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Giovannini M, Skypala IJ, Caubet JC, Du Toit G, Nowak-Wegrzyn A. Diagnosis and Management of Pollen Food Allergy Syndrome to Nuts. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:599-604. [PMID: 38280450 DOI: 10.1016/j.jaip.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
Oral allergy syndrome or pollen food allergy syndrome (PFAS) represents a common clinical conundrum when the reported trigger food is a tree nut (usually almond or hazelnut) or peanut. The PFAS may give rise to uncertainty about the potential severity of the future reactions, indications for prescribing epinephrine, and the extent of the necessary dietary avoidance. As a food allergy, secondary to cross-reactivity with airborne pollen, PFAS usually manifests toward the end of the first decade of life as contact urticaria of the oropharyngeal mucous membranes. Molecular allergology facilitates diagnosis and risk stratification by establishing the profile of sensitization. Exclusive sensitization to pathogenesis-related proteins family 10 (PR10) and profilins indicates that signs and symptoms are due to PFAS, whereas sensitization to seed storage proteins with or without sensitization to PR10 and profilins may indicate a more severe primary nut allergy phenotype. Management relies on avoidance of the specific nut trigger, advice on the likelihood of more severe local or systemic symptoms, and treatment of reactions according to the severity. Future studies are needed to better delineate the risk of systemic reactions in individuals with nut PFAS and to establish the role of food or pollen allergen immunotherapy for the prevention or moderation of this condition.
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Affiliation(s)
- Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guys & St Thomas NHS Foundation Trust, London, United Kingdom; Department of Inflammation and Repair, Imperial College, London, United Kingdom.
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| | - George Du Toit
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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2
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Lee ASE, Ramsey N. Climate Change and Food Allergy. Immunol Allergy Clin North Am 2024; 44:75-83. [PMID: 37973261 DOI: 10.1016/j.iac.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The role of environmental factors including climate change and consequent influences of air pollution on food allergy remains less explored compared with impacts on allergic rhinitis and asthma. In this review, we discuss the epithelial barrier hypothesis as a proposed mechanism of food allergy development that may be relevant in this context. We also discuss existing studies that provide insight into the intricate relationship between food allergy and climate-related environmental factors.
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Affiliation(s)
- Ashley Sang Eun Lee
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York 10029, USA; Department of Pediatrics, Jaffe Food Allergy Institute, 10540 Avenue K, Brooklyn, NY 11236-3018, USA.
| | - Nicole Ramsey
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York 10029, USA; Department of Pediatrics, Jaffe Food Allergy Institute, 10540 Avenue K, Brooklyn, NY 11236-3018, USA
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3
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Conner JE, Steinberg JA. Approach to Idiopathic Anaphylaxis in Adolescents. Med Clin North Am 2024; 108:123-155. [PMID: 37951646 DOI: 10.1016/j.mcna.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Anaphylaxis is a potentially-life threatening condition. Adolescents are particularly vulnerable due to increased risk-taking behaviors, poor disease management, and minimized perception of risk. Although most anaphylaxis can be attributed to food, drug, or venom allergy via a detailed history and confirmatory studies, in nearly 1 in 5 cases, the cause may not be obvious. Clinical differentials including rare allergens, cofactors, mast-cell disorders, and mimic disorders can increase the likelihood of discovering of the cause of anaphylaxis.
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Affiliation(s)
- Jeanne E Conner
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA
| | - Joshua A Steinberg
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, 9000 West Wisconsin Avenue. B440, Milwaukee, WI 53226, USA; Section of Allergy, Department of Medicine, Clement J. Zablocki Veterans' Affairs Medical Center, 5000 West National Avenue, 1AN, Milwaukee, WI 53295, USA.
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Da Silva-Mojón L, Pérez-Lamela C, Falqué-López E. Smoothies Marketed in Spain: Are They Complying with Labeling Legislation? Nutrients 2023; 15:4426. [PMID: 37892501 PMCID: PMC10610167 DOI: 10.3390/nu15204426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
There is no legal definition of a smoothie, so the European legislation applicable to its labeling is that of fruit juice. The smoothie market has grown in recent years, as it can include a wide variety of ingredients: fruits, fruit purees, honey, milk and vegetable milks, vegetables, herbs, cereals, cereal flours, seaweed, and crushed ice. In this study, 57 smoothies were reviewed. All of them were purchased in supermarkets and classified into eight types according to the main ingredients. Fifteen legal statements/items were reviewed on the pack labels: eleven mandatory and three optional. Moreover, nutrition labels, nutritional claims, images, marks, and other symbols were also reviewed. Only 22.8% of the samples complied with EU and Spanish labeling legislation. More incorrectness was related to the name of the food and the fruits included as main ingredients; other errors related to the allergy/intolerance statements, and some nutritional claims concerning vitamin C were also detected to a lesser extent. General advice is provided for consumers to interpret smoothie labels correctly. Lawmakers should amend legislation to accept the term "smoothie" as a legal name.
