Food allergy develops when a person’s immune system becomes sensitized to proteins from a certain food. Whenever the person eats the allergenic food, the immune system launches an abnormal reaction as though the food were a dangerous invasive particle such as a virus, bacterium, toxin, or parasite. Food allergies can cause a huge range of symptoms, which may be mild or severe. An allergenic food may cause a mild reaction in a person one day and a severe one in the same person the next day.
Our immune systems have many different types of defenses designed to protect us against infections. Each defense has a different way of responding to attacks from foreign particles, or antigens. One of the most important defenses our bodies have is antibodies (also called immunoglobulins or Ig) produced by white blood cells called B cells. Antibodies are proteins that can recognize specific antigens and launch an attack against them. The first time B cells come into contact with an antigen, they memorize the makeup of the particle. In the case of food allergies, the antigen is a protein from a particular food. On this first contact, there is no allergic reaction, but B cells begin producing antibodies called immunoglobulin E, or IgE, specific to that antigen.
The IgE antibodies circulate through the blood and collect in the skin, lungs, and mucus membranes such as those that line the nose, mouth, and throat. After this first contact, each time the antibodies come into contact with the antigen, they recognize it and launch an attack that involves triggering inflammatory chemicals — histamines, interleukins, and leukotrienes. The inflammatory chemicals flood the body, causing allergy symptoms.
Food allergies have been noted throughout history. Chinese emperors Shen Nong and Huang Di recorded their existence as early as 2,500 BCE. In ancient Greece, the philosopher Aristotle later observed that some people experienced reactions to fruit that others did not. Ancient Greek physician Hippocrates observed that certain foods could cause death in some people.
Early in the 20th century, American pediatrician Oscar Menderson Schloss developed a skin test to diagnose food allergies. The test placed extracted protein from food on the skin to observe a reaction. However, the skin test can produce false positives — reactions that indicate a food allergy when the person is not actually allergic. Many doctors were frustrated by the lack of accuracy.
The mid-20th century saw scientists study food allergies such as eggs, wheat, tree nuts, peanuts, and dairy. Aristotle's centuries-old observations about fruit allergies were tested in a 1942 study. The results showed that some people experience oral reactions to raw fruit, now known as oral allergy syndrome.
In the mid-1970s, American pediatrician Charles May developed the double-blind oral food challenge, which is considered the gold standard of food allergy diagnosis today. In a double-blind oral food challenge, according to Food Allergy Research & Education (FARE), the patient receives increasing doses of the suspected food allergen and a placebo (a harmless substance).
Epinephrine — also known as adrenaline — is a naturally occurring hormone. Epinephrine was first synthesized in 1904 by German chemist Friedrich Stolz. In the 1970s, American scientists Robert Lefkowitz and Brian Kobilka studied how epinephrine works in the body. They received the Nobel Prize in Chemistry in 2012. Epinephrine is now prescribed in a pen-like device that can be automatically injected into the muscle without needing to measure the medication or prepare a syringe. EpiPen and other brands are prescribed to be used in cases of anaphylaxis, a severe reaction to a food or other allergen.
Studies in the 1990s found that breastfeeding prevented atopic dermatitis and milk allergy in infants. This led to the belief that delaying an infant’s exposure to major food allergens (such as peanut, egg, and milk) would allow the immune system to “mature” and decrease the chance for food allergies later. Avoidance became standard advice from pediatricians and allergists. However, studies in 2015 and 2016 found that early oral introduction to peanuts dramatically reduced the occurrence of peanut allergy in children. Early introduction of eggs can also decrease the risk of an egg allergy. Early oral introduction has not yet been proven effective with other food allergens.
Today researchers are studying a type of oral desensitization called oral immunotherapy (OIT). OIT introduces minute amounts of allergens to allergic individuals to build up an immune tolerance. Several studies have shown a reduction in peanut allergy severity. The U.S. Food and Drug Administration (FDA) has approved Palforzia for peanut OIT. Many board-certified allergists also perform OIT for other foods, although these therapies are not yet FDA approved.
Between 4 percent and 6 percent of children and approximately 4 percent of adults have a food allergy. Food allergies are most common in children under age 3. Some children outgrow their food allergies. Less commonly, an adult develops an allergic reaction to a food they have eaten for years.
The prevalence of food allergies seems to be increasing, especially in Western countries such Australia, the United Kingdom, and the United States. According to the Centers for Disease Control and Prevention, reported cases of food allergies in children under 18 grew by 18 percent from 1997 to 2007 in the U.S.
Nearly any food could cause an allergic reaction. However, eight food groups are responsible for 90 percent of food allergies. The eight major food allergens and any ingredients derived from them are listed on food labels by law in the U.S. They are:
Sesame is an emerging allergen in the United States. A new law requires sesame to be declared in packaged foods, similar to the other eight major food allergens.
Symptoms of food allergy can vary widely. Some people develop skin symptoms such as itching, rash, or hives. Others have respiratory symptoms such as asthma, sneezing, cough, and trouble breathing. Gastrointestinal symptoms including cramping, vomiting, and diarrhea are also common. Others experience anxiety, behavior changes, heart palpitations, dizziness, or many other reactions.
The most serious symptom of food allergy is anaphylaxis — a life-threatening reaction. Anaphylaxis is characterized by a sudden narrowing of the airways that makes it difficult to breathe, severe rash or swelling, or a sudden drop in blood pressure. Learn more about food allergy symptoms.