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Patients with birch-pollen hay fever may have OAS symptoms after ingesting hazelnut, apple, carrot, and celery, whereas patients with IgE-mediated sensitivity to ragweed pollen may react to melons (e.g., watermelon or cantaloupe) and banana.
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This localized reaction occurs primarily in patients with respiratory allergies (rhinoconjunctivitis, asthma) that have specific IgE directed against panallergens, which are proteins featuring homologous epitopes present in seasonal or perennial aeroallergens (such as pollens) and certain foods-mostly fruits and vegetables. OAS, also known as pollen-food syndrome, is characterized by itching and tingling sensation of the oral mucosa and/or upper pharynx, the erythema of the perioral and oral mucosa with mild edema that occurs within minutes from ingestion of some foods, especially fresh fruits, and vegetables. The gastrointestinal (GI) tract is a common target for immediate hypersensitivity reactions to food with the main clinical presentations being the oral allergic syndrome (OAS) and the symptoms of immediate GI hypersensitivity. In this narrative review, the pathophysiological and clinical features of immune and non-immune adverse reactions to food-along with general diagnostic and therapeutic strategies-are outlined in particular, the specific nutritional concerns are discussed from the combined point of view of gastroenterology and immunology, in an attempt to offer a useful tool to practicing physicians in discriminating these very different disease entities and in planning their correct management. This evolving landscape for immediate hypersensitivity reactions to food, as well as increased knowledge on non-IgE- or mixed IgE/non-IgE immunological responses brings increasing nutritional challenges for diseases in which long-term food elimination is a primary therapeutic strategy, underscoring the key role of a correct dietary approach strictly driven by appropriate diagnostics. The impact of therapeutic food allergy regimens on nutritional needs will therefore need to be adjusted according to this expanding spectrum, as this is the cornerstone of all types of food allergy prevention, from primary to tertiary. Stringent surveys of food allergy prevalence indicate, at least in westernized countries, a trend towards greater persistence of pediatric food allergies and higher rates of adult-onset cases than previously appreciated. It is well established that the prevalence of true IgE-mediated food allergy is significantly less common than food allergy identified as self-reported disease, yet even epidemiological data reflect the difficulty in the identification of bona fide IgE-mediated allergy, as several reports do not include a clinical confirmation of disease. non-immunologic adverse reactions to food. We conclude that a correct diagnostic approach and dietary control of both immune- and non-immune-mediated food-induced diseases might minimize the nutritional gaps in these patients, thus helping to improve their quality of life and reduce the economic costs of their management. Special emphasis is placed on specific nutritional concerns for each of these conditions from the combined point of view of gastroenterology and immunology, in an attempt to offer a useful tool to practicing physicians in discriminating these diverging disease entities and planning their correct management.
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![cid episode 1342 cid episode 1342](https://www.researchgate.net/profile/Majid-Artus/publication/260644579/figure/tbl1/AS:669658524958720@1536670442182/Characteristics-of-included-observational-cohort-studies-n-19.png)
This narrative review provides an outline of the pathophysiologic and clinical features of immune and non-immune adverse reactions to food-along with general diagnostic and therapeutic strategies. The risk of an inappropriate approach to their correct identification can lead to inappropriate diets with severe nutritional deficiencies. actual prevalence of immune-mediated food allergies and non-immune reactions to food that are extremely common. Furthermore, there is a discrepancy between the perceived vs. However, this distinction and the involvement of different pathogenetic mechanisms are often confused. Adverse food reactions include immune-mediated food allergies and non-immune-mediated intolerances.