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Affiliation(s)
- Lorena Da Silva-Mojón
- Analytical Chemistry Area, Analytical Chemistry and Food Department, Faculty of Sciences, University of Vigo, E-32004 Ourense, Spain; (L.D.S.-M.); (E.F.-L.)
| | - Concepción Pérez-Lamela
- Nutrition and Bromatology Area, Analytical Chemistry and Food Department, Faculty of Sciences, University of Vigo, E-32004 Ourense, Spain
| | - Elena Falqué-López
- Analytical Chemistry Area, Analytical Chemistry and Food Department, Faculty of Sciences, University of Vigo, E-32004 Ourense, Spain; (L.D.S.-M.); (E.F.-L.)
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5
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Olivieri B, Stoenchev KV, Skypala IJ. Anaphylaxis across Europe: are pollen food syndrome and lipid transfer protein allergy so far apart? Curr Opin Allergy Clin Immunol 2022; 22:291-297. [PMID: 35942860 DOI: 10.1097/aci.0000000000000847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Traditionally pollen-food syndrome (PFS) is considered to be a mild cross-reacting food allergy affecting only Northern Europe, with lipid transfer protein (LTP) allergy being more severe and mainly occurring in Southern Europe. This review seeks to update the reader on both types of plant food allergy and to determine whether the stereotypical presentations of these plant food allergies remain the same, with a particular focus on reaction severity. RECENT FINDINGS Recent findings suggest that both these types of plant food allergy occur in children and adults. Although it is true that PFS allergy is more prevalent in Northern Europe and LTP allergy is more well known in Southern Europe, these conditions are not hidebound by geography, and the increasing spread and allergenicity of pollen due to global warming continues to change their presentation. Both conditions have a spectrum of symptom severity, with PFS sometimes presenting with more severe symptoms, including anaphylaxis and LTP allergy with milder reactions. SUMMARY It is important to consider that in many parts of Europe, reactions to plant foods, especially fruits or vegetables, could be mediated either by pollen cross-reactivity or primary sensitization to LTP allergens. All those presenting with symptoms to plant foods will benefit from a detailed clinical history and appropriate tests so that an accurate diagnosis can be made, and correct management implemented.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Kostadin V Stoenchev
- Royal Brompton & Harefield Hospitals, Part of Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Part of Guys and St Thomas NHS Foundation Trust, London, United Kingdom
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Turner PJ, Arasi S, Ballmer‐Weber B, Baseggio Conrado A, Deschildre A, Gerdts J, Halken S, Muraro A, Patel N, Van Ree R, de Silva D, Worm M, Zuberbier T, Roberts G. Risk factors for severe reactions in food allergy: Rapid evidence review with meta-analysis. Allergy 2022; 77:2634-2652. [PMID: 35441718 PMCID: PMC9544052 DOI: 10.1111/all.15318] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/04/2022] [Accepted: 04/17/2022] [Indexed: 02/06/2023]
Abstract
This rapid review summarizes the most up to date evidence about the risk factors for severe food-induced allergic reactions. We searched three bibliographic databases for studies published between January 2010 and August 2021. We included 88 studies and synthesized the evidence narratively, undertaking meta-analysis where appropriate. Significant uncertainties remain with respect to the prediction of severe reactions, both anaphylaxis and/or severe anaphylaxis refractory to treatment. Prior anaphylaxis, an asthma diagnosis, IgE sensitization or basophil activation tests are not good predictors. Some molecular allergology markers may be helpful. Hospital presentations for anaphylaxis are highest in young children, yet this age group appears at lower risk of severe outcomes. Risk of severe outcomes is greatest in adolescence and young adulthood, but the contribution of risk taking behaviour in contributing to severe outcomes is unclear. Evidence for an impact of cofactors on severity is lacking, although food-dependent exercise-induced anaphylaxis may be an exception. Some medications such as beta-blockers or ACE inhibitors may increase severity, but appear less important than age as a factor in life-threatening reactions. The relationship between dose of exposure and severity is unclear. Delays in symptom recognition and anaphylaxis treatment have been associated with more severe outcomes. An absence of prior anaphylaxis does not exclude its future risk.
