Food allergy.

Adverse clinical reactions to food associated with disturbed immunologic function (food allergy) affect 1-3% of the population and vary from life-threatening to a minor inconvenience. They must be differentiated from reactions caused by toxins, pharmacologic agents, enzyme deficiences and non-specific release of inflammatory mediator substances. Enteric absorption of food protein antigens which may occur despite an array of gastrointestinal protective mechanisms normally induces both a protective immune response and immunologic tolerance. Quantitative changes in absorption related to deficient protective mechanisms or excessive antigen load may contribute to the development of an allergic immune response and explain the greater incidence of food allergy in infants and children. Important factors include immunologic immaturity, enhanced macromolecular mucosal transport, intrauterine and neonatal malnutrition, breast feeding and infection. Double-blind food challenge tests remain as the most definitive diagnostic yardstick but carefully standardized skin tests may be helpful if interpreted in the context of the clinical history. Despite the association of food allergy with food antigen specific IgE hypersensitivity, immune complex formation and lymphocyte sensitization the pathophysiological changes which result in symptoms remain obscure. Recent advances have clarified many aspects of our knowledge of food allergy but inevitably have raised many more questions for future study.