Anaphylaxis after consumption of pumpkin seeds in a 2-y-old child tolerant to its pulp: A case study

Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024

BACKGROUND

Anaphylaxis represents the most severe end of the spectrum of allergic reactions. Frequent elicitors of anaphylaxis are insects, foods, and drugs. This paper summarizes recent development with regard to emerging and novel elicitors of anaphylaxis.

SUMMARY

Food allergens on the rise include pulses (like pea, chickpea), seeds (hemp, chia), nuts (cashew), pseudograins (buckwheat, quinoa), fruits, and microalgae. Novel foods are foods that were not consumed to any significant extent in the European Union before May 1997, which includes four edible insects (mealworm, migratory locust, house cricket, and buffalo worm). Recent investigations have pointed out the risk of anaphylaxis associated with the consumption of yellow mealworm for people allergic to shellfish and house dust mites. In Europe, fire ants (mostly Solenopsis invicta) and Vespa velutina nigrithorax represent invasive species, which account for increasing numbers of anaphylactic reactions. Also, several new drugs, especially biologicals, have been associated with anaphylaxis.

KEY MESSAGES

Elicitors of anaphylaxis are changing as a result of (i) increase in demand for plant-based food, (ii) introduction of novel foods, (iii) spreading of allergens by climate changes and globalization, or (iv) due to exposure to newly developed drugs.

New arrivals in anaphylaxis to foods

PURPOSE OF REVIEW

More people are excluding wheat from their diet, or turning to a more sustainable diet in which includes meat substitutes or is mainly or wholly plant-based. This increases the availability of new foods and with it the increasing likelihood of novel allergens.

RECENT FINDINGS

There is a growing body of evidence which suggests that allergies to seeds and legumes are increasing potentially due to their use in concentrated form in vegan or health foods. Insects can be a sustainable source of protein, but mealworm could provoke symptoms in individuals sensitized or allergic to shellfish or house dust mite. Novel plant food allergens such as gibberellin-regulated proteins and thaumatin-like proteins are increasingly being reported as significant causes of severe reactions to fruits.

SUMMARY

these findings make it even more imperative to take a full dietary history to ensure apparent idiopathic anaphylaxis is not in reality due to a novel food, especially in cases where other forms of the food are tolerated. Given the lack of diagnostic tests for these novel foods, a prick-to-prick skin prick test should be performed with the suspected food. There is currently more work needed to define and sequence many of the allergens involved.

Recurrent Anaphylaxis with Watermelon and Pumpkin Seeds in a Boy Tolerant to Their Pulps

Background: Seeds are widely consumed as a traditional snack and have rich contents beneficial to health. With an increase in consumption rates, allergic reactions occur more frequently. We focus on multiple seed consumption related to recurrent anaphylaxis in this case. Case Presentation: We evaluated an 11-year-old boy with recurrent anaphylaxis. According to his medical records, he had been hospitalized several times, diagnosed with anaphylaxis, and treated. The family noticed direct (eating) or indirect contact with pumpkin seeds. In addition, the family mentioned another anaphylactic episode after watermelon seed and poppy seed bread consumption. We conducted skin prick-to-prick tests, examined total immunoglobulin E levels, and prescribed the treatment with an adrenalin autoinjector and preventive dietary recommendations. Conclusion: Anaphylaxis, particularly recurrent ones, should be evaluated with detailed anamnesis and supported with laboratory tests. Although seeds are beneficial and highly nutritious, it is necessary to consider them a source of allergens.

IgE-Mediated food allergy: Current diagnostic modalities and novel biomarkers with robust potential

Food allergy (FA) is a serious public health issue afflicting millions of people globally, with an estimated prevalence ranging from 1-10%. Management of FA is challenging due to overly restrictive diets and the lack of diagnostic approaches with high accuracy and prediction. Although measurement of serum-specific antibodies combined with patient medical history and skin prick test is a useful diagnostic tool, it is still an imprecise predictor of clinical reactivity with a high false-positive rate. The double-blind placebo-controlled food challenge represents the gold standard for FA diagnosis; however, it requires large healthcare and involves the risk of acute onset of allergic reactions. Improvement in our understanding of the molecular mechanism underlying allergic disease pathology, development of omics-based methods, and advances in bioinformatics have boosted the generation of a number of robust diagnostic biomarkers of FA. In this review, we discuss how traditional diagnostic modalities guide appropriate diagnosis and management of FA in clinical practice, as well as uncover the potential of the latest biomarkers for the diagnosis, monitoring, and prediction of FA. We also raise perspectives for precise and targeted medical intervention to fill the gap in the diagnosis of FA.