Oral allergy syndrome in children

Revisiting Fruit Allergy: Prevalence across the Globe, Diagnosis, and Current Management

Fruit allergies manifest with a diverse array of clinical presentations, ranging from localized contact allergies and oral allergy syndrome to the potential for severe systemic reactions including anaphylaxis. The scope of population-level prevalence studies remains limited, largely derived from single-center or hospital-based investigations. In this comprehensive review, we conducted a systematic literature search spanning the years 2009 to 2023, with full acknowledgment of potential analytical biases, to provide a global overview of fruit allergy prevalence. The primary mechanistic underpinning of fruit allergies stems from cross-reactivity between aeroallergens and food allergens, a consequence of structurally similar epitopes-a phenomenon recognized as pollen food allergy syndrome (PFAS). In the era of molecular allergology, numerous studies have dissected allergen components with substantial clinical relevance. Within this review, we explore important allergenic molecules found in plant-based foods, scrutinize pertinent cross-reactivity patterns, and offer insights into management recommendations. Additionally, we compare guideline recommendations to enhance clinical understanding and inform decision making.

The epidemiology of food allergy in adults

The prevalence and awareness of food allergy (FA) among US adults is arguably at a historical high, both with respect to primary immunoglobulin E-mediated food hypersensitivity and other food-triggered conditions that operate through a variety of immunologic mechanisms (eg, pollen-FA syndrome, alpha-gal syndrome, food protein-induced enterocolitis syndrome, eosinophilic esophagitis). Worryingly, not only are many adults retaining childhood-onset food allergies as they age into adulthood, it seems that many adults are experiencing adult-onset allergies to previously tolerated foods, with correspondingly adverse physical, and psychological health impacts. Consequently, this review aims to summarize what is currently known about the epidemiology and population-level burden of FA among adult populations in North America and around the globe. This article also provides insights into the natural history of these conditions and what we need to know as we look to the future to support effective care and prevent FA.

Food allergy in early childhood increases the risk of oral allergy syndrome in schoolchildren: A birth cohort study

BACKGROUND

The level of pollen in Korea has increased over recent decades. Research suggests that oral allergy syndrome (OAS) may be more frequent in childhood than previously recognized. We aimed to investigate the prevalence and characteristics of OAS in children aged 6-10 years from a general-population-based birth cohort.

METHODS

We analyzed 930 children from the cohort for childhood origin of asthma and allergic diseases (COCOA). Allergic diseases were diagnosed annually by pediatric allergists. The skin prick tests were performed with 14 common inhalant allergens and four food allergens for the general population of children aged 3 and 7 years.

RESULTS

Of the 930 eligible children, 44 (4.7%) aged 6-10 years were diagnosed with OAS. The mean age at onset was 6.74 years. OAS prevalence was 7.2% among children with allergic rhinitis (AR) and 19.1% among those with pollinosis, depending on comorbidity. OAS was more prevalent in schoolchildren with atopic dermatitis, food allergy, and sensitization to food allergens and grass pollen in early childhood. In schoolchildren with AR, only a history of food allergy until the age of 3 years increased the risk of OAS (aOR 2.971, 95% CI: 1.159-7.615).

CONCLUSION

Food allergy and food sensitization in early childhood were associated with OAS in schoolchildren with AR. Further study is required to elucidate the mechanism by which food allergy in early childhood affects the development of OAS.

Allergen Tests of Fruit Sensitization Involving Children with Allergic Diseases

Fruit is a kind of plant food which is rich in nutrients and immune-regulating ingredients. A meta-analysis has demonstrated that fruits have a protective effects against asthma. On the other hand, clinical syndromes of allergic reactions to fruits manifest as an oral allergy syndrome. We aimed to investigate the patterns and associated factors of fruit allergen-specific IgE (sIgE) sensitization among patients with suspected clinical symptoms. Data were extracted from the Chang Gung Research Database. Fruit sensitization in Taiwan was evaluated using the presence of IgE antibodies against specific fruits. The overall prevalence of positive sIgE responses to fruit allergens in Taiwan, in order of decreasing importance, was pineapple, kiwi, banana, and papaya. Children aged 0–18 had a higher positive rate of allergic responses to pineapple, kiwi, banana, and papaya than adults over the age of 18. Positive specific IgE for kiwi, banana, or papaya was more frequent in younger than in older children and children with a higher total IgE of both logarithmic (log) and arithmetic values. The analysis of log IgE for pineapple positive vs. negative children determined an optimal cutoff value, log IgE 2.2, with both sensitivity (0.9) and specificity (0.5). Dermatitis was significantly more prevalent in children with positive IgE for pineapple, kiwi, banana, and papaya than negative specific IgE. The highest positive rate of sIgE against fruits was pineapple among children. Even in older children, the positive rate of pineapple allergens was high. IgE discriminates with and without sIgE for pineapple, with an optimal cutoff of 158.5 U/mL.

Monoclonal Antibodies in Treating Food Allergy: A New Therapeutic Horizon

Food allergy (FA) is a pathological immune response, potentially deadly, induced by exposure to an innocuous and specific food allergen. To date, there is no specific treatment for FAs; thus, dietary avoidance and symptomatic medications represent the standard treatment for managing them. Recently, several therapeutic strategies for FAs, such as sublingual and epicutaneous immunotherapy and monoclonal antibodies, have shown long-term safety and benefits in clinical practice. This review summarizes the current evidence on changes in treating FA, focusing on monoclonal antibodies, which have recently provided encouraging data as therapeutic weapons modifying the disease course.

Pollen-related food allergy in children with seasonal allergic rhinitis

INTRODUCTION

Seasonal allergic rhinitis (SAR) and bronchial asthma are typical manifestations of pollen-food sensitization in adults. There is limited information regarding the sensitization patterns of pollen-food allergy in children.

AIM

To evaluate the prevalence of SAR in children with pollen-food sensitization and assess the impact of food allergens on nasal symptoms.

MATERIAL AND METHODS

Forty-three children with pollen-food sensitization aged 2-14 years were evaluated for evidence of SAR. The inclusion criteria was IgE-mediated sensitization to pollen and homologous food allergens. The control group consisted of 19 children with SAR caused by pollen without sensitization to homologous food allergens.

RESULTS

Allergic rhinitis was the main symptom in 65.1% of children; in 25.6% an association between ingestion of pollen-related foods and nasal symptoms was observed. The simultaneous sensitization to animal origin food allergens was stated in 63.3% of children with SAR. In 25.6% anaphylactic reactions to foods were registered. 37.2% of children were asymptomatic to pollen origin foods despite pollen-food sensitization. The statistically significant differences between values were noticed in comparison to the control group.

CONCLUSIONS

Allergic rhinitis is a common manifestation of pollen-food sensitization in children and this type of immunological hyperreactivity should be taken into account regardless of age. The lack of association of symptoms with plant origin foods in the majority of cases and the asymptomatic course of food sensitization in more than one third of patients indicates the need for follow-up and being careful in routine recommending the avoidance diet.

Otolaryngologists Practice Pattern on Oral Allergy Syndrome

BACKGROUND

Oral allergy syndrome is a unique type of food allergy caused by cross-sensitivity between inhalant allergens and food allergens. Despite its significant prevalence and potentially serious outcome, the knowledge base and practