Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité -Universitätsmedizin Berlin, Berlin, Germany.
Clin Exp Allergy. 2022 Nov;52(11):1302-1310. doi: 10.1111/cea.14203. Epub 2022 Aug 10.
Food allergy is a growing health concern with a prevalence of 2%-3% in the adult population in Europe. Non-immune-mediated food hypersensitivities, which include reactions after ingestion of food additives, affect 1% of adults and may resemble IgE-induced allergic reactions without identifiable immunologic sensitization. A double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for the diagnosis of any food hypersensitivity.
We analysed a large group of adult patients with suspected food hypersensitivity, who had undergone DBPCFC, to better understand IgE-mediated food allergy and non-immune-dependent food hypersensitivity to food additives in adults regarding elicitors, symptoms and positivity rates of oral challenges.
Data from 541 patients with suspected food hypersensitivity were analysed, who underwent an oral food challenge between 2010 and 2019.
IgE-dependent food allergy was confirmed in 114 of 329 adult patients (34.6%). The confirmation rate was lower in the group of patients with suspected non-immune-mediated reactions to food additives (65 of 286, 22.7%). Urticaria and angioedema appeared more frequently in patients with IgE-mediated food allergies. By contrast, flush and diarrhoea were the most frequent symptoms after a challenge in the group with the non-immune-mediated reactions to food additives. Wheat and celery were the most frequently identified food allergens in adults, whereas colourings and preservatives were the most frequent elicitors of non-immune-mediated food hypersensitivity.
The importance of oral food challenges for the diagnosis of food hypersensitivity is confirmed. IgE-dependent food allergy is more frequently proven, reaching a positivity rate of one-third and only about 20% for non-immune-mediated hypersensitivity. Future studies should elaborate on the mechanisms of non-immune-mediated food hypersensitivity and the clinical impact of cofactors in this setting.
食物过敏是一个日益严重的健康问题，在欧洲成年人中的发病率为 2%-3%。非免疫介导的食物超敏反应，包括摄入食物添加剂后的反应，影响 1%的成年人，并且可能类似于 IgE 诱导的过敏反应，而没有可识别的免疫致敏。双盲安慰剂对照食物挑战（DBPCFC）是诊断任何食物超敏反应的金标准。
我们分析了一组接受 DBPCFC 检测的疑似食物过敏的成年患者，以更好地了解成年人中 IgE 介导的食物过敏和非免疫依赖的食物添加剂超敏反应，包括激发物、症状和口服挑战的阳性率。
分析了 2010 年至 2019 年间接受口服食物挑战的 541 名疑似食物过敏患者的数据。
在 329 名成年患者中，114 名（34.6%）被证实为 IgE 依赖性食物过敏。在疑似非免疫介导的食物添加剂反应患者组中，确认率较低（286 例中的 65 例，22.7%）。荨麻疹和血管性水肿在 IgE 介导的食物过敏患者中更为常见。相比之下，在非免疫介导的食物添加剂反应组中，潮红和腹泻是最常见的挑战后症状。小麦和芹菜是成年人中最常见的食物过敏原，而着色剂和防腐剂是最常见的非免疫介导的食物超敏反应激发物。
口服食物挑战对食物过敏诊断的重要性得到证实。IgE 依赖性食物过敏更频繁地被证实，阳性率达到三分之一，而非免疫介导的超敏反应仅约为 20%。未来的研究应详细阐述非免疫介导的食物超敏反应的机制以及在这种情况下的协同因素的临床影响。
