Immunoglobulin EaEuromediated food allergies in childhood

Immunoglobulin E (IgE)-mediated food allergies are common in childhood. In infants and toddlers primary food allergy is the most common. Most frequent triggers are hen's egg, followed by cow's milk, peanuts, tree nuts, wheat, soy and fish. Moreover, pollen-associated food allergy often develops in school children and teenagers. Immediate type reactions are most common in food allergies. Patients with primary food allergy often present with urticaria, angioedema, vomiting, asthmatic symptoms, stridor and drop in blood pressure. Patients with pollen-associated food allergies often develop oral or pharyngeal symptoms. An important risk factor for the development of primary food allergy is the presence of atopic eczema with skin barrier dysfunction followed by sensitization. Prevention strategies through early oral tolerance induction are currently under evaluation. Patient history, determination of sensitization and oral food challenges are the most important diagnostic tools. Elimination diets are currently the only therapeutic option. Patients at increased risk for anaphylaxis require an adrenalin autoinjector for the treatment of accidental reactions, instructions on usage, an anaphylaxis pass with written instructions and thorough schooling. Immunotherapeutic approaches for food allergies are currently under development. The long-term prognosis of food allergies depends on the allergen. Peanut and tree nut allergies tend to persist lifelong whereas hen's egg and cow's milk allergies are frequently outgrown. Regular re-evaluation is therefore necessary.