Interdisciplinary Significance of Food-Related Adverse Reactions in Adulthood.

Background: Adults frequently interpret food-associated adverse reactions as indicators of a food allergy. However, the public perception of food allergy may differ from a clinician's point of view. The prevalence of patient-reported food allergy tends to be higher than physician-confirmed cases. Dermatological manifestations (urticaria, pruritus, dermatitis, and edema) are frequently reported by patients. Objective: The aim of this study was to describe patient-reported symptoms related to suspected food allergies and particularly to characterize and highlight the volume of patients who visit Budapest allergy clinics with suspected food allergies. Methods: In this prospective study, adult (≥18 years) patients were examined at the Allergology Outpatient Unit of the Dept. of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest. The examination included a detailed medical history; physical examination; and when necessary the measurement of allergen-specific serum immunoglobulin E (IgE) levels. Results: Data from 501 patients (393 women, 108 men) were analyzed. Intolerance to dietary biogenic amines occurred in 250 cases (250/501, 50%). Oral allergy syndrome was confirmed in 71 patients (71/501, 14%). Allergy to food preservatives was diagnosed in 14 (14/501, 3%) cases by a dermatologist-allergist specialist. Five individuals (5/501, 1%) were diagnosed with IgE-mediated food allergy. In some cases (28/501, 6%), edema-inducing/enhancing side effects of drugs were observed which patients had misattributed to various foods. Among the food groups considered to be provoking factors, the most frequently mentioned were fruits (198/501, 40%), milk/dairy products (174/501, 35%), and nuts/oilseeds (144/501, 29%). Overwhelmingly, urticaria (47%) was the most common dermatological diagnosis, followed by dermatitis (20%) and allergic contact dermatitis (8%). Conclusion: Improvement is needed in food allergy, food intolerance, and general nutritional knowledge among the general public. According to our data, perceived/self-reported food allergies were overestimated by adults when compared against physician-confirmed food allergies; however, other diseases potentially responsible for food-related problems were underestimated. The prevalence of oral allergy syndrome was high in the cohort. Intolerance to dietary biogenic amines was common, and although the role of dietary histamine and biogenic amine is not entirely understood in eliciting patients' symptoms, improvements in complaints were reported during the control visits.

Food allergy? Intolerance? ­ Examination of adverse reactions to foods in 406 adult patients / Ételallergia? Intolerancia? - Étel adverz reakciók vizsgálata 406 felnott betegen

INTRODUCTION: The prevalence of adverse food reactions is increasing, with 10-20% of the adult population experiencing such complaints. Most symptoms are thought to be indicators of food allergy, although non-immune-mediated food intolerance and other (e.g., gastroenterological) disorders are more likely to cause them. AIM: Our aim was to gain a better understanding of the adult patient group that has adverse food reactions and to discover the real background of the symptoms that are believed to be caused by food allergy. In addition, in the context of interdisciplinarity, we would like to emphasize the importance of differential diagnosis and collaboration with associate specialists. METHOD: 406 adult (>18) patients underwent an allergo-dermatological examination in order to assess, identify, and isolate symptoms related to food. Patients were presented with various symptoms, all of which were identified as a sign of 'food allergy'. After a thorough medical history and examination, specific IgE tests were performed if deemed necessary. Patients were referred to other specialists if further examinations were needed to complete the examination. RESULTS: 307 (75.6%) women and 99 (24.4%) men were examined. The average age was 43.6 years. The most common dermatological diagnosis was urticaria (44.1%). Relevant IgE-mediated food allergy was detected in 6 of 406 patients (1.5%). Oral allergy syndrome was diagnosed in 35 cases (8.6%). In many cases, biogenic amine intolerance (50.2%) and other comorbidities (gastroenterological: 62.1%, chronic inflammation: 22.2%) were found as provocative factors. In the background of the symptoms, side effects of drugs taken by patients during meals were identified in 20 cases. CONCLUSION: According to our data, biogenic amine intolerance is very common in the background of patients' food-related reactions, but the number of food allergies is overestimated. It is important for both healthcare professionals and patients to emphasize the diverse pathology behind adverse food reactions. Differentiation should always be based on thorough medical history, examination, and personalized management. Orv Hetil. 2020; 161(25): 1042-1049.