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Affiliation(s)
- Paul J. Turner
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Stefania Arasi
- Translational Research in Paediatric Specialities AreaDivision of AllergyBambino Gesù Children's HospitalIRCCSRomeItaly
| | - Barbara Ballmer‐Weber
- Clinic for Dermatology and AllergologyKantonsspital St. GallenSt. GallenSwitzerland,Department of DermatologyUniversity Hospital ZürichZürichSwitzerland
| | | | - Antoine Deschildre
- CHU Lille, Univ. LillePediatric Pulmonology and Allergy DepartmentHôpital Jeanne de FlandreLilleFrance
| | | | - Susanne Halken
- Hans Christian Andersen Children’s HospitalOdense University HospitalOdenseDenmark
| | | | - Nandinee Patel
- National Heart & Lung InstituteImperial College LondonLondonUK
| | - Ronald Van Ree
- Departments of Experimental Immunology and of OtorhinolaryngologyAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | | | - Margitta Worm
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité, Universitätsmedizin BerlinBerlinGermany
| | - Torsten Zuberbier
- Division of Allergy and ImmunologyDepartment of Dermatology, Venerology and AllergyCharité, Universitätsmedizin BerlinBerlinGermany
| | - Graham Roberts
- NIHR Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustFaculty of MedicineUniversity of SouthamptonSouthamptonUK,The David Hide Asthma and Allergy Research CentreSt Mary's HospitalIsle of WightUK
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Evrard B, Cosme J, Raveau M, Junda M, Michaud E, Bonnet B. Utility of the Basophil Activation Test Using Gly m 4, Gly m 5 and Gly m 6 Molecular Allergens for Characterizing Anaphylactic Reactions to Soy. FRONTIERS IN ALLERGY 2022; 3:908435. [PMID: 35769564 PMCID: PMC9234935 DOI: 10.3389/falgy.2022.908435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
There are two major clinically described forms of IgE-dependent soy allergy: (i) a primary dietary form, linked to sensitization against soy storage proteins Gly m 5 and Glym 6, and (ii) a form included in birch-soy syndromes linked to Gly m 4, a PR-10-like allergen. This second form sometimes causes severe systemic reactions, even anaphylaxis, especially on consuming certain forms of soy such as soymilks or smoothies. Skin prick tests and specific IgE assays against soy whole extracts lack sensitivity. Assays of anti-Gly m 4, Gly m 5 and Gly m 6 specific IgEs have been developed to overcome this obstacle, but they unfortunately lack specificity, especially for anti-Gly m 4. We hypothesized that the basophil activation test (BAT) using molecular soy allergens Gly m 4, Gly m 5 and Gly m 6 would both remedy the lack of sensitivity of other tests and offer, through its mechanistic contribution, greater specificity than the assay of anti-Gly m 4 specific IgEs. This would enable the two types of soy allergy to be separately identified. In a characteristic clinical example of PR-10-induced anaphylactic reaction after consuming soymilk, we report preliminary results of Gly m 4-exclusive positivity of BAT supporting our hypothesis. It will be necessary to confirm these results on more patients in subsequent studies, and to specify the place of the BAT in an overall diagnostic strategy. Meanwhile, soy BAT using molecular allergens is a promising diagnostic tool for soy allergy and probably also for follow-up in specific immunotherapies.
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Affiliation(s)
- Bertrand Evrard
- Service d'Immunologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Laboratoire d'Immunologie, ECREIN, UMR 1019 Unité de Nutrition Humaine, Faculté de Médecine de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
- *Correspondence: Bertrand Evrard
| | - Justine Cosme
- Service d'Immunologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Laboratoire d'Immunologie, ECREIN, UMR 1019 Unité de Nutrition Humaine, Faculté de Médecine de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marion Raveau
- Unité d'Allergologie Pédiatrique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Maud Junda
- Service d'Immunologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Elodie Michaud
- Unité d'Allergologie Pédiatrique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Bonnet
- Service d'Immunologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Laboratoire d'Immunologie, ECREIN, UMR 1019 Unité de Nutrition Humaine, Faculté de Médecine de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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Elghoudi A, Narchi H. Food allergy in children—the current status and the way forward. World J Clin Pediatr 2022; 11:253-269. [PMID: 35663006 PMCID: PMC9134150 DOI: 10.5409/wjcp.v11.i3.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Food allergy in children is a major health concern, and its prevalence is rising. It is often over-diagnosed by parents, resulting occasionally in unnecessary exclusion of some important food. It also causes stress, anxiety, and even depression in parents and affects the family’s quality of life. Current diagnostic tests are useful when interpreted in the context of the clinical history, although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations. Although the oral food challenge is the current gold standard for making the diagnosis, it is only available to a small number of patients because of its requirement in time and medical personnel. New diagnostic methods have recently emerged, such as the Component Resolved Diagnostics and the Basophil Activation Test, but their use is still limited, and the latter lacks standardisation. Currently, there is no definite treatment available to induce life-long natural tolerance and cure for food allergy. Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food, usually taken by accident. New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy. If standardised and widely implemented, this may result in decreasing the prevalence of food allergy.
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Affiliation(s)
- Ahmed Elghoudi
- Paediatric Department, Sheikh Khalifa Medical City, Abu Dhabi NA, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
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Lyons SA, Welsing PMJ, Hakobyan M, Kansen HM, Knol EF, Otten HG, Ree R, Knulst AC, Le T. Measurement of IgE to hazelnut allergen components cannot replace hazelnut challenge in Dutch adults. Allergy 2022; 77:1559-1569. [PMID: 34731517 PMCID: PMC9298907 DOI: 10.1111/all.15166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/20/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023]
Abstract
Background Component‐resolved diagnostics (CRD) help predict hazelnut allergy (HA) in children, but are of unknown diagnostic value in adults. This study aimed to evaluate the diagnostic accuracy of IgE to hazelnut extract and components in adults. Methods A Dutch population of consecutively presenting adults suspected of HA, who underwent a double‐blind placebo‐controlled food challenge, were included. Serum IgE to hazelnut extract and Cor a 1, 8, 9, and 14 was measured on ImmunoCAP. Diagnostic accuracy was assessed by area under the curve (AUC) analysis. Results Of 89 patients undergoing challenge, 46 had challenge‐confirmed HA: 17 based on objective and 29 based on subjective symptoms. At commonly applied cutoffs 0.1 and 0.35 kUA/L, high sensitivity was observed for IgE to hazelnut extract and Cor a 1 (range 85–91%), and high specificity for IgE to Cor a 8, 9 and 14 (range 77–95%). However, the AUCs for hazelnut extract and components were too low for accurate prediction of HA (range 0.50–0.56). Combining hazelnut extract and component IgE measurements did not significantly improve accuracy. Higher IgE levels to Cor a 9 and 14 were tentatively associated with HA with objective symptoms, but the corresponding AUCs still only reached 0.68 and 0.63, respectively. Conclusions Although hazelnut allergic adults are generally sensitized to hazelnut extract and Cor a 1, and hazelnut tolerant adults are usually not sensitized to Cor a 8, 9, or 14, challenge testing is still needed to accurately discriminate between presence and absence of HA in adults from a birch‐endemic country.
