Food allergy. Part 1: Immunopathogenesis and clinical disorders,☆☆,

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Abstract

Up to 8% of children less than 3 years of age and approximately 2% of the adult population experience food-induced allergic disorders. A limited number of foods are responsible for the vast majority of food-induced allergic reactions: milk, egg, peanuts, fish, and tree nuts in children and peanuts, tree nuts, fish, and shellfish in adults. Food-induced allergic reactions are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract and may be caused by IgE-mediated and non-IgE-mediated mechanisms. In part 1 of this series, immunopathogenic mechanisms and clinical disorders of food allergy are described. (J Allergy Clin Immunol 1999;103:717-28.)

Section snippets

PREVALENCE OF FOOD HYPERSENSITIVITY

About one fourth of American households alter their dietary habits because at least one member of the family is perceived to have food allergies.9 True food allergy is much less frequent and more prevalent in young children and individuals with atopic disease. In a prospective study of 480 consecutive newborns followed through their third birthday, 28% were reported to have experienced adverse food reactions, most during the first year of life.10 About one fourth of the reactions reported (or

Gut barrier

Within hours of birth, a newborn’s gastrointestinal tract and gut-associated lymphoid tissue (gut barrier) are confronted with foreign proteins in the form of bacteria and food antigens. This immature system must process ingested food into a form that can be absorbed and used for energy and cell growth, mount rapid and potent responses against various pathogens (ie, develop immunity), and remain unresponsive to enormous quantities of foreign nutrient antigens (ie, develop tolerance). A number

Gastrointestinal food hypersensitivity reactions

Given the complexity of the gastrointestinal immune system and the fact that the gastrointestinal tract is first to confront an enormous quantity of food allergens, it is not surprising that a variety of gastrointestinal hypersensitivity disorders may develop. As indicated in Fig 1 from a recent consensus workshop [Workshop on the Classification of Gastrointestinal Diseases of Infants and Children -November 1998, Washington, DC], gastrointestinal hypersensitivities may be exclusively IgE

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    Supported in part by AI-24439 from the National Institute of Allergy and Infectious Disease and RR-00052 from the General Clinical Research Center Program.

    ☆☆

    Reprint requests: Hugh A. Sampson, MD, Department of Pediatrics, Box 1198, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029-6574.

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