History and physical examination in the patient with possible food allergy
- Wesley Burks, MD
Wesley Burks, MD
- Executive Dean
- University of North Carolina School of Medicine
An adverse food reaction is a generic term that refers to any untoward reaction following the ingestion of a food. Adverse food reactions are common and may be secondary to food allergy or to a wide variety of other disorders.
This topic reviews the history and physical examination in patients with possible food allergy. The clinical manifestations and diagnostic testing modalities are discussed separately. (See "Clinical manifestations of food allergy: An overview" and "Diagnostic evaluation of food allergy".)
Adverse food reactions can be subdivided into allergic and nonallergic reactions. Food allergy (or hypersensitivity) is defined broadly as an immunologic reaction to food and can be further distinguished into immunoglobulin E (IgE)-mediated mechanisms and non-IgE-mediated mechanisms. The National Institute of Allergy and Infectious Diseases (NIAID) guidelines for the diagnosis and management of food allergy in the United States define food allergy as "an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food" .
The history is of critical importance in the evaluation of a patient with possible food allergy [1-3]. Primary goals of the history are to determine if food allergy could be present and, if so, what type and which food may be responsible. The history is subsequently used to guide testing and interpret results.
Food allergy — Food allergy is due to an abnormal immunologic response following exposure (usually ingestion) to a food . Allergy and hypersensitivity are used interchangeably in these sections to refer to these abnormal immunologic reactions. However, the term "hypersensitivity" is sometimes used more liberally in other literature to describe all exuberant adverse reactions to food, including lactose intolerance, for example .
- NIAID-Sponsored Expert Panel, Boyce JA, Assa'ad A, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126:S1.
- Sampson HA, Aceves S, Bock SA, et al. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016.
- Muraro A, Werfel T, Hoffmann-Sommergruber K, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69:1008.
- Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 2004; 113:832.
- Bock SA, Atkins FM. Patterns of food hypersensitivity during sixteen years of double-blind, placebo-controlled food challenges. J Pediatr 1990; 117:561.
- Jansen JJ, Kardinaal AF, Huijbers G, et al. Prevalence of food allergy and intolerance in the adult Dutch population. J Allergy Clin Immunol 1994; 93:446.
- Sicherer SH, Muñoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003; 112:1203.
- 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.
- Yocum MW, Butterfield JH, Klein JS, et al. Epidemiology of anaphylaxis in Olmsted County: A population-based study. J Allergy Clin Immunol 1999; 104:452.
- Bruijnzeel-Koomen C, Ortolani C, Aas K, et al. Adverse reactions to food. European Academy of Allergology and Clinical Immunology Subcommittee. Allergy 1995; 50:623.
- Du Toit DF. Auriculo-temporal nerve. Clinicopathological relevance to facial-maxillary practice. SADJ 2003; 58:62.
- Kaddu S, Smolle J, Komericki P, Kerl H. Auriculotemporal (Frey) syndrome in late childhood: an unusual variant presenting as gustatory flushing mimicking food allergy. Pediatr Dermatol 2000; 17:126.
- Johnson IJ, Birchall JP. Bilatral auriculotemporal syndrome in childhood. Int J Pediatr Otorhinolaryngol 1995; 32:83.
- Sicherer SH, Sampson HA. 9. Food allergy. J Allergy Clin Immunol 2006; 117:S470.
- Moneret-Vautrin DA, Morisset M. Adult food allergy. Curr Allergy Asthma Rep 2005; 5:80.
- Osterballe M, Hansen TK, Mortz CG, et al. The prevalence of food hypersensitivity in an unselected population of children and adults. Pediatr Allergy Immunol 2005; 16:567.
- Derby CJ, Gowland MH, Hourihane JO. Sesame allergy in Britain: a questionnaire survey of members of the Anaphylaxis Campaign. Pediatr Allergy Immunol 2005; 16:171.
- Sampson HA, Sicherer SH, Birnbaum AH. AGA technical review on the evaluation of food allergy in gastrointestinal disorders. American Gastroenterological Association. Gastroenterology 2001; 120:1026.
- Sampson HA. Food allergy. J Allergy Clin Immunol 1989; 84:1062.
- Sampson HA, Burks AW. Mechanisms of food allergy. Annu Rev Nutr 1996; 16:161.
- Atkins FM, Steinberg SS, Metcalfe DD. Evaluation of immediate adverse reactions to foods in adult patients. I. Correlation of demographic, laboratory, and prick skin test data with response to controlled oral food challenge. J Allergy Clin Immunol 1985; 75:348.
- Hill DJ, Heine RG, Hosking CS. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol 2004; 15:435.
- Niggemann B, Beyer K. Factors augmenting allergic reactions. Allergy 2014; 69:1582.
- Lack G. Clinical practice. Food allergy. N Engl J Med 2008; 359:1252.
- Burks AW, Sampson HA. Diagnostic approaches to the patient with suspected food allergies. J Pediatr 1992; 121:S64.