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Affiliation(s)
- Sarah A. Lyons
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Paco M. J. Welsing
- Division of internal medicine and dermatology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Mariam Hakobyan
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Hannah M. Kansen
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Department of Pediatric Pulmonology and Allergology Wilhelmina Children’s Hospital University Medical Center Utrecht University Utrecht the Netherlands
| | - Edward F. Knol
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Henny G. Otten
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Ronald Ree
- Department of experimental immunology Amsterdam University Medical Centers Amsterdam the Netherlands
- Department of otorhinolaryngology Amsterdam University Medical Centers Amsterdam the Netherlands
| | - André C. Knulst
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
| | - Thuy‐My Le
- Department of Dermatology and Allergology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Center of Translational Immunology University Medical Center Utrecht Utrecht the Netherlands
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Jiang N, Xu W, Huang H, Hou X, Xiang L. Anaphylaxis in Chinese Children with Pollen Sensitization: Triggers, Clinical Presentation, and Acute Management. J Asthma Allergy 2022; 15:633-643. [PMID: 35603012 PMCID: PMC9122664 DOI: 10.2147/jaa.s363113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Pollen sensitization is increasing in children. However, there is little evidence regarding the characteristics of anaphylaxis in individuals with pollen sensitization. Patients and Methods We conducted a retrospective study of patients with anaphylaxis combined with pollen sensitization who attended an allergy department in a tertiary children’s hospital from 2014 to 2021. Results A total of 157 anaphylaxis events in 108 patients were analyzed; the mean age at the reaction was 5.8 ± 4.17 years. A total of 99.1% (107/108) of the patients came from northern China. The most common sensitizing pollen was mugwort (93.5%,101/108), followed by ragweed (68.5%, 74/108) and birch (40.7%, 44/108). A total of 76.9% (83/108) of the patients showed polysensitization to pollen. Allergic rhinitis/conjunctivitis was the most common comorbidity (87.0%, 94/108). Children with severe anaphylaxis were more likely to have a history of recurrent urticaria (16.1% vs 3.9%, p = 0.028). The most frequently implicated foods were fruits/vegetables (22.3%, 35/157), followed by wheat (8.9%, 14/157) and milk (8.3%, 13/157), and the most common fruit allergen was peach (n = 7). Of 14% (22/157) exercise-induced reactions, 63.6% (14/22) occurred in pollen season. Skin symptoms were the most frequent (86.0%, 135/157) symptoms, followed by respiratory (73.9%, 116/157) and gastrointestinal (21%, 33/157) symptoms. Regarding acute management, only 7.4% of the patients were treated with epinephrine. Conclusion Our findings revealed the characteristics of anaphylaxis in children with pollen sensitization. Fruits/vegetables accounted for a substantial percentage of anaphylaxis triggers. The suboptimal use of epinephrine highlights the need for educational programs promoting the use of epinephrine.
