Food Allergies Clinical Presentation

  • Author: Scott H Sicherer, MD; Chief Editor: Michael A Kaliner, MD   more...
 
Updated: Mar 7, 2012
 

History and Physical Examination

Symptoms of food-induced anaphylaxis can include the following:

  • Oropharyngeal pruritus
  • Angioedema (eg, laryngeal edema)
  • Stridor
  • Dysphonia
  • Cough
  • Dyspnea
  • Wheezing
  • Nausea
  • Vomiting
  • Diarrhea
  • Flushing
  • Urticaria
  • Angioedema
  • Ocular injection, ocular pruritus, conjunctival edema, periocular swelling
  • Nasal congestion, nasal pruritus, rhinorrhea, and sneezing
  • Abdominal pain
  • Feeling of impending doom
  • Cardiovascular collapse

History

Necessary elements of a thorough medical history include the following:

  • Develop a complete list of all foods suspected to cause symptoms
  • Discuss the manner of preparation of the food (cooked, raw, added spices or other ingredients)
  • Determine the minimum quantity of food exposure required to cause the symptoms
  • Determine the reproducibility of symptoms upon exposure to the food
  • Inquire about a personal or family history of other allergic disease
  • Inquire about eliciting factors that can potentiate a food-allergic reaction (eg, exercise[49] , nonsteroidal anti-inflammatory drugs [NSAIDs], or alcohol)

In addition, obtain a thorough description of each reaction, including the following:

  • The route of exposure (ingestion, skin contact, inhalation) and dose
  • The timing of the onset of symptoms in relation to food exposure
  • All observed symptoms and each one’s severity
  • The duration of the reaction
  • The treatment provided and the clinical response to treatment
  • The most recent reaction

Food-associated exercise-induced anaphylaxis describes a disorder in which exercise is tolerated and a food or foods are tolerated, but when exercise follows ingestion of a specific food or foods, anaphylaxis results.[50]

Physical examination

The physical examination findings are most useful for assessing overall nutritional status, growth parameters, and signs of other allergic disease, such as atopic dermatitis, allergic rhinitis, or asthma.

Findings from a comprehensive physical examination can help rule out other conditions that may mimic food allergy.

Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Scott H Sicherer, MD  Professor of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine of New York University

Scott H Sicherer, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Michael A Kaliner, MD  Clinical Professor of Medicine, George Washington University School of Medicine; Chief, Section of Allergy and Immunology, Washington Hospital Center; Medical Director, Institute for Asthma and Allergy

Michael A Kaliner, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Allergy, Asthma and Immunology, American Society for Clinical Investigation, American Thoracic Society, and Association of American Physicians

Disclosure: Alcon Consulting fee Consulting; Teva Consulting fee Consulting; Meda Honoraria Speaking and teaching; Ista Consulting fee Consulting; sunovian Consulting fee Consulting; dey Honoraria Review panel membership

Additional Contributors

Dan Atkins, MD Assistant Professor, Department of Pediatrics, University of Colorado Health Sciences Center; Head, Division of Ambulatory Pediatrics, Department of Pediatrics, Director, Pediatric Day Program, National Jewish Medical and Research Center

Dan Atkins, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology and American Thoracic Society

Disclosure: Nothing to disclose.

Stephen C Dreskin, MD, PhD Professor of Medicine, Departments of Internal Medicine, Director of Allergy, Asthma, and Immunology Practice, University of Colorado Health Sciences Center

Stephen C Dreskin, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association for the Advancement of Science, American Association of Immunologists, American College of Allergy, Asthma and Immunology, Clinical Immunology Society, and Joint Council of Allergy, Asthma and Immunology

Disclosure: Genentech Consulting fee Consulting; American Health Insurance Plans Consulting fee Consulting; Johns Hopkins School of Public Health Consulting fee Consulting; Array BioPharma Consulting fee Consulting

John M James, MD Consulting Staff, Department of Pediatrics, Department of Allergy and Immunology, Colorado Allergy and Asthma Centers, PC

John M James, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, American Medical Association, Colorado Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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