Portal de Periódicos da CAPES

Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment

2014; Elsevier BV; Volume: 133; Issue: 2 Linguagem: Inglês

10.1016/j.jaci.2013.11.020

1097-6825

Scott H. Sicherer, Hugh A. Sampson,

Contact Dermatitis and Allergies

In the 3 years since our last review, remarkable advances have occurred in understanding and managing food allergies. Unfortunately, the intense efforts to improve diagnosis, treatment, and prevention are partly the result of an unexplained significant increase in prevalence. Although conflicting studies and disappointing results in some clinical treatment trials are frustrating, remarkable advances in diagnosis and treatment are already apparent, and new insights on cause and pathogenesis are resulting in renewed efforts with novel approaches toward prevention, diagnosis, and treatment. With deeper insights into genetics and the microbiome, incorporation of bioinformatics, and numerous approaches to treatment in preclinical and clinical studies, we are poised to witness a revolution in our approach to food allergy over the next several years.What do we know?•The prevalence of food allergy is high, up to 10% of the population, and likely increased in the past decades.•Numerous genetic and environmental risk factors have been identified.•Insights on route of sensitization, allergen characterization, and immune response provide insights for diagnosis and treatment.•There is a wide spectrum of disease caused by food allergy related to different immune mechanisms and the target organs affected. Diagnosis depends on combining a knowledge of pathophysiology and epidemiology with the patient's history and test results. It is clearly possible to have sensitization without clinical reactivity and vice versa.•The use of CRD is entering clinical practice.•Management currently requires attention to allergen avoidance and emergency treatment, and numerous resources are available to patients and physicians to promote education and counseling to improve safety and quality of life.•Numerous clinical trials are underway for more definitive therapies.What is still unknown?•The cause for an increase in food allergy•Translation of environmental and genetic risk factors into improved prevention•The best diagnostic approaches•How to maximize safety and quality of life during management•The best novel therapeutic options•A “personalized medicine” approach to diagnosis and treatment of food allergy is likely required but remains elusive.Key concepts and therapeutic implications•Identification of food-specific IgE by means of testing indicates sensitization but is not, in isolation, diagnostic.•Knowledge of the epidemiology, natural course, pathophysiology, and clinical manifestations of food allergies and other adverse reactions to foods is required to approach diagnosis and management. The medical history is key, noninvasive tests are supportive and possibly diagnostic, and the OFC is the most definitive test.•Management requires attention to education about avoidance and prompt appropriate treatment of anaphylaxis.•Various approaches to treatment are under investigation, and patients should be alerted to clinical trials.