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Affiliation(s)
- Nannan Jiang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Wei Xu
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Huijie Huang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Xiaoling Hou
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Li Xiang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health; Key Laboratory of Major Diseases in Children, Ministry of Education; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
- Correspondence: Li Xiang, Department of Allergy, Beijing Children’s Hospital, Capital Medical University, National Center for Children′s Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, People’s Republic of China, Tel +861059616934, Fax +861059616934, Email
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11
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Lipp T, Acar Şahin A, Aggelidis X, Arasi S, Barbalace A, Bourgoin A, Bregu B, Brighetti MA, Caeiro E, Caglayan Sozmen S, Caminiti L, Charpin D, Couto M, Delgado L, Di Rienzo Businco A, Dimier C, Dimou MV, Fonseca JA, Goksel O, Guvensen A, Hernandez D, Hoffmann TM, Jang DT, Kalpaklioglu F, Lame B, Llusar R, Makris MP, Mazon A, Mesonjesi E, Nieto A, Öztürk A, Pahus L, Pajno GB, Panasiti I, Papadopoulos NG, Pellegrini E, Pelosi S, Pereira AM, Pereira M, Pinar M, Potapova E, Priftanji A, Psarros F, Sackesen C, Sfika I, Suarez J, Thibaudon M, Travaglini A, Tripodi S, Verdier V, Villella V, Xepapadaki P, Yazici D, Matricardi PM, Dramburg S. Heterogeneity of pollen food allergy syndrome in seven Southern European countries: The @IT.2020 multicenter study. Allergy 2021; 76:3041-3052. [PMID: 33492738 DOI: 10.1111/all.14742] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pollen food allergy syndrome (PFAS) is a frequently underdiagnosed disease due to diverse triggers, clinical presentations, and test results. This is especially relevant in geographic areas with a broad spectrum of pollen sensitization, such as Southern Europe. OBJECTIVES To elucidate similarities and differences of PFAS in nine Southern European centers and identify associated characteristics and unique markers of PFAS. METHODS As part of the @IT.2020 Multicenter Study, 815 patients with seasonal allergic rhinitis (SAR), aged 10-60 years, were recruited in seven countries. They completed questionnaires regarding SAR, comorbidities, family history, and PFAS, and underwent skin prick testing (SPT) and serum IgE testing. RESULTS Of the 815 patients, 167 (20.5%) reported PFAS reactions. Most commonly, eliciting foods were kiwi (58, 34.7%), peach (43, 25.7%), and melon (26, 15.6%). Reported reactions were mostly local (216/319, 67.7%), occurring within 5 min of contact with elicitors (209/319, 65.5%). Associated characteristics included positive IgE to at least one panallergen (profilin, PR-10, or nsLTP) (p = 0.007), maternal PFAS (OR: 3.716, p = 0.026), and asthma (OR: 1.752, p = 0.073). Between centers, heterogeneity in prevalence (Marseille: 7.5% vs. Rome: 41.4%, p < 0.001) and of clinical characteristics was apparent. Cypress played a limited role, with only 1/22 SPT mono-sensitized patients reporting a food reaction (p < 0.073). CONCLUSIONS PFAS is a frequent comorbidity in Southern European SAR patients. Significant heterogeneity of clinical characteristics in PFAS patients among the centers was observed and may be related to the different pollen sensitization patterns in each geographic area. IgE to panallergen(s), maternal PFAS, and asthma could be PFAS-associated characteristics.
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Affiliation(s)
- Theresa Lipp
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine Charité – Universitätsmedizin Berlin Berlin Germany
| | - Aydan Acar Şahin
- Department of Biology Faculty of Science Ankara University Ankara Turkey
| | - Xenophon Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity Hospital "Attikon" Athens Greece
| | - Stefania Arasi
- Pediatric Allergology Unit Department of Pediatric Medicine Bambino Gesù Children's Research Hospital (IRCCS) Rome Italy
| | - Andrea Barbalace
- Department of Pediatrics‐Allergy Unit University of Messina Messina Italy
| | - Anne Bourgoin
- Department of Pneumonology and Allergy La Timone HospitalAPHMAix‐Marseille University Marseille France
| | - Blerina Bregu
- Department of Allergology and Clinical Immunology UHC Mother TeresaMedical University Tirana Tirana Albania
| | | | - Elsa Caeiro
- MED‐Mediterranean Institute for Agriculture, Environment and Development Institute for Advanced Studies and Research University of Évora Évora Portugal
- Portuguese Society of Allergology and Clinical Immunology Lisbon Portugal
| | - Sule Caglayan Sozmen
- Department of Pediatric Allergy and Immunology Okan University Faculty of Medicine Istanbul Turkey
| | - Lucia Caminiti
- Department of Pediatrics‐Allergy Unit University of Messina Messina Italy
| | - Denis Charpin
- Department of Pneumonology and Allergy La Timone HospitalAPHMAix‐Marseille University Marseille France
| | - Mariana Couto
- Department of Immunoallergology CUF Decobertas HospitalJosé de Mello Saúde Porto Portugal
| | - Luís Delgado
- Basic and Clinical Immunology Unit Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- CINTESIS Center for Health Technology and Services Research Porto Portugal
- Allergy Unit Instituto & Hospital CUF Porto Porto Portugal
| | | | - Claire Dimier
- Department of Pneumonology and Allergy La Timone HospitalAPHMAix‐Marseille University Marseille France
| | - Maria V. Dimou
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital “P&A Kyriakou”University of Athens Athens Greece
| | - João A. Fonseca
- CINTESIS Center for Health Technology and Services Research Porto Portugal
- Allergy Unit Instituto & Hospital CUF Porto Porto Portugal
- MEDCIDS‐Department of Community Medicine, Information, and Health Sciences Faculty of Medicine University of Porto Porto Portugal
| | - Ozlem Goksel
- Department of Pulmonary Medicine Division of Immunology, Allergy and Asthma Faculty of Medicine Ege University Izmir Turkey
