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Pathogenesis of food allergy

Philippe A Eigenmann, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


Tolerance is the normal immune response to the food an individual eats over a lifetime [1]. Food allergy is an abnormal immune reaction consisting of hypersensitivity to food components, most commonly proteins [2,3].

This topic will focus on food allergy due to primary sensitization through the gut and will review organization of the gut immune system and factors that influence oral tolerance induction. Theories addressing the increasing prevalence of food allergy are briefly mentioned. The pathogenesis of pollen-food allergy syndrome, seen more frequently in adolescents and adults, is discussed separately. (See "Pathogenesis of oral allergy syndrome (pollen-food allergy syndrome)".)


The prevalence of food allergies, particularly to peanut, appears to have increased from the late 1990s to the early 2010s (figure 1) [4-9]. While there are a number of theories regarding the apparent increase in prevalence of food allergies, especially peanut allergy, definitive answers are still lacking [10-13]. Postulated hypotheses have focused on hygiene, dietary fat, antioxidants, vitamin D, and dual allergen exposure (ie, initial exposure to a food allergen via a nonoral route, such as the skin). There are some data in support of these hypotheses to explain the increasing risk of asthma and allergic rhinitis. However, there are limited data regarding the role for these hypotheses in the increased prevalence of food allergy. (See "Food allergy in children: Prevalence, natural history, and monitoring for resolution", section on 'Prevalence of childhood food allergy'.)

Hygiene hypothesis – Early life exposure to infectious pathogens, as well as normal gut microbiota, may influence the development of the immune system away from a T helper type 2 (Th2) and towards a T regulatory cell (Treg) response. Better hygiene, resulting in less microbial exposure, may lead to an increase in atopic disease.

Microbiome depletion hypothesis – This hypothesis evolved from the hygiene hypothesis. The ecosystem of the human body (the human biome) can influence immune function. Loss of species diversity from the human microbiome can result in allergy, autoimmune disease, and other disorders related to increased inflammation [14-16].

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Literature review current through: Nov 2017. | This topic last updated: Sep 27, 2017.
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