Table 2.4-2. Manifestations of food allergiesa

Reaction

Clinical manifestations

Diagnostic tests

IgE-dependent

Anaphylactic reaction (IgE-dependent)

Onset (typically in 30 min) of urticaria, angioedema, abdominal pain, nausea, vomiting, diarrhea, rhinitis, wheeze, syncope, hypotension

– SPT and/or sIgE

– ± Oral challenge

Oral allergy syndrome (IgE-dependent)

Minutes after exposure of oral mucosa: pruritus; tingling; erythema and/or mild edema of lips, tongue, oral mucosa, and pharyngeal mucosa

– SPT with fresh fruits/vegetables (prick-prick test) and/or sIgE

– ± Oral challenge (positive with fresh and negative with cooked fruits/vegetables)

IgE-dependent and non–IgE-dependent

Eosinophilic esophagitis

Chronic or intermittent reflux, vomiting, dysphagia

Endoscopy (rings, furrows, edema, microabscesses, strictures, crepe paper appearance) and biopsy (>15 eosinophils/HPF)

Eosinophilic gastroenteritis

Chronic or intermittent abdominal pain, vomiting, irritability, anorexia, malnutrition, weight loss, anemia, protein-losing enteropathy

– CBC (elevated eosinophils in 80%)

– CT

– Endoscopy with biopsy showing increased eosinophilic infiltration

a Celiac disease and less common conditions are not included.

CBC, complete blood count; CT, computed tomography; HPF, high power field; sIgE, serum-specific IgE; SPT, skin prick test.