| | - Aykut Guvensen
- Department of Biology Faculty of Science Ege University Izmir Turkey
| | - Dolores Hernandez
- Department of Allergy Health Research Institute Hospital La Fe Valencia Spain
| | - Tara Maria Hoffmann
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine Charité – Universitätsmedizin Berlin Berlin Germany
| | - Dah Tay Jang
- Pediatric Allergy and Pneumology Unit Children's Hospital La Fe Health Research Institute La Fe Valencia Spain
| | - Fusun Kalpaklioglu
- Department of Immunology and Allergic Diseases Kırıkkale University School of Medicine Ankara Turkey
| | - Blerta Lame
- Department of Allergology and Clinical Immunology UHC Mother TeresaMedical University Tirana Tirana Albania
| | - Ruth Llusar
- Pediatric Allergy and Pneumology Unit Children's Hospital La Fe Health Research Institute La Fe Valencia Spain
| | - Michael P. Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology National and Kapodistrian University of AthensUniversity Hospital "Attikon" Athens Greece
| | - Angel Mazon
- Pediatric Allergy and Pneumology Unit Children's Hospital La Fe Health Research Institute La Fe Valencia Spain
| | - Eris Mesonjesi
- Department of Allergology and Clinical Immunology UHC Mother TeresaMedical University Tirana Tirana Albania
| | - Antonio Nieto
- Pediatric Allergy and Pneumology Unit Children's Hospital La Fe Health Research Institute La Fe Valencia Spain
| | - Ayse Öztürk
- Department of Pulmonary Medicine Division of Allergy and Immunology Koç University, School of Medicine Istanbul Turkey
| | - Laurie Pahus
- Department of Pneumonology and Allergy North HospitalAPHMAix‐Marseille University Marseille France
| | | | - Ilenia Panasiti
- Department of Pediatrics‐Allergy Unit University of Messina Messina Italy
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital “P&A Kyriakou”University of Athens Athens Greece
- Division of Infection, Immunity & Respiratory Medicine Royal Manchester Children's HospitalUniversity of Manchester Manchester UK
| | - Elisabetta Pellegrini
- Department of Reggio Calabria ARPA‐Regional Agency for Environmental Protection Calabria Italy
| | | | - Ana M. Pereira
- CINTESIS Center for Health Technology and Services Research Porto Portugal
- Allergy Unit Instituto & Hospital CUF Porto Porto Portugal
- MEDCIDS‐Department of Community Medicine, Information, and Health Sciences Faculty of Medicine University of Porto Porto Portugal
| | - Mariana Pereira
- CINTESIS Center for Health Technology and Services Research Porto Portugal
- Allergy Unit Instituto & Hospital CUF Porto Porto Portugal
| | - Munevver Pinar
- Department of Biology Faculty of Science Ankara University Ankara Turkey
| | - Ekaterina Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine Charité – Universitätsmedizin Berlin Berlin Germany
| | - Alfred Priftanji
- Department of Allergology and Clinical Immunology UHC Mother TeresaMedical University Tirana Tirana Albania
| | - Fotis Psarros
- Allergy Department Athens Naval Hospital Athens Greece
| | - Cansin Sackesen
- Division of Pediatric Allergy Koç University School of Medicine Istanbul Turkey
| | - Ifigenia Sfika
- Pediatric Allergy Unit Sandro Pertini Hospital Rome Italy
| | - Javier Suarez
- Department of Biology of Organisms and Systems Area of Botany University of Oviedo Oviedo Spain
| | | | - Alessandro Travaglini
- Department of Biology Tor Vergata University Rome Italy
- Italian Aerobiology Monitoring Network‐Italian Aerobiology Association Rome Italy
| | - Salvatore Tripodi
- Pediatric Allergy Unit Sandro Pertini Hospital Rome Italy
- Allergolology Service Policlinico Casilino Rome Italy
| | - Valentine Verdier
- Department of Pneumonology and Allergy La Timone HospitalAPHMAix‐Marseille University Marseille France
| | | | - Paraskevi Xepapadaki
- Allergy Department 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Duygu Yazici
- Cellular and Molecular Medicine KUTTAM Graduate School of Health Sciences Koç University Istanbul Turkey
| | - Paolo M. Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine Charité – Universitätsmedizin Berlin Berlin Germany
| | - Stephanie Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine Charité – Universitätsmedizin Berlin Berlin Germany
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12
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Soller L, La Vieille S, Cameron SB, Mak R, Cook VE, Gerdts J, Chan ES. Allergic reactions to emerging food allergens in Canadian children. Allergy Asthma Clin Immunol 2021; 17:71. [PMID: 34256836 PMCID: PMC8276401 DOI: 10.1186/s13223-021-00573-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Most Canadian food allergy data has focused on Health Canada’s priority food allergens. This study describes which non-priority (emerging) food allergens were most commonly reported by Canadian parents and categorized/confirmed by allergists. A secondary aim was to describe severity of allergic reactions to emerging allergens. Parents reported allergic reactions to emerging food allergens experienced by their child (< 18 years) which occurred in the past 12 months, and allergists categorized/confirmed them according to likelihood of IgE-mediated food allergy. Of 68 eligible patients completing the survey, the most commonly reported emerging allergens were fruits/vegetables (58.8%), seeds (22.1%), legumes (19.1%) and other (11.8%). Median allergist ranking for legumes was ‘probable’ IgE-mediated food allergy, ‘possible’ for seeds and fruits/vegetables, and ‘unlikely’ for other. Median reaction severity was mild for legumes, and moderate for seeds, fruits/vegetables, and other. Our study highlights that non-priority food allergens, namely legumes and seeds, can lead to probable/likely allergic reactions in Canadian children. These food allergens are increasing in popularity in the Canadian diet, which could lead to increasing reports of allergic reactions. More research is needed to confirm reports of reactions to emerging allergens, and to document their inclusion as ingredients in packaged foods.
