Food Allergy Quiz

True: Food allergens are the most common cause of anaphylaxis, accounting for about 30 to 40% of cases in all ages and 70 to 80% of cases in children. The exact prevalence of food-induced anaphylaxis in the United States is unknown. Estimates suggest emergency department visits for food-induced acute reactions occur about every 3 minutes and visits for food-induced anaphylaxis every 6 minutes in the United States, and the rates appear to be increasing.

Decker WW, Campbell RL, Manivannan V, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol. 2008 Dec;122(6):1161-5.

Lin RY, Anderson AS, Shah SN, Nurruzzaman F. Increasing anaphylaxis hospitalizations in the first 2 decades of life: New York State, 1990 -2006. Ann Allergy Asthma Immunol. 2008 ct;101(4):387-93.

Branum AM, Lukacs SL. Food allergy among children in the United States. Pediatrics 2009 Dec;124(6):1549-55.

Rudders SA, Banerji A, Vassallo MF, Clark S, Camargo CA Jr. Trends in pediatric emergency department visits for food-induced anaphylaxis. J Allergy Clin Immunol. 2010 Aug;126(2):385-8.

Clark S, Espinola J, Rudders SA, Banerji A, Camargo CA Jr. Frequency of US emergency department visits for food-related acute allergic reactions. J Allergy Clin Immunol. 2011 Mar;127(3):682-3.

Huang F, Chawla K, Järvinen KM, Nowak-Węgrzyn A. Anaphylaxis in a New York City pediatric emergency department: triggers, treatments, and outcomes. J Allergy Clin Immunol. 2012 Jan;129(1):162-8.e1-3.

False: Case studies suggest that adolescent/young adult age, a prior history of reaction, absence of symptoms involving or affecting the skin, a history of asthma, and the delay in the administration of epinephrine are all associated with fatal food-induced anaphylaxis.

Yunginger JW, Sweeney KG, Sturner WQ, Giannandrea LA, Teigland JD, Bray M, et al. Fatal food-induced anaphylaxis. JAMA: the journal of the American Medical Association. 1988 Sep 9;260(10):1450-2.

Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001 Jan;107(1):191-3.

Vogel NM, Katz HT, Lopez R, Lang DM. Food allergy is associated with potentially fatal childhood asthma. The Journal of Asthma: official journal of the Association for the Care of Asthma. 2008 Dec;45(10):862-6.

Pumphrey RS, Gowland MH. Further fatal allergic reactions to food in the United Kingdom, 1999-2006. J Allergy Clin Immunol. 2007 Apr;119(4):1018-9.

False: Newer diagnostic methods that detect serum IgE to specific components of food allergens may enhance current testing and identify those patients at risk for anaphylaxis, but there is no current diagnostic test can predict the severity of future reactions.

Pumphrey RS, Gowland MH. Further fatal allergic reactions to food in the United Kingdom, 1999-2006. J Allergy Clin Immunol. 2007 Apr;119(4):1018-9.

Spergel JM, Beausoleil JL, Fiedler JM, Ginsberg J, Wagner K, Pawlowski NA. Correlation of initial food reactions to observed reactions on challenges. Ann Allergy Asthma Immunol. 2004 Feb;92(2):217-24.

Atkins D, Bock SA. Fatal anaphylaxis to foods: epidemiology, recognition, and prevention. Current Allergy and Asthma Reports. 2009 May;9(3):179-85.

True: Exercising, having a related viral illness, ingesting alcohol, or taking drugs such as antacids, aspirin and NSAIDs may increase the severity of an acute reaction to food.

Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010 Dec;126(6 Suppl):S1-58.

True: A delay in administering epinephrine is associated with most fatal cases. A second dose of epinephrine may be required in up to 20% of cases. 2010 NIAID Food Allergy Guidelines recommend that all patients at risk for fatal food-induced anaphylaxis be prescribed epinephrine. These include patients with food allergy and asthma; patients allergic to peanut, tree nuts, fish, and shellfish; and patients with a prior history of a systemic reaction due to food.

In addition, the expert panel suggests consideration should be given to prescribing epinephrine to all patients with IgE-mediated food allergy. Patients and caregivers should know how to use the device and have it readily available at all times.

Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010 Dec;126(6 Suppl):S1-58.

False: FPIES is a non-IgE mediated food allergic disorder that involves severe, repetitive vomiting within 2-4 hours after food ingestion. The first line of treatment in FPIES is administration of intravenous fluids to counteract fluid loss from vomiting and diarrhea. Epinephrine is not usually prescribed for patients with FPIES.

