Prospective studies in the natural history of food allergy.
The study of the natural history of food allergy is hindered by the lack of a reliable method of diagnosing food allergy except through oral challenge. This need raises a conflict between the need to document continued sensitivity and the effects of these repeated challenges not only on the natural history but also on the immediate induction of symptoms especially in the highly sensitive patient. Despite this difficulty, a number of investigators have provided data on a total of 177 infants and children who were subjected to repeated challenges. In only a few reports were these repeated challenges carried out in rigorous double-blind protocol. When the challenges were repeated, the results did not differ from the group as a whole. These studies agree that the prognosis in food allergy is excellent, with 60% to 73% of infants losing their food sensitivity in the first year and 26% to 53% of older children eventually remitting. The specific food causing symptoms (egg, milk, soy, etc) affected the prognosis but the intensity of IgE-mediated sensitization as indicated by skin testing or RAST did not. The data regarding the loss of immunologic tests as symptoms subsided differed from study to study. This may be due to the age at which patients were first studied varied widely or because the compliance with dietary restrictions in the various studies varied. Finally, a large majority of children developed respiratory symptoms to inhalant allergens at the same time their food-related symptoms disappeared.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
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Eggleston
D000367:Age Factors; D000818:Animals; D004531:Eggs / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008892:Milk / Q000009:adverse effects; D011446:Prospective Studies