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Affiliation(s)
- Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada.
| | | | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada.,Victoria Allergy, Victoria, BC, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada
| | - Victoria E Cook
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada.,Victoria Allergy, Victoria, BC, Canada
| | | | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, 4480 Oak St, Rm 1C31B, Vancouver, BC, V6H 3V4, Canada
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13
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Sicherer SH, Abrams EM, Nowak-Wegrzyn A, Hourihane JO. Managing Food Allergy When the Patient Is Not Highly Allergic. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:46-55. [PMID: 34098164 DOI: 10.1016/j.jaip.2021.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
Few patients with food allergy are "highly allergic," meaning they always have severe reactions and always react to very small amounts of allergen. Standard medical approaches for allergy management have focused on the safety and lifestyle modifications this group truly needs, but consequently families with food allergy are typically advised to strictly avoid any exposure to their implicated allergens. Most food-allergic subjects are actually not reactive to very low doses, and many never experience severe reactions. There are also notable conditions where a different care plan is already commonly offered: patients with pollen-related food allergy syndrome, with food-associated exercise-induced anaphylaxis, and with resolving or mild milk or egg allergy might be advised to ingest the allergens in specific circumstances with detailed instructions. Because oral immunotherapy and allergy prevention by early exposure have emphasized alternatives to strict avoidance, there is increasing interest in prospects to forego strict avoidance in those with food allergy. For patients with a high threshold of reactivity (low-dose tolerant, high-dose mildly reactive), there may be options such as allowing the ingestion of products with precautionary allergen labels, allowing dietary indiscretions with small amounts of the allergen, or even encouraging ingestion of subthreshold amounts with therapeutic intent. These practices have not been extensively studied and could be considered controversial. If these approaches are considered, shared decision making is needed in discussing them with patients and families. This review considers the potential approaches to those who are "not highly allergic": the risks, benefits, shared decision making, and research needs.
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Affiliation(s)
- Scott H Sicherer
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anna Nowak-Wegrzyn
- New York University Grossman School of Medicine, Allergy and Immunology, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Irerland, Dublin, Ireland; Childrens Health Ireland Temple St, Dublin, Ireland
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14
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Durban R, Groetch M, Meyer R, Coleman Collins S, Elverson W, Friebert A, Kabourek J, Marchand SM, McWilliam V, Netting M, Skypala I, Van Brennan T, Vassilopoulou E, Vlieg-Boerstra B, Venter C. Dietary Management of Food Allergy. Immunol Allergy Clin North Am 2021; 41:233-270. [PMID: 33863482 DOI: 10.1016/j.iac.2021.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention must result in a nutritionally sound plan including alternatives to support optimal growth and development. Inappropriate or incomplete dietary advice may increase the risk of adverse reactions, growth faltering, and nutrient deficiencies. Evidence indicates input from a registered dietitian improves nutritional outcomes. Nutritional input plays a critical role managing nutritional disorders related to food allergy.
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Affiliation(s)
- Raquel Durban
- Carolina Asthma & Allergy Center, 2600 E 7th St unit a, Charlotte, NC 28204, USA
| | - Marion Groetch
- Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1198, New York, NY 10029, USA
| | - Rosan Meyer
- Department of Pediatrics, Imperial College, London, UK
| | | | - Wendy Elverson
- Boston Children's Hospital Center for Nutrition, 333 Longwood Avenue, 4th floor, Boston, MA 02115, USA
| | - Alyssa Friebert
- Allergy and Immunology Clinic, 13123 East 16th Avenue Box 270, Aurora, CO 80045, USA
| | - Jamie Kabourek
- University of Nebraska-Lincoln, Food Innovation Center, Room 279c, 1901 North 21 Street, Lincoln, NE 68588, USA
| | - Stephanie M Marchand
- Department of Pediatrics, The Warren Alpert School of Medicine at Brown University, 593 Eddy Street, Providence, RI 02903, USA; Food and Nutrition Services, Hasbro Children's Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Vicki McWilliam
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Merryn Netting
- Women and Kids Theme, South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006, Australia; Department of Pediatrics, University of Adelaide, Adelaide, South Australia, Australia; Nurition Department, Women's and Children's Health Network, North Adelaide 5006, South Australia, Australia
| | - Isabel Skypala
- Imperial College, London, UK; Department of Allergy and Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, Royal Brompton Hospital, 4th Floor Fulham Wing, Sydney Street, London SW3 6NP, UK
| | - Taryn Van Brennan
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA
| | - Emillia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki 57400, Greece
| | - Berber Vlieg-Boerstra
- Department of Pediatrics, OLVG Hospital, PO Box 95500, Amsterdam 1090HM, The Netherlands
| | - Carina Venter
- Children's Hospital of Colorado, 13123 East 16th Avenue Box B518 Anschutz Medical Campus, Aurora CO 80045, USA.
