DÄ internationalArchive7/2009Food Allergy in Adults: An Over- or Underrated Problem? In reply

Correspondence

Food Allergy in Adults: An Over- or Underrated Problem? In reply

Dtsch Arztebl Int 2009; 106(7): 115; DOI: 10.3238/arztebl.2009.0116

Trautmann, A

LNSLNS In principle we have nothing to add to the correspondence, which primarily refers to the guidelines for the diagnosis of food allergies. However, in this context the advantages/problems of guidelines—which we actually cited (1)—should not remain unmentioned. On the one hand these are often published in journals to which many potentially interested parties do not have access. On the other hand, if one searches for answers to concrete questions-often those of particular importance-one often finds only a discussion of different approaches-unequivocal and practical recommendations for action are unfortunately rarely provided.

With regard to the provocation tests, we wish to point out that our study was confined to the diagnosis of IgE mediated (type I) food allergy with typical immediate symptoms (oral allergy syndrome, urticaria/angioedema, anaphylaxis). Simple methods were the main focus, including history taking and skin prick tests. Additional laboratory tests (serum IgE, tryptase) and/or provocation tests take time; and, especially in IgE mediated allergies, provocation tests entail substantial risks. Rational selection and interpretation of diagnostic methods in individual patients depend on symptoms (anaphylaxis or oral allergy syndrome), the suspected foodstuff (common or rare allergen), and should take into considerations sensitivity and specificity of the test method. In obvious symptoms or oral allergy syndrome or anaphylaxis in connection with ingestion of a known food allergen for which IgE sensitization was confirmed by skin test, no provocation test is necessary (2, 3). This is in complete contrast to suspected deterioration of atopic eczema after ingestion of certain foodstuffs, a scenario in which patients should undergo a provocation test with a positive result before starting a diet—but our study did not include any such patients. DOI: 10.3238/arztebl.2009.0116


Priv.-Doz. Dr. med. Axel Trautmann
Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie
der Universität Würzburg
Josef-Schneider-Str. 2, 97080 Würzburg, Germany
trautmann_a@klinik.uni-wuerzburg.de

Conflict of interest statement
The authors of the letter and of the reply declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Seitz CS, Pfeuffer P, Raith P, Bröcker EB, Trautmann A: Nahrungsmittelallergie bei Erwachsenen – über- oder unterschätzt. Dtsch Arztebl 2008; 105(42): 715–23. VOLLTEXT
2.
Trautmann A: Nahrungsallergie. In: Trautmann A: Allergiediagnose, Allergietherapie. Stuttgart, New York: Thieme 2006; 181–201.
3.
Bernstein IL et al.: Food allergy: a practice parameter. Ann Allergy Asthma Immunol 2006; 96: 1–68.
1. Seitz CS, Pfeuffer P, Raith P, Bröcker EB, Trautmann A: Nahrungsmittelallergie bei Erwachsenen – über- oder unterschätzt. Dtsch Arztebl 2008; 105(42): 715–23. VOLLTEXT
2. Trautmann A: Nahrungsallergie. In: Trautmann A: Allergiediagnose, Allergietherapie. Stuttgart, New York: Thieme 2006; 181–201.
3. Bernstein IL et al.: Food allergy: a practice parameter. Ann Allergy Asthma Immunol 2006; 96: 1–68.