Sequence of Immunological Events During IgE-Mediated Allergic Reactions to Food

Food allergies (FA) represent a significant global health burden. Upon allergen re-exposure, allergic patients exhibit a sequence of symptoms that vary in terms of affected organ systems, severity, time of onset and allergen reactivity thresholds. This review focuses on the sequence of immediate immunological and clinical events that occur during allergen exposure in individuals with FA. It highlights both clinical and immunological baseline risk factors and discusses recent advances in understanding the acute allergic response. We explore the implications of immune mechanistic knowledge for predicting clinical reactivity and therapy of FA. The current diagnostic gold standard, the oral food challenge (OFC), may help identify early biomarkers for patient stratification and provide insights into the immune dynamics underlying acute allergic reactions in vivo.