- Sampson HA. Adverse reactions to foods. In: Middleton's allergy: Principles and practice, 6th ed, Adkinson NF, Yunginger JW, Busse WW, et al (Eds), Mosby, St. Louis, MO 2003. p.1619.
- Skypala IJ, Venter C, Meyer R, et al. The development of a standardised diet history tool to support the diagnosis of food allergy. Clin Transl Allergy 2015; 5:7.
- Atkins D, Malka-Rais J. Food allergy: transfused and transplanted. Curr Allergy Asthma Rep 2010; 10:250.
- Ching JC, Lau W, Hannach B, Upton JE. Peanut and fish allergy due to platelet transfusion in a child. CMAJ 2015; 187:905.
- Ponnampalam A, Growe G, Loftus P, et al. Acquired peanut hypersensitivity following platelet transfusion. Transfus Med 2014; 24:426.
- Poisson JL, Riedo FX, AuBuchon JP. Acquired peanut hypersensitivity after transfusion. Transfusion 2014; 54:256.
- Arnold DM, Blajchman MA, Ditomasso J, et al. Passive transfer of peanut hypersensitivity by fresh frozen plasma. Arch Intern Med 2007; 167:853.
- Bellou A, Kanny G, Fremont S, Moneret-Vautrin DA. Transfer of atopy following bone marrow transplantation. Ann Allergy Asthma Immunol 1997; 78:513.
- Legendre C, Caillat-Zucman S, Samuel D, et al. Transfer of symptomatic peanut allergy to the recipient of a combined liver-and-kidney transplant. N Engl J Med 1997; 337:822.
- Castells M, Boyce J. Transfer of peanut allergy by a liver allograft. N Engl J Med 1998; 338:202.
- Phan TG, Strasser SI, Koorey D, et al. Passive transfer of nut allergy after liver transplantation. Arch Intern Med 2003; 163:237.
- Chehade M, Nowak-Wegrzyn A, Kaufman SS, et al. De novo food allergy after intestinal transplantation: a report of three cases. J Pediatr Gastroenterol Nutr 2004; 38:545.
- Dobson R. Peanut allergy may be transferred by lung transplantation, case shows. BMJ 2008; 337:a1512.
- Khalid I, Zoratti E, Stagner L, et al. Transfer of peanut allergy from the donor to a lung transplant recipient. J Heart Lung Transplant 2008; 27:1162.
- Vagefi PA, Blazick E, Hamilos D, et al. Transference of food allergy after adult liver transplantation. Transplantation 2009; 87:1426.
- Dewachter P, Vézinet C, Nicaise-Roland P, et al. Passive transient transfer of peanut allergy by liver transplantation. Am J Transplant 2011; 11:1531.
- Bhinder S, Heffer MJ, Lee JK, et al. Development of transient peanut allergy following lung transplantation: a case report. Can Respir J 2011; 18:154.
- Schuller A, Barnig C, Matau C, et al. Transfer of peanut allergy following lung transplantation: a case report. Transplant Proc 2011; 43:4032.
- Ip W, Cale C, Veys P, Qasim W. Peanut allergy transferred by BMT. Bone Marrow Transplant 2014; 49:993.
- Berry A, Campsen J, Shihab F, Firszt R. Transfer of peanut IgE sensitisation after combined pancreas-kidney transplant. Clin Exp Allergy 2014; 44:1020.
- Feliu J, Clay J, Raj K, et al. Transplant-acquired food allergy (TAFA) following cord blood stem cell transplantation in two adult patients with haematological malignancies. Br J Haematol 2014; 167:426.
- Catal F, Topal E, Selimoglu MA, et al. Acquired IgE-mediated food allergy after liver transplantation in children. Allergol Immunopathol (Madr) 2015; 43:392.
- Jacobs JF, Baumert JL, Brons PP, et al. Anaphylaxis from passive transfer of peanut allergen in a blood product. N Engl J Med 2011; 364:1981.
- Gao L, Sha Y, Yuan K, et al. Allergic transfusion reaction caused by the shrimp allergen of donor blood: a case report. Transfus Apher Sci 2014; 50:68.
- Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol 1999; 104:S114.
- Burks AW, James JM, Hiegel A, et al. Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998; 132:132.
- Food allergy
- Nonimmunologic reactions
- Role of the history in evaluation
- TYPES OF FOOD ALLERGY
- Immunoglobulin E (IgE)-mediated allergy
- - Symptoms
- - Timing
- - Common culprit foods
- - Related allergic conditions
- Other forms of food allergy
- - Symptoms
- - Timing
- SPECIFIC KEY QUESTIONS
- Questions related to the suspected food allergen
- Questions related to symptoms
- Questions related to contributory factors
- PHYSICAL EXAMINATION
- Acute presentation
- Chronic symptoms
- DIFFERENTIAL DIAGNOSIS
- ROLE OF THE GENERALIST
- When the type of allergy is unclear
- Treatment from the generalist
- - Prescribing epinephrine
- Testing by the generalist
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- INFORMATION FOR PATIENTS