One type of food allergy may trigger another

Having had an immunoglobulin E (IgE)-mediated allergy to a specific food may predispose children to another, more dangerous type of allergy to the same food.

Results of a study presented at the 2014 annual meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI), held last month in San Diego, California, indicate that children who have had an IgE-mediated allergy to a specific food may develop eosinophilic esophagitis (EE) to the same food, after their IgE-mediated allergy is resolved.

Researchers from the Children’s Hospital of Philadelphia retrospectively studied 1,375 children with EE. In 425 of the children, a causative food was identified. The most common offending foods were milk, egg, wheat, and soy.

However, a subgroup of 17 children developed EE to a food after outgrowing an IgE-mediated allergy to the same food. The investigators noted that although the 2 types of food allergies seem to have distinct pathophysiologies, IgE-mediated food allergies might predispose children to developing EE to the same food. Once children develop EE, they often don’t develop a tolerance to the food that triggers it.

According to the AAAAI, EE is only recently recognized as a chronic, often painful, allergy/immune condition that involves swelling and inflammation of the esophagus. Infants and toddlers with the ailment may refuse food and, thus, grow improperly. School-aged children may complain of abdominal pain, difficulty swallowing, or nausea and vomiting. Teenagers and adults most often note difficulty swallowing. Swelling of the esophagus can progress to the point where food gets stuck, becoming a medical emergency.

To get weekly clinical advice for today's pediatrician, subscribe to the Contemporary Pediatrics eConsult.