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The immunologic basis for gastrointestinal food allergy

MacDonald, Thomas Ta; Di Sabatino, Antoniob

Current Opinion in Gastroenterology: November 2009 - Volume 25 - Issue 6 - p 521–526
doi: 10.1097/MOG.0b013e3283306236
Immunology: Edited by W. Allan Walker

Purpose of review Food allergies are common in children, although rare in adults. They can be life threatening via anaphylaxis, especially to peanut, and cause distress to children and parents because of the disease itself, and then through the difficulty of pursuing a strict elimination diet. In parents/carers and adults, this has significant impact on quality of life. The purpose of this review is to determine the therapeutic potential and current treatments for these conditions by understanding and manipulating the immune response.

Recent findings The single largest change in attitude to food allergies has been the realization that delaying exposure to foods may be harmful in terms of immune sensitization. Instead, strategies aimed at early introduction of foods to induce oral tolerance are now being re-evaluated. At the same time, very encouraging results are being obtained in desensitizing allergic children via oral tolerance. The aim of this strategy is not necessarily to induce complete tolerance to foods in allergic children but to raise the threshold dose at which adverse events occur, to minimize reactions to trace amounts of allergens.

Summary Food allergies are now recognized as being a treatable component of the atopic march.

aCentre for Immunology and Infectious Disease, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK

bFirst Department of Medicine, Fondazione IRCCS Policlinico S. Matteo, Centro per lo Studio e la Cura delle Malattie Infiammatorie Croniche Intestinali, University of Pavia, Pavia, Italy

Correspondence to Professor Thomas T. MacDonald, Centre for Infectious Disease, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Whitechapel, London E1 2AT, UK E-mail: t.t.macdonald@qmul.ac.uk

© 2009 Lippincott Williams & Wilkins, Inc.