The science of
food allergy has been rapidly evolving before our eyes in the past half century. Like other allergic disorders, the prevalence of
food allergies has dramatically increased, and coupled with the increased public awareness of
anaphylaxis due to
food allergy, this has driven an explosion in basic and clinical research in this extremely broad subject. Treatment of
food allergies has evolved and practices such as food challenges have become an integral part of an
allergy practice. The impact of the increase of
food allergy has driven package labeling laws, legislation on
emergency treatment availability in schools and other public places, and school policy. But to this day, our knowledge of the pathogenesis of
food allergy is still incomplete. There are the most obvious
IgE-mediated
immediate hypersensitivity reactions, but then multiple previously unidentified conditions such as
eosinophilic esophagitis, food
protein-induced
enterocolitis syndrome,
milk protein allergy, food-induced
atopic dermatitis, oral
allergy syndrome, and others have complicated the diagnosis and management of many of our patients who are unable to tolerate certain foods. Many of these conditions are not
IgE-mediated, but may be T cell-driven diseases. The role of T regulatory cells and immune tolerance and the newly discovered immunological role of
vitamin D have shed light on the variable clinical presentation of
food allergy and the development of new methods of
immunotherapy in an example of bench-to-bedside research. Component-resolved diagnostic techniques have already begun to allow us to more precisely define the
epitopes that are targeted in food allergic patients. The development of
biological modulators, research on genomics and proteomics, and epigenetic techniques all offer promising avenues for new modes of
therapy of
food allergy in the twenty-first century.