Journal List > Korean J Pediatr Gastroenterol Nutr > v.14(2) > 1043496

Hwang: Clinical Perspectives of Food Allergy in Infants and Young Children

Abstract

Food allergies affect 7~8% of infants and young children, and their prevalence appears to have increased in recent years. Food allergy refers to an abnormal immunological reaction to a specific food. These reactions can be recurrent each time the food is ingested. Food allergy manifests itself with a wide spectrum of clinical characteristics including IgE-mediated diseases as immediate reactions, non-IgE-mediated disorders as delayed reactions, and mixed hypersensitivities. As a consequence, the clinical picture of a food allergy is pleomorphic. A well-designed oral food challenge is the most reliable diagnostic test for infants and young children whose clinical history and physical examination point towards a specific food allergy. Food specific IgE antibody tests (RAST, MAST, skin prick test, Uni-CAP, etc) are an alternative tool to determine oral food challenge for IgE-mediated disorders, but not for non-IgE-mediated allergies. Moreover, parents often impose their children on unnecessary diets without adequate medical supervision. These inappropriate dietary restrictions may cause nutritional deficiencies. This review aims to introduce clinical perspectives of food allergy in infants and young children and to orient clinicians towards different strains of diagnostic approaches, dietary management, and follow-up assessment of tolerance development.

Figures and Tables

Table 1
Clinical Features and Differential Diagnosis of Food Allergy in Infants and Young Children
kjpgn-14-113-i001

OFC: oral food challenge, PH/AA: protein hydrolysate or amino acid formula, FPIES: food protein-induced enterocolitis syndrome, FPIPC: food protein-induced proctocolitis, GERD: gastroesophageal reflux disease.

