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Ismail, N. Managing Food Allergy. Encyclopedia. Available online: https://encyclopedia.pub/entry/18235 (accessed on 09 February 2026).
Ismail N. Managing Food Allergy. Encyclopedia. Available at: https://encyclopedia.pub/entry/18235. Accessed February 09, 2026.
Ismail, Noor. "Managing Food Allergy" Encyclopedia, https://encyclopedia.pub/entry/18235 (accessed February 09, 2026).
Ismail, N. (2022, January 14). Managing Food Allergy. In Encyclopedia. https://encyclopedia.pub/entry/18235
Ismail, Noor. "Managing Food Allergy." Encyclopedia. Web. 14 January, 2022.
Managing Food Allergy
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This entry is adapted from the peer-reviewed paper 10.3390/life11111275

There are conventional and newly proposed food allergy management. Conventional food allergy (FA) management focuses on patients who are clinically suspected or confirmed with food allergy. Detailed clinical history is the central part of this management approach with ‘exposure-to-symptoms’ providing the primary information on the potential allergens.

nutriepigenomics personalized nutrition avoidance diet food allergy

1. Introduction

Food allergy has been a problem affecting humankind since more than 4500 years ago. The earliest evidence of food allergy was first appreciated in the Chinese literature (~2750–2650 BC), through a practice of “Shi Jin-Jing”, in which individuals suffering from certain skin lesions and pregnant women were advised to avoid certain foods particularly those containing shrimp and meats [1]. Later, Hippocrates (460–377 BC) proposed the role of IgE antibodies in food allergy, describing them as “hostile humors’’ in individuals with allergic reactions upon ingestion of cheese [2]. Although the presence of food allergy had been recognized well before, it was Praustnizt and Kutsner exactly a century ago, who explained scientifically the immunological basis of our current understanding of food allergy reactions [3]. In their landmark experiment, Praustnizt, using Kutsner’s fish-sensitized serum, demonstrated a factor in Kutsner’s serum (which was subsequently identified as IgE) as the main factor driving the pathology in the development of specific food allergy [3].

Since then, food allergy has emerged as a growing concern worldwide and is even considered as the ‘second wave of the allergy epidemic’ [4]. Food allergy incidents are increasing in recent years, with a prevalence in children ranging from 6.53% to 11.0% [5][6][7][8][9][10]. The prevalence of food allergy in Asia is widely variable, but recent studies show the prevalence is comparable to that in western countries, ranging from 3.4–6.4% and 5.3% among children in Taiwan and Korea, respectively [11][12]. Despite the increasing trend of food allergy globally, the disease tends to be ignored by most stakeholders and health-funders, especially among developing countries. The management of a child with food allergy on average was documented to cost USD 4184 per year, thus is a significant economic impact on the patient’s family [13]. More disturbing is the fact that food allergy has been reported to have a detrimental effect on the quality of life of the patients and caretakers, making food allergy one of the debilitating diseases in the current health era [14][15].

2. Dual-Allergen Exposure Hypothesis and Shifting of Nutritional Intervention

The conventional standard strategy in the management of food allergy used to be dependent on removing causative food from the children’s diet [16][17]. However, this older approach was not just proven to be challenging but there is building evidence suggesting a pure elimination diet might be futile in the prevention of food allergy development [18][19][20][21]. With the rise of food allergy among children in recent years, genetic predisposition alone is not adequate to explain this, and changes in environmental factors are suggested to be a main contributing factor to this current phenomenon. Several factors have been proposed, with the dual-allergen exposure hypothesis being implicated as the present contemporary notion [22][23].

The dual-allergen exposure hypothesis is based on the principle of earlier pathogenic sensitization towards a certain food allergen, occurring through a breakdown of the skin barrier, resulting in an allergic reaction upon subsequent oral ingestion of food [24][25]. This theory is strengthened by the common clinical observation as well as explaining the manifestation of eczema as the main risk factor in a child for developing a food allergy [26]. Two studies, namely the LEAP and EAT, further supported this notion of dual-allergen exposure hypothesis and challenged the previous dogma of pure diet elimination role in the management of food allergy [27][28]. It was shown in these two landmark studies that earlier and routine introduction of allergenic food in high-risk infants as early as three months of age reduced the risk of developing food allergy [27][28]. Based on this, the National Institute of Allergy and Infectious Diseases (NIAID), the American Academy of Pediatrics, and the American Academy of Allergy Asthma and Immunology all recommended the early introduction of allergenic food in high-risk infants for the prevention of food allergy [21][29].

