DÄ internationalArchive7/2009Food Allergy in Adults: An Over- or Underrated Problem? Stringent Elimination Diet

Correspondence

Food Allergy in Adults: An Over- or Underrated Problem? Stringent Elimination Diet

Dtsch Arztebl Int 2009; 106(7): 115. DOI: 10.3238/arztebl.2009.0115

Werfel, T; Lepp, U; Worm, M

LNSLNS Seitz et al conducted a retrospective analysis of more than 400 patients with suspected food allergies and rightly emphasize that "only a comprehensive allergological evaluation" can protect patients from the negative consequences of over- or underestimating the food allergy (1). In 66 cases they describe oral provocation tests—following a medical history and standardized skin tests—whose results were negative. The authors diagnose a food allergy in more than 50% of their patients—but we don't know whether in case the situation was not obvious, oral provocation tests were conducted in these patients too.

In everyday practice, the proportion of patients with unclear constellations after a medical history has been taken, skin tests have been conducted, or IgE concentrations were measured is high (for example, existing differential diagnoses to food allergies and sensitization to several foodstuffs in unequivocal symptoms after a composite meal). The food allergy working group of the three German allergy societies (the German Society for Allergology and Clinical Immunology [DGAKI], the Medical Association of German Allergologists [ÄDA,], and the Society of Pediatric Allergology [GPA]) have compiled position papers and guidelines relevant to clinical practice that can be found at http://www.leitlinien.net by searching for "food allergy". The specialist societies are particularly concerned that institutions with allergological experience should extensively offer the option of oral provocation tests for patients whose constellation is unclear. Targeted oral provocation tests can be sufficiently reproduced in hospitals under DRG conditions and are often the only option to confirm a suspected diagnosis of food allergy (2, 3).

Food allergies can have harmless outcomes but they can also be fatal, albeit rarely. Neither the degree of sensitization nor the extent of a previous systemic reaction are predictive of the outcome of life threatening reactions to foodstuffs. Hence even patients with "mild" confirmed systemic reactions to foodstuffs should stringently adhere to a strict elimination diet after dietary advice and should carry an emergency kit (adrenaline auto injector, antihistamine, steroid) on their person.
DOI: 10.3238/arztebl.2009.0115


Prof. Dr. med. Thomas Werfel
Klinik für Dermatologie, Allergologie und Venerologie
Medizinische Hochschule Hannover
Ricklinger Str. 5
30449 Hannover, Germany
Werfel.Thomas@mh-hannover.de

Dr. med. Ute Lepp
Herz-Lungenpraxis Stade
Harsefelder Str. 6
21680 Stade, Germany
info@herzlunge.de

Prof. Dr. med. Margitta Worm
Allergie-Centrum-Charité
Klinik für Dermatologie, Venerologie und Allergologie
Charité Campus Mitte
Universitätsmedizin Berlin
Charitéplatz 1
10117 Berlin, Germany
margitta.worm@charite.de
1.
Seitz CS, Pfeuffer P, Raith P, Bröcker E-B, Trautmann A: Nahrungsmittelallergie bei Erwachsenen – über- oder unterschätzt? Dtsch Arztebl 2008; 105(42): 715–23. VOLLTEXT
2.
Niggemann B, Erdmann S, Jäger L et al.: Standardisierung von oralen Provokationstests bei IgE-vermittelten Nahrungsmittelallergien. Aktualisierte Leitlinie von DGAKI, GPA und ÄDA. Allergo J 2006; 14: 262–70.
3.
Henzgen M, Vieths S, Reese I et al.: Nahrungsmittelallergien durch immunologische Kreuzreaktionen. Leitlinie der DGAKI und des ÄDA. Allergo J 2005; 14: 48–59.
1. Seitz CS, Pfeuffer P, Raith P, Bröcker E-B, Trautmann A: Nahrungsmittelallergie bei Erwachsenen – über- oder unterschätzt? Dtsch Arztebl 2008; 105(42): 715–23. VOLLTEXT
2. Niggemann B, Erdmann S, Jäger L et al.: Standardisierung von oralen Provokationstests bei IgE-vermittelten Nahrungsmittelallergien. Aktualisierte Leitlinie von DGAKI, GPA und ÄDA. Allergo J 2006; 14: 262–70.
3. Henzgen M, Vieths S, Reese I et al.: Nahrungsmittelallergien durch immunologische Kreuzreaktionen. Leitlinie der DGAKI und des ÄDA. Allergo J 2005; 14: 48–59.