RISKS FACTORS FOR FOOD ALLERGY FOR THE LATIN AMERICAN
POPULATION.
Speaker: Emilia María Hidalgo Castro.
Food allergy or Allergic Food Hipersensibility is defined as an adverse immunologic
reaction caused by immunologic mechanisms mediated or not by IgE. It is a
complex disease influenced by polygenetic heritance and environmental factors.
Epidemiologic studies have provided data on a number of emerging thoughts about
risk factors of food allergy but information is variable and controversial.
Risks factors can be classified on prenatal and postnatal.
Prenatal risks factors.
1. Genetic risks. Only a small number of studies have investigated the
association between genetic traits and susceptibility to food allergy.
a. Specific genes:
-the promoter polymorphism 159T/C in the CD14 gene is more common in
subjects with food allergy.1
- STAT-6 G allele frequency is increased in nut allergy patients.2
-IL-10 gene polymorphism was associated with food allergy .3
-IL-13 polymorphism was associated with food allergy.4
b. Familial associations: a child has 7 fold increased risk for peanut allergy
if he or she has a parent or sibling with peanut allergy. For monozygotic twins, a
child has 64% more risk for developing peanut allergy if his or her twin sibling has
peanut allergy.5
2. Intrauterine sensitization.
In children with at least one allergic parent it has been demonstrated that high IgE
levels at birth are associated with food allergy urticaria in the first year of life.6
3. Maternal ingestion: controversy about maternal ingestion of allergen during
pregnancy being risk factor.7 Maternal peanut consumption during
pregnancy and breast feeding showed a dose-response association with
peanut IgE >5 in the infant. Consumption during pregnancy was a significant
predictor.8
4. Caesarean birth: among children with allergic mothers a study reported that
caesarean section was associated with 7 fold increased risk of parentally
perceived reactions to egg, fish and nuts, and 4 fold increased risk of
confirmed egg allergy.9
5. Maternal age: children whose mothers are aged 30 and over have increased
risk for developing food allergy.10
6. Sex: boys appear to be at higher risk than girls for food allergy. 11
7. Race/ethnicity: racial and ethnic differences have not been explored widely
but in the United States of America the National Health and Nutrition
Examination Survey study reported that non- Hispanic blacks had increased
food allergy (OR 3.1).¹°
Postnatal risk factors.
1. Associated atopic disease: family history of atopy and presence of atopic
dermatitis are risks factors for the development of both sensitization to food
and confirmed food allergy.12 Having atopic dermatitis in infancy is a risk for
developing food allergy. Atopic dermatitis in the first 6 months of life has
been associated with increased risk for milk, egg and peanut allergies.⁵
2. Lack of breast feeding: many prospective, observational studies reported
that exclusive breast feeding for at least 4-6 months decrease cumulative
incidence of cow´s milk allergy until 18 months and atopic dermatitis until 3
years.13
3. Early introduction of solid foods: introduction of complementary foods before
4-6 months of age has been associated with a higher risk of atopic
dermatitis14 and food allergy.15
4. Birth weight and gestational age: there appears to be an association
between very low birth weight <1000 g and gestational age <28 weeks with
food allergy (RR 2.15 and 1.9 respectively). 16
5. Exposure route: lack of ingestion exposure during period of environmental
exposure may increase risk.17It is argued that low-doses exposure to
environmental food (table tops, hands and dust) penetrates the skin barrier
and is taken up by the Langerhan´s cells leading to TH2 response and IgE
production. In contrast early high-doses oral consumption leads to TH1 and
regulatory cells responses inducing tolerance.⁵
6. Dietary constituents:
a. Reduced consumption of ɯ-3 polyunsaturated fatty acids and increased
consumption of ɯ-6 leads to the production of PGE2. PGE2 reduces IFγ
production by T lymphocytes, thus resulting in increased production of
IgE by B cells. This has been proposed to explain the increase in
prevalence of allergic diseases but there few data to support or refute
this hypothesis respect to food allergy.⁵
b. Vitamin D: one study report that infants who had vitamin D
supplementation had increased risk for food allergy.18 In contrast, other
study links the vitamin D deficiency with food allegy.
19
This controversy
remains unresolved.
7. Obesity: may be an inflammatory state associated with increased risk for
food allergy.20
8. Anti-acid medications: anti-ulcer drugs inhibit peptic digestion and turn
harmless food proteins into allergenic molecules, which are able to perform
sensitization and to elicit allwergy.21
1
Cochrane S, Beyer K, Clausen M, WjSt M, Hiller R, Nicolleti C, Szepfalusi Z, Savelkoul,H. Breiteneder H,
Manios Y,Crittenden, Burney P. Factors influencing the incidence and prevalence of food allergy. Allergy
2009; 64: 1246-55.
