History and physical examination in the patient with possible food allergy
- Wesley Burks, MD
Wesley Burks, MD
- Chair of Pediatrics
- University of North Carolina
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 .
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- 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
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS