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Food Allergy and Adverse Reactions to Foods


Adverse reactions to foods consist of any untoward reaction following the ingestion of a food or food additive and are classically divided into food intolerances (e.g., lactose intolerance ), which are adverse physiologic responses, and food allergies, which are adverse immunologic responses and can be IgE mediated or non–IgE mediated ( Tables 176.1 and 176.2 ). As with other atopic disorders, food allergies appear to have increased over the past 3 decades, primarily in countries with a Western lifestyle. Worldwide, estimates of food allergy prevalence range from 1–10%; food allergies affect an estimated 3.5% of the U.S. population. Up to 6% of children experience food allergic reactions in the 1st 3 yr of life, including approximately 2.5% with cow's milk allergy, 2% with egg allergy, and 2–3% with peanut allergy. Peanut allergy prevalence tripled over the past decade. Most children “outgrow” milk and egg allergies, with approximately 50% doing so by school-age. In contrast, 80–90% of children with peanut, tree nut, or seafood allergy retain their allergy for life.

Table 176.1
Adverse Food Reactions

Food Intolerance (non–immune system mediated, nontoxic, noninfectious)

Host Factors

  • Enzyme deficiencies—lactase (primary or secondary), sucrase/isomaltase, hereditary fructose intolerance, galactosemia

  • Gastrointestinal disorders—inflammatory bowel disease, irritable bowel syndrome, pseudoobstruction, colic

  • Idiosyncratic reactions—caffeine in soft drinks (“hyperactivity”)

  • Psychologic—food phobias, obsessive/compulsive disorder

  • Migraines (rare)

Food Factors (Toxic or Infectious or Pharmacologic)

  • Infectious organisms— Escherichia coli, Staphylococcus aureus, Clostridium perfringens, Shigella, botulism, Salmonella, Yersinia, Campylobacter

  • Toxins—histamine (scombroid poisoning), saxitoxin (shellfish)

  • Pharmacologic agents—caffeine, theobromine (chocolate, tea), tryptamine (tomatoes), tyramine (cheese), benzoic acid in citrus fruits (perioral flare)

  • Contaminants—heavy metals, pesticides, antibiotics

Food Allergy

IgE Mediated

  • Cutaneous—urticaria, angioedema, morbilliform rashes, flushing, contact urticarial

  • Gastrointestinal—oral allergy syndrome, gastrointestinal anaphylaxis

  • Respiratory—acute rhinoconjunctivitis, bronchospasm

  • Generalized—anaphylactic shock, exercise-induced anaphylaxis

Mixed IgE Mediated and Non–IgE Mediated

  • Cutaneous—atopic dermatitis, contact dermatitis

  • Gastrointestinal—allergic eosinophilic esophagitis and gastroenteritis

  • Respiratory—asthma

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