2
Amoli MM, Hand S, Hajeer AH, Jones KP, Rolf S, Sting C, et al. Polymorphism inthe STAT6 gene encodes
risk for nut allergy. Genes Immun 2002;3:220-4.
3
Campos Alberto EJ, Shimojo N, Suzuki Y, Mashimo Y, Arima T, Matsuura T, et al.IL-10 gene
polymorphism, but not TGF-beta1 gene polymorphisms, is associatedwith food allergy in a Japanese
population. Pediatr Allergy Immunol 2008; Jan 16
4
Liu X, Beaty TH, Deindl P, Huang SK, Lau S, Sommerfeld C, et al. Associations between specific serum
IgE response and 6 variants within the genes IL4, IL13, and IL4RA in German children: the German
Multicenter Atopy Study. J Allergy Clin Immunol 2004;113:489-95.
5
Gideon Lack MD.Epidemiologic risks for food allergies. J Allergy Clin Immunol 2008;121:1331-6.
6
Kaan et al. Cord Blood IgE: its determinants and prediction of development of asthma and other allergic
disorders at 12 months. Ann Allergy Asthma Immunol 2000;84:37– 42.
7
Muraro et al. Dietary prevention of allergic diseases in infants and small children Part III: Critical review of
published prereviewed observational and interventional studies and final recommendations. Pediatr Allergy
Immunol 2004: 15: 291–307
8
Sicherer SH, Wood RA, Stablein D, Lindblad R, Burks AW, Liu AH et al. Maternal consumption of peanut
during pregnancy is asspciated with peanut sensitization in atopic infants. J Allergy Clin Immunol
2010;126:1191-7.
9
Merete Eggesbo, Grete Botten, Hyein Stigum, Per Nafatad, Per Magnus. Is delivery by cesarean section a
risk factor for food allergy? J Allergy Clin Immunol 2003; 112: 420-426
10
Anahita F. Dioun, Sion Kim Harris, Patricia L. Hibberd. Is maternal age at delivery related to childhood
food allergy? Pediatric Allergy and Immunology 2003;14: 307–311.
11
Liu AH, Jaramillo R, Sicherer SH, Wood RA, Bock SA, Burks AW, et al. National prevalence and risk
factors for food allergy and relationship to asthma: results from the National Health and Nutrition
Examination Survey 2005-2006. J Allergy Clin Immunol 2010;126:798-806.
12
Boyce JA et al. Guidelines for the diagnosis and management of Foos Allergy in the Unites States:
Summary of the NIAID Sponsored Expert Panel Report. J Allergy Clin Immunol 2010;126:1105-18.
13
Halken S. Prevention of Allergic disease in Childhood: clinical and epidemiological aspects of primary and
secondary allergy prevention. Pediatric Allergy Immunol 2004;15 S16: 9-32.
14
Fergusson DM, Horwood LJ, Shannon FT. Early solid food feeding and recurrent childhood eczema: a 10year longitudinal study. Pediatrics. 1990;86:541–546.
15
Kajosaari M, Saarinen UM. Prophylaxis of atopic disease by six months_ total solid food elimination.
Acta Paediatr Scand 1983: 73: 411–4.
16
Liem JJ, Kozyrskyj AL, Becker AB. The risk of developing food allergy in premature/low birth-weight
children. J Allergy Clin Immunol Feb 2005;S242.
17
Sicherer SH. Epidemiology of food allergy. J Allergy Clin Immunol 2011;127:594-602.
18
Milner JD, Stein DM, McCarter R, Moon RY. Early infant multivitamin supplementation is associated with
increased risk for food allergy and asthma. Pediatrics 2004;114:27-32.
19
Camargo CA, Clark S, Kaplan MS, Lieberman P, Wood RA. Regional differences in EpiPen prescriptions
in the United States: the potential role of vitamin D. J Allergy Clin Immunol 2007;120:131-6.
20
Visness CM, London SJ, Daniels JL, Kaufman JS, Yeatts KB, Siega-Riz Al et al. Association of obesity
with IgE levels and allergy symptoms in children and adolescents: results from the National Health and
Nutrition Examination Survey 2005-2006. J Allergy Clin Immnunol 2009;123: 1163-9.
21
Pali-Schöll I, Jensen-Jarolim E. Anti-acid medication as a risk factor for food allergy. Allergy 2011; 66:
469-477.