Food Hypersensitivity: Diagnosing and Managing Food Allergies and Intolerances

The last two years have seen the publication of 3 major guidelines on the diagnosis and management of food hyper-sensitivity (FHS) [1–3]. These guidelines have highlighted important issues in dealing with those with FHS, primarily food allergies. Dealing with adults and children with food allergies requires the healthcare professional to have an understanding of the immune mechanisms involved in the development of allergy versus tolerance, diagnostic methods, managing the patient, and the development of new treatment modalities. In this issue, we have continued to discuss topics such as the role of the epithelial barrier in the development of FHS, the importance of patient education and support groups, the effect of food production on the allergenicity of foods, and the induction of oral tolerance. This special issue is concluded with a tutorial from expert allergy dietitians on the diagnosis and management of FHS in children. Food hypersensitivity includes a wide spectrum of symptoms and mechanisms. Many researchers and clinicians have discussed the possible role of the gut (barrier) and the mucosal immune system in the development of food allergies. Factors that have been addressed in particular include weaning and the weaning diet [4], age of solid food introduction and breast feeding [5], gut bacteria [6], and gastrointestinal infections [7]. What is clear is that a better understanding of the immunological mechanisms involved in sensitisation and tolerance will enhance our efforts of allergy prevention and discovering novel treatments. L. C.-H. Yu discusses in the review paper " Intestinal epithelial barrier dysfunction in food hypersensitivity " the epithelial barrier dysfunction in sensitized intestines with particular reference to the enhanced transcytotic rates of allergens and the mechanisms involved in development of sensitisation. They discuss that recent studies demonstrate that food allergens manage to be transported across the epithelium and avoid lysosomal degradation by binding to cell surface IgE and the low-affinity receptor CD23/FcεRII—leading to investigation of anti-IgE and anti-CD23 antibodies in the prevention and management of allergic diseases. A clear diagnosis plays a very important role in the management of food hypersensitivities. The paper " Late type of bronchial response to milk ingestion challenge: a comparison of open and double-blind challenge " by Z. Pelikan addresses two important issues often discussed by allergists and other health care professionals [8]. (1) Can cow's milk cause a bronchial response in patients with diagnosed asthma and (2) can open food challenges be used for the diagnosis of …