Since FPIES does not present with classic allergic symptoms involving the skin or respiratory tract, it is frequently misdiagnosed in the emergency setting. Therefore, it is helpful to provide the patient with an emergency letter that describes the symptoms and management. An FPIES emergency treatment plan can be downloaded from the International Association for Food Protein Enterocolitis website.

Järvinen KM, Nowak-Węgrzyn A. Food Protein-Induced Enterocolitis Syndrome (FPIES): Current management strategies and Review of the Literature. J Allergy Clin Immunol – In Practice 2013, Jul/Aug;1(4)317-322.

False: Eosinophilic (ee-uh-sin-uh-fil-ik) esophagitis (EoE) is an allergic condition that causes inflammation of the esophagus. The esophagus is the tube that sends food from the throat to the stomach.

Research suggests that the leading cause of EoE is a local allergy or a sensitivity to particular proteins found in foods. Previously, allergy skin tests and patch tests were used try and identify food triggers in EoE. Because EoE is not caused by the allergic antibody IgE, and it is not a systemic allergy, these tests are not accurate. Skin prick testing predicted 13% of causative foods in adults and children and combination prick and patch testing predicted 44% of causative foods in children. Food patch testing has not been standardized or validated in EoE.

Instead, foods are eliminated from the diet based on how commonly they trigger EoE. After elimination, an endoscopic biopsy is performed to see if the eosinophilic inflammation has resolved. Through sequential elimination and reintroduction of foods, esophageal biopsies can be used to identify food triggers. Foods such as dairy products, wheat, egg and soy are main causes of EoE. Dairy products should generally be eliminated first as this approach is often as effective as broader food elimination diets.

Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011 Jul;128(1):3-20.e6; quiz 21-2.

Spergel JM, Brown-Whitehorn TF, Cianferoni A, Shuker M, Wang ML, Verma R, et al. Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. The Journal of Allergy and Clinical Immunology. 2012 Aug;130(2):461-7 e5. PubMed PMID: 22743304. Epub 2012/06/30. eng. 2012.

Chang JW, Kliewer K, Haller E, Lynett A, Doerfler B, Katzka DA, et al. Development of a Practical Guide to Implement and Monitor Diet Therapy for Eosinophilic Esophagitis. Clin Gastroenterol Hepatol. 2023;21(7):1690-8.

McGowan EC, Wright BL, Ruffner MA, Pesek RD, Rothenberg ME, Spergel JM, et al. Eosinophilic esophagitis: An allergy and immunology perspective on the updated guidelines. J Allergy Clin Immunol. 2025;156(2):252-8.

Kliewer KL, Gonsalves N, Dellon ES, Katzka DA, Abonia JP, Aceves SS, et al. One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol. 2023;8(5):408-21.

Kliewer KL, Abonia JP, Aceves SS, Atkins D, Bonis PA, Capocelli KE, et al. One-food versus 4-food elimination diet for pediatric eosinophilic esophagitis: A multisite randomized trial. J Allergy Clin Immunol. 2025;155(2):520-32.

True: In about 20% of children with peanut allergy, it resolves with time. In children allergic to tree nuts the resolution rate is about 9%. In contrast, the majority of children with cow milk, egg, soybean, and wheat allergy outgrow these allergies with age. Those with peak lifetime food-specific serum IgE level greater than 50 kU/L are more likely to retain their allergy until teenage years.

Skolnick HS, Conover-Walker MK, Koerner CB, Sampson HA, Burks W, Wood RA. The natural history of peanut allergy. J Allergy Clin Immunol. 2001 Feb;107(2):367-74.

Fleischer DM, Conover-Walker MK, Christie L, Burks AW, Wood RA. The natural progression of peanut allergy: Resolution and the possibility of recurrence. J Allergy Clin Immunol. 2003 Jul;112(1):183-9.

Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol. 2005 Nov;116(5):1087-93.

Savage JH, Limb SL, Brereton NH, Wood RA. The natural history of peanut allergy: Extending our knowledge beyond childhood. J Allergy Clin Immunol. 2007 Sep;120(3):717-9

True: Any food can cause food-induced anaphylaxis, but peanuts, tree nuts, fish, seeds, shellfish, milk, and egg are the most common trigger foods in the United States. In fact, peanut and tree nuts have been identified as triggers in over 90% of cases of fatal food-induced anaphylaxis.

Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal food anaphylaxis reactions in children. N Engl J Med 1992;327:380-4.

Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol. 2001 Jan;107(1):191-3.

Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol. 2007 Apr;119(4):1016-8.