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Hypersensitivity reactions to ingested foods are generally due to IgE-mediated reactions to food components or additives. IgE-coated mast cells lining the gastrointestinal tract react to presented allergens in ingested foods and produce clinical findings associated with the release of biologic mediators, as previously described. Non-IgE-mediated food allergy reactions have also been described. Dairy products, eggs, and nuts are some of the most commonly implicated foods.

A detailed history will provide the best clues to food allergy, with particular attention to other allergic history and prior reactions. Diagnosis is often difficult, since the offending food or foods may only occasionally produce symptoms, depending on the amount ingested and other foods present.

Symptoms of food allergy include swelling and itching of the lips, mouth, and pharynx; nausea; abdominal cramps; vomiting; and diarrhea. Cutaneous manifestations, such as angioedema and urticaria, as well as anaphylaxis, can occur. Treatment for mild reactions is supportive, with the administration of antihistamines to lessen symptoms. More severe reactions or anaphylaxis are managed as previously described. Referral to an allergy specialist is indicated. -I!3

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