Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment

J Allergy Clin Immunol. 2014 Feb;133(2):291-307; quiz 308. doi: 10.1016/j.jaci.2013.11.020. Epub 2013 Dec 31.


This review focuses on advances and updates in the epidemiology, pathogenesis, diagnosis, and treatment of food allergy over the past 3 years since our last comprehensive review. On the basis of numerous studies, food allergy likely affects nearly 5% of adults and 8% of children, with growing evidence of an increase in prevalence. Potentially rectifiable risk factors include vitamin D insufficiency, unhealthful dietary fat, obesity, increased hygiene, and the timing of exposure to foods, but genetics and other lifestyle issues play a role as well. Interesting clinical insights into pathogenesis include discoveries regarding gene-environment interactions and an increasing understanding of the role of nonoral sensitizing exposures causing food allergy, such as delayed allergic reactions to carbohydrate moieties in mammalian meats caused by sensitization from homologous substances transferred during tick bites. Component-resolved diagnosis is being rapidly incorporated into clinical use, and sophisticated diagnostic tests that indicate severity and prognosis are on the horizon. Current management relies heavily on avoidance and emergency preparedness, and recent studies, guidelines, and resources provide insight into improving the safety and well-being of patients and their families. Incorporation of extensively heated (heat-denatured) forms of milk and egg into the diets of children who tolerate these foods, rather than strict avoidance, represents a significant shift in clinical approach. Recommendations about the prevention of food allergy and atopic disease through diet have changed radically, with rescinding of many recommendations about extensive and prolonged allergen avoidance. Numerous therapies have reached clinical trials, with some showing promise to dramatically alter treatment. Ongoing studies will elucidate improved prevention, diagnosis, and treatment.

Keywords: AD; APT; Allergen-specific serum IgE; Atopic dermatitis; Atopy patch test; CMA; COFAR; CRD; Component-resolved diagnostics; Consortium of Food Allergy Research; Cow's milk allergy; EHCF; EoE; Eosinophilic esophagitis; Extensively hydrolyzed casein formula; FLG; Filaggrin; Food allergy; Galactose-α-1,3-galactose; LR; Likelihood ratio; NHANES; National Health and Nutrition Examination Survey; OFC; OR; Odds ratio; Oral food challenge; PPV; Positive predictive value; SPT; Skin prick test; anaphylaxis; food allergens; food hypersensitivity; gastrointestinal food hypersensitivity; oral tolerance; sIgE; α-Gal.

Publication types

  • Review

MeSH terms

  • Filaggrin Proteins
  • Food Hypersensitivity* / diagnosis
  • Food Hypersensitivity* / epidemiology
  • Food Hypersensitivity* / etiology
  • Food Hypersensitivity* / therapy
  • Humans