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Challenges of modern medicine: food allergy and its complicated reality
Introduction
Food allergy is an abnormal reaction of the immune system to proteins in foods. The immune system in the case of food allergy recognizes certain food components as harmful, which leads to the activation of the body's defense mechanisms. The classification of food allergy includes different types of immune reactions, and these mechanisms can be complex. Pediatricians, who play a key role in the diagnosis and treatment of food allergy, face numerous difficulties in becoming the first line of defense against this condition.
Classification and immune mechanisms
Here is basic information on the classification and immunological mechanisms of food allergy:
Food allergy classification:
- Type I (immediate, IgE-mediated reactions): Characteristic symptoms appear within minutes to hours after ingestion of the allergen. The immune system reacts by releasing chemicals such as histamine.
- Examples: allergies to nuts, milk, eggs, seafood.
- Type II (cytotoxic):The immune system attacks the cells containing the allergen, causing cellular damage.
- Rare in food allergies.
- Type III (immune complexes) :
- Formation of immune complexes that become embedded in tissues and lead to inflammatory reactions.
- Rarely seen in food allergy.
- Type IV (delayed cellular, cell-mediated, T-interstitial reactions): Immune reactions occur hours to days after contact with the allergen. T-cells are involved. Example: skin contact allergy.
Immune mechanisms of food allergy:
- Sensitization: initial contact with the allergen results in the production of specific IgE antibodies.
- Mast cell activation:
- Re-contact with the allergen leads to the activation of mast cells, which release chemicals such as histamine.
- Inflammatory reaction: The release of histamine and other mediators leads to allergy symptoms such as itching, rash, swelling, and difficulty breathing.
- Cellular reactions (Type IV) :
- T-cells react with an allergen, causing inflammatory reactions in tissues.
- Cytokine production: The immune response produces various cytokines that are involved in regulating the immune response.
Diagnosis and treatment
Diagnosis and treatment of food allergy are key to controlling symptoms and improving the patient's quality of life. Below is general information on the diagnosis and treatment of food allergy:
Diagnosis of food allergy:
Medical history and interview: Your doctor will take a thorough history of your symptoms, how often they occur and how they relate to the food you eat.
Skin tests: Skin tests are performed, in which small amounts of allergens are introduced under the patient's skin, and the skin reaction is evaluated.
Blood testing: Determining the level of specific IgE antibodies in the blood can help identify allergens.
Provocation tests: In cases of doubt, your doctor may order provocative tests, during which you consume controlled amounts of an allergen under medical supervision.
Elimination and provocation: This involves eliminating potential allergens from the diet and then gradually introducing them under medical supervision.
Food allergy treatment:
Allergen elimination: The patient must avoid eating foods containing the allergen responsible for the allergic reaction.
Patient education: Guidance on reading food labels, recognizing hidden allergens and awareness of risk situations.
Antihistamines: For allergic reactions, antihistamines can be used to relieve symptoms such as itching, rash and runny nose.
Epinephrine: Patients with severe allergies, especially to nuts, can carry an epinephrine auto-syringe with them to reduce reaction time in case of sudden anaphylactic shock.
Dietary treatment: Work with a dietitian to develop a balanced elimination diet that provides essential nutrients.
Immune desensitization: In some cases, under medical supervision, desensitization, the gradual introduction of small amounts of an allergen to minimize the reaction, may be used.
Monitoring progress: Regular check-ups with the doctor to monitor progress, adjust treatment and assess any changes in allergic reactions.
Prevalence and symptoms of food allergy
The incidence of food allergy is increasing, becoming a global health problem. Symptoms of food allergy can vary and involve many body systems. Below is information on the prevalence and main symptoms of food allergy:
Prevalence:
Children:
In children, food allergies are relatively more common than in adults. About 6-8% of children may experience some type of food allergy. The most common allergens in children are milk, eggs, nuts, soy, wheat.
Adults:
The prevalence of food allergy in adults is lower than in children, but still significant. Some food allergies, especially to seafood, nuts and fish, can persist throughout life.
Upward trend:
There is an upward trend in the incidence of food allergies in many countries.
Food Allergy Symptoms:
- Skin Symptoms: Rashes, itching, hives (skin sensitization), redness.
