Priming the paradox: food allergen exposure & intervention

Abstract

Priming the Paradox: Food Allergen Exposure and Intervention. Context: Food allergies are immunological reactions triggered by allergen proteins, which can elicit symptoms ranging from mild oral irritation to life-threatening anaphylaxis. There is currently no official cure for food allergies. However, allergists can alleviate symptoms with allergy management plans and emergency medications, like epinephrine injectors. Purpose Priming the Paradox: Food Allergen Exposure & Intervention comprehensively examines the "Big Nine" food allergens, which include cow milk, egg, wheat, soy, peanuts, tree nuts, sesame, fish, and shellfish. In addition, this literature review analyzes how food allergies are diagnosed, treated, and how molecular alteration impacts immunology. IgE-mediated reactions result in immediate physical symptoms; meanwhile, IgG-mediated reactions are chronically underdiagnosed due to delayed symptoms. Methods: To write this literature review, a comprehensive search was conducted using platforms like PubMed and Science Direct. Key search words included, "Big Nine" food allergens, immunoglobin, epitope, gut microbiome, hygiene hypothesis, oral allergy, and oral food challenge. Treatments researched to alleviate food allergies were oral immunotherapy, subcutaneous immunotherapy, epinephrine injectors like EpiPen, and biologic injections, like Omalizumab. This literature review analyzes how socioenvironmental and immunological frameworks can be used to differentiate IgE-mediated, immediate allergies from IgG-mediated, delayed adverse reactions. Findings Food allergen structures differ greatly in heat-resistance and enzymatic hydrolysis. Heat-labile allergens are prominent in cow milk, hen egg, wheat, and soy, but their conformational epitopes are denatured in baking. This structural change is significant and can reduce allergenicity, which is why heat-labile allergenic foods are used for oral immunotherapy. Meanwhile, heat-resistant allergens are prominent in peanuts, tree nuts, sesame, fish, and shellfish, but their structures persist through food processing and digestion. By analyzing antibody mechanisms, oral immunotherapy is vital for IgE-mediated allergy management. Significance: With newer studies and previous claims supporting the hygiene hypothesis, modern allergy research is shifting from strict allergen avoidance toward a proactive immunological intervention, which can be known as immunotherapy. An early allergy diagnosis is critical, because children's immune systems are the least primed and most responsive to intervention treatments. Allergy immunotherapy involves an allergist dosing known concentrations of an allergen to build patient tolerance. Furthermore, researchers are investigating how to personalize immunotherapy to treat multiple allergies in a patient to promote long-term success.