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Food Allergy and Anaphylaxis Research

Works Count: 56566

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Description

This cluster of papers focuses on the diagnosis and management of food allergy, with an emphasis on anaphylaxis, allergen immunotherapy, peanut allergy, epidemiology, and prevalence in children. It covers topics such as IgE-mediated reactions, clinical features, oral immunotherapy, and the impact of food allergy on quality of life.

Keywords

Food Allergy; Anaphylaxis; Allergen Immunotherapy; Peanut Allergy; Epidemiology; Diagnosis; Management; Children; IgE-mediated; Prevalence

Oral gene delivery with chitosan–DNA nanoparticles generates immunologic protection in a murine model of peanut allergy

1999-04-01

Krishnendu Roy , Hai‐Quan Mao , Shau Ku Huang +1 more

Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology

2014-06-09

Antonella Muraro , Graham Roberts , Margitta Worm +7 more

Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of … Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidence-based recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis. Anaphylaxis is a potentially life-threatening condition whose clinical diagnosis is based on recognition of a constellation of presenting features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use the device should be provided. Specialist follow-up is essential to investigate possible triggers, to perform a comprehensive risk assessment, and to prevent future episodes by developing personalized risk reduction strategies including, where possible, commencing allergen immunotherapy. Training for the patient and all caregivers is essential. There are still many gaps in the evidence base for anaphylaxis.

Stability of food allergens to digestion in vitro

1996-10-01

James D. Astwood , John N. Leach , Roy L. Fuchs

Clinical efficacy and immune regulation with peanut oral immunotherapy

2009-07-04

Stacie M. Jones , Laurent Pons , Joseph L. Roberts +7 more

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Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment

2014-01-03

Scott H. Sicherer , Hugh A. Sampson

Lessons for management of anaphylaxis from a study of fatal reactions

2000-08-01

Pumphrey

Background The unpredictability of anaphylactic reactions and the need for immediate, often improvised treatment will make controlled trials impracticable; other means must therefore be used to determine optimal management. Objectives … Background The unpredictability of anaphylactic reactions and the need for immediate, often improvised treatment will make controlled trials impracticable; other means must therefore be used to determine optimal management. Objectives This study aimed to investigate the circumstances leading to fatal anaphylaxis. Methods A register was established including all fatal anaphylactic reactions in the UK since 1992 that could be traced from the certified cause of death. Data obtained from other sources suggested that deaths certified as due to anaphylaxis underestimate the true incidence. Details of the previous medical history, the reaction and necropsy were sought for all cases. Results Approximately half the 20 fatal reactions recorded each year in the UK were iatrogenic, and a quarter each due to food or insect venom. All fatal reactions thought to have been due to food caused difficulty breathing that in 86% led to respiratory arrest; shock was more common in iatrogenic and venom reactions. The median time to respiratory or cardiac arrest was 30 min for foods, 15 min for venom and 5 min for iatrogenic reactions. Twenty‐eight per cent of fatal cases were resuscitated but died 3 h–30 days later, mostly from hypoxic brain damage. Adrenaline (epinephrine) was used in treatment of 62% of fatal reactions but before arrest in only 14%. Conclusions Immediate recognition of anaphylaxis, early use of adrenaline, inhaled beta agonists and other measures are crucial for successful treatment. Nevertheless, a few reactions will be fatal whatever treatment is given; optimal management of anaphylaxis is therefore avoidance of the cause whenever this is possible. Predictable cross‐reactivity between the cause of the fatal reaction and that of previous reactions had been overlooked. Adrenaline overdose caused at least three deaths and must be avoided. Kit for self‐treatment had proved unhelpful for a variety of reasons; its success depends on selection of appropriate medication, ease of use and good training.

Epidemiology of food allergy

2011-01-14

Scott H. Sicherer

Food allergy. Part 1: Immunopathogenesis and clinical disorders

1999-05-01

Hugh A. Sampson

Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents

1997-10-01

Hugh A. Sampson , Deborah G. Ho

Background: The double-blind, placebo-controlled food challenge (DBPCFC) is the "gold standard" for diagnosis of food hypersensitivity. Skin prick tests and RASTs are sensitive indicators of food-specific IgE antibodies but poor … Background: The double-blind, placebo-controlled food challenge (DBPCFC) is the "gold standard" for diagnosis of food hypersensitivity. Skin prick tests and RASTs are sensitive indicators of food-specific IgE antibodies but poor predictors of clinical reactivity. Previous studies suggested that high concentrations of food-specific IgE antibody were predictive of food-induced clinical symptoms. Because the CAP System FEIA (Pharmacia Diagnostics, Uppsala, Sweden) provides a quantitative assessment of allergen-specific IgE antibody, this study was undertaken to determine the potential utility of the CAP System FEIA in diagnosis of IgE-mediated food hypersensitivity. Methods: Sera from 196 patients with food allergy were analyzed for specific IgE antibodies to egg, milk, peanut, soy, wheat, and fish by CAP System FEIA. Sera were randomly selected from 300 stored samples of children and adolescents who had been evaluated by history, skin prick tests, and DBPCFCs. The study population was highly atopic; all patients had atopic dermatitis, and approximately 50% had asthma and allergic rhinitis at the time of initial evaluation. The performance characteristics of the CAP System FEIA were compared with those of skin prick tests and the outcome of DBPCFCs or "convincing" histories of anaphylactic reactions. Results: The prevalence of specific food allergies in the study population varied from 22% for wheat to 73% for egg. Allergy to egg, milk, peanut, and soy accounted for 87% of confirmed reactions. The performance characteristics of skin prick tests and CAP System FEIA (egg, milk, peanut, fish) were comparable, with excellent sensitivity and negative predictive accuracy but poor specificity and positive predictive accuracy. The performance characteristics of the CAP System FEIA for soy and wheat were poor. For egg, milk, peanut, and fish allergy, diagnostic levels of IgE, which could predict clinical reactivity in this population with greater than 95% certainty, were identified: egg, 6 kilounits of allergen-specific IgE per liter (kUA/L); milk, 32 kUA/L; peanut, 15 kUA/L; and fish, 20 kUA/L. Conclusions: When compared with the outcome of DBPCFCs, results of CAP System FEIA are generally comparable to those of skin prick tests in predicting symptomatic food hypersensitivity. Furthermore, by measuring the concentrations of food-specific IgE antibodies with the CAP System FEIA, it is possible to identify a subset of patients who are highly likely (>95%) to experience clinical reactions to egg, milk, peanut, or fish. This could eliminate the need to perform DBPCFCs in a significant number of patients suspected of having IgE-mediated food allergy. (J Allergy Clin Immunol 1997;100:444-51.)

Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy

2008-11-01

George Du Toit , Yitzhak Katz , Peter Sasieni +7 more

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Probiotics: A novel approach in the management of food allergy☆☆☆★★★

1997-02-01

Heli Majamaa , Erika Isolauri

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Further fatalities caused by anaphylactic reactions to food, 2001-2006

2007-02-16

S. Allan Bock , Anne Muñoz‐Furlong , Hugh A. Sampson

The lipocalin protein family: structural and sequence overview

2000-10-01

Darren R. Flower , A.C.T. North , Clare Sansom

Second symposium on the definition and management of anaphylaxis: Summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium

2006-02-01

Hugh A. Sampson , Anne Muñoz‐Furlong , Ronna L. Campbell +7 more

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Prevalence of common food allergies in Europe: a systematic review and meta-analysis

2014-05-10

Bright I. Nwaru , Lennart Hickstein , Sukhmeet S. Panesar +3 more

Allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish constitutes the majority of food allergy reactions, but reliable estimates of their prevalence are lacking. This systematic … Allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish constitutes the majority of food allergy reactions, but reliable estimates of their prevalence are lacking. This systematic review aimed to provide up-to-date estimates of their prevalence in Europe.Studies published in Europe from January 1, 2000, to September 30, 2012, were identified from searches of four electronic databases. Two independent reviewers appraised the studies and extracted the estimates of interest. Data were pooled using random-effects meta-analyses. Fifty studies were included in a narrative synthesis and 42 studies in the meta-analyses. Although there were significant heterogeneity between the studies, the overall pooled estimates for all age groups of self-reported lifetime prevalence of allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish were 6.0% (95% confidence interval: 5.7–6.4), 2.5% (2.3–2.7), 3.6% (3.0–4.2), 0.4% (0.3–0.6), 1.3% (1.2–1.5), 2.2% (1.8–2.5), and 1.3% (0.9–1.7), respectively. The prevalence of food-challenge-defined allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish was 0.6% (0.5–0.8), 0.2% (0.2–0.3), 0.1% (0.01–0.2), 0.3% (0.1–0.4), 0.2% (0.2–0.3), 0.5% (0.08–0.8), 0.1% (0.02–0.2), and 0.1% (0.06–0.3), respectively. Allergy to cow's milk and egg was more common among younger children, while allergy to peanut, tree nuts, fish, and shellfish was more common among the older ones. There were insufficient data to compare the estimates of soy and wheat allergy between the age groups. Allergy to most foods, except soy and peanut, appeared to be more common in Northern Europe. In summary, the lifetime self-reported prevalence of allergy to common foods in Europe ranged from 0.1 to 6.0%. The heterogeneity between studies was high, and participation rates varied across studies reaching as low as <20% in some studies. Standardizing the methods of assessment of food allergies and initiating strategies to increase participation will advance this evidence base.

Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey

2003-12-01

Scott H. Sicherer , Anne Muñoz‐Furlong , Hugh A. Sampson

Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report

2010-12-01

Joshua A. Boyce , Amal Assa’ad , A. Wesley Burks +7 more

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The natural history of IgE-mediated cow's milk allergy

2007-11-01

Justin M. Skripak , Elizabeth C. Matsui , Kim Mudd +1 more

Prevalence of challenge-proven IgE-mediated food allergy using population-based sampling and predetermined challenge criteria in infants

2011-03-01

Nicholas J. Osborne , Jennifer J. Koplin , Pamela Martin +7 more

Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: A manual

1988-12-01

S. Allan Bock , Hugh A. Sampson , Fred M. Atkins +5 more

The prevalence of food allergy: A meta-analysis

2007-07-13

Roberto J. Rona , Thomas Keil , Colin Summers +7 more

Factors Associated with the Development of Peanut Allergy in Childhood

2003-03-13

Gideon Lack , Deborah Fox , Kate Northstone +1 more

The prevalence of peanut allergy appears to have increased in recent decades. Other than a family history of peanut allergy and the presence of atopy, there are no known risk … The prevalence of peanut allergy appears to have increased in recent decades. Other than a family history of peanut allergy and the presence of atopy, there are no known risk factors.

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Effect of Anti-IgE Therapy in Patients with Peanut Allergy

2003-03-13

Donald Y.M. Leung , Hugh A. Sampson , John W. Yunginger +6 more

Peanut-induced anaphylaxis is an IgE-mediated condition that is estimated to affect 1.5 million people and cause 50 to 100 deaths per year in the United States. TNX-901 is a humanized … Peanut-induced anaphylaxis is an IgE-mediated condition that is estimated to affect 1.5 million people and cause 50 to 100 deaths per year in the United States. TNX-901 is a humanized IgG1 monoclonal antibody against IgE that recognizes and masks an epitope in the CH3 region of IgE responsible for binding to the high-affinity Fcε receptor on mast cells and basophils.

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EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy

2014-06-09

Antonella Muraro , Thomas Werfel , Karin Hoffmann‐Sommergruber +7 more

Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy … Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.

Diagnostic Approach and Management of Cow's‐Milk Protein Allergy in Infants and Children

2012-05-08

Sibylle Koletzko , B. Niggemann , András Arató +7 more

This guideline provides recommendations for the diagnosis and management of suspected cow's-milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on … This guideline provides recommendations for the diagnosis and management of suspected cow's-milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on recently published evidence-based guidelines on CMPA.If CMPA is suspected by history and examination, then strict allergen avoidance is initiated. In certain circumstances (eg, a clear history of immediate symptoms, a life-threatening reaction with a positive test for CMP-specific IgE), the diagnosis can be made without a milk challenge. In all other circumstances, a controlled oral food challenge (open or blind) under medical supervision is required to confirm or exclude the diagnosis of CMPA.In breast-fed infants, the mother should start a strict CMP-free diet. Non-breast-fed infants with confirmed CMPA should receive an extensively hydrolyzed protein-based formula with proven efficacy in appropriate clinical trials; amino acids-based formulae are reserved for certain situations. Soy protein formula, if tolerated, is an option beyond 6 months of age. Nutritional counseling and regular monitoring of growth are mandatory in all age groups requiring CMP exclusion. REEVALUATION: Patients should be reevaluated every 6 to 12 months to assess whether they have developed tolerance to CMP. This is achieved in >75% by 3 years of age and >90% by 6 years of age. Inappropriate or overly long dietary eliminations should be avoided. Such restrictions may impair the quality of life of both child and family, induce improper growth, and incur unnecessary health care costs.

Standardization of food challenges in patients with immediate reactions to foods – position paper from the European Academy of Allergology and Clinical Immunology

