Food Hypersensitivity and Adverse Reactions

University of California, Davis Division of Rheumatology/Allergy and Clinical Immunology One Shields Avenue, TB 192 Davis, CA 95616-8660 E-mail: ssteuber{at}ucdavis.edu

Food Hypersensitivity and Adverse Reactions, edited by Marianne Frieri and Brett Kettelhut, 1999, 507 pages, hardcover, $195. Marcel Dekker, Inc, New York.

This is the 14th book in the Clinical Allergy and Immunology series (Michael A Kaliner, executive editor). The editors have recruited 30 authors, mainly from institutions in the United States, some of whom are top names in their respective fields. The text is logically arranged into 5 parts. Part 1 covers the basic science of hypersensitivity reactions, emphasizing mucosal immunity at the level of the gastrointestinal tract. This section of the text represents a good review of the function of mast cells, basophils, and their mediators. Chapter 4 in this section is a discussion of the major food allergens and their characteristics but falls short of providing adequate up-to-date references (for 1999), albeit a daunting task. For example, the reference to the major allergen of Brazil nut, Ber e 1, and its allergenicity when transformed into soybean and expressed is to an abstract published in 1994, rather than to the full-length article published in 1996.

Part 2 covers etiologic factors. The 4 chapters cover the diverse topics of cow milk allergy, adverse reactions to food additives, cross-reactive and hidden allergies, and toxic effects due to foods. The review of cow milk allergy is thorough and excellent, as is the discussion of cross-reactive allergens, which points out the many areas in which additional research is needed for further understanding. The problem of hidden allergens is well illustrated by reference to many fascinating case reports. Histamine intoxication mimicking allergy symptoms and symptoms due to monoamine oxidase inhibitors are covered in excellent detail.

Part 3 consists of chapters 9–16 and deals with the clinical manifestations of food hypersensitivity. The literature reviews in these chapters are useful and reveal some of the ongoing controversies in the area of food hypersensitivity, both at the level of the public compared with the medical community and within the medical field. For example, the public perception of adverse reactions to foods or additives far exceeds the actual, documented prevalence of adverse reactions. Also, many of the studies that suggested adverse reactions to certain additives or food constituents, such as monosodium glutamate, dyes, and sugars, were not well controlled. When these substances are mentioned in various chapters throughout the text, some of the authors do discuss the shortcomings of the published reports, whereas others do not.

Part 4 consists of chapters 17–20 and covers the diagnosis, prevention, and treatment of adverse reactions to foods. This section reviews how to work up possible food allergies and the different techniques that can be used. Staudenmayer and Selner are to be commended for an excellent, critical look at the literature in their chapter, "Psychological Manifestations in Idiopathic Environmental Intolerance (Foods)." Not only do these authors point out how anecdotal observations can erroneously become accepted fact, but they also reanalyze data from a past study to shed new light on the outcome, ie, the putative role of wheat and cow milk in schizophrenia. Their reviews of the issues of Candida hypersensitivity and attention deficit hyperactivity disorder are excellent, as is their fascinating discussion of biological mechanisms of learned sensitivity.

Part 5 looks at the management of food hypersensitivity. The first 2 chapters provide an overview of the management issues whereas the last 2 chapters break down the many different hypoallergenic formulas and list all the patient resources available nationwide. Hill and Hosking provide an outstanding summary in the chapter titled "The Management and Prevention of Food Allergy," but another chapter in this section contains misleading generalizations in stating that "an allergy to aspirin may also include sensitivity to salicylate-containing foods, including avocado, berries, cucumbers, melon, root beer, quick breads, potatoes, tomatoes, red and green peppers, pickles, olives, almonds, peanuts. . ."—a statement that is not well-founded.

Overall, Food Hypersensitivity and Adverse Reactions is a comprehensive text on food allergy. It is a solid addition to the Clinical Allergy and Immunology series. Most of the chapters are well written. A few authors have not taken the time to properly reference the information presented or to critically review studies in the more controversial areas of adverse reactions to foods, but others have done an outstanding job. This text is a useful resource for anyone with an interest in adverse reactions to foods to keep on the shelf.