Foods are an important cause of severe acute hypersensitivity reactions including fatal anaphylaxis. Food allergy has been estimated to be the most frequent cause of anaphylaxis treated in emergency rooms.<sup>69 Yocum M.W., Khan D.A. Assessment of patients who have experienced anaphylaxis: A three year survey Mayo Clin Proc 1994 ;  69 : 16-23

Cliccare qui per andare alla sezione Riferimenti</sup> Severe reactions to foods can occur at all ages, from infants receiving cow's milk or casein or whey hydrolysate formulas<sup>21 Ellis M.H., Short J.A., Heiner D.C. Anaphylaxis after ingestion of a recently introduced hydrolyzed whey protein formula J Pediatr 1991 ;  118 : 74-77  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 57 Saylor J.D., Bahna S.L. Anaphylaxis to casein hydrolysate formula J Pediatr 1991 ;  118 : 71-74  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> to children, adolescents, and adults.<sup>56 Sampson H.A., Mendelsoon I.M., Rosen J.P. Fatal and near-fatal anaphylactic reactions to food in children and adolescents N Engl J Med 1992 ;  327 : 380-384  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 70 Yunginger J.W., Sweeney K.G., Sturner W.Q. , e al. Fatal food-induced anaphylaxis JAMA 1988 ;  260 : 1450-1452

Cliccare qui per andare alla sezione Riferimenti</sup> Although some reactions caused by formula proteins in infants may decrease in intensity with age,<sup>7 Bock S.A. Natural history of severe reactions to foods in young children J Pediatr 1985 ;  107 : 676-680  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> the risk for severe reactions to other foods persists for long periods of time, even in absence of exposure.<sup>8 Bock S.S. The natural history of food sensitivity J Allergy Clin Immunol 1982 ;  69 : 173-177  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup>

The current management of patients with severe acute food reactions is based on avoidance of specific foods and on the availability of emergency medications to immediately treat an acute reaction. These severe reactions have been associated with fish, shellfish, nuts and seeds, legumes, celery, and to a lesser extent with grains, milk, and eggs.<sup>7 Bock S.A. Natural history of severe reactions to foods in young children J Pediatr 1985 ;  107 : 676-680  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 8 Bock S.S. The natural history of food sensitivity J Allergy Clin Immunol 1982 ;  69 : 173-177  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 70 Yunginger J.W., Sweeney K.G., Sturner W.Q. , e al. Fatal food-induced anaphylaxis JAMA 1988 ;  260 : 1450-1452

Cliccare qui per andare alla sezione Riferimenti</sup> It is clear from looking at this list that even the most careful patients may not be safe from an accidental or inadvertent exposure. In most instances, individuals experiencing a food-induced anaphylactic reaction have inadvertently ingested the food that caused the allergic reaction.<sup>56 Sampson H.A., Mendelsoon I.M., Rosen J.P. Fatal and near-fatal anaphylactic reactions to food in children and adolescents N Engl J Med 1992 ;  327 : 380-384  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The unpredictability of accidental exposures and the long periods of time during which patients at risk may not come in contact with the offending foods makes it difficult to have acute treatment medications available at all times, which is necessary for the prevention of fatal food reactions.<sup>56 Sampson H.A., Mendelsoon I.M., Rosen J.P. Fatal and near-fatal anaphylactic reactions to food in children and adolescents N Engl J Med 1992 ;  327 : 380-384  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 70 Yunginger J.W., Sweeney K.G., Sturner W.Q. , e al. Fatal food-induced anaphylaxis JAMA 1988 ;  260 : 1450-1452

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The vast majority of the acute, severe reactions to food appear to be IgE-mediated, although non–IgE-mediated reactions can also account for some severe food reactions.<sup>28 Hill D.J., Cameron D.J.S., Francis D.E.M. , e al. Challenge confirmation of late-onset reactions to extensively hydrolyzed formulas in infants with multiple food protein intolerance J Allergy Clin Immunol 1995 ;  96 : 386-394  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The presence of IgE antibodies as the likely cause for severe acute food reactions suggests the possibility of changing this allergic reactivity to a less noxious or even protective form of immune response through immunotherapy or by altering the ability of major food allergens to interact with IgE antibodies through molecular biology methods.

Strategies for developing any potentially successful food allergy immunotherapy for patients with life-long sensitivities must satisfy several requirements. First, these methods must be safe and provide an optimal risk-to-benefit ratio for the patient. Procedures must be cost effective and relatively easy to perform so that patients can be treated on a routine basis. In the ensuing discussion, we explore the mucosal immune response as it relates to food allergy, potential treatments of food-allergic individuals through alteration of the host immune responses, use of mucosal vaccines, and traditional and novel approaches to immunotherapy. Finally, genetic engineering and its use to alter allergenic protein molecules to reduce or abolish their allergenicity is discussed.