Despite the documented evidence and the current recommendations, the challenge in implementing the shift in nutritional interventions are multifaceted. This includes (i) introduction of diverse types of food including a selection of the intended allergenic food, (ii) adherence and sustained feeding to reduce food allergy development risk, and (iii) identifying infants to be considered at risk of developing food allergy later in life [30]. Guidance to correctly determine which babies are at risk of food allergy, thus benefiting from this nutritional intervention, will be helpful in convincing parents and ensuring compliance to the intended nutritional intervention. Additionally, precisely knowing the types of allergenic foods to be emphasized during this early dietary introduction allows for a structured dietary program to be planned between the parents, physician and the dietitian. Moreover, the inception of a food allergy towards a different food allergen is variable, thus knowing exactly which and when the timing of this pathogenesis happens permits understanding when a particular diet tolerance induction program should be initiated [31].

Genetics, although not solely, plays an integral part in the development of pediatric food allergy. Genetic role in the development of food allergy is clearly documented through observations of higher concordance in monozygotic twins compared with dizygotic twins, albeit less than 100% thus emphasizing the influence of other factors such as the environment [32][33]. The interplay of the human genome and nutrition through exploration of the role of nutriepigenomics may deepen our current understanding of the pathophysiology of food allergy among children.

3. The Role of Nutriepigenomics in Food Allergy

The development of food allergy requires a certain interaction through prolonged exposure to the nutrient intake since in utero. Numerous twin studies and/or sibling studies revealed there is an increased rate of sensitization which does not equate to reactivity to the allergens. Most studies that are linked to food allergy have highlighted the expression of genes that produce signaling proteins that in turn activate the downstream stimulation of the T cell helper (Th2) phenotype. Th2 is one of the key players that mediate the recruitment of IgE to further produce B-cells, mast cells and eosinophils in activating allergic reactions. Various epigenetic changes affecting DNA methylation at the promoter regions and increasing/decreasing the rate of histone acetylation were seen in different genes encoding signaling proteins involved in immune responses which subsequently regulate downstream protein production in allergic inflammation. For example, epigenetic changes in the FOXP3 gene influence regulatory T cells (Treg) function, which are responsible for suppressing immune responses [34], whilst epigenetic changes in the PGM3 gene affect glycosylation of Treg, thus changing the immunoregulation responses [35].

4. Personalized Nutrition in the Management of Food Allergy

Personalized nutrition has gained a spotlight in the last ten years as a proposed management for food allergy. Earlier personalized nutrition was based on food avoidance from the data gathered from the Food Frequency Questionnaire (FFQ), especially the frequency of food intake that triggers allergic reaction. The current movement to advocate general nutrition advice is based on various factors, including the anthropometric data, meal content, activity tracking and dietary intake data. Only recently, a similar approach has been conducted for food allergy, with additional clinical and biochemical parameters, microbiome and genetics for each individual [36][37][38].

The current practice in dietary management is based on the results obtained from several types of diagnostic testing, such as history taking for the investigations for food allergy in identifying IgE-mediated food allergy that further can be confirmed by food challenges or elimination diets [39]. The results are interpreted as types of food to be removed from the diet, in which dietitians later analyze the adequacy of nutrients based on the standard requirements of each individual to suggest any food alternatives to be prescribed to the individual, to compensate for the deficiency from any of the food avoided to ensure healthy growth of individuals, particularly children and patients at risk of malnutrition. This approach, however, took place when signs of anaphylactic shock had occurred.

It is understood that the key management for the long-term treatment of patients with a food allergy is food avoidance [40]. The biggest concern of this approach is the high risk of malnutrition and further exacerbating feeding difficulties among children [41], especially in picky eaters. It is also known that some food can be introduced gradually to allow the body to build a tolerance to the food later in life. This point is very hopeful in providing a more wholesome and balanced diet that will lead to better life quality. With the new data obtained from the epigenetic testing, one individual’s potential allergy, namely from food, can be identified early with more precise information to guide and personalize dietary management, mainly among children with a strong family history of food allergy [37]. Perhaps not just food, but more certain substances that may trigger the allergic reaction can be identified. If this can be understood, more strategies can be developed, as for example, there are certain cooking techniques that can be performed to denature the trigger elements so that the individuals are able to enjoy the food and not totally eliminate it from the diet.

Examples of food allergens such as peanut, tree nut (cashew, Brazil nut, pistachio), crustaceans, and mollusks, are crucial to identify earlier in life and avoid them all at once. However, the current practice of eliminating them totally from the diet may not be so relevant when the nutriepigenomics approach is explored further. The foods can be introduced gradually in several phases, together with additional cooking techniques that can be taken by the families [42][43]. This will later lead to a more structured food allergy management, as for example, categorizing food allergy into several types of dietary intervention techniques from a full dietary elimination to foods that can be introduced gradually.

References

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