestibility and antacids on food allergy outcomes. J Allergy Clin Immunol. 2008;121:1301–8.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Kusunoki T, Mukaida K, Morimoto T, et al. Birth order effect on childhood food allergy. Pediatr Allergy Immunol. 2012;23:250–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Martin PE, Eckert JK, Koplin JJ, et al. Which infants with eczema are at risk of food allergy? Results from a population-based cohort. Clin Exp Allergy. 2015;45:255–64.CrossRefPubMedGoogle Scholar
  32. 32.
    Kelleher MM, Dunn-Galvin A, Gray C, et al. Skin barrier impairment at birth predicts food allergy at 2 years of age. J Allergy Clin Immunol. 2016;137:1111–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Du Toit G, Roberts G, Sayre PH, et al; LEAP study team. Randomised trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015;372:803–13.Google Scholar
  34. 34.
    Chehade M, Mayer L. Oral tolerance and its relation to food hypersensitivities. J Allergy Clin Immunol. 2005;115:3–12.CrossRefPubMedGoogle Scholar
  35. 35.
    Fernandez-Rivas M, Bolhaar S, Gonzalez-Mancebo E, et al. Apple allergy across Europe: how allergen sensitization profiles determine the clinical expression of allergies to plant foods. J Allergy Clin Immunol. 2006;118:481–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Anagnostou K, Stiefel G, Brough H, et al. Active management of food allergy: an emerging concept. Arch Dis Child. 2015;100:386–90.CrossRefPubMedGoogle Scholar
  37. 37.
    Neuman-Sunshine DL, Eckman JA, Keet CA, et al. The natural history of persistent peanut allergy. Ann Allergy Asthma Immunol. 2012;108:326–31.CrossRefPubMedGoogle Scholar
  38. 38.
    Wood RA, Sicherer SH, Vickery BP, et al. The natural history of milk allergy in an observational cohort. J Allergy Clin Immunol. 2013;131:805–12.CrossRefPubMedGoogle Scholar
  39. 39.
    Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol. 2001;107:891–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Perry TT, Matsui EC. Kay Conover-Walker M, et al. the relationship of allergen-specific IgE levels and oral food challenge outcome. J Allergy Clin Immunol. 2004;114:144–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Du Toit G, Katz Y, Sasieni P, et al. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol. 2008;122:984–91.CrossRefPubMedGoogle Scholar
  42. 42.
    Katz Y, Rajuan N, Goldberg MR, et al. Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy. J Allergy Clin Immunol. 2010;126:77–82.CrossRefPubMedGoogle Scholar
  43. 43.
    Koplin JJ, Osborne NJ, Wake M, et al. Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol. 2010;126:807–13.CrossRefPubMedGoogle Scholar
  44. 44.
    Perkin MR, Logan K, Tseng A, et al; EAT study team. Randomised trial of introduction of allergenic food in breast-fed infants. N Engl J Med. 2016;374:1733–43.Google Scholar
  45. 45.
    Ierodiakonou D, Garcia-Larsen V, Logan A, et al. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease: a systematic review and meta-analysis. JAMA. 2016;316:1181–92.CrossRefPubMedGoogle Scholar
  46. 46.
    Du Toit G, Roberts G, Sayre PH, et al. Identifying infants at high risk of peanut allergy: the learning early about peanut allergy (LEAP) screening study. J Allergy Clin Immunol. 2013;131:135–43.CrossRefPubMedGoogle Scholar
  47. 47.
    Maloney JM, Rudengren M, Ahlstedt S, et al. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol. 2008;122:145–51.CrossRefPubMedGoogle Scholar
  48. 48.
    Kim JS, Nowak-Węgrzyn A, Sicherer SH, et al. Dietary baked milk accelerates the resolution of cow’s milk allergy in children. J Allergy Clin Immunol. 2011;128:125–31.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Lemon-Mulé H, Sampson H. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008;122:977–83.CrossRefPubMedGoogle Scholar
  50. 50.
    Leonard SA, Sampson HA, Sicherer SH, et al. Dietary baked egg accelerates resolution of egg allergy in children. J Allergy Clin Immunol. 2012;130:473–80.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Berni Canani R, Nocerino R, Terrin G, et al. Effect of lactobacillus GG on tolerance acquisition in infants with cow’s milk allergy: a randomized trial. J Allergy Clin Immunol. 2012;129:580–2.CrossRefPubMedGoogle Scholar
  52. 52.
    Berni Canani R, Nocerino R, Terrin G, et al. Formula selection for management of children with cow’s milk allergy influences the rate of acquisition of tolerance: a prospective multicenter study. J Pediatr. 2013;163:771–7.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  • Jaidev M. Devdas
    • 1
  • Christopher Mckie
    • 2
  • Adam T. Fox
    • 3
  • Vinod H. Ratageri
    • 4
  1. 1.Department of PediatricsFather Muller Medical CollegeMangaloreIndia
  2. 2.Department of PediatricsSunderland Royal HospitalSunderlandUK
  3. 3.Department of Pediatric AllergyGuy’s and St Thomas’ HospitalLondonUK
  4. 4.Department of PediatricsKarnataka Institute of Medical SciencesHubballiIndia

Personalised recommendations