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Nat Rev Gastroenterol Hepatol. 2017 Apr;14(4):241-257. doi: 10.1038/nrgastro.2016.187. Epub 2016 Dec 21.

Food allergy and the gut.

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Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, New York 10029, USA.
The Medical University of Warsaw, Department of Paediatrics, Zwirki i Wigury 63A, 02091 Warsaw, Poland.
King's College London Academic Paediatric Allergy Service, Guy's &St Thomas' NHS Foundation Trust Children's Allergies Department, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.


Food allergy develops as a consequence of a failure in oral tolerance, which is a default immune response by the gut-associated lymphoid tissues to ingested antigens that is modified by the gut microbiota. Food allergy is classified on the basis of the involvement of IgE antibodies in allergic pathophysiology, either as classic IgE, mixed pathophysiology or non-IgE-mediated food allergy. Gastrointestinal manifestations of food allergy include emesis, nausea, diarrhoea, abdominal pain, dysphagia, food impaction, protein-losing enteropathy and failure to thrive. Childhood food allergy has a generally favourable prognosis, whereas natural history in adults is not as well known. Elimination of the offending foods from the diet is the current standard of care; however, future therapies focus on gradual reintroduction of foods via oral, sublingual or epicutaneous food immunotherapy. Vaccines, modified hypoallergenic foods and modification of the gut microbiota represent additional approaches to treatment of food allergy.

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