Henry Ford Hospital Medical Journal


Food allergy occurs in as many as 5% of infants less than 1 year old. Most food sensitivities disappear by age 3 to 4. Most immunologically mediated food allergy reactions are due to type I IgE mechanisms, with skin, gastrointestinal, and respiratory signs and symptoms the most common manifestations. U sing the double-blind, placebo-controlled food challenge (DBPCFC) technique and atopic dermatitis as a model, the most common foods to which children are allergic are cow's milk, eggs, peanuts, wheat, fish, and soy proteins. Anaphylactic sensitivity in older children often involves crustacean seafoods (eg, shrimp), nuts, peanuts, fish, and eggs. Such sensitivities may be lifelong. Infant colic is not due to allergy but may be improved with dietary manipulation. Food-induced diarrhea may be due to food intolerance or allergy. In severe milk-induced enterocolitis, caseinhydrolysate formula rather than soy formula is advised. Specific foods can exacerbate atopic dermatitis: their elimination from the diet will improve the condition. Gluten sensitivity is both a food intolerance and food allergy. A few cases of the attention deficit disorder can be improved with a diet absent of food dyes, particularly yellow #5. Although migraine headaches can be triggered by a number of factors, food allergy is not included. Pulmonary infiltrates due to cow's milk hyperimmune reactions (the Heiner syndrome) is thought to be a type III milk immune-complex reaction. In the infant, asthma and allergic rhinitis may be a manifestation of food allergy. The diagnosis of food allergy depends upon the history, an IgE-mediated skin prick test or radioallergosorbent test, followed by dietary elimination, open challenge, or DBPCFC. In food anaphylaxis management, however, no food challenge is advised because of the risk. Some tests of unproved validity have been promoted in the diagnosis of food allergy. The principal treatment, strict avoidance of a specific food, is sometimes difficult. Because anaphylaxis is a life-threatening risk, patients are advised always to have an aqueous epinephrine 1:1,000 self injector unit available. Manipulation of the diet of the pregnant woman, nursing mother, and infant helps reduce the risk of allergy in the infant. Medications are of limited use in food allergy prevention, but specific drugs such as epinephrine and cortisone are helpful in treating allergic reactions.