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Management of the Patient with Multiple Food Allergies

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Abstract

Food allergies affect 6% of children and 3% to 4% of adults in the United States. Although several studies have examined the prevalence of food allergy, little information is available regarding the prevalence of multiple food allergies. Estimates of prevalence of people allergic to multiple foods is difficult to ascertain because those with allergy to one food may avoid additional foods for concerns related to cross-reactivity, positive tests, or prior reactions, or they may be reluctant to introduce foods known to be common allergens. Diagnosis relies on an accurate history and selective IgE testing. It is important to understand the limitations of the available tests and the role of cross-reactivity between allergens. Allergen avoidance and readily accessible emergency medications are the cornerstones of management. In addition, a multidisciplinary approach to management of individuals with multiple food allergies may be needed, as avoidance of several food groups can have nutritional, developmental, and psychosocial consequences.

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References

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

  1. Sicherer SH, Sampson HA: 9. Food allergy. J Allergy Clin Immunol 2006, 117(2 Suppl Mini-Primer):S470–S475.

    Article  CAS  PubMed  Google Scholar 

  2. Sicherer SH, Burks AW, Sampson HA: Clinical features of acute allergic reactions to peanut and tree nuts in children. Pediatrics 1998, 102:e6.

    Article  CAS  PubMed  Google Scholar 

  3. Jones SM, Magnolfi CF, Cooke SK, et al.: Immunologic cross-reactivity among cereal grains and grasses in children with food hypersensitivity. J Allergy Clin Immunol 1995, 96:341–351.

    Article  CAS  PubMed  Google Scholar 

  4. Mittag D, Akkerdaas J, Ballmer-Weber BK, et al.: Ara h 8, a bet v 1-homologous allergen from peanut, is a major allergen in patients with combined birch pollen and peanut allergy. J Allergy Clin Immunol 2004, 114:1410–1417.

    Article  CAS  PubMed  Google Scholar 

  5. Sicherer SH, Dhillon G, Laughery KA, et al.: Caution: the Phadia hazelnut ImmunoCAP (f17) has been supplemented with recombinant cor a 1 and now detects bet v 1-specific IgE, which leads to elevated values for persons with birch pollen allergy. J Allergy Clin Immunol 2008, 122:413–414.

    Article  CAS  PubMed  Google Scholar 

  6. Park JH, Ahn SS, Sicherer SH: Prevalence of allergy to multiple versus single foods in a pediatric food allergy referral practice. J Allergy Clin Immunol 2010, 125:AB216.

    Google Scholar 

  7. 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, 100:444–451.

    Article  CAS  PubMed  Google Scholar 

  8. Wang J, Visness CM, Sampson HA: Food allergen sensitization in inner-city children with asthma. J Allergy Clin Immunol 2005, 115:1076–1080.

    Article  PubMed  Google Scholar 

  9. Sorva R, Makinen-Kiljunen S, Juntunen-Backman K: Beta-lactoglobulin secretion in human milk varies widely after cow’s milk ingestion in mothers of infants with cow’s milk allergy. J Allergy Clin Immunol 1994, 93:787–792.

    Article  CAS  PubMed  Google Scholar 

  10. Sampson HA, Albergo R: Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis. J Allergy Clin Immunol 1984, 74:26–33.

    Article  CAS  PubMed  Google Scholar 

  11. Sporik R, Hill DJ, Hosking 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.

    Article  CAS  PubMed  Google Scholar 

  12. Ortolani C, Ispano M, Pastorello EA, 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, 83:683–690.

    Article  CAS  PubMed  Google Scholar 

  13. Osterballe M, Scheller R, Stahl Skov P, et al.: Diagnostic value of scratch-chamber test, skin prick test, histamine release and specific IgE in birch-allergic patients with oral allergy syndrome to apple. Allergy 2003, 58:950–953.

    Article  CAS  PubMed  Google Scholar 

  14. Bock SA, Buckley J, Holst A, et al.: Proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children. Clin Allergy 1977, 7:375–383.

    Article  CAS  PubMed  Google Scholar 

  15. Ostblom E, Lilja G, Ahlstedt S, et al.: Patterns of quantitative food-specific IgE-antibodies and reported food hypersensitivity in 4-year-old children. Allergy 2008, 63:418–424.

