Food Allergy
C. Warren Bierman MD1
Clifton T. Furukawa MD1
1 Department of Pediatrics, University of Washington School of Medicine, and Division of Allergy, Children's Orthopedic Hospital and Medical Center, Seattle
Adverse reactions to food have been recognized since ancient times. Hippocrates observed: "Most are curable by the same means as those by which they are produced. For any one thing is food to one and injurious to another. Thus the physician should understand and distinguish the season of each so that at one time he may attend to the nourishment and at another to abstraction."
Although reactions to foods seemed reasonably simple to the ancient Greeks, today they have acquired dimensions of controversy and distortion. Some physicians (who usually care for children) ascribe a staggering array of symptoms to foodstuffs; others (who usually care for adults) seem unwilling to consider any food reaction "allergic" except for acute anaphylactic reactions.
These attitudes are reflected in editorial commentaries. A quarter century ago, Lowell and Schiller wrote, "Controversy rages around the clinical importance and frequency of food allergy in a more lively manner than around any other subject in the field of allergy."
Recently, it has been observed, "Nobody doubts that food allergy exists but the subject has acquired a dubious reputation.... Extravagant therapeutic claims have excited an antagonistic response, putting the subject under a cloud of controversy (which perhaps shelters a little quackery).1
May2 notes that "confusion among professionals and the public can be traced in part to lack of a rational integration of existing knowledge with basic concepts that could aid in the care of patients with suspected adverse reactions to foods."
