Food allergy in children in 2023

Abstract

The aim of this article is to describe the most common clinical presentations of non-IgE-mediated, IgE-mediated and mixed forms of food allergy.

Four clinical groups of non-IgE-mediated food allergy can be distinguished: food protein-induced dysmotility, food protein-induced allergic proctocolitis (FPIAP), food protein-induced enterocolitis syndrome (FPIES) and food protein-induced enteropathy (FPE). In non-IgE mediated food allergy, cow's milk and soya are the 2 most common offenders, but other food allergens may be involved. Diagnosis is based on clinical criteria, elimination of the suspected food and, if necessary, oral food challenge.

IgE-mediated food allergy has a wide spectrum of clinical manifestations which can involve several organ systems. The most severe manifestation is anaphylaxis. Eight food allergens are responsible for 90% of allergic reactions in children: cow's milk, hen's egg, hazelnut, peanut, soya, wheat, fish and shellfish. Diagnosis is based on a thorough medical history, skin prick testing and serum IgE testing.

Food allergy can also occur as a mixed IgE and non-IgE mechanism, with atopic dermatitis and eosinophilic oesophagitis being the most common clinical manifestations.

Strict avoidance of the offending foods is the main goal in the management of food allergy. This is best achieved in multidisciplinary collaboration with dieticians experienced in food allergy.