Definitions

Food allergy affects 6% of US children younger than 5 years and 3.5–4% of the general population. Incidence of peanut allergy has quadrupled over the past decade in the USA. Pathophysiology of food reactions may be IgE-mediated, non-IgE-mediated, or mixed, IgE- and non-IgE-mediated, affecting the skin, gastrointestinal tract, respiratory tract, and/or cardiovascular system. Foods are major triggers of anaphylaxis in all ages. Increasing levels of serum food-specific IgE or skin-prick wheal diameters correlate with increasing probabilities of reactions. The double-blind, placebo-controlled food challenge remains the diagnostic gold standard. Food allergen avoidance requires education about reading ingredient labels, avoiding cross-contact, and obtaining safe meals. Managing food-induced anaphylaxis requires education about recognizing symptoms and prompt treatment with epinephrine. Early exposure to food through a disrupted skin barrier leads to allergic sensitization, whereas early oral exposure to peanut may induce tolerance. Novel therapies utilize both allergen-specific and allergen-non-specific approaches, with great potential for effective desensitization. Because of safety concerns and ongoing evaluation of long-term efficacy parameters, immunotherapy for food allergy remains investigational.