2004-06-04

Carsten Bindslev‐Jensen , Barbara Ballmer‐Weber , Ulf Bengtsson +7 more

At present, the double blind placebo controlled food challenge (DBPCFC) represents the only way to establish or rule out an adverse reaction to a food in older children and adults, … At present, the double blind placebo controlled food challenge (DBPCFC) represents the only way to establish or rule out an adverse reaction to a food in older children and adults, whereas an open challenge controlled by trained personnel is sufficient in infants and young children (1). The challenge procedure is not, however, fully developed and no standardised procedure has so far been agreed upon, although a manual describing several of the issues has previously been published (2). For the safety and feasibility of the patient undergoing challenge there is a need for standardisation of the procedures. Standardization also allows for comparison of results between different centers and different populations in scientific protocols. This Position Paper gives advice on how the procedures can be performed, but since there are no direct comparative studies available in the literature directly comparing the various parameters (e.g. timing between two subsequent challenges or increment of the dose for challenge) we have not been able to recommend truly evidence based guidelines. It is also important to realize, that legislative aspects vary in different countries within Europe, and that the guidelines presented herein must be adjusted according to local legislation. Furthermore this guideline does not constitute a guideline for Ethics Committees to decide feasibility of DBPCFC in a scientific protocol. There are several issues to be determined, prior to commencing a challenge in a patient. These can be divided into patient-related parameters, which are parameters concerning the actual patient in question and procedure-related parameters, which deal with the parameters independent of the patient in question (Table 1). Challenge should be performed either for establishment or exclusion of the diagnosis, for scientific reasons in clinical trials or for enabling determination of the sensitivity of the actual patient (threshold value) or for determining the allergenicity of foods. The determination of the sensitivity both enables tailor-made guidelines for the patient and opens the possibility of following sensitivity by repeated challenges especially in children with food allergies normally outgrown during childhood (cow's milk or hen's egg). Patients should be investigated according to the EAACI guidelines (1) using case history combined with in vivo and in vitro testing supplemented with a elimination diet period prior to challenge when necessary. Based on the findings here, the patient-related parameters can be determined. The guidelines in this position paper focus mainly on patients presenting classical immediate type allergic symptoms and signs (IgE-mediated type I allergy), as defined in EAACI position paper (1). Patients of any age with a history of adverse reaction to a food: For establishment or exclusion of the diagnosis of food intolerance/allergy For scientific reasons in clinical trials For determination of the threshold value or degree of sensitivity For assessment of tolerance. Once diagnosed, when a patient is suspected to have outgrown his clinical allergy – especially in children, whose food allergies normally outgrow during childhood, e.g. cow's milk or hen's egg allergies. Patients without specific history of adverse reaction to a food: If any chronic symptom is suspected by the patient or the physician to be food-related If a patient is on an improper elimination diet - without history of adverse food reaction –, the food has to be reintroduced and there are reasons for suspecting that an adverse reaction is possible. If a sensitization to a food is diagnosed and tolerance is not known – for example, sensitization to cross-reactive foods that have not been eaten after the adverse reaction. Eliglible patients for DBPCFC include: All patients with suspicion of an immediate, systemic allergic reaction to a food for establishment or exclusion of the diagnosis in infants and children ≤three years, an open challenge controlled and evaluated by a physician is most often sufficient. Patients with pollen related oral allergy syndrome (5) as their only symptom should only undergo DBPCFC outside scientific protocols in selected cases; for example in cases with discrepancy between case history and outcome of in vivo and/or in vitro tests. An open challenge may precede DBPCFC in older children and adults because a negative result herein renders DBPCFC unnecessary. Open challenges should not be applied in cases with a high probability of a positive outcome or in cases with subjective and/or controversial symptoms only (6). There are, however other types of patients, who also should be investigated in a standardised programme: patients with isolated, late reactions such as a subgroup of patients with atopic eczema dermatitis syndrome (AEDS) (7–12). In the majority of AEDS patients with associated food hypersensitivity an immediate reaction is seen (eg exanthema, flushing, urticaria together with symptoms and signs from the respiratory and gastrointestinal tract), but data are accumulating on a subgroup of patients who only experience exacerbation of their eczema within 24–48 hours after challenge. In such patients, the challenge procedure should be adjusted to meet the demands concerning e.g. timing and settings (11–15). patients with controversial symptoms often of subjective nature such as chronic fatigue syndrome, multiple chemical sensitivities, migraine or joint complaints, who are presenting symptoms which are not in accordance with classical atopic symptoms. Such patients should only be investigated in strict scientific protocols with special attention to the statistical evaluation of the outcome, see ''Statistics section''(6). patients with chronic urticaria, where a subgroup is reactive to additives or to high doses of special foods (e.g. tomatoes) (16–24). Standardised protocols for DBPCFC in these patients have so far not been fully developed, and the actual incidence of food dependent chronic urticaria remains to be established. patients with isolated late reactions in the gut (25, 26). Also for this group of patients, special attention must be paid to the lack of knowledge of incidence and nature of reaction, since these patients have not been finally classified. Specific guidelines for these four latter groups are not dealt with in this Position Paper. In these patients, the challenge procedures must be adjusted according to the nature and severity of the reactions. Detailed guidelines for such patients have so far not been developed within the EAACI. A detailed position paper which has just been published from the German Society of Allergology and Clinical Immunology for identification of the late reactions in AD is now being modified for the EAACI (13). Challenge is thus performed when the diagnosis is not made by case history and outcome of in vivo/in vitro tests, in scientific protocols for research purposes, or when a patient is suspected to have outgrown his/her clinical allergy. Patients with a clear cut case history of anaphylaxis (or a severe systemic reaction) to one or more specific food items should not be challenged, provided the risk of misinterpretation of a positive skin prick test or specific IgE due to clinically insignificant cross reaction is considered and ruled out - this may be the case for instance in patients with a false positive specific IgE to peanut due to grass pollen sensitization (27). The potential risk to the patient must always be weighed against the risk of misinterpreting e.g. skin prick test results or positive findings in specific IgE. We define Anaphylaxis according to EAACI 2002, comparable to class 3 to 4 in the Müller classification of reactions to bee or wasp (28). In selected cases where positive test results makes challenge unnecessary as is the case in children with positive spt to egg and specific IgE (CAP) above a certain level from ≥0.35 KUA/L to 17.5 ≥ KUA/L, in which the probability of a positive challenge outcome exceeds 95%. At present, such a correlation has only been demonstrated in children with AEDS and allergy to selected foods (29–32). By omitting challenge, determination of the clinical sensitivity (''threshold'') of the patient is not possible (33). Patients with ongoing disease should not be challenged e.g. patients with acute infection, unstable angina pectoris or patients with seasonal allergy during the season. Patients with chronic atopic disease such as asthma or AEDS should only be challenged when disease activity is at a stable and low level. Pregnant women should not be challenged. Patients taking medication which may enhance, mask, delay or prevent evaluation of a reaction or interfere with treatment of a reaction should not be challenged. Drugs include antihistamines, neuroleptics, oral steroid above 5 mg per day, aspirin and other NSAID's, ACE-inhibitors, beta-blockers and clinical experience and new drugs may extend the list. Medication such as short acting β2-agonists, inhaled or topical steroids can normally be continued during challenge, but the amount used must be kept at a fixed level. Discontinuation of these drugs may interfere with the interpretation of the outcome of the challenge. Double blind challenge (DB) DB is the procedure generally recommended, especially if a positive challenge outcome is expected (for example, when studying an adverse reaction believed to be IgE-mediated, and the food skin test is positive). DB is the method of choice for scientific protocols. DB is the method of choice when studying late reactions or chronic symptoms, such as AEDS, isolated digestive late reactions, or chronic urticaria. DB is the only way to conveniently study subjective food-induced complains, such as acute subjective adverse reactions, chronic fatigue syndrome, multiple chemical sensitivities, migraine or joint complaints. Open challenge A negative DB should always be followed by an open challenge. A positive open challenge could be sufficient when dealing with IgE-mediated acute reactions manifesting with objective signs. For practical reasons, an open challenge can be the first approach when the probability of a negative outcome is estimated to be very high (for example, when studying an adverse reaction believed to be IgE-mediated, and a properly performed food skin test is negative). In infants and children ≤3 years, an open, physician- controlled challenge is often sufficient for suspected immediate type reactions (unless a psychological reaction of the mother is expected). For patients with pollen-related OAS as their only symptom, an open challenge could be sufficient as regular procedure - due to difficulties in blinding fruits and vegetables conserving their allergenicity -. However, in these patients, DB are recommended for scientific protocols and other selected cases for example, discrepancies between clinical history and outcome of diagnostic tests. Single Blind Challenge Single blind challenge carries the same difficulties for blinding foods as for DB, and introduces subjective biases of the observer. Therefore, with only a minor additional work (cross-over by an external technician), DB can be performed, and the result will be more robust. Therefore, our recommendation is to always use DB instead. The personnel involved in challenge procedure must be specially trained in management of acute allergic reactions and equipment for resuscitation (including adrenaline for injection and oxygen) must be readily available. In cases where a severe reaction is suspected, challenge should be performed in settings with immediate access to intensive care units. A possible need for latex-free surroundings should be considered. Placebo challenge and active challenge should ideally be separated by at least 24 hours, but when late reactions are not expected, both challenges can in many cases of classical type 1 allergy be performed on the same day. If a reaction needing treatment occurs, the next challenge should not be performed until the symptoms have resolved and the quarantine period for the drugs used has expired. Intravenous access should be available before initiation of challenges as a general rule, and always if a severe systemic reaction is expected. In small children, iv access is only necessary in selected cases, but if there is any doubt on the outcome (severity) of a challenge, it is advisable to place a cannula in advance. Patients can be in most cases be challenged as out patients and discharged after an observation period of at least 2 hours after the last dose given, provided no reaction has occurred. The observation period must be adjusted to the expected symptoms and signs in the patient in question. The patient must be discharged with specific information and satisfactory arrangements for care if a late reaction (especially asthma) occurs. In some cases, ''rescue medication'' consisting of antihistamines, β-agonists and steroids may be given to the patient to take prn after contacting the physician. If a patient experiences a severe reaction needing treatment (asthma, laryngeal oedema, severe urticaria), he/she should be kept under observation at the hospital overnight and treated accordingly. A negative outcome of DBPCFC must always be followed by an open serving of the food in order to avoid possible false negative outcome of DBPCFC due to destruction of allergens during preparation of the challenge (34). For clinical purposes, a patient may thus be classified as positive, or likely positive (only positive in open challenge) whereas as in a scientific protocol a positive open challenge in a DBPCFC negative patient should be considered as a drop-out. If case history is suggestive of reactions in special situations only (reaction elicited only when exercising after eating (food dependent, exercise induced anaphylaxis (3) or with concomitant intake of a drugs (e.g. aspirin (4)) or intake of processed food (35–37)) challenges should first be performed without exercise/drug intake and if negative repeated with exercise/drug intake . Many of these reactions are, however, severe of nature and the use of pharmaceutical ''facilitators'' such as aspirine may enhance the severity of the reaction resulting in life-threatening situations. Such challenges should always be considered carefully. The challenge protocol should be decided on beforehand. In cases of classical type 1 patients presenting objective signs a protocol using one active and one placebo is normally sufficient due to the low frequency of reactions to placebo in these patients (38–49). In more dubious cases and especially in cases patients presenting with subjective signs only a protocol with repeated challenges should be applied, either using three plus three challenges or three plus two challenges (50–53). The starting dose, ie the amount of food in question administered to the patient as the first dose should be evaluated based on patient's case history and correlated to available data from the literature (Table 2). In published papers, 5% of patients react to less than 1 mg of peanut, whereas 15% of milk allergic patients react to less than 5 ml of cow's milk (43, 54). A computer model for assessment of threshold has recently been published demonstrating a possible threshold for a reaction in one in a hundred patients for milk, egg and peanut of 0,1 mg (55). It is advisable to begin with a starting dose below the expected 'threshold dose', because this will enable determination of the actual sensitivity in the patient (low adverse effect level and no observed adverse effect level). There is no correlation between the size of a skin prick test or the level of specific IgE and the clinical sensitivity in individual patients (33, 65). A time interval of 15–30 minutes is in most cases suitable for investigation of IgE associated reactions unless using capsules. In published papers, symptoms most often occur 3 to 15 minutes after intake; especially the severe reactions always occur immediately - if the patient history claims a reaction developed later, time schedule should be adjusted accordingly (39, 42, 43, 45, 50, 56, 66, 67). All patients follow the above incremental scheme if an acute reaction is suspected, patients with suspected isolated late reactions (e.g. exacerbation of AD) continue on another protocol with intake of normal daily amount the following day settings (11–15). The increment may either be a doubling of the dose every 15–30 minutes until top dose has been reached or the patient react, or a increment using logarithmic mean ie 1, 3, 10, 30, 100 etc. No comparative studies comparing these two protocols are available. There is a theoretical risk of passive rush desensitization during the procedure, but evidence for such a phenomenon has not been published and is unlikely since this would result in a positive outcome of the open feeding following a negative DBPCFC. Such reactions have only been seen in cases, where the active substance was destroyed during the blinding procedure (34, 68). If too large increments, on the other hand, are used, the risk of severe reactions increases. Therefore, at the present state of knowledge, either doubling or logarithmic increment is recommended. The top dose ie the maximal amount administered should normally be the normal daily intake in a serving of the food in question, adjusted for the age of the patient. Data concerning the foods most often causing allergic reactions has previously been published (69). Active and placebo challenges should be identical regarding taste, looks, smell, viscosity, texture, structure and volume. Assessment of possible differences between active and placebo should be evaluated by standard procedures such as duo-test and triangle-test, where differences in taste, texture, smell etc. are compared either in pairs or by ability for finding one different between three samples (70). In infants and children liquid foods can be masked in extensive hydrolysed cow's milk based formulas or in amino acid formulas eventually with addition of flavouring agents or colourants. Items with a strong taste such as black currant juice or peppermint oil may help masking an unpleasant taste. Different recipes for masking liquid and solid foods (peanut, soy, wheat, milk, egg, fish, hazelnut, almond, brazil nut, apple, carrot, celery, apricot, banana, zucchini, crustaceans) have been developed and are available on the EAACI homepage (http://www.eaaci.org or http://www.ig-food.org.) It is of crucial importance to ensure presence and stability of the allergenicity of the food in the mixture. In cases with very stable foods such as peanut or cod (42, 71) stability in the serving is not a problem, whereas in other cases especially with foods of vegetable origin (apples) the stability is very low (72). The procedures must be adjusted according to the stability of the food in question (35, 37). Only in cases of a suspected reaction to additives is masking in gelatine capsules recommended. Capsules should else wise be avoided, since reactions in mouth and throat are bypassed (OAS) and since the whole procedure is delayed due to the lag phase when the capsule is dissolved in the stomach. Measures to avoid toxicity from the food administered should be taken (aflatoxins in brazil nuts, salmonella bacteria in eggs, and mites in flour). Different approaches should be taken in patients presenting classical allergic symptoms with objective signs of a reaction on challenge and patients presenting subjective symptoms only. Furthermore, special attention should be made to the statistical evaluation when investigating patients with controversial symptoms. In classical type I allergy reacting with objectively measurable signs (e.g. a drop in FEV1, sneezing or urticaria), reactions to placebo are relatively rare and a challenge procedure using one active and one placebo challenge is normally sufficient (40, 42, 61, 73). In contrast, the frequency of reactions to placebo seen in patients reacting with subjective symptoms (OAS, migraine, itching) is higher (50, 53). Here, repeated challenges are normally necessary. Two statistical approaches exist, necessitating different approaches in challenge procedure. This is especially true for patients only presenting subjective symptoms: 1. An approach considering the actual patient The risk of a patient guessing the right sequence of challenges by chance is 50 per cent, if one active and one placebo is administered. Therefore repeated challenges must be used to ensure statistical significance. A protocol using three active and three placebo's has been published (51). The chance of a patient guessing the right sequence by chance is 0.05 (0.5 × 0.6 × 0.5 × 0.67 × 0.5). Recently a new model has been proposed, where using five challenges in stead of six, where the patient is aware of the presence of either three active and two placebo challenges or vice versa (52). This approach holds the same statistical reliability as using six challenges. 2. An approach considering a cohort of patients In several published papers patients reacting to placebo challenges are excluded from statistical analysis. This approach carries the risk of overestimating the actual frequency of patients with actual allergy. As a fictive example, the following outcome of a trial with 100 patients reacting with subjective symptoms only can be used for illustration: It is evident, that using the whole cohort, no correlation between challenge and outcome is obtained. Excluding the patients reacting to placebo (1 and 3), however, results in a frequency of 50% in the remaining patients. The frequency of placebo reactors in a trial must therefore always be taken into consideration and the actual frequency reported. In both cases, a statistical model has been developed (51). The use of such statistical evaluation of the outcome of a trial is highly recommended. All challenges should be documented. For comparative reasons, preformed and standardised documentation sheets should be used. Examples of such sheets are available at http://www.ig-food.org. The present position paper reviews the present level of knowledge for performing double-blind, placebo controlled challenges. The use of the guidelines presented here will both increase safety and feasibility for the patient and staff involved in the challenge procedure and also, by using mutual protocols, enable comparisons between results obtained in different centres.

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Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas

2007-12-31

Frank R. Greer , Scott H. Sicherer , A. Wesley Burks

This clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in … This clinical report reviews the nutritional options during pregnancy, lactation, and the first year of life that may affect the development of atopic disease (atopic dermatitis, asthma, food allergy) in early life. It replaces an earlier policy statement from the American Academy of Pediatrics that addressed the use of hypoallergenic infant formulas and included provisional recommendations for dietary management for the prevention of atopic disease. The documented benefits of nutritional intervention that may prevent or delay the onset of atopic disease are largely limited to infants at high risk of developing allergy (ie, infants with at least 1 first-degree relative [parent or sibling] with allergic disease). Current evidence does not support a major role for maternal dietary restrictions during pregnancy or lactation. There is evidence that breastfeeding for at least 4 months, compared with feeding formula made with intact cow milk protein, prevents or delays the occurrence of atopic dermatitis, cow milk allergy, and wheezing in early childhood. In studies of infants at high risk of atopy and who are not exclusively breastfed for 4 to 6 months, there is modest evidence that the onset of atopic disease may be delayed or prevented by the use of hydrolyzed formulas compared with formula made with intact cow milk protein, particularly for atopic dermatitis. Comparative studies of the various hydrolyzed formulas also indicate that not all formulas have the same protective benefit. There is also little evidence that delaying the timing of the introduction of complementary foods beyond 4 to 6 months of age prevents the occurrence of atopic disease. At present, there are insufficient data to document a protective effect of any dietary intervention beyond 4 to 6 months of age for the development of atopic disease.

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World Allergy Organization Guidelines for the Assessment and Management of Anaphylaxis

2011-01-01

F. Estelle R. Simons , Ledit Ardusso , Maria Beatrice Bilò +7 more

The illustrated World Allergy Organization (WAO) Anaphylaxis Guidelines were created in response to absence of global guidelines for anaphylaxis. Uniquely, before they were developed, lack of worldwide availability of essentials … The illustrated World Allergy Organization (WAO) Anaphylaxis Guidelines were created in response to absence of global guidelines for anaphylaxis. Uniquely, before they were developed, lack of worldwide availability of essentials for the diagnosis and treatment of anaphylaxis was documented. They incorporate contributions from more than 100 allergy/immunology specialists on 6 continents. Recommendations are based on the best evidence available, supported by references published to the end of December 2010. The Guidelines review patient risk factors for severe or fatal anaphylaxis, co-factors that amplify anaphylaxis, and anaphylaxis in vulnerable patients, including pregnant women, infants, the elderly, and those with cardiovascular disease. They focus on the supreme importance of making a prompt clinical diagnosis and on the basic initial treatment that is urgently needed and should be possible even in a low resource environment. This involves having a written emergency protocol and rehearsing it regularly; then, as soon as anaphylaxis is diagnosed, promptly and simultaneously calling for help, injecting epinephrine (adrenaline) intramuscularly, and placing the patient on the back or in a position of comfort with the lower extremities elevated. When indicated, additional critically important steps include administering supplemental oxygen and maintaining the airway, establishing intravenous access and giving fluid resuscitation, and initiating cardiopulmonary resuscitation with continuous chest compressions. Vital signs and cardiorespiratory status should be monitored frequently and regularly (preferably, continuously). The Guidelines briefly review management of anaphylaxis refractory to basic initial treatment. They also emphasize preparation of the patient for self-treatment of anaphylaxis recurrences in the community, confirmation of anaphylaxis triggers, and prevention of recurrences through trigger avoidance and immunomodulation. Novel strategies for dissemination and implementation are summarized. A global agenda for anaphylaxis research is proposed.

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US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up

2010-05-12

Scott H. Sicherer , Anne Muñoz‐Furlong , James Godbold +1 more

Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy

2015-02-24

George Du Toit , Graham Roberts , Peter H. Sayre +7 more

The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies … The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy.

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Update on food allergy☆

2004-05-01

Hugh A. Sampson

Second Symposium on the Definition and Management of Anaphylaxis: Summary Report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium

2006-03-18

Hugh A. Sampson , Anne Muñoz‐Furlong , Ronna L. Campbell +7 more

Food hypersensitivity and atopic dermatitis: Evaluation of 113 patients

1985-11-01

Hugh A. Sampson , Cynthia C. McCaskill

Food Allergy Among Children in the United States

2009-11-17

Amy M. Branum , Susan L. Lukacs

The goals were to estimate the prevalence of food allergy and to describe trends in food allergy prevalence and health care use among US children.A cross-sectional survey of data on … The goals were to estimate the prevalence of food allergy and to describe trends in food allergy prevalence and health care use among US children.A cross-sectional survey of data on food allergy among children <18 years of age, as reported in the 1997-2007 National Health Interview Survey, 2005-2006 National Health and Nutrition Examination Survey, 1993-2006 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, and 1998-2006 National Hospital Discharge Survey, was performed. Reported food allergies, serum immunoglobulin E antibody levels for specific foods, ambulatory care visits, and hospitalizations were assessed.In 2007, 3.9% of US children <18 years of age had reported food allergy. The prevalence of reported food allergy increased 18% (z = 3.4; P < .01) from 1997 through 2007. In 2005-2006, serum immunoglobulin E antibodies to peanut were detectable for an estimated 9% of US children. Ambulatory care visits tripled between 1993 and 2006 (P < .01). From 2003 through 2006, an estimated average of 317000 food allergy-related, ambulatory care visits per year (95% confidence interval: 195000-438000 visits per year) to emergency and outpatient departments and physician's offices were reported. Hospitalizations with any recorded diagnoses related to food allergy also increased between 1998-2000 and 2004-2006, from an average of 2600 discharges per year to 9500 discharges per year (z = 3.4; P < .01), possibly because of increased use of food allergy V codes.Several national health surveys indicate that food allergy prevalence and/or awareness has increased among US children in recent years.

Clinical features and severity grading of anaphylaxis

2004-08-01

Simon G.A. Brown

The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States

2011-06-21

Ruchi S. Gupta , Elizabeth E. Springston , Manoj R. Warrier +4 more

The goal of this study was to better estimate the prevalence and severity of childhood food allergy in the United States.A randomized, cross-sectional survey was administered electronically to a representative … The goal of this study was to better estimate the prevalence and severity of childhood food allergy in the United States.A randomized, cross-sectional survey was administered electronically to a representative sample of US households with children from June 2009 to February 2010. Eligible participants included adults (aged 18 years or older) able to complete the survey in Spanish or English who resided in a household with at least 1 child younger than 18 years. Data were adjusted using both base and poststratification weights to account for potential biases from sampling design and nonresponse. Data were analyzed as weighted proportions to estimate prevalence and severity of food allergy. Multiple logistic regression models were constructed to identify characteristics significantly associated with outcomes.Data were collected for 40 104 children; incomplete responses for 1624 children were excluded, which yielded a final sample of 38 480. Food allergy prevalence was 8.0% (95% confidence interval [CI]: 7.6-8.3). Among children with food allergy, 38.7% had a history of severe reactions, and 30.4% had multiple food allergies. Prevalence according to allergen among food-allergic children was highest for peanut (25.2% [95% CI: 23.3-27.1]), followed by milk (21.1% [95% CI: 19.4-22.8]) and shellfish (17.2% [95% CI: 15.6-18.9]). Odds of food allergy were significantly associated with race, age, income, and geographic region. Disparities in food allergy diagnosis according to race and income were observed.Findings suggest that the prevalence and severity of childhood food allergy is greater than previously reported. Data suggest that disparities exist in the clinical diagnosis of disease.

Fatalities due to anaphylactic reactions to foods

2001-01-01

Stefan Böck , Anne Muñoz‐Furlong , H. A. Sampson

Food allergy: A practice parameter update—2014

2014-08-28

Hugh A. Sampson , Seema S. Aceves , S. Allan Bock +7 more

The diagnosis and management of anaphylaxis practice parameter: 2010 Update

2010-08-08

Phillip Lieberman , Richard A. Nicklas , John Oppenheimer +7 more

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Utility of food-specific IgE concentrations in predicting symptomatic food allergy

2001-05-01

Hugh A. Sampson

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Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants

2016-03-04

Michael R. Perkin , Kirsty Logan , Anna Tseng +7 more

The age at which allergenic foods should be introduced into the diet of breast-fed infants is uncertain. We evaluated whether the early introduction of allergenic foods in the diet of … The age at which allergenic foods should be introduced into the diet of breast-fed infants is uncertain. We evaluated whether the early introduction of allergenic foods in the diet of breast-fed infants would protect against the development of food allergy.We recruited, from the general population, 1303 exclusively breast-fed infants who were 3 months of age and randomly assigned them to the early introduction of six allergenic foods (peanut, cooked egg, cow's milk, sesame, whitefish, and wheat; early-introduction group) or to the current practice recommended in the United Kingdom of exclusive breast-feeding to approximately 6 months of age (standard-introduction group). The primary outcome was food allergy to one or more of the six foods between 1 year and 3 years of age.In the intention-to-treat analysis, food allergy to one or more of the six intervention foods developed in 7.1% of the participants in the standard-introduction group (42 of 595 participants) and in 5.6% of those in the early-introduction group (32 of 567) (P=0.32). In the per-protocol analysis, the prevalence of any food allergy was significantly lower in the early-introduction group than in the standard-introduction group (2.4% vs. 7.3%, P=0.01), as was the prevalence of peanut allergy (0% vs. 2.5%, P=0.003) and egg allergy (1.4% vs. 5.5%, P=0.009); there were no significant effects with respect to milk, sesame, fish, or wheat. The consumption of 2 g per week of peanut or egg-white protein was associated with a significantly lower prevalence of these respective allergies than was less consumption. The early introduction of all six foods was not easily achieved but was safe.The trial did not show the efficacy of early introduction of allergenic foods in an intention-to-treat analysis. Further analysis raised the question of whether the prevention of food allergy by means of early introduction of multiple allergenic foods was dose-dependent. (Funded by the Food Standards Agency and others; EAT Current Controlled Trials number, ISRCTN14254740.).

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Fatal and Near-Fatal Anaphylactic Reactions to Food in Children and Adolescents

1992-08-06

Hugh A. Sampson , Louis M. Mendelson , James P. Rosen

Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven … Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients).

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EAACI Molecular Allergology User's Guide

2016-05-01

Paolo Maria Matricardi , Jörg Kleine‐Tebbe , Hans Jürgen Hoffmann +7 more

The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and … The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.

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Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management

2017-11-21

Scott H. Sicherer , Hugh A. Sampson

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The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States

2018-11-19

Ruchi S. Gupta , Christopher Warren , Bridget Smith +4 more

: media-1vid110.1542/5840360268001PEDS-VA_2018-1235Video Abstract BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, population-based survey estimates childhood FA prevalence and severity of … : media-1vid110.1542/5840360268001PEDS-VA_2018-1235Video Abstract BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, population-based survey estimates childhood FA prevalence and severity of all major allergenic foods. Detailed allergen-specific information was also collected regarding FA management and health care use.A survey was administered to US households between 2015 and 2016, obtaining parent-proxy responses for 38 408 children. Prevalence estimates were based on responses from NORC at the University of Chicago's nationally representative, probability-based AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models were used to evaluate FA predictors.Overall, estimated current FA prevalence was 7.6% (95% confidence interval: 7.1%-8.1%) after excluding 4% of children whose parent-reported FA reaction history was inconsistent with immunoglobulin E-mediated FA. The most prevalent allergens were peanut (2.2%), milk (1.9%), shellfish (1.3%), and tree nut (1.2%). Among food-allergic children, 42.3% reported ≥1 severe FA and 39.9% reported multiple FA. Furthermore, 19.0% reported ≥1 FA-related emergency department visit in the previous year and 42.0% reported ≥1 lifetime FA-related emergency department visit, whereas 40.7% had a current epinephrine autoinjector prescription. Prevalence rates were higher among African American children and children with atopic comorbidities.FA is a major public health concern, affecting ∼8% of US children. However, >11% of children were perceived as food-allergic, suggesting that the perceived disease burden may be greater than previously acknowledged.

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Prevalence and Severity of Food Allergies Among US Adults

2019-01-04

Ruchi S. Gupta , Christopher Warren , Bridget Smith +5 more

<h3>Importance</h3> Food allergy is a costly, potentially life-threatening condition. Although studies have examined the prevalence of childhood food allergy, little is known about prevalence, severity, or health care utilization related … <h3>Importance</h3> Food allergy is a costly, potentially life-threatening condition. Although studies have examined the prevalence of childhood food allergy, little is known about prevalence, severity, or health care utilization related to food allergies among US adults. <h3>Objective</h3> To provide nationally representative estimates of the distribution, severity, and factors associated with adult food allergies. <h3>Design, Setting, and Participants</h3> In this cross-sectional survey study of US adults, surveys were administered via the internet and telephone from October 9, 2015, to September 18, 2016. Participants were first recruited from NORC at the University of Chicago's probability-based AmeriSpeak panel, and additional participants were recruited from the non–probability-based Survey Sampling International (SSI) panel. <h3>Exposures</h3> Demographic and allergic participant characteristics. <h3>Main Outcomes and Measures</h3> Self-reported food allergies were the main outcome and were considered convincing if reported symptoms to specific allergens were consistent with IgE-mediated reactions. Diagnosis history to specific allergens and food allergy–related health care use were also primary outcomes. Estimates were based on this nationally representative sample using small-area estimation and iterative proportional fitting methods. To increase precision, AmeriSpeak data were augmented by calibration-weighted, non–probability-based responses from SSI. <h3>Results</h3> Surveys were completed by 40 443 adults (mean [SD] age, 46.6 [20.2] years), with a survey completion rate of 51.2% observed among AmeriSpeak panelists (n = 7210) and 5.5% among SSI panelists (n = 33 233). Estimated convincing food allergy prevalence among US adults was 10.8% (95% CI, 10.4%-11.1%), although 19.0% (95% CI, 18.5%-19.5%) of adults self-reported a food allergy. The most common allergies were shellfish (2.9%; 95% CI, 2.7%-3.1%), milk (1.9%; 95% CI, 1.8%-2.1%), peanut (1.8%; 95% CI, 1.7%-1.9%), tree nut (1.2%; 95% CI, 1.1%-1.3%), and fin fish (0.9%; 95% CI, 0.8%-1.0%). Among food-allergic adults, 51.1% (95% CI, 49.3%-52.9%) experienced a severe food allergy reaction, 45.3% (95% CI, 43.6%-47.1%) were allergic to multiple foods, and 48.0% (95% CI, 46.2%-49.7%) developed food allergies as an adult. Regarding health care utilization, 24.0% (95% CI, 22.6%-25.4%) reported a current epinephrine prescription, and 38.3% (95% CI, 36.7%-40.0%) reported at least 1 food allergy–related lifetime emergency department visit. <h3>Conclusions and Relevance</h3> These data suggest that at least 10.8% (>26 million) of US adults are food allergic, whereas nearly 19% of adults believe that they have a food allergy. Consequently, these findings suggest that it is crucial that adults with suspected food allergy receive appropriate confirmatory testing and counseling to ensure food is not unnecessarily avoided and quality of life is not unduly impaired.

World Allergy Organization Anaphylaxis Guidance 2020

2020-10-01

Victòria Cardona , Ignacio J. Ansotegui , Motohiro Ebisawa +7 more

Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions. The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating … Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions. The occurrence of anaphylaxis has increased in recent years, and subsequently, there is a need to continue disseminating knowledge on the diagnosis and management, so every healthcare professional is prepared to deal with such emergencies. The rationale of this updated position document is the need to keep guidance aligned with the current state of the art of knowledge in anaphylaxis management. The World Allergy Organization (WAO) anaphylaxis guidelines were published in 2011, and the current guidance adopts their major indications, incorporating some novel changes. Intramuscular epinephrine (adrenaline) continues to be the first-line treatment for anaphylaxis. Nevertheless, its use remains suboptimal. After an anaphylaxis occurrence, patients should be referred to a specialist to assess the potential cause and to be educated on prevention of recurrences and self-management. The limited availability of epinephrine auto-injectors remains a major problem in many countries, as well as their affordability for some patients.

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Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel

2010-12-01

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Food allergy

2009-12-30

Scott H. Sicherer , Hugh A. Sampson

An Overview of Seafood Allergens: Structure–Allergenicity Relationship and Allergenicity Elimination Processing Techniques

2025-06-25

Yang Yang , Yingjun Zhang , Xinrong He +6 more | Foods

Seafood (fish, crustacean, and mollusk) allergy represents a critical global health issue. Food processing offers a viable strategy for allergenicity mitigation and serves as a critical intervention for seafood allergy … Seafood (fish, crustacean, and mollusk) allergy represents a critical global health issue. Food processing offers a viable strategy for allergenicity mitigation and serves as a critical intervention for seafood allergy prevention. This paper reviews recent advances in seafood allergen research, with particular focus on molecular properties, epitopes, and structure–allergenicity relationships, which are foundations for designing processing technologies to mitigate allergenicity. Furthermore, an analysis of how various food processing techniques modulate allergen structures and epitopes, ultimately affecting their allergenicity, was conducted. Current World Health Organization (WHO)/International Union of Immunological Societies (IUIS) listings include 44 fish allergens and 60 shellfish allergens, with their characterization enabling targeted processing approaches for allergenicity elimination. Physical processing techniques, including thermal and non-thermal treatment, can dramatically influence the conformational and linear epitopes by altering or destroying the structure of an allergen. Chemistry-based processing techniques (enzymatic-catalyzed cross-linking and glycation), which induce covalent/non-covalent interactions between allergens and various modifiers, can effectively mask epitopes through molecular complexation. Biological processing attenuates allergenicity by inducing protein unfolding, polypeptide chain uncoiling, and enzymatic degradation. Nevertheless, the structure–activity relationship of seafood allergens remains insufficiently elucidated, despite its critical role in guiding processing technologies for allergenicity elimination and elucidating the fundamental mechanisms involved.

The Significance of Stone Analysis, Metabolic Evaluation and Their Effect on Metaphylaxis: The Results from Tekirdağ Province

2025-06-23

Mehmet Fatih Şahin , Cenk Murat Yazıcı , Rıdvan Özcan +2 more | Namık Kemal Tıp Dergisi

Natural History of Cow’s Milk Protein Allergy in Preterm Infants: Insights from a Retrospective Cohort Study

2025-06-23

Hanna Abu Hanna , Avishay Lahad , Muhammad Said +3 more | International Archives of Allergy and Immunology

Cow's-milk protein allergy (CMPA) affects approximately 2-3% of healthy children. The natural history of CMPAis poorly described in preterm infants. The aim of the study is to determine disease characteristics … Cow's-milk protein allergy (CMPA) affects approximately 2-3% of healthy children. The natural history of CMPAis poorly described in preterm infants. The aim of the study is to determine disease characteristics and long-term natural history of CMPAin preterm infants. This was a retrospective cohort study of Clalit Health Services (CHS) members (the largest of 4 integrated health care organizations in Israel). The medical records of children, who developed, as preterm infants, symptoms suggestive for CMPA during their hospitalization at the neonatal intensive care unit between June 2009 and June 2020 and subsequently were attending primary care clinics of the CHS in Northeastern Israel, were retrospectively reviewed for clinical manifestation and laboratory variables at disease onset and during follow-up. Among 141 preterm infants (mean gestational age 31 weeks, median follow-up 3.4 years), CMPA persistence was 16% at 1 year, 1.8% at 3 years, and 1.5% at 6 years. Atopic conditions developed at 39%, with asthma being most frequent (31%). Cesarean delivery was associated with higher risk of subsequent atopic disease (HR 1.22, p=0.009). CMPA in preterm infants often resolves by one year. Accurate diagnosis and earlier reintroduction of cow milk protein may improve outcomes and reduce unnecessary interventions.

