This review provides general information to serve as a primer for those embarking
on understanding food allergy and also details advances and updates in epidemiology,
pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our
last comprehensive review. Although firm prevalence data are lacking, there is a strong
impression that food allergy has increased, and rates as high as approximately 10%
have been documented. Genetic, epigenetic, and environmental risk factors are being
elucidated increasingly, creating potential for improved prevention and treatment
strategies targeted to those at risk. Insights on pathophysiology reveal a complex
interplay of the epithelial barrier, mucosal and systemic immune response, route of
exposure, and microbiome among other influences resulting in allergy or tolerance.
The diagnosis of food allergy is largely reliant on medical history, tests for sensitization,
and oral food challenges, but emerging use of component-resolved diagnostics is improving
diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests,
determination of epitope binding, DNA methylation signatures, and bioinformatics approaches,
will further change the landscape. A number of prevention strategies are under investigation,
but early introduction of peanut has been advised as a public health measure based
on existing data. Management remains largely based on allergen avoidance, but a panoply
of promising treatment strategies are in phase 2 and 3 studies, providing immense
hope that better treatment will be imminently and widely available, whereas numerous
additional promising treatments are in the preclinical and clinical pipeline.