Respiratory tract and food hypersensitivity

Respiratory symptom complaints are among the most frequent reasons patients seek medical attention. These symptoms typically include nasal congestion, rhinorrhea, sneezing, itching of the nose and throat, coughing, or wheezin g. Numerous causes should be considered in the differential diagnosis (Tabl e 1) of these symptoms. Of these, respiratory tract symptoms are commonly a ttributed to inhalant allergies, such as those observed with allergic rhini tis. In contrast, food allergy as a specific cause for respiratory tract sy mptoms has been less well-defined. Other articles in this issue have highlighted the most common clinical mani festations of allergic reactions to foods. These symptoms typically involve the skin and gastrointestinal tract.(44) In addition, respiratory symptoms may result from an allergic reaction to food but are not as common as cuta neous and intestinal symptoms and rarely occur in isolation. In general, re spiratory symptoms are a more worrisome group of clinical manifestations be cause they have been frequently observed in fatal and near-fatal reactions following food ingestion.(47) This article reviews information implicating foods and food additives as ca uses for specific symptoms in the upper and lower respiratory tract. A spec ific focus is placed on the role of food hypersensitivity in asthma, rhinit is, otitis media, and respiratory anaphylaxis. Key clinical points are disc ussed, as well as a reasonable diagnostic work-up for food allergy and resp iratory symptoms. This information provides a practical approach to the wor k-up of food allergy in patients presenting with respiratory complaints.