دانلود رایگان مقاله بررسی آلرژی غذایی از گذشته تا امروز

abstract

Hippocrates is often credited with first recognizing that food could be responsible for adverse symptoms and even death in some individuals, but it was not until the seminal observations by Prausnitz that the investigation of food allergy was viewed on a more scientific basis. In the first half of the 20th century, there were periodic reports in the medical literature describing various food allergic reactions. In the mid- to late- 1970's, the studies of Charles May and colleagues began to penetrate the medical world's skepticism about the relevance of food allergy and how to diagnose it, since standard skin testing was known to correlate poorly with clinical symptoms. With May's introduction of the double-blind placebocontrolled oral food challenge, the study of food allergy became evidence-based and exponential strides have been made over the past four decades in the study of basic immunopathogenic mechanisms and natural history, and the diagnosis and management of food allergies. Today IgE- and non-IgE-mediated food allergic disorders are well characterized and efforts to treat these allergies by various immunotherapeutic strategies are well under way.

Future

While tremendous progress has been made in the diagnosis and management of food allergy, especially in the past decade, the next decade will undoubtedly witness further advances in our understanding of basic underlying immunologic mechanisms associated with food allergy and the development of tolerance. Recent murine studies indicate that not only the gastrointestinal tract, but normal skin is a powerful tolerogenic organ that may be exploited for the prevention and treatment of food allergy.84e87 A recent doubleblind placebo-controlled study demonstrated that the use of omalizumab in combination with oral immunotherapy (OIT) to milk could markedly reduce adverse reactions due to OIT compared to placebo, significantly improving the risk:benefit ratio of this approach.88 A number of other novel therapies are in pre-clinical or early clinical trials for treating food allergies: epicutaneous immunotherapy has shown promise in pre-clinical murine models and in a phase I and II clinical trial89,90; an herbal formulation based on traditional Chinese medicine has proved effective in pre-clinical murine studies and shown some positive responses in early human trials91e93; and CpG-coated nanoparticles containing food protein,94 modified allergenic proteins95,96 and toll-like receptor (TLR)- conjugated proteins similar to those used for grass pollen immunotherapy,97,98 have all shown promise in murine models of food allergy. A number of trials are now underway to determine the most effective strategies for preventing food allergies and a number of diagnostic approaches, e.g. allergenic epitope analysis99 and basophil activation assays100e102 are being evaluated for their ability to provide better tools for accurately identifying patients with symptomatic food allergy.