Adult IgE-mediated food allergy is on the rise: A review of phenotypes, pathophysiologic mechanisms, diagnosis, and advances in management
Chanita Unhapipatpong,1 Narachai Julanon,2 Thanachit Krikeerati,3,4 Irin Vichara-anont,3,4 Mongkhon Sompornrattanaphan3,4
1 Division of Clinical Nutrition, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand
2 Division of Dermatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
3 Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
4 Faculty of Medicine Siriraj Hospital, Center of Research Excellence in Allergy and Immunology, Mahidol University, Bangkok, Thailand
Abstract
The prevalence of adult food allergies is increasing worldwide. Many aspects of food allergy in adulthood are different from childhood. We review the current evidence on adult food allergy regarding the global prevalence, adult phenotypes, cofactors, diagnostic methods, and management. A high proportion of severe reactions and unique phenotypes in adults have been characterized. Individual comorbidities could be risk factors for severe reactions and complicate the physician’s diagnosis as various conditions can mimic food allergies. Many cofactors affect the eliciting threshold of reaction, affecting whether a reaction occurs and its severity. Large and complex meals, various food allergens, and contaminants increase diagnostic difficulties. An action plan should be devised to add a framework for national policies, thereby lessening the biophysical and health-related quality of life impacts of food allergy. Research into novel treatments is ongoing.
Key words: Anaphylaxis, epidemiology, food allergy, immunoglobulin E, phenotype, prevalence