Food allergy: Is strict avoidance the only answer?

Authors

  • C. W. Allen,

    1. Department of Allergy and Immunology, The Children’s Hospital at Westmead, Sydney Australia
    2. Discipline of Paediatrics and Child Health, Clinical School, University of Sydney, Sydney, Australia
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  • D. E. Campbell,

    1. Department of Allergy and Immunology, The Children’s Hospital at Westmead, Sydney Australia
    2. Discipline of Paediatrics and Child Health, Clinical School, University of Sydney, Sydney, Australia
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  • A. S. Kemp

    1. Department of Allergy and Immunology, The Children’s Hospital at Westmead, Sydney Australia
    2. Discipline of Paediatrics and Child Health, Clinical School, University of Sydney, Sydney, Australia
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Professor Andrew Kemp, The Department of Allergy Immunology and Infectious Diseases, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, New South Wales 2145, Australia
Tel.: +61 2 9845 0000
Fax: +61 2 9845 3421
E-mail: andrewk5@chw.edu.au

Abstract

It is an immunological paradigm that avoidance of food allergen may reduce the risk or prevent immunological reactions and conversely that a greater exposure increases the magnitude of the immune response. Consequently, food allergen avoidance has been recommended to reduce the risk of sensitization in infants and to prevent clinical reactions in children with positive skin prick tests (SPT). In the latter setting, it is hoped that avoidance may either promote or at least not retard the development of tolerance. Animal studies, however, have demonstrated that tolerance to food allergens may be induced by either large (high zone tolerance) or small (low zone tolerance) doses, whereas doses in between may actually stimulate immune responses. In this review, we discuss whether strict allergen avoidance is always the most appropriate strategy for preventing or managing IgE-mediated food allergy.

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