    Article  CAS  PubMed  Google Scholar 

  16. Sampson HA: Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001, 107:891–896.

    Article  CAS  PubMed  Google Scholar 

  17. 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, 114:144–149.

    Article  CAS  PubMed  Google Scholar 

  18. Garcia-Ara C, Boyano-Martinez T, Diaz-Pena JM, et al.: Specific IgE levels in the diagnosis of immediate hypersensitivity to cows’ milk protein in the infant. J Allergy Clin Immunol 2001, 107:185–190.

    Article  CAS  PubMed  Google Scholar 

  19. Boyano Martinez T, Garcia-Ara C, Diaz-Pena JM, et al.: Validity of specific IgE antibodies in children with egg allergy. Clin Exp Allergy 2001, 31:1464–1469.

    Article  CAS  PubMed  Google Scholar 

  20. Wang J, Godbold JH, Sampson HA: Correlation of serum allergy (IgE) tests performed by different assay systems. J Allergy Clin Immunol 2008, 121:1219–1224.

    Article  CAS  PubMed  Google Scholar 

  21. Sicherer SH: Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol Allergy 2001, 108:881–890.

    Article  CAS  Google Scholar 

  22. • Asarnoj A, Ostblom E, Ahlstedt S, et al.: Reported symptoms to peanut between 4 and 8 years among children sensitized to peanut and birch pollen—results from the BAMSE birth cohort. Allergy 2010, 65:213–219. This study found that children with detectable IgE levels to peanut and birch were less likely to have clinical reactivity to peanut than those who had detectable IgE levels only to peanut.

  23. Bernhisel-Broadbent J, Sampson HA: Cross-allergenicity in the legume botanical family in children with food hypersensitivity. J Allergy Clin Immunol 1989, 83:435–440.

    Article  CAS  PubMed  Google Scholar 

  24. Fernandes J, Reshef A, Patton L, et al.: Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomyosin, in unexposed orthodox Jews. Clin Exp Allergy 2003, 33:956–961.

    Article  CAS  PubMed  Google Scholar 

  25. Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, et al.: Work group report: oral food challenge testing. J Allergy Clin Immunol 2009, 123(6 Suppl):S365–S383.

    Article  PubMed  Google Scholar 

  26. • Nicolaou N, Poorafshar M, Murray C, et al.: Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol 2010, 125:191–197. This study reported that the prevalence of peanut allergy in peanut-sensitized individuals is about 22% and that children with peanut allergy had different component recognition patterns than those who were tolerant to peanut. Furthermore, the authors found that Ara h 2 was the most important predictor of clinical allergy to peanut.

  27. Lin J, Bardina L, Shreffler WG, et al.: Development of a novel peptide microarray for large-scale epitope mapping of food allergens. J Allergy Clin Immunol 2009, 124:315–322.

    Article  CAS  PubMed  Google Scholar 

  28. Flinterman AE, Knol EF, Lencer DA, et al.: Peanut epitopes for IgE and IgG4 in peanut-sensitized children in relation to severity of peanut allergy. J Allergy Clin Immunol 2008, 121:737–743.

    Article  CAS  PubMed  Google Scholar 

  29. Cerecedo I, Zamora J, Shreffler WG, et al.: Mapping of the IgE and IgG4 sequential epitopes of milk allergens with a peptide microarray-based immunoassay. J Allergy Clin Immunol 2008, 122:589–594.

    Article  CAS  PubMed  Google Scholar 

  30. Wang J, Lin J, Bardina L, et al.: Correlation of IgE/IgG4 milk epitopes and affinity of milk-specific IgE antibodies with different phenotypes of clinical milk allergy. J Allergy Clin Immunol 2010, 125:695–702.

    Article  CAS  PubMed  Google Scholar 

  31. Ocmant A, Mulier S, Hanssens L, et al.: Basophil activation tests for the diagnosis of food allergy in children. Clin Exp Allergy 2009, 39:1234–1245.

    Article  CAS  PubMed  Google Scholar 

  32. Wanich N, Nowak-Wegrzyn A, Sampson HA, et al.: Allergen-specific basophil suppression associated with clinical tolerance in patients with milk allergy. J Allergy Clin Immunol 2009, 123:789–794.

    Article  CAS  PubMed  Google Scholar 

  33. • Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al.: Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol 2008, 122:342–347. This study shows that most children with milk allergy can tolerate extensively heated milk products.

