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Respiratory manifestations of food allergy

Scott H Sicherer, MD, FAAAAI
Section Editor
Robert A Wood, MD
Deputy Editor
Elizabeth TePas, MD, MS


Respiratory tract symptoms observed with food hypersensitivity reactions include nasal congestion, rhinorrhea, sneezing, itching of the nose and throat, coughing, and wheezing [1]. Food allergen exposure is usually through ingestion, but the inhalation of food proteins in the form of dust or aerosolized particles may also trigger respiratory symptoms.

Isolated asthma or rhinitis secondary to food allergy is reported but is rare [2]. More commonly, respiratory symptoms of food allergy are accompanied by skin and/or gastrointestinal manifestations. Foods can elicit asymptomatic airway hyperreactivity or symptomatic asthmatic responses. In addition, systemic anaphylactic reactions often have a respiratory component.

This topic review covers the etiology, diagnosis, and clinical manifestations of respiratory symptoms related to food allergy. Other clinical manifestations of food allergy, oral allergy syndrome, and food-induced anaphylaxis are discussed separately. Occupational asthma and rhinitis are discussed in more detail elsewhere (See "Clinical manifestations of food allergy: An overview" and "Clinical manifestations and diagnosis of oral allergy syndrome (pollen-food allergy syndrome)" and "Food-induced anaphylaxis" and "Occupational rhinitis" and "Occupational asthma: Definitions, epidemiology, causes, and risk factors".)


This section reviews the prevalence of respiratory manifestations of food allergy and examines several associations between food allergy and asthma.

Prevalence — The public perception of food allergy, including food allergy-induced asthma, is disproportionate to its actual prevalence [1,3]. Suspected cases of food allergies are often not confirmed when objective investigations, including food challenges, are undertaken [4,5]. While respiratory symptoms as a component of systemic allergic reactions triggered by food occur in almost one-half of patients, isolated food-induced respiratory symptoms are rare. As an example, of 314 positive food challenges in one-year-old infants, 4 percent experienced respiratory or cardiovascular compromise, and none of these symptoms occurred in isolation [6].

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Literature review current through: Nov 2017. | This topic last updated: Feb 23, 2016.
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