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15
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Birch Pollen Related Pear Allergy: A Single-Blind Oral Challenge TRIAL with 2 Pear Cultivars. Nutrients 2021; 13:nu13041355. [PMID: 33919631 PMCID: PMC8073155 DOI: 10.3390/nu13041355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/06/2023] Open
Abstract
Approximately 70% of birch pollen allergic patients in Europe experience hypersensitivity reactions to Immunoglobulin E (IgE) cross-reactive food sources. This so-called pollen-food syndrome (PFS) is defined by allergic symptoms elicited promptly by the ingestion of fruits, nuts, or vegetables in these patients. So far, in the literature, less attention has been given to Bet v 1 cross-reactive symptoms caused by pear (Pyrus communis). In the Netherlands, pears are widely consumed. The primary objective of this study was to measure the type and severity of allergic symptoms during pear challenges in birch pollen allergic patients, with a positive history of pear allergy, using two different pear varieties. Fifteen patients were included, skin prick test (SPT), prick-to-prick test (PTP), specific Immunoglobulin E (sIgE), and single-blind oral challenges were performed with two pear (Pyrus communis) varieties: the ‘Cepuna’ (brand name Migo®) and the ‘Conference’ pears. All patients were sensitized to one or both pear varieties. A total of 12 out of 15 participants developed symptoms during the ‘Cepuna’ food challenge and 14/15 reacted during the ‘Conference’ challenge. Challenges with the ‘Cepuna’ pears resulted in less objective symptoms (n = 2) in comparison with challenges with ‘Conference’ pears (n = 7). Although we did not find significance between both varieties in our study, we found a high likelihood of fewer and less severe symptoms during the ‘Cepuna’ challenges. Consequently selected pear sensitized patients can try to consume small doses of the ‘Cepuna’ pear outside the birch pollen season.
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16
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Gabrielli S, Clarke AE, Morris J, Gravel J, Lim R, Chan ES, Goldman RD, O'Keefe A, Gerdts J, Chu DK, Upton J, Hochstadter E, Moisan J, Bretholz A, McCusker C, Zhang X, Protudjer JLP, Abrams EM, Simons E, Ben-Shoshan M. Fruit-Induced Anaphylaxis: Clinical Presentation and Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2825-2830.e2. [PMID: 33727108 DOI: 10.1016/j.jaip.2021.02.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data are sparse regarding the clinical characteristics and management of fruit-induced anaphylaxis. OBJECTIVE To assess clinical characteristics and management of patients with fruit-induced anaphylaxis and determine factors associated with severe reactions and epinephrine use. METHODS Over 9 years, children and adults presenting with anaphylaxis to seven emergency departments in four Canadian provinces and patients requiring emergency medical services in Outaouais, Quebec were recruited as part of the Cross-Canada Anaphylaxis Registry. A standardized form documenting symptoms, triggers, and management was collected. Multivariate logistic regression was used to identify factors associated with severe reactions and epinephrine treatment in the pre-hospital setting. RESULTS We recruited 250 patients with fruit-induced anaphylaxis, median age 10.2 years (interquartile range, 3.6-23.4 years); 48.8% were male. The most common fruit triggers were kiwi (15.6%), banana (10.8%), and mango (9.2%). Twenty-three patients reported having eczema (9.3%). Epinephrine use was low in both the pre-hospital setting and the emergency department (28.4% and 40.8%, respectively). Severe reactions to fruit were more likely to occur in spring and among those with eczema (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI], 1.03-1.23; and 1.17, 95% CI, 1.03-1.34, respectively). Patients with moderate and severe reactions (aOR = 1.23; 95% CI, 1.06-1.43) and those with a known food allergy (aOR = 1.38; 95% CI, 1.24-1.54) were more likely to be treated with epinephrine in the pre-hospital setting. CONCLUSIONS Severe anaphylaxis to fruit is more frequent in spring. Cross-reactivity to pollens is a potential explanation that should be evaluated further.
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Affiliation(s)
- Sofianne Gabrielli
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Ann E Clarke
- Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Emergency Medicine, Sacré-Coeur Hôpital, Montreal, QC, Canada
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Rodrick Lim
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Science Centre, London, ON, Canada
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Ran D Goldman
- Division of Clinical Pharmacology and Emergency Medicine, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew O'Keefe
- Department of Pediatrics, Faculty of Medicine, Memorial University, St John's, NL, Canada
| | | | - Derek K Chu
- Division of Clinical Immunology and Allergy, Department of Medicine, and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Julia Upton
- Division of Immunology and Allergy, Department of Pediatrics, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Elana Hochstadter
- Department of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Moisan
- Emergency Medical Services of Outaouais, Outaouais, QC, Canada
| | - Adam Bretholz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC, Canada
| | - Christine McCusker
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Section of Allergy and Clinical Immunology, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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