  34. Simons E, Weiss CC, Furlong TJ, et al.: Impact of ingredient labeling practices on food allergic consumers. Ann Allergy Asthma Immunol 2005, 95:426–428.

    Article  PubMed  Google Scholar 

  35. Bock SA, Munoz-Furlong A, Sampson HA: Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001, 107:191–193.

    Article  CAS  PubMed  Google Scholar 

  36. Young MC, Munoz-Furlong A, Sicherer SH: Management of food allergies in schools: a perspective for allergists. J Allergy Clin Immunol 2009, 124:175–182.

    Article  PubMed  Google Scholar 

  37. Furlong TJ, DeSimone J, Sicherer SH: Peanut and tree nut allergic reactions in restaurants and other food establishments. J Allergy Clin Immunol 2001, 108:867–870.

    Article  CAS  PubMed  Google Scholar 

  38. Christie L, Hine RJ, Parker JG, et al.: Food allergies in children affect nutrient intake and growth. J Am Diet Assoc 2002, 102:1648–1651.

    Article  PubMed  Google Scholar 

  39. Isolauri E, Sutas Y, Salo MK, et al.: Elimination diet in cow’s milk allergy: risk for impaired growth in young children. J Pediatr 1998, 132:1004–1009.

    Article  CAS  PubMed  Google Scholar 

  40. Haas AM, Maune NC: Clinical presentation of feeding dysfunction in children with eosinophilic gastrointestinal disease. Immunol Allergy Clin North Am 2009, 29:65–75.

    Article  PubMed  Google Scholar 

  41. Cohen BL, Noone S, Munoz-Furlong A, et al.: Development of a questionnaire to measure quality of life in families with a child with food allergy. J Allergy Clin Immunol 2004, 114:1159–1163.

    Article  PubMed  Google Scholar 

  42. King RM, Knibb RC, Hourihane JO: Impact of peanut allergy on quality of life, stress and anxiety in the family. Allergy 2009, 64:461–468.

    Article  CAS  PubMed  Google Scholar 

  43. Vogel NM, Katz HT, Lopez R, et al.: Food allergy is associated with potentially fatal childhood asthma. J Asthma 2008, 45:862–866.

    Article  PubMed  Google Scholar 

  44. Skripak JM, Matsui EC, Mudd K, et al.: The natural history of IgE-mediated cow’s milk allergy. J Allergy Clin Immunol 2007, 120:1172–1177.

    Article  CAS  PubMed  Google Scholar 

  45. Savage JH, Matsui EC, Skripak JM, et al.: The natural history of egg allergy. J Allergy Clin Immunol 2007, 120:1413–1417.

    Article  CAS  PubMed  Google Scholar 

  46. Skolnick HS, Conover-Walker MK, Koerner CB, et al.: The natural history of peanut allergy. J Allergy Clin Immunol 2001, 107:367–374.

    Article  CAS  PubMed  Google Scholar 

  47. Fleischer DM, Conover-Walker MK, Matsui EC, et al.: The natural history of tree nut allergy. J Allergy Clin Immunol 2005, 116:1087–1093.

    Article  CAS  PubMed  Google Scholar 

  48. Shek LP, Soderstrom L, Ahlstedt S, et al.: Determination of food specific IgE levels over time can predict the development of tolerance in cow’s milk and hen’s egg allergy. J Allergy Clin Immunol 2004, 114:387–391.

    Article  CAS  PubMed  Google Scholar 

  49. • Lemon-Mule H, Sampson HA, Sicherer SH, et al.: Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol 2008, 122:977–983. This study demonstrated that most egg allergic children tolerated extensively heated egg, and continued ingestion was associated with immunologic changes that paralleled the changes observed with the development of clinical tolerance to regular egg.

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Acknowledgment

Dr. Wang’s work is funded in part by a grant from the National Institutes of Health/National Institute of Allergy and Infectious Diseases (K23 AI083883).

Disclosure

Dr. Wang has served as a consultant for Quest Diagnostics.

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Authors and Affiliations

  1. Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, Box 1198, One Gustave L. Levy Place, New York, NY, 10029, USA

    Julie Wang

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Correspondence to Julie Wang.

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Wang, J. Management of the Patient with Multiple Food Allergies. Curr Allergy Asthma Rep 10, 271–277 (2010). https://doi.org/10.1007/s11882-010-0116-0

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