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Food hypersensitivity in children
Food hypersensitivity (FHS) refers to a nontoxic adverse reaction to food. Immune-mediated reactions are termed 'food allergy' and are either mediated by the antibody IgE (IgE-mediated food allergy), or via other immune mechanisms (non-IgE-mediated food allergy) [1]. Those reactions not mediated by the immune system are termed nonallergic FHS [2].
Symptoms of FHS differ depending on the mechanism by which they occur, and range from mild to severe, affecting one or more organs, typically; the skin (hives, angioedema [swelling] and atopic dermatitis), the gastrointestinal tract (mild pruritis [itching], angioedema of the lip or tongue, tingling in the throat; reflux, dysphagia [difficulty swallowing], and abdominal pain; nausea, abdominal cramps, vomiting and diarrhea) or the respiratory system (periocular pruritis [itchy eyes], conjunctivitis [runny, itchy eyes], rhinitis [runny, itchy or congested nose] and asthma) [2]. In severe cases of IgE-mediated food allergy, a reaction may be systemic resulting in, potentially fatal, anaphylactic shock [3].
Studies indicate that 5-6% of children in the first 3 years of life [4], 1.6-2.5% of children aged 6 years [5], 1.4-2.3% of children aged 11 years and 2.1-2.3% of children aged 15 years in the UK have a food allergy or intolerance [6]. The foods children are commonly allergic or intolerant to vary according to age [4-6] and research suggests that allergies to milk, egg, soy and wheat are likely to be outgrown and that those to tree nuts, seeds, fish and shellfish are likely to persist [7].
Management of FHS
In the absence of a cure or treatment for FHS, management by eliminating the food-allergen(s) from the diet to avoid a reaction is the only available option. For the patient this involves checking all food labels. Patients also need to be careful when eating out, avoid high-risk restaurants and take care when travelling abroad. Despite these measures, accidental ingestion is not uncommon [8,9]. In mild reactions antihistamines may be sufficient to relieve symptoms but to manage systemic reactions at-risk patients are given an adrenaline autoinjector (commonly an EpiPen ® or Anapen® ). Those with FHS should be advised what symptoms to look for, how to use the injector, that they need to inform their friends, family, colleagues or school about their FHS and what to do...