References

1. Cianferoni A, Spergel JM. Food allergy: review, classification and diagnosis. Allergol Int. 2009. 58:457–466.
crossref
2. Bischoff SC. Food allergy and eosinophilic gastroenteritis and colitis. Curr Opin Allergy Clin Immunol. 2010. 10:238–245.
crossref
3. Husby S. Food allergy as seen by a paediatric gastroenterologist. J Pediatr Gastroenterol Nutr. 2008. 47:49S–53S.
crossref
4. Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010. 125:116S–125S.
crossref
5. Sampson HA, Anderson JA. Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J Pediatr Gastroenterol Nutr. 2000. 30:Suppl 1. 87–94.
crossref
6. Allen KJ, Davidson GP, Day AS, Hill DJ, Kemp AS, Peake JE, et al. Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health. 2009. 45:481–486.
crossref
7. Heine RG. Allergic gastrointestinal motility disorders in infancy and early childhood. Pediatr Allergy Immunol. 2008. 19:383–391.
crossref
8. Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P. Cow's milk protein allergy in children: a practical guide. Ital J Pediatr. 2010. 36:5–11.
crossref
9. Hwang JB, Song JY, Kang YN, Kim SP, Suh SI, Kam S, et al. The significance of gastric juice analysis for a positive challenge by a standard oral challenge test in typical cow's milk protein-induced enterocolitis. J Korean Med Sci. 2008. 23:251–255.
crossref
10. Choi SY, Park MH, Choi WJ, Kang U, Oh HK, Kam S, et al. Clinical features and the natural history of dietary protein induced proctocolitis: a study on the elimination of offending foods from the maternal diet. Korean J Pediatr Gastroenterol Nutr. 2005. 8:21–30.
crossref
11. Hwang JB, Sohn SM, Kim AS. Prospective follow-up oral food challenge in food protein-induced enterocolitis syndrome. Arch Dis Child. 2009. 94:425–428.
crossref
12. Klemola T, Vanto T, Juntunen-Backman K, Kalimo K, Korpela R, Varjonen E. Allergy to soy formula and to extensively hydrolyzed whey formula in infants with cow's milk allergy: a prospective, randomized study with a follow-up to the age of 2 years. J Pediatr. 2002. 140:219–224.
crossref
13. Bhatia J, Greer F. Use of soy protein-based formulas in infant feeding. Pediatrics. 2008. 121:1062–1068.
crossref
14. Lifschitz CH, Hawkins HK, Guerra C, Byrd N. Anaphylactic shock due to cow's milk protein hypersensitivity in a breast-fed infant. J Pediatr Gastroenterol Nutr. 1988. 7:141–144.
crossref
15. Isolauri E, Tahvanainen A, Peltola T, Arvola T. Breastfeeding of allergic infants. J Pediatr. 1999. 134:27–32.
crossref
16. Hwang JB, Kang YN, Won KS. Protein losing enteropathy in severe atopic dermatitis in an exclusively breast-fed infant. Pediatr Dermatol. 2009. 26:638–639.
crossref
17. Restani P, Gaiaschi A, Plebani A, Beretta B, Velonà T, Cavagni G, et al. Evaluation of the presence of bovine proteins in human milk as a possible cause of allergic symptoms in breast-fed children. Ann Allergy Asthma Immunol. 2000. 84:353–360.
crossref
18. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol. 2004. 113:11–28.
crossref
19. Manoura A, Hatzidaki E, Korakaki E, Mitsaki M, Valari V, Giannakopoulou C. Eosinophilia in sick neonates. Haematologia. 2002. 32:31–37.
crossref
20. DeBrosse CW, Case JW, Putnam PE, Collins MH, Rothenberg ME. Quantity and distribution of eosinophils in the gastrointestinal tract of children. Pediatr Dev Pathol. 2006. 9:210–218.
crossref
21. Shon SM, Kim KI, Park MH, Kang YN, Lee HJ, Hwang JB. A case of Churg-Strauss syndrome in infancy. Korean J Pediatr Gastroenterol Nutr. 2007. 10:65–70.
crossref
22. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011. 04. 07. [Epub ahead of print].
23. Hwang JB, Lee SH, Kang YN, Kim SP, Suh SI, Kam S. Indexes of suspicion of typical cow's milk protein-induced enterocolitis. J Korean Med Sci. 2007. 22:993–997.
crossref
24. Nowak-Wegrzyn A, Sampson H, Wood RA, Sicherer SH. Food protein-induced enterocolitis syndrome caused by solid food proteins. Pediatrics. 2003. 111:829–835.
crossref
25. Park MH, Sohn SM, Choe BK, Kim YH, Kang YN, Choi WJ, et al. A case of isolated rice allergy. Korean J Pediatr Gastroenterol Nutr. 2006. 9:80–84.
crossref
26. Hwang JB, Kang KJ, Kang YN, Kim AS. Probiotic gastrointestinal allergic reaction caused by Saccharomyces boulardii. Ann Allergy Asthma Immunol. 2009. 103:87–88.
crossref
27. Hwang JB, Park MH, Kang YN, Kim SP, Suh SI, Kam S. Advanced criteria for clinicopathological diagnosis of food protein-induced proctocolitis. J Korean Med Sci. 2007. 22:213–217.
crossref
28. Song JY, Kang YN, Kim JR, Hwang JB. Clinical significance of food-specific IgE antibody tests in food protein-induced proctocolitis. Korean J Pediatr Gastroenterol Nutr. 2008. 11:36–41.
crossref
29. Xanthakos SA, Schwimmer JB, Melin-Aldana H, Rothenberg ME, Witte DP, Cohen MB. Prevalence and outcome of allergic colitis in healthy infants with rectal bleeding: a prospective cohort study. J Pediatr Gastroenterol Nutr. 2005. 41:16–22.
crossref
30. Odze RD, Bines J, Leichtner AM, Goldman H, Antonioli DA. Allergic proctocolitis in infants: a prospective clinicopathologic biopsy study. Hum Pathol. 1993. 24:668–674.
crossref
31. Machida HM, Catto Smith AG, Gall DG, Trevenen C, Scott RB. Allergic colitis in infancy: clinical and pathologic aspects. J Pediatr Gastroenterol Nutr. 1994. 19:22–26.
32. Ohtsuka Y, Shimizu T, Shoji H, Kudo T, Fujii T, Wada M, et al. Neonatal transient eosinophilic colitis causes lower gastrointestinal bleeding in early infancy. J Pediatr Gastroenterol Nutr. 2007. 44:501–505.
crossref
33. Arvola T, Ruuska T, Keränen J, Hyöty H, Salminen S, Isolauri E. Rectal bleeding in infancy: clinical, allergological, and microbiological examination. Pediatrics. 2006. 117:e760–e768.
crossref
34. Iacono G, Carroccio A, Cavataio F, Montalto G, Kazmierska I, Lorello D, et al. Gastroesophageal reflux and cow's milk allergy in infants: a prospective study. J Allergy Clin Immunol. 1996. 97:822–827.
crossref
TOOLS
Similar articles