Fuchs M
Dĕtské oddĕlení Fakultní nemocnice Bulovka, Praha.
Cas Lek Cesk. 1998 Sep 21;137(18):547-51.
Food allergy must have an immunological background. Till recently it was restricted only to the IgE mechanism, today we include also non-atopical reactions (in particular type III and IV according to Coombs and Gell). We speak of probable and possible food allergies. By differential diagnosis we must differentiate food allergies from food intolerance (e.g. enzyme deficiencies), food aversions (psychic factor) as well as toxic and pharmacological effects. There are more than 10% undesirable reactions in humans after ingestion of food but only every fifth (some 2% of the population have food allergies. The diagnosis is based above all on the case-history, subsequent elimination and exposure tests and examination by allergological tests, or examination of specific immunoglobulins E (IgE). The diagnosis is not always unequivocal--it is influenced among others by a different specificity and sensitivity of food antigens (allergens). The manifestations of food allergy are found at the site of action (mouth, GIT) or are systemic (respiration, cardiovascular system, skin etc.). A special type of food allergy is the oral alimentary syndrome, i.e. food allergy crossed with pollen hypersensitivity, described in the great majority of subjects sensitive to pollen. Food allergy has its specific age-conditioned and geographical features. In childhood sensitivity to the protein of cows milk, egg white but also soya or flour predominates, with advancing age allergies to nuts, fruit, vegetables, spices, cheese, sea foods increase. Food allergy can be a very early allergy (manifested already in infant age) but it is one of the few allergies which can also recede (incl. laboratory tests). Treatment is dietetic, the period of dietetic treatment depends on the type of food and the patient's age, not infrequently it must be lifelong. If diet does not suffice, preventive medication is used (sodium cromoglycate) or symptomatic (antihistamine preparations, corticosteroids, external agents etc.), in some countries specific immunotherapy is being tested.
食物过敏必须有免疫学背景。直到最近，它还仅局限于IgE机制，如今我们也纳入了非特应性反应（特别是根据库姆斯和盖尔分类的III型和IV型）。我们提及可能的食物过敏。通过鉴别诊断，我们必须将食物过敏与食物不耐受（如酶缺乏）、食物厌恶（心理因素）以及毒性和药理作用区分开来。人类摄入食物后有超过10%的不良反应，但只有五分之一（约2%的人口有食物过敏）。诊断首先基于病史、随后的排除和激发试验以及过敏学检测，或特异性免疫球蛋白E（IgE）检测。诊断并不总是明确的——它受到食物抗原（过敏原）不同的特异性和敏感性等因素影响。食物过敏的表现出现在作用部位（口腔、胃肠道）或全身性（呼吸、心血管系统、皮肤等）。一种特殊类型的食物过敏是口腔消化道综合征，即食物过敏与花粉过敏交叉，在绝大多数对花粉敏感的个体中都有描述。食物过敏有其特定的年龄条件和地域特征。在儿童时期，对牛奶蛋白、蛋清以及大豆或面粉的敏感性占主导，随着年龄增长，对坚果、水果、蔬菜、香料、奶酪、海鲜的过敏增加。食物过敏可能是一种非常早期的过敏（在婴儿期就已表现），但它是少数几种也可能消退的过敏之一（包括实验室检测）。治疗是饮食性的，饮食治疗的时间取决于食物类型和患者年龄，通常必须是终身的。如果饮食治疗不足，会使用预防性药物（色甘酸钠）或对症药物（抗组胺制剂、皮质类固醇、外用药物等），在一些国家正在试验特异性免疫疗法。
