• Food adverse reactions: Any undesirable reaction that may occur after ingesting a food.
• Food intolerance: It is the inability of a person to tolerate a food for some reason. They are non-immunological reactions (lactase deficiency, galactosemia, cystic fibrosis, G6PD deficiency-favism .. etc.) in the body that occur due to metabolic disorder, enzyme deficiency, toxic substances in the food, pharmacological properties of the food or infective agents in the food and can be seen in everyone. It may also occur as a pharmacological response to chemical substances (such as a drug side effect). In addition, toxic effects against foods are also included in this classification.
• Symptoms of food intolerance appear when large amounts of food are taken, whereas in food hypersensitivity, the reaction or symptoms appear after a small amount of food is taken.
• Late introduction to allergic foods increases the risk of allergy related to these foods, especially in cases with atopic dermatitis.
• Since it has been understood that a deterioration in the skin barrier is a risk factor for food allergy, measures to reduce the incidence of food allergy, such as reducing the frequency of bathing from birth and using a moisturizer, are still in the experimental stage.
Tests used in diagnosis
1. Skin-prick test or measurement of specific IgE in blood in IgE-mediated reactions
2. Patch testing if cell-mediated reactions
Definitive diagnosis is made with a (+) double-blind and, if possible, placebo-controlled food provocation test performed after the patient's recovery with an elimination diet for 2 weeks in IgE-mediated reactions and 8 weeks in non-IgE-mediated reactions.
Special Situations In Food Allergies
1. Oral allergy syndrome (pollen-related food allergy syndrome):
It is seen in cases with pollen allergy and allergic rhinitis. With the intake of food that cross-reacts with pollen, itching of the lips, throat, tongue, uvula, soft palate, angioedema, and a feeling of narrowing in the throat occur and pass in a short time. There is a cross-reaction between peaches, carrots, cherries, apples and hazelnuts and birch pollen.
2. Food allergy-related exercise anaphylaxis:
It is most commonly seen if patients with allergies to bananas, kiwis, wheat products (wheat and omega-5-gliadin) or shrimp eat these foods and exercise within 4-6 hours.
3. Latex allergy:
There may be cross-reactions with walnuts, bananas, kiwis, avocados, peaches, tomatoes, figs and peppers, and anaphylaxis may develop with the ingestion of these foods.
Similar reactions may occur if exercise is performed within 4-6 hours of taking aspirin and NSAIDs.
Allergen Immunotherapy
• Generally recommended for children over 5 years old, excluding venom allergy (with the exception of bee venom anaphylaxis).
• Increases allergen-specific IgG formation and decreases allergen-specific IgE.
Indications
• Seasonal or perennial allergic rhinoconjunctivitis
• Allergic asthma
• Venom allergy
• Atopic dermatitis
Immunotherapy is not recommended for food allergy, latex allergy and acute-chronic urticaria.
Contraindications
• Patients using beta-blockers (risk of allergic reaction increases and response decreases).
• Patients using ACE inhibitors
• Allergic bronchopulmonary aspergillosis (no use).
• Hypersensitivity pneumonitis (no use).
• Severe psychiatric disorders
• Unstable asthma (increased risk of fatal anaphylaxis)
• Autoimmune diseases (disease can be activated by immunotherapy)
• The above situations are contraindications for initiation and dose escalation of immunotherapy.
• The patient who receives his current treatment can continue his treatment throughout the pregnancy.
