The presentation of individuals with food-related symptoms appears to be increasingly prevalent. Not all symptoms are associated with defined immunological mechanisms and therefore the range of foods in which intolerance can be described is potentially infinite. A small subset of foods usually accounts for more than 90% of severe reactions to foods that are mediated by or associated with IgE.
Not all individuals with evidence of IgE to foods are at risk of anaphylaxis. Not every individual requires prescription of epinephrine. The subjects who need epinephrine are those who have had severe reactions previously or who have a previous history of asthma. This is, however, the majority of patients and therefore most patients with food-related allergies should have epinephrine available. This does not mean, however, that administration of epinephrine should be an automatic step in every case. Most reactions are to small doses and either are self-limiting or respond well to oral antihistamines.
The warning signs of reactions and preparedness to treat despite uncertainty as to how the reaction will progress are the cornerstones of management for these patients. These people need to be aggressively polite in enquiring about the contents of the meals that they are being served by persons who are not friends or family and who may not necessarily have a vested interest in their well-being.
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