- Gastrointestinal Symptoms
- :
- Abdominal pain, nausea, vomiting, diarrhea.
- Respiratory Symptoms: Runny
- nose, sneezing, shortness of breath, asthma.
- Cardiovascular symptoms:
- Swelling of the mouth, tongue, so-called angioedema.
- General symptoms
- : Fatigue
- , loss of consciousness, anaphylaxis (systemic reaction, potentially life-threatening).
- Delayed symptoms (Type IV)
- :
- Appear a few hours to a few days after ingestion of the allergen.
- May include skin inflammation, gastrointestinal problems.
- Allergen-dependent symptoms: Specific symptoms related to the type of allergen, such as burning in the mouth and throat in the case of a fruit allergy, or hives in a reaction to nuts .
Food allergies vs. other food reactions
Food allergies are different from other food reactions, such as food intolerances or food toxin infections. Here are some key differences between food allergies and food intolerances.
Food allergies:
Immune mechanism:
Food allergies are reactions of the immune system to proteins in foods. The immune mechanism, usually associated with IgE antibodies, leads to the release of chemicals such as histamine.
Symptoms:
Symptoms of food allergy can include itching, rash, difficulty breathing, abdominal pain, vomiting, diarrhea and even anaphylaxis. Symptoms usually occur quickly after ingestion of the allergen.
Diagnostic tests
Skin tests, blood tests (determination of IgE levels), provocation tests under medical supervision.
Food Intolerances:
Mechanism:
Food intolerances result from difficulties in digesting or assimilating certain nutrients. Lacking immune system involvement, intolerances are usually caused by a deficiency of digestive enzymes.
Symptoms:
Symptoms of food intolerance can include abdominal pain, bloating, diarrhea, and general malaise. Symptoms may appear gradually after eating a particular food.
Diagnostic tests:
- Often more difficult to diagnose than allergies.
- Elimination tests, breath tests, blood tests, and dietary trials .
New perspectives and therapies
Research into food allergies is leading to new perspectives and therapies to better understand immune mechanisms, develop more effective forms of diagnosis, and find innovative treatments. Below are some areas that are currently the focus of food allergy research and development:
Immunotherapy:
Oral Immunotherapy (OIT):
Patients are gradually exposed to small amounts of allergen, increasing the dose gradually.
The goal: to induce immune tolerance and reduce allergic reactions.
Research on efficacy and safety is ongoing, especially for nut and egg allergies.
Immunotherapy through the skin (EPIT):
Patients are treated with small amounts of allergens on special patches placed on the skin.
Research on potential efficacy and safety.
Biological treatment:
Monoclonal antibodies:
Research into the use of monoclonal antibodies to block allergy-related immune responses. An example is research on monoclonal antibodies that block IgE.
Cytokine inhibitors:
Research on substances that block cytokines associated with allergic reactions, such as interleukin-4 (IL-4) or interleukin-13 (IL-13).
Molecular diagnostics:
Studies of molecular markers:
Search for specific molecular markers associated with different types of food allergy. Facilitate accurate diagnosis and determine the risk of allergic reaction.
Information technologies:
Mobile applications and web-based platforms:
Developing information technologies for monitoring and managing food allergies. Electronic data management systems for allergy patients.
Gene therapies:
Gene therapy research:
Experimental research on modifying genes to reduce immune responses.
Probiotics and gut microbiota:
Research on the role of the gut microbiota:
Research on the impact of probiotics and modification of the gut microbiota on the development of food allergies. Identification of beneficial bacteria affecting immune system health.
Education and awareness:
Educational programs and public awareness campaigns:
Promoting food allergy awareness. Educate the public, including medical personnel, about allergy diagnosis, treatment and management.
Summary
This article discusses the complexity of food allergy, with its various immunological mechanisms, challenges of diagnosis and treatment, and new therapeutic perspectives. It also covers key aspects related to prevalence, symptoms and the difference between allergy and intolerance. Food allergy, becoming a global health problem, requires a comprehensive approach that takes into account both clinical and social aspects.
Bibliography
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- 2010 Dec;126(6):1105-18.
- Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy .
- N Engl J Med.
- 2015 Feb 26;372(9):803-13. Sampson
- HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: Summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol.
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