Food Allergy in China: A Comprehensive Population‐Based Investigation

2025-06-22

Yali Liu , Wenwen Xiong , Yi‐Bo Luo +5 more | Clinical & Experimental Allergy

Oral immunotherapy directs systemic transcriptomic changes in children with hen's egg allergy.

2025-06-22

Sehun Jang , Ji Hwan Moon , Hosu Kim +7 more | PubMed

Hen's egg (HE) is a major food allergen in children. Oral immunotherapy (OIT) has emerged as a promising therapeutic option for hen's egg allergy (HEA), but the precise immunological mechanisms … Hen's egg (HE) is a major food allergen in children. Oral immunotherapy (OIT) has emerged as a promising therapeutic option for hen's egg allergy (HEA), but the precise immunological mechanisms underlying HE-OIT are not fully understood. We aimed to investigate the systemic immune phenotype in children with HEA and to examine transcriptomic changes during HE-OIT. We enrolled 16 children, aged between 3 and 12 years, diagnosed with HEA (median age, 4.5 years). Peripheral blood mononuclear cells were collected before the initiation of HE-OIT and after the completion of the build-up phase. The transcriptomics of the samples were analyzed using single-cell RNA sequencing. All eight patients (8/8) whose blood samples were collected after the build-up phase achieved desensitization to 60 g of boiled HE white (6.0 g of HE proteins). Following the OIT build-up phase, significant reductions in total CD4+ T cells and early activated CD4+ T cell were observed (P = 0.001 and 0.045, respectively), while the frequencies of late activated CD4+ T cells and fully activated CD8+ T cells were increased (P = 0.019 and 0.038, respectively). Clonal analysis revealed proliferation within the late activated CD8+ T cell subset following OIT, indicative of the exhausted state of CD8+ T cells. Additionally, the population of regulatory T cells with abundant IKZF2 expression was significantly increased after the OIT build-up phase. HE-OIT was associated with systemic immune cell transcriptomic changes, suggesting that its efficacy derives from these immune alterations.

Recurrence rate and risk factors of recurrent anaphylaxis: A ten-year retrospective cohort study.

2025-06-22

Suwannee Uthaisangsook , Nadda Padsee , Sagoontee Inkate | PubMed

Few studies have investigated the risk factors for recurrent anaphylaxis. Identifying these factors may help patients implement preventive measures. To determine the rate and risk factors for recurrent anaphylaxis, assess … Few studies have investigated the risk factors for recurrent anaphylaxis. Identifying these factors may help patients implement preventive measures. To determine the rate and risk factors for recurrent anaphylaxis, assess the time to recurrence, and compare the characteristics, triggers, and clinical manifestations between recurrent and non-recurrent cases. A retrospective cohort study was conducted at Naresuan University Hospital from March 2011 to February 2021, using medical records of patients with ICD-10-confirmed anaphylaxis. Risk factors for recurrence were analyzed using Cox proportional hazards regression model. A total of 439 anaphylactic episodes were identified in 381 patients (49 children, 332 adults). Of these, 42 patients (11.2%) experienced 58 recurrent episodes (7/49 [14.3%] children, 35/332 [10.6%] adults). Food and medications were the most and second most common triggers. The median time to recurrence was 9.9 months (IQR: 3.1-18.8), while the median follow-up duration for non-recurrent cases was 41.8 months (IQR: 23.8-61.8). The recurrent anaphylaxis rate was 4.1 events per 100 person-years. Statistically significant risk factors included a history of food, a history of insect, a history of drug allergies, chest discomfort, and severe anaphylaxis (HR [95%CI]: 3.31 [1.50-7.29], p = 0.003; 4.96 [1.47-16.82], p = 0.010; 5.87 [2.64-13.07], p < 0.001; 2.43 [1.19-4.99], p = 0.015; and 2.29 [1.07-4.88], p = 0.033, respectively). Conversely, palpitations were associated with a lower risk of recurrence (HR 0.11 [0.01-0.86], p = 0.036). Identifying risk factors in anaphylaxis patients enhances medical care and aids in preventing recurrence.

Emergency management of ceftriaxone-induced Type II Kounis syndrome: A case report

2025-06-20

Jiali Wang , Zhenhua Jiang | Medicine

Ceftriaxone, a broad-spectrum β-lactam antibiotic, can induce severe allergic reactions such as anaphylaxis, which may lead to life-threatening type II Kounis syndrome (K-S), a variant of acute coronary syndrome triggered … Ceftriaxone, a broad-spectrum β-lactam antibiotic, can induce severe allergic reactions such as anaphylaxis, which may lead to life-threatening type II Kounis syndrome (K-S), a variant of acute coronary syndrome triggered by allergic reactions. This case report aims to enhance the clinical understanding of ceftriaxone-induced type II K-S by presenting a detailed account of a patient's emergency management and subsequent recovery, emphasizing the importance of early recognition, intervention, and the role of nursing care in achieving a favorable outcome. A 73-year-old male with no known allergy history was admitted for cough and shortness of breath. After ceftriaxone administration, he developed chest tightness, shortness of breath, hypotension, and abdominal rash. Type II K-S triggered by ceftriaxone-induced anaphylaxis was diagnosed. Immediate management included discontinuing ceftriaxone, emergency tracheal intubation, and intravenous epinephrine. Emergency coronary angiography showed no significant coronary artery stenosis. Postoperatively, the patient received antiplatelet therapy, plaque stabilization, and vasodilation in the intensive care unit. The patient's condition stabilized, tracheal intubation was removed, and he was discharged after 10 days of treatment with significant clinical improvement. This case emphasizes the critical importance of early recognition and management of ceftriaxone-induced type II K-S. Vigilant monitoring for allergic reactions and a multidisciplinary approach to care are essential for achieving favorable patient outcomes.

Epitope‐Specific Antibodies in Allergic Disease and Clinical Tolerance

2025-06-20

Orlee Marini‐Rapoport , Moumita Bhowmik , Tarun Keswani +1 more | Immunological Reviews

ABSTRACT B‐cell epitope specificity on food allergens is highly relevant to understanding both the pathogenesis of IgE and IgG‐mediated clinical tolerance after immunotherapy. The molecular binding interactions between the paratopes … ABSTRACT B‐cell epitope specificity on food allergens is highly relevant to understanding both the pathogenesis of IgE and IgG‐mediated clinical tolerance after immunotherapy. The molecular binding interactions between the paratopes of antibodies and the epitopes of food allergens drive IgE‐crosslinking, the subsequent activation of allergen effector cells, and the symptoms of systemic and life‐threatening anaphylaxis. Various characteristics of allergen‐specific IgE, such as high affinity and clonal diversity, can contribute to the persistence of food allergy and the severity of anaphylaxis upon allergen exposure. On the other hand, the induction of epitope‐specific IgG antibodies in allergic individuals can inhibit IgE binding to food allergens. A subset of these can be neutralizing antibodies that effectively disrupt multiple allergen‐IgE interactions to suppress effector responses. This review details the crucial role of epitope specificity and antibody clonality in both the pathogenesis of food allergy and in the development of clinical tolerance.

Erythritol allergy diagnosed following anaphylactic shock after ingestion of the jelly drink

2025-06-19

Hideki Yoshikawa , Naho Nakazaki | Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology

Anaphylaxis due to midazolam administered before induction of general anesthesia: a case report

2025-06-19

Ryosuke Funabiki , Tatsuo Horiuchi , Toshie Shiraishi +3 more | JA Clinical Reports

The safety of low-dose peanut oral food challenges in toddlers aged 1-2 years

2025-06-19

Taichi Adachi , Tetsuhiro Sakihara , Toaki Kohagura +1 more | Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology

A case of food protein-induced enterocolitis syndrome triggered by rice that developed tolerance over time

2025-06-19

Naoko Suzuki , Yukihiko Kawasaki , Hisao Okabe +2 more | Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology

Severity assessment of food allergies according to DEFASE criteria in the German healthcare system (d-DEFASE)

2025-06-19

Stefania Arasi , Lars Lange , Katharina Blümchen +7 more | Allergo Journal International

Summary Background There is currently no standardized evaluation system in Germany for defining and classifying the severity of IgE-mediated food allergies (FA). Following the development of the international classification system … Summary Background There is currently no standardized evaluation system in Germany for defining and classifying the severity of IgE-mediated food allergies (FA). Following the development of the international classification system named DEFASE (Definition of Food Allergy Severity), this evaluation system is now also being introduced in Germany and its applicability in the German healthcare system is being tested. Methods An international consensus was reached on DEFASE through a two-stage process (systematic literature review followed by an e‑Delphi). Conclusion The DEFASE score is the first comprehensive classification of the severity of a FA that takes into account not only the severity of an individual reaction, but the entire scenario of the disease, including the clinical features alongside patient’s reported outcomes and economic burden. It is important that an international consensus has been reached on a scoring system for FA, which can now also be used in Germany as d‑DEFASE. The scoring system is currently tested in research projects to be introduced soon into clinical practice, targeting these models to various food allergenic sources, populations, and settings.

Current State of Celery Allergy: Is Discovering Api g 7 a Milestone in Diagnosing Celeriac-Allergic Patients?

2025-06-18

Bernadetta Kosztulska , Zbigniew Bartuzi , Natalia Ukleja-Sokołowska | International Journal of Molecular Sciences

Celery allergy is a common food allergy, particularly among the European population. Currently, several diagnostic methods are available, including multiplex assays, which are useful for identifying celery-allergic patients. However, all … Celery allergy is a common food allergy, particularly among the European population. Currently, several diagnostic methods are available, including multiplex assays, which are useful for identifying celery-allergic patients. However, all of these methods have certain limitations. Api g 7 is a newly identified celeriac allergen belonging to the defensin protein family. Its clinical relevance lies in the high risk of severe systemic reactions among patients sensitized to this molecule. Patients sensitized to Api g 7 are often co-sensitized to Art v 1, the major mugwort (Artemisia vulgaris) allergen, due to structural similarity between these two molecules. This molecular homology plays a key role in the pathogenesis of celery-mugwort syndrome. Although Api g 7may be a major celery allergen, none of the currently available commercial diagnostic tests are capable of detecting sIgE against it. This highlights the need for the development of new, commercially available diagnostic tools in allergology.

Food Allergy Prevalence and Characteristics Among Adults in Cyprus: Effects on Health-Related Quality of Life

2025-06-18

Stella A. Nicolaou , Alisa Pham , Andreas Alexandrou +3 more | Nutrients

Background/Objectives: Food allergy (FA) is an increasing global concern, yet its prevalence, characteristics, and management vary across populations. Country-specific differences have also been observed in the health-related quality of life … Background/Objectives: Food allergy (FA) is an increasing global concern, yet its prevalence, characteristics, and management vary across populations. Country-specific differences have also been observed in the health-related quality of life (HRQL) of patients with FAs. This study aimed to determine the prevalence and characteristics of FAs among Cypriot adults, aged 18-39 years, and explore its effects on HRQL. Methods: A total of 939 randomly selected adults attending universities and colleges across Cyprus completed a questionnaire on demographics and allergy status. Those reporting FA (n = 67, 7.1%) completed the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF). The results were analyzed using descriptive and inferential statistics. Results: Fruits/vegetables (40.5%) and seafood (12.6%) were the most common allergens, and 34.3% of participants reported multiple food allergies. Most participants (94%) experienced symptoms within two hours of allergen exposure, yet only 1.5% carried an epinephrine auto-injector, raising concerns regarding access to allergists or the confirmation of IgE-mediated FA. The mean FAQLQ-AF score was 3.32 ± 0.5 (on a scale of 1-7), indicating mild overall impairment. HRQL impairment was greatest in the Food Allergy-Related Health (FAH) domain and lowest in the Avoidance and Dietary Restrictions (AADR) domain, with participants with multiple allergies, concomitant allergic conditions, or severe symptoms reporting the greatest impacts. Conclusions: FA is the most commonly reported allergic disease amongst Cypriot adults and significantly affects their HRQL. The limited confirmation of FA diagnoses through objective methods and the inadequate management of such conditions highlight the need for improved education and access to allergy care for both healthcare providers and patients.

Nutritional Interventions and Management Strategies in Pediatric Food Allergies: A Review

2025-06-18

Tehseen Javed , Nafisa Farheen , W Anitha +2 more | Journal of Neonatal Surgery

The prevalence of childhood food allergies is increasing in both developed and developing countries, posing a significant public health challenge. This review aims to synthesize current evidence on the prevention … The prevalence of childhood food allergies is increasing in both developed and developing countries, posing a significant public health challenge. This review aims to synthesize current evidence on the prevention and management of food allergies, with a particular focus on the role of nutritional components and dietary practices in supporting immune system development and function. Key nutrients such as essential fatty acids, zinc, and vitamin D are believed to enhance the body’s anti-inflammatory and antioxidative defenses, thereby promoting immunological tolerance. Moreover, emerging research highlights the potential of prebiotics and probiotics in modulating gut microbiota and fostering a tolerogenic immune environment. These insights have prompted a critical reassessment of the traditional avoidance-based dietary strategies. Recent findings suggest that early exposure to a diverse range of dietary antigens during infancy may reduce the risk of allergic sensitization by supporting the maturation of the immune system. Consequently, both therapeutic and preventive interventions must be personalized, accounting for individual nutritional needs and allergic risk profiles.

Advances in conventional and innovative anti-allergic agents for managing food allergies: from mechanisms to challenges

2025-06-18

Yuying Zhu , Enning Zhou , Gang Chen +3 more | Critical Reviews in Food Science and Nutrition

Food allergies constitute a significant and escalating global public health issue. Over the past decade, efforts have intensified to prevent and treat these allergies, including exploring new anti-allergic agents and … Food allergies constitute a significant and escalating global public health issue. Over the past decade, efforts have intensified to prevent and treat these allergies, including exploring new anti-allergic agents and natural bioactive compounds with minimal side effects. Despite progress, consensus on effective strategies remains elusive. This study undertakes a comprehensive review and discussion of current anti-allergic medications, natural bioactive ingredients, and innovative nano/micro-carriers, focusing on four key mechanisms: binding to allergen epitopes, modulating gut microbiota, restoring intestinal epithelial integrity, and regulating immune responses. Many natural compounds show effectiveness through multiple pathways. Advances in nanotechnology have improved delivery systems such as nanoparticles and sporopollenin exine capsules, enhancing targeted delivery and efficacy. Given the distinct cellular and molecular targets of these anti-allergic agents, investigating synergies between natural and synthetic drugs is essential. For instance, combine traditional anti-allergic drugs with glucocorticoids to quickly relieve initial symptoms; then, use natural agents like probiotics for immune regulation, reducing treatment time and recurrence risk. This review lays the foundation for a scientific framework to guide the future development of combination therapy models in clinical applications.

Lenalidomide-induced type II Kounis syndrome: a case report

2025-06-16

Rui-Han Hu , Guoxiang He | Frontiers in Cardiovascular Medicine

Kounis syndrome is an allergic myocardial ischemia syndrome triggered by various factors. Herein, we presented a case of a patient with Multiple Myeloma who developed chest pain as a result … Kounis syndrome is an allergic myocardial ischemia syndrome triggered by various factors. Herein, we presented a case of a patient with Multiple Myeloma who developed chest pain as a result of lenalidomide use. The patient’s electrocardiogram (ECG) revealed ST-segment depression, along with elevated troponin I and eosinophils levels. Emergency coronary angiography identified thrombosis in the middle segment of the anterior descending branch of the left coronary artery. Previous case reports have linked lenalidomide chemotherapy to myocarditis as the primary form of myocardial damage. This case marks the first documented occurrence of myocardial infarction attributed to lenalidomide, highlighting a previously unrecognized aspect of its cardiotoxic profile.

Cow milk protein allergy mimics in infancy

2025-06-16

Mohammed Al‐Beltagi , Nermin Kamal Saeed , Adel Salah Bediwy +2 more | World Journal of Clinical Pediatrics

Cow milk protein allergy (CMPA) is a prevalent food allergy in infancy. It often presents with symptoms that overlap with other conditions, such as gastroesophageal reflux disease, lactose intolerance, food … Cow milk protein allergy (CMPA) is a prevalent food allergy in infancy. It often presents with symptoms that overlap with other conditions, such as gastroesophageal reflux disease, lactose intolerance, food protein-induced enterocolitis syndrome, and eosinophilic esophagitis. This diagnostic overlap makes distinguishing CMPA from its mimics difficult, resulting in potential misdiagnoses and unnecessary dietary restrictions. This review aims to comprehensively analyze CMPA and its mimicking conditions, highlighting their clinical presentations, diagnostic approaches, and management strategies to enhance diagnostic accuracy and optimize patient care. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies published within the last 20 years. Articles addressing CMPA and its mimicking conditions were selected, with data synthesized into comparative analyses of diagnostic methods and management strategies. Accurate differentiation between CMPA and its mimics requires a thorough clinical evaluation supported by diagnostic tests such as skin prick tests, serum-specific IgE, and oral food challenges. Misdiagnosis can lead to nutritional deficiencies, psychological stress, and increased healthcare costs. Emerging diagnostic technologies, including component-resolved diagnostics and cytokine profiling, offer promising avenues for improving accuracy. A multidisciplinary approach involving pediatricians, allergists, and dietitians is essential for precise diagnosis and effective management. Ongoing research and education are crucial to enhancing clinical outcomes and reducing the burden on families.

Effect of oral food challenge on quality of life and family activities in children with IgE-mediated food allergies

2025-06-16

Azwin Mengindra Putera , Irwanto Irwanto | World Journal of Clinical Pediatrics

BACKGROUND Oral food challenge (OFC) is an integral part of confirming and evaluating the diagnosis of food allergy (FA), and most incidents of FA occur in children. FA significantly impairs … BACKGROUND Oral food challenge (OFC) is an integral part of confirming and evaluating the diagnosis of food allergy (FA), and most incidents of FA occur in children. FA significantly impairs the quality of life (QoL) and causes limited activities outside the home for children and their parents. AIM To evaluate the effect of OFC on QoL and family activities in children with FA. METHODS This prospective study identified children suspected of FA using a skin prick test (SPT) between January 2022 and December 2024. These children conduct an elimination diet for 4 wk, followed by OFC under protocol. Rating scales evaluated QoL using pediatric QoL inventory and family activities using family activities impact scale (FAIS), in which data are collected before and after an elimination diet and OFC. Statistical analysis utilized χ 2, Spearman , paired t , Wilcoxon, independent t , and Mann–Whitney tests, with P < 0.05 considered significant. RESULTS Most participants were boys (137; 65.55%); 102 (64.56%) had a positive OFC and 35 (68.63%) a negative OFC. The average QoL before OFC was 69.13 ± 5.78, and 92.40 ± 4.22 after OFC (Z = 12.537; P < 0.001). In the FAIS score, the average result before OFC was 5.36 ± 0.68 and 4.10 ± 0.38 after OFC, which was a significant difference (Z = 12.162; P < 0.001). Although the difference in QoL before and after increased, and FAIS reduced, there was no significant difference. Additionally, most results of positive SPT are higher than positive OFC in each specific food allergen. CONCLUSION OFC may improve QoL and FAIS in children with FA and their families as it increases activities outside the home and reduces worry about allergen exposure.

Hymenoptera venom allergy

2025-06-16

Hans‐Jørgen Malling , Kirsten Skamstrup Hansen , Susanne Halken +3 more | Ugeskrift for Læger

This review finds that diagnostics should only be performed in patients who might be candidates for venom immunotherapy (VIT). VIT is recommended for children and adults with documented sensitisation and … This review finds that diagnostics should only be performed in patients who might be candidates for venom immunotherapy (VIT). VIT is recommended for children and adults with documented sensitisation and systemic anaphylactic reactions (respiratory and/or circulatory symptoms) or reduced quality of life due to less severe reactions. VIT is not recommended for children with monosymptomatic urticaria. VIT should be continued for five years. Patients should carry an adrenaline autoinjector during insect season until a maintenance dose is reached.

Exploring oleosin allergenicity: Structural insights, diagnostic challenges, and advances in purification and solubilization

2025-06-15

Yi Liao , Yu Gao , Liang Ma +3 more | Food Chemistry

Síndrome de Kounis a propósito de un caso clínico

2025-06-15

Carolina Castrillón | Revista Médica del Uruguay

Real‐World Evaluation of Associations Between Regular Intake and Food Challenge Outcome in Children

2025-06-15

Sayaka Hamaguchi , Limin Yang , Chisato Jimbo +7 more | Clinical & Experimental Allergy

Food allergy: emerging therapies in the twenty-first century

2025-06-14

Agnes Sze Yin Leung , Yuhan Xing , Gary Wong | World Journal of Pediatrics

Advances in Food Allergy Immunotherapy: Current Strategies and Role of Antibodies Isotypes

2025-06-14

Yolanda García-Carmona , Maria A. Curotto de Lafaille | Cells

Food allergies result from dysregulated immune responses to dietary antigens. IgE antibodies are key in triggering allergic reactions through binding to high-affinity receptors on mast cells and triggering mast cell … Food allergies result from dysregulated immune responses to dietary antigens. IgE antibodies are key in triggering allergic reactions through binding to high-affinity receptors on mast cells and triggering mast cell activation when crosslinked by allergens. In contrast, IgG antibodies-particularly IgG4-are linked to immunomodulation and tolerance. Allergen-specific memory B cells, especially IgG1+ cells, undergo class-switching to IgE, and IgE plasma cells underlie allergy persistence. Although there is no cure, allergen-specific immunotherapy (AIT) aims to achieve sustained unresponsiveness by gradually increasing allergen exposure. Oral immunotherapy (OIT), a form of AIT, induces a shift from a TH2-skewed response to a more regulated immune profile, characterized by a switch from IgE to IgG4 and IgA isotypes. This review outlines current insights into AIT's cellular and humoral mechanisms, with implications for improving long-term outcomes and developing predictive biomarkers.

The Immunology of Alpha‐Gal Syndrome: History, Tick Bites, <scp>IgE</scp>, and Delayed Anaphylaxis to Mammalian Meat

2025-06-14

Thomas A.E. Platts‐Mills , Roopesh Singh Gangwar , Lisa J. Workman +1 more | Immunological Reviews

ABSTRACT The primary features of the alpha‐gal syndrome (AGS) are (i) The IgE ab that are causally related to anaphylaxis with infusions of Cetuximab are specific for galactose alpha‐1,3‐galactose. (ii) … ABSTRACT The primary features of the alpha‐gal syndrome (AGS) are (i) The IgE ab that are causally related to anaphylaxis with infusions of Cetuximab are specific for galactose alpha‐1,3‐galactose. (ii) In the USA, this IgE ab is induced by bites of the tick Amblyomma americanum . (iii) The anaphylactic reactions to food derived from non‐primate mammals are delayed in onset by three to five hours. A further important fact is that all humans make a “natural” response to alpha‐gal which includes IgM, IgG, and IgA, but not IgE. The clinical features of AGS are recognized in many parts of the world, but different species of ticks are involved. The immune response to tick bites includes T cells specific for tick protein, while IgE producing B cells appear to be derived from B cells specific for IgM or IgG. With repeated tick bites, the T cells develop a strong Th2 signal with IL‐4 and IL‐13 This obviously relates to IgE production, but may also be relevant to itching after tick bites which can last for weeks. The current hypothesis about the cause of the delayed reactions is based on the time that it takes to digest glycolipids from meat to LDL. The management of AGS symptoms is based on the avoidance of food derived from mammals; however, the only thing that can allow IgE to decrease is avoidance of tick bites.

A Growing Concern for Cashew and an Unexpected Risk From Almonds: Data From the Anaphylaxis Registry

2025-06-13

Veronika Höfer , Sabine Dölle , D. Sabouraud-Leclerc +7 more | Allergy

ABSTRACT Background Food allergies are a major health concern with rising prevalence. Dietary habits are changing, and information about cashew‐induced anaphylaxis is limited. Methods Cases of tree nut‐induced anaphylaxis (TIA) … ABSTRACT Background Food allergies are a major health concern with rising prevalence. Dietary habits are changing, and information about cashew‐induced anaphylaxis is limited. Methods Cases of tree nut‐induced anaphylaxis (TIA) registered from 2007 until April 2024 were extracted from the European Anaphylaxis Registry and analyzed. Results 1389 cases of TIA out of 5945 registered food‐induced reactions (23%) were identified. 1,083 cases with confirmed elicitor status, including 845 children (median age 4 years, 61% male) and 238 adults (38 years, 40% male), were selected for further analysis. The most frequent elicitors among children were cashew ( n = 334), hazelnut ( n = 211) and walnut ( n = 146). The proportion of cashew‐induced anaphylaxis increased from 2007 to 2024, and reactions were frequently caused by small amounts (< 1 teaspoon). Adults reacted frequently to hazelnut ( n = 105), walnut ( n = 47) but also almond ( n = 35) and to higher amounts. Potential cofactors were present in 50% of the adult patients and 17% of children. The reaction severity was age‐independent, and only a minority of patients was previously aware of their allergy (children 23%, adults 21%). The use of adrenaline was low in lay treatment (children 13%, adults 3%) and reached approximately 40% upon professional treatment. Conclusion Cashew is an increasing, relevant allergen leading to anaphylaxis and is now the most frequent cause of TIA among children. These findings highlight the need for effective prevention and treatment measures. Almond was a frequent elicitor among adults and should be further monitored. The acute management requires improvement to comply with current guidelines.

Minimization of Protein Allergenicity in Food Products Through Conventional and Novel Processes: A Comprehensive Review on Mechanisms, Detection, and Applications

2025-06-12

Özgür Tarhan , Andrea Venerando , Reza Falsafi +7 more | Food Reviews International

Role of human antigen-specific T cells in tolerance and IgE-mediated allergic reactions to food

2025-06-12

Rosina López‐Fandiño | Frontiers in Immunology

Allergen-specific CD4 + T cells play a pivotal role in the pathophysiology of food allergy and in the induction of tolerance during desensitization. However, their study remains challenging due to … Allergen-specific CD4 + T cells play a pivotal role in the pathophysiology of food allergy and in the induction of tolerance during desensitization. However, their study remains challenging due to the considerable heterogeneity in the frequency and phenotype of food allergy-specific Th2 cells in allergic individuals, together with an extremely low abundance of T cells specific to a given allergen. Furthermore, a major limitation of human studies is their reliance on peripheral blood sampling, whereas higher frequencies of allergen-specific cells may reside in intestinal tissues directly implicated in the allergic response. Among the most targeted approaches to quantify and characterize these cells stand MHC class II tetramers and activation-based detection methods. These techniques have identified pathogenic Th2 cell subpopulations in allergic individuals, that are absent in non-allergic subjects and differentiate patients with diverse degrees of clinical reactivity. These cells, crucial in driving immune responses and mediating immunological memory, exhibit distinct phenotypic and functional properties compared to conventional Th2 cells. However, there is no conclusive evidence supporting a definitive role for allergen-specific regulatory T (Treg) cells in food allergy, natural tolerance, or desensitization following immunotherapy. Moreover, pathogenic Th2 and Treg cells may differ in their allergen specificity, potentially due to priming by distinct sets of food-derived antigens. A deeper understanding of the characteristics and roles of specific pathogenic Th2 and Treg cell populations in food allergy could pave the way for novel preventive and therapeutic strategies for this disease.

Basophil Activation Test: Bridging Allergy and Oncology for Diagnostic, Therapeutic and Prognostic Applications in <scp>AllergoOncology</scp>: An <scp>EAACI</scp> Position Paper

2025-06-12

Mariona Pascal , Jitesh Chauhan , Edward F. Knol +7 more | Allergy

ABSTRACT The basophil activation test (BAT) is gaining increasing relevance as an ex vivo functional assay in allergy to evaluate IgE‐mediated hypersensitivity reactions to food allergens, venoms, and drugs and … ABSTRACT The basophil activation test (BAT) is gaining increasing relevance as an ex vivo functional assay in allergy to evaluate IgE‐mediated hypersensitivity reactions to food allergens, venoms, and drugs and to monitor tolerance induction. Establishing universal standard operating protocols has been difficult, due to several challenges including variable activation markers, positive control selection, the need for processing fresh blood samples, and the existence of non‐releasing individuals. In oncology, BAT is also an emerging promising diagnostic and management tool to assess hypersensitivity reactions to biologics and chemotherapy agents, monitor drug tolerance in desensitisation, and predict and address the safety of novel anti‐cancer IgE‐based therapeutics. This position paper highlights the emerging significance of BAT in AllergoOncology, in facilitating therapy monitoring, biomarker discovery, and risk stratification. Capitalising on long‐acquired expertise in the development of BAT for allergy, we propose research directions and routes to clinical applications of this highly promising tool in AllergoOncology. We advocate the need for enhanced focus on addressing standardisation challenges and leveraging outputs for precision medicine. By linking allergy and oncology, the key remaining limitations can be addressed, with the aim of realising the significant promise of BAT as a robust tool to enhance personalised care in allergy and AllergoOncology.

Anaphylactic Reactions

2025-06-09

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