Clinical manifestations of food allergy: An overview
- Wesley Burks, MD
Wesley Burks, MD
- Executive Dean
- University of North Carolina School of Medicine
An adverse food reaction is a general term for any untoward response to the ingestion of a food. Adverse food reactions can be divided into food allergies, which are immunologically mediated, and all other reactions, which are nonimmunologic (table 1).
Adverse food reactions are common and often assumed by patients to be allergic in nature. However, nonimmunologic reactions to food are more common than true food allergies. (See "Food allergy in children: Prevalence, natural history, and monitoring for resolution", section on 'Prevalence of childhood food allergy' and "Food intolerance and food allergy in adults: An overview", section on 'Epidemiology'.)
Food allergy is due to an abnormal immunologic response following exposure (usually ingestion) to a food [1,2]. The terms "allergy" and "hypersensitivity" are used interchangeably in this topic review. There are multiple types of food allergy, each with distinct clinical and pathophysiologic features. Food allergies are broadly categorized into either immunoglobulin E (IgE)-mediated or non-IgE-mediated processes . Some disorders, such as atopic dermatitis or the eosinophilic gastrointestinal disorders (EGIDs), have characteristics of both mechanisms. (See "Role of allergy in atopic dermatitis (eczema)" and "Clinical manifestations and diagnosis of eosinophilic esophagitis".)
This topic reviews the clinical manifestations of the different categories of food allergies. Other aspects of food allergy are discussed separately. (See "History and physical examination in the patient with possible food allergy" and "Diagnostic evaluation of food allergy".)
Immunoglobulin E (IgE)-mediated food allergic reactions are rapid in onset, typically beginning within minutes to two hours from the time of ingestion. IgE-mediated reactions to carbohydrate allergens in meats, a type of reaction reported mainly in adults, represent an exception to this temporal pattern since these reactions begin four to six hours after ingestion. Most patients react to one or two specific foods/food groups, although an increasing number of patients react to multiple foods. (See "Allergy to meats".)
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- IgE-MEDIATED REACTIONS
- Urticaria and angioedema
- Oropharyngeal symptoms
- Respiratory tract symptoms
- Gastrointestinal symptoms
- NON-IgE-MEDIATED REACTIONS
- Gastrointestinal manifestations
- Skin manifestations
- Pulmonary manifestations
- MIXED IgE AND NON-IgE-MEDIATED REACTIONS
- Atopic dermatitis (eczema)
- Eosinophilic gastrointestinal disorders
- DIFFERENTIAL DIAGNOSIS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS