1
|
İlgün Gürel D, Parlak Z, Şahiner ÜM, Soyer Ö, Şekerel BE. Recognition of nuts and seeds in children with/without food allergies and their mothers: A reflection of culinary culture. Nutr Health 2024:2601060231209371. [PMID: 38504662 DOI: 10.1177/02601060231209371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Nuts and seeds are among the leading causes of food allergy. Effective food allergy management hinges on the ability to identify and avoid relevant foods. AIM To evaluate the nut/seed recognition ability in both children and mothers. METHODS Primary caregivers (mothers) and their children (6-18 years old) with/without food allergies were shown photographs of nuts/seeds, and their products with visible/hidden allergens to assess their ability to recognize accurately. RESULTS A total of 196 children and 184 mothers participated. The median ages of the children and mothers were 7.6 (6.8-10) and 37.8 (33.1-41.5) years, respectively. Over 75% of the children/adolescents and over 90% of the mothers accurately identified the kernel forms of nuts/seeds, except pine nuts. Walnuts, hazelnuts, almonds, and cashews were the most accurately recognized kernel forms by both populations. Generally, the kernel forms were recognized 5-20% more accurately than their in-shell forms, followed by products with visible and hidden forms, respectively. Some Turkish culinary-specific products with visible/hidden allergens were recognized as frequently as the kernel/in-shell forms by both study groups. Although there was a similar recognition pattern between study groups and subgroups (nut/seed allergy, other food allergy, controls), higher rates of recognition were found in mothers than in their children and adolescents than in schoolchildren. CONCLUSION In Eastern Mediterranean region, nuts and sesame seeds are highly recognized by both mothers and their children. Accurate identification of these foods is likely a culinary feature, but not the result of increased awareness. More information is needed on whether this ability reduces the risk of exposure.
Collapse
Affiliation(s)
- Deniz İlgün Gürel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeynep Parlak
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
- Nutrition and Dietetics Unit, Hacettepe İhsan Doğramacı Children's Hospital, Ankara, Turkey
| | - Ümit Murat Şahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Özge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bülent Enis Şekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| |
Collapse
|
2
|
Heraghty F, Hurley S, Flynn N, Sheehan M, Wilson F, Kelleher M, Byrne A, Hourihane JOB. The ability of children and families with and without nut allergy to correctly identify nuts. Clin Exp Allergy 2023; 53:959-962. [PMID: 37345277 DOI: 10.1111/cea.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Affiliation(s)
- F Heraghty
- Children's Health Ireland, Dublin, Ireland
| | - S Hurley
- Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - N Flynn
- Children's Health Ireland, Dublin, Ireland
| | - M Sheehan
- Children's Health Ireland, Dublin, Ireland
| | - F Wilson
- Children's Health Ireland, Dublin, Ireland
| | - M Kelleher
- Children's Health Ireland, Dublin, Ireland
| | - A Byrne
- Children's Health Ireland, Dublin, Ireland
| | - J O B Hourihane
- Children's Health Ireland, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
3
|
Labrosse R, Graham F, Caubet JC. Recent advances in the diagnosis and management of tree nut and seed allergy. Curr Opin Allergy Clin Immunol 2022; 22:194-201. [DOI: 10.1097/aci.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Anagnostou A. Addressing Common Misconceptions in Food Allergy: A Review. CHILDREN-BASEL 2021; 8:children8060497. [PMID: 34207962 PMCID: PMC8230601 DOI: 10.3390/children8060497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
Background: Food allergies are common, affecting 1 in 13 school children in the United States and their prevalence is increasing. Many misconceptions exist with regards to food allergy prevention, diagnosis and management. Objective: The main objective of this review is to address misconceptions with regards to food allergies and discuss the optimal, evidence-based approach for patients who carry this diagnosis. Observations: Common misconceptions in terms of food allergy prevention include beliefs that breastfeeding and delayed introduction of allergenic foods prevent the development of food allergies. In terms of diagnosis, statements such as ‘larger skin prick tests or/and higher levels of food-specific IgE can predict the severity of food-induced allergic reactions’, or ‘Tryptase is always elevated in food-induced anaphylaxis’ are inaccurate. Additionally, egg allergy is not a contraindication for receiving the influenza vaccine, food-allergy related fatalities are rare and peanut oral immunotherapy, despite reported benefits, is not a cure for food allergies. Finally, not all infants with eczema will develop food allergies and epinephrine auto-injectors may unfortunately be both unavailable and underused in food-triggered anaphylaxis. Conclusions and relevance: Healthcare professionals must be familiar with recent evidence in the food allergy field and avoid common misunderstandings that may negatively affect prevention, diagnosis and management of this chronic disease.
Collapse
Affiliation(s)
- Aikaterini Anagnostou
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; ; Tel.: +1-832-824-1319; Fax: +1-832-825-1260
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children’s Hospital, Houston, TX 77030, USA
| |
Collapse
|
5
|
Midun E, Radulovic S, Brough H, Caubet JC. Recent advances in the management of nut allergy. World Allergy Organ J 2021; 14:100491. [PMID: 33510829 PMCID: PMC7811165 DOI: 10.1016/j.waojou.2020.100491] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/25/2022] Open
Abstract
Peanut/tree nut allergy is common and has been associated with particularly severe reactions. Epidemiological data have shown that the prevalence ranges between 0.05% and 4.9% for tree nut and between 0.5% and 3% for peanut. These large variations can be explained by differences in the age of included patients and the geographical region. In addition, the food consumption modality (ie, raw versus roasted) plays a major role, as heat treatment has the capacity to modify the allergenicity of nuts and legumes. Nut allergies tend to persist into adulthood and consequently have a high impact on quality of life. Recently, it has been demonstrated that a significant proportion of nut allergic patients are able to tolerate other nuts. As opposed to the avoidance of all nuts, this approach is currently proposed in several tertiary allergy centers. However, diagnosis of nut allergy is particularly difficult due to co-sensitization leading to high rate of false positive skin prick tests and/or specific IgE to whole allergen extracts. The use of component resolved diagnosis leads to major improvement of diagnosis, particularly to distinguish between primary and secondary nut allergies. The basophil activation test has been suggested to be useful but is still used mainly as a research tool. Thus, diagnosis remains mainly based on the oral food challenge, which is considered as the gold standard. Regarding treatment, avoidance remains the cornerstone of management of nut allergy. Oral immunotherapy is increasingly proposed as an alternative management strategy.
Collapse
Key Words
- Component-resolved diagnostic, CRD
- Cross reactivity
- Double-blind, placebo-controlled, food challenge, DBPCFC
- Food allergy
- Lipid transfer protein, LTP
- Oral allergy syndrome, OAS
- Oral food challenge, OFC
- Oral immunotherapy
- Oral induction tolerance, OIT
- Pathogenesis related protein type 10, PR-10
- Peanut
- Platelet-activating factor, PAF
- Pollen-food syndrome, PFS
- Precautionary Allergen Labels, (PAL)
- Skin prick test, SPT
- Tree nut
- Tree nut, TN
Collapse
Affiliation(s)
- Elise Midun
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205 Geneva, Switzerland, University Lyon 1 Claude Bernard, 43 Boulevard Du 11-Novembre-1918, 69100, Villeurbanne, France
- Corresponding author.
| | - Suzana Radulovic
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Helen Brough
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom, Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom, Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Rue Willy Donzé 6, 1205, Geneva, Switzerland
| |
Collapse
|
6
|
Bartnikas LM, Huffaker MF, Sheehan WJ, Kanchongkittiphon W, Petty CR, Leibowitz R, Young MC, Phipatanakul W. Racial and socioeconomic differences in school peanut-free policies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:340-342.e1. [PMID: 31319221 PMCID: PMC6960368 DOI: 10.1016/j.jaip.2019.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lisa M Bartnikas
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | | | - William J Sheehan
- Boston Children's Hospital, Boston, Mass; Children's National Health System, Washington, DC
| | | | | | | | - Michael C Young
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| |
Collapse
|
7
|
|
8
|
Wang H, Anagnostou A. An Approach to the Diagnostic Challenges of Tree Nut Allergy. Curr Pediatr Rev 2019; 15:2-3. [PMID: 30973100 DOI: 10.2174/157339631501190405120050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Helen Wang
- Texas Children's Hospital Division of Immunology, Allergy and Rheumatology, Houstan, TX, United States.,Baylor College of Medicine Division of Immunology, Allergy and Rheumatology, Houstan, TX, United States
| | - Aikaterini Anagnostou
- Texas Children's Hospital Division of Immunology, Allergy and Rheumatology, Houstan, TX, United States.,Baylor College of Medicine Division of Immunology, Allergy and Rheumatology, Houstan, TX, United States
| |
Collapse
|
9
|
Abstract
Tree nut (TN) allergy is common and often severe. It has become an important health concern as availability and consumption have increased. Prevalence varies by age and geographic region and appears to have increased in children. Accidental ingestion of TNs is common. Unfortunately, there is a lower likelihood of resolution of TN allergy, roughly 10%. TN-specific skin tests and serum immunoglobulin E levels can help aid in the diagnosis of TN allergy, but a careful medical history is important because a positive test in isolation is not typically diagnostic. Component-resolved diagnostic tests are being increasingly utilized and may improve accuracy. Management consists of strict avoidance of the causal nut(s) and prompt treatment of symptoms upon accidental exposure. A specific consideration with regard to the management of TN allergy is the decision to avoid all TNs or only the TNs to which a patient is clinically allergic. There are currently no data on the primary or secondary prevention of TN allergy. Treatment strategies are being evaluated.
Collapse
Affiliation(s)
- Tamar Weinberger
- The Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Sicherer
- The Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
10
|
Uotila R, Kukkonen AK, Blom WM, Remington B, Westerhout J, Pelkonen AS, Mäkelä MJ. Component-resolved diagnostics demonstrates that most peanut-allergic individuals could potentially introduce tree nuts to their diet. Clin Exp Allergy 2018; 48:712-721. [PMID: 29377469 DOI: 10.1111/cea.13101] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nut allergy varies from pollen cross-allergy, to primary severe allergy with life-threatening symptoms. The screening of IgE antibodies to a wide spectrum of allergens, including species-specific and cross-reactive allergens, is made possible via microarray analysis. OBJECTIVE We sought to study the association of variable IgE sensitization profiles to clinical response in peanut-challenged children and adolescents in a birch-endemic region. In addition, we studied the avoidance of tree nuts and species-specific sensitizations. METHODS We studied 102 peanut-sensitized patients who underwent a double-blind placebo-controlled challenge to peanut. We analysed ISAC ImmunoCAP microarray to 112 allergens, singleplex ImmunoCAPs for hazelnut Cor a 14 and cashew Ana o 3, and performed skin prick tests to peanut, tree nuts and sesame seed. We surveyed avoidance diets with a questionnaire. RESULTS Sensitization to PR-10 proteins was frequent (Bet v 1 90%), but equally high in the challenge negatives and positives. IgE to Ara h 2 and Ara h 6 discriminated peanut allergic (n = 69) and tolerant (n = 33) the best. Avoidance of tree nuts was common (52% to 96%), but only 6% to 44% presented species-specific sensitizations to tree nuts, so a great number could potentially introduce these species into their diet. CONCLUSIONS AND CLINICAL RELEVANCE PR-10-sensitizations were frequent and strong regardless of peanut allergy status. Component-resolved diagnostics can be employed to demonstrate to patients that sensitization to seed storage proteins of tree nuts is uncommon. Several tree nuts could potentially be reintroduced to the diet.
Collapse
Affiliation(s)
- R Uotila
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
| | - A K Kukkonen
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
| | - W M Blom
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - B Remington
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - J Westerhout
- The Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - A S Pelkonen
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
| | - M J Mäkelä
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki, Finland
| |
Collapse
|
11
|
Collins SC. Practice Paper of the Academy of Nutrition and Dietetics: Role of the Registered Dietitian Nutritionist in the Diagnosis and Management of Food Allergies. J Acad Nutr Diet 2017; 116:1621-1631. [PMID: 27671759 DOI: 10.1016/j.jand.2016.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Indexed: 12/30/2022]
Abstract
Incidence of food allergy has increased significantly over the past decade and represents an important health issue for millions of Americans. Diagnosis of immunoglobulin E-mediated food allergies is sometimes difficult because blood and skin tests have high rates of false positives, and oral food challenges are uncommon due to the expense and potential for serious reactions. Accurate diagnosis is crucial to avoid unnecessary dietary restriction, especially in children. Because registered dietitian nutritionists often work independently, receiving referrals for dietary education and guidance for a patient who is followed by one or several other practitioners, navigating the data available and making the appropriate follow-up contact optimizes treatment. The purpose of this paper is to provide guidance to the registered dietitian nutritionists and nutrition and dietetics technician, registered on appropriate and evidence-based nutrition counseling for diagnosis and management of food allergies.
Collapse
|
12
|
Impact of school peanut-free policies on epinephrine administration. J Allergy Clin Immunol 2017; 140:465-473. [PMID: 28347736 DOI: 10.1016/j.jaci.2017.01.040] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 01/01/2017] [Accepted: 01/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Children with food allergies spend a large proportion of time in school but characteristics of allergic reactions in schools are not well studied. Some schools self-designate as peanut-free or have peanut-free areas, but the impact of policies on clinical outcomes has not been evaluated. OBJECTIVE We sought to determine the effect of peanut-free policies on rates of epinephrine administration for allergic reactions in Massachusetts public schools. METHODS In this retrospective study, we analyzed (1) rates of epinephrine administration in all Massachusetts public schools and (2) Massachusetts public school nurse survey reports of school peanut-free policies from 2006 to 2011 and whether schools self-designated as "peanut-free" based on policies. Rates of epinephrine administration were compared for schools with or without peanut-restrictive policies. RESULTS The percentage of schools with peanut-restrictive policies did not change significantly in the study time frame. There was variability in policies used by schools self-designated as peanut-free. No policy was associated with complete absence of allergic reactions. Both self-designated peanut-free schools and schools banning peanuts from being served in school or brought from home reported allergic reactions to nuts. Policies restricting peanuts from home, served in schools, or having peanut-free classrooms did not affect epinephrine administration rates. Schools with peanut-free tables, compared to without, had lower rates of epinephrine administration (incidence rate per 10,000 students 0.2 and 0.6, respectively, P = .009). CONCLUSIONS These data provide a basis for evidence-based school policies for children with food allergies. Further studies are required before decisions can be made regarding peanut-free policies in schools.
Collapse
|
13
|
Uotila R, Kukkonen AK, Pelkonen AS, Mäkelä MJ. Cross-sensitization profiles of edible nuts in a birch-endemic area. Allergy 2016; 71:514-21. [PMID: 26706253 DOI: 10.1111/all.12826] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sensitization to birch pollen causes cross-sensitization to nuts, but rarely leads to clinical nut allergy. The aim was to study sensitizations to nuts in individuals sensitized to birch pollen and examine cross-reactivities between birch and nut species. METHODS All subjects with skin prick tests (SPTs) for birch pollen conducted during 1997-2013 in the Skin and Allergy Hospital in Helsinki (n = 114 572) and their available SPTs for nuts (n = 50 604) were included. Nut sensitizations were analyzed both with and without cosensitization to birch and stratified into age-categories. Cross-reactivities were analyzed with hierarchical clustering. One group of 1589 patients was surveyed for symptoms. Data were gathered also from Lapland to examine sensitizations in an area with less birch-pollen exposure. RESULTS Of subjects with birch sensitization, 84% were cosensitized to hazelnut, 71% to almond, and 60% to peanut. In a subgroup without birch sensitization, young children (<5 years) were most commonly nut-sensitized (8-40%); and this prevalence decreased in adolescents and further in adults (4-12%). Cashew and pistachio (ρ = 0.66; P < 0.001) and pecan and walnut (ρ = 0.65; P < 0.001) correlated the strongest. The majority of nut-sensitized patients (71% hazelnut, 83% almond, 73% peanut) reported no or mild symptoms. Cosensitizations between nuts and birch were similar in Lapland with its lower birch-pollen exposure. CONCLUSION Birch-sensitized individuals are frequently cosensitized to hazelnut, almond, and peanut. Among the birch-negatives, prevalences of nut sensitizations decrease from early childhood to adolescence. Cashew and pistachio, and pecan and walnut cross-react the most.
Collapse
Affiliation(s)
- R. Uotila
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - A. K. Kukkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - A. S. Pelkonen
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. J. Mäkelä
- Skin and Allergy Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| |
Collapse
|
14
|
Brough HA, Turner PJ, Wright T, Fox AT, Taylor SL, Warner JO, Lack G. Dietary management of peanut and tree nut allergy: what exactly should patients avoid? Clin Exp Allergy 2016; 45:859-871. [PMID: 25443673 DOI: 10.1111/cea.12466] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peanut and tree nut allergies are the commonest cause of life-threatening food-allergic reactions and significantly affect quality of life in children and their families. Dietary nut avoidance and provision of emergency medication is currently the mainstay of treatment. Nut avoidance has consequences on both quality of life and nutrition. We review the terminology that may cause confusion and lead to unnecessary dietary restrictions. In peanut or tree nut-allergic children, introduction of specific nuts to which the child is not allergic may improve quality of life and should be considered in patients with multiple foods allergies, vegan or ethnic-specific diets, in whom nuts are an important source of protein. Nut-allergic consumers do not just need to avoid foods containing nuts as an ingredient, but also contend with pre-packed foods which frequently have precautionary allergen labelling (PAL) referring to possible nut contamination. Although the published rate of peanut contamination in 'snack' foods with PAL (see Box ) ranges from 0.9-32.4%, peanut contamination in non-snack items with PAL is far less common. We propose that in some peanut-allergic patients (depending on history of reactivity to trace levels of peanut, reaction severity, other medical conditions, willingness to always carry adrenaline, etc.), consideration may be given to allow the consumption of non-snack foods containing PAL following discussion with the patient's (and their family's) specialist. More work is needed to provide consumers with clearer information on the risk of potential nut contamination in pre-packed food. We also draw attention to the change in legislation in December 2014 that require mandatory disclosure of allergens in non-pre-packed foods.
Collapse
Affiliation(s)
- H A Brough
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - P J Turner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - T Wright
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - A T Fox
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - S L Taylor
- Food Allergy Research & Resource Program, Department of Food Science & Technology, University of Nebraska, Lincoln, NE, USA
| | - J O Warner
- Section of Paediatrics (Allergy & Immunology) & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust / NIHR Biomedical Research Unit
| | - G Lack
- Children's Allergy Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Asthma, Allergy and Lung Biology & MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| |
Collapse
|
15
|
Masthoff LJ, van Hoffen E, de Reus A, Boonacker CW, Bruijnzeel-Koomen CA, Pasmans SG, Knulst AC. Hazelnut allergy differs between children and adults in frequency of severity, aetiology and relevance of diagnostic parameters. Clin Exp Allergy 2014; 44:1539-45. [DOI: 10.1111/cea.12440] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/25/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- L. J. Masthoff
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - E. van Hoffen
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. de Reus
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - C. W. Boonacker
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - C. A. Bruijnzeel-Koomen
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| | - S. G. Pasmans
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
- Center for Paediatric Allergology; Wilhelmina Children's Hospital; University Medical Center Utrecht; Utrecht The Netherlands
| | - A. C. Knulst
- Department of Dermatology/Allergology; University Medical Center Utrecht; Utrecht The Netherlands
| |
Collapse
|
16
|
Baker TW, Forester JP, Johnson ML, Stolfi A, Stahl MC. The HIT study: Hymenoptera Identification Test--how accurate are people at identifying stinging insects? Ann Allergy Asthma Immunol 2014; 113:267-70. [PMID: 24969241 DOI: 10.1016/j.anai.2014.05.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/08/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Stinging insects in the order Hymenoptera include bees, wasps, yellow jackets, hornets, and ants. Hymenoptera sting injuries range from localized swelling to rarely death. Insect identification is helpful in the management of sting injuries. OBJECTIVE To determine the accuracy of adults in identifying stinging insects and 2 insect nests. METHODS This was a cross-sectional, multicenter study using a picture-based survey to evaluate an individual's success at identifying honeybees, wasps, bald-face hornets, and yellow jackets. Bald-face hornet and paper wasp nest identification also was assessed in this study. RESULTS Six hundred forty participants completed the questionnaire. Overall, the mean number of correct responses was 3.2 (SD 1.3) of 6. Twenty participants (3.1%) correctly identified all 6 stinging insects and nests and only 10 (1.6%) were unable to identify any of the pictures correctly. The honeybee was the most accurately identified insect (91.3%) and the paper wasp was the least correctly identified insect (50.9%). For the 6 questions regarding whether the participant had been stung in the past by any of the insects (including an unidentified insect), 91% reported being stung by at least 1. Men were more successful at identify stinging insects correctly (P = .002), as were participants stung by at least 4 insects (P = .018). CONCLUSION This study supports the general perception that adults are poor discriminators in distinguishing stinging insects and nests with the exception of the honeybee. Men and those participants who reported multiple stings to at least 4 insects were more accurate overall in insect identification.
Collapse
Affiliation(s)
- Troy W Baker
- Malcolm Grow Medical Clinics and Surgery Center, Department of Allergy/Immunology, Joint Base Andrews, Maryland.
| | | | - Monica L Johnson
- Mike O'Callaghan Federal Medical Center, Nellis Air Force Base, Nevada
| | | | - Mark C Stahl
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio
| |
Collapse
|
17
|
Abstract
Food allergy has established itself as a matter of significant public health importance and relevance. It has had substantial impacts across the world and continues to represent the most common cause of anaphylaxis seen in emergent settings. However, its increasing incidence has yielded a silver lining of increased interest and investment, which has powered major research in the field. Much has been learned about food allergy as a result. Recent work has elicited increased understanding about food allergy prevalence, mechanisms, and risk factors. In turn, this has allowed for application of this understanding to potential treatments. Current practice of food allergy treatment through restricted exposure may ultimately be replaced with novel therapies including, perhaps ironically, introduction of the allergenic foods in question. This review presents broad highlights of the rapidly increasing understanding into food allergy mechanisms and experimental therapies.
Collapse
|
18
|
Kao L, Bhangoo PS, Roy L, Bird JA. Identification of peanuts and tree nuts: are allergists smarter than their patients? Ann Allergy Asthma Immunol 2013; 111:282-5. [PMID: 24054364 DOI: 10.1016/j.anai.2013.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/28/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND It has been reported that peanut- or tree nut-allergic individuals and their guardians are poorly capable of differentiating various tree nuts and peanuts. No information exists on the ability of allergists to differentiate peanuts and tree nuts. OBJECTIVE To measure the ability of allergists and other specialists within the allergy and immunology field to identify various types of tree nuts and peanuts. METHODS A nut box with a clear cover was constructed and contained various tree nuts and peanuts in shelled and unshelled forms. Attendees at the 2012 national meeting of the American Academy of Allergy, Asthma, and Immunology were offered participation by viewing the nut box and filling in their responses to a questionnaire. A similar procedure was conducted in the Food Allergy Center at Children's Medical Center (Dallas, TX) for guardians of children with and without peanut or tree nut allergies. RESULTS Allergists were better able to identify and differentiate tree nuts and peanuts than guardians of peanut- or tree nut-allergic children, guardians of children without food allergies, and allergy and immunology fellows in training. CONCLUSION It is important for allergists to educate peanut- and tree nut-allergic individuals and their guardians on the proper avoidance of peanuts and tree nuts. This includes education in the ability to identify peanuts and tree nuts. In addition, allergy and immunology fellows in training may benefit from education in proper peanut and tree nut identification.
Collapse
Affiliation(s)
- Leon Kao
- Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | |
Collapse
|
19
|
Abstract
Though much has been studied and written about food allergy, the majority of the available literature focuses on food allergies in the pediatric population. Unfortunately, it is likely that in regard to food allergies, adults are not just big children, and extrapolating findings from pediatric to adult patient populations might lead to erroneous assumptions. Thus, it is important to validate the correlation between pediatric and adult data, gather data regarding adult food allergy and understand the specific nuances of subsets of adults to better treat their food allergy. This review was conducted by identifying potentially relevant studies regarding food allergies in adults through electronic databases, including PubMed, Medline, and Google Scholar. The search terms included "allergy", "food" and "adults". Parameters of 19+ years of age were added to search terms and all journals were written in or translated to English. From these search results, focus was placed on studies from 2010 to 2012. This systematic update on food allergy in adults found that the evidence regarding prevalence, diagnosis and management of food allergies is very limited, with the majority of data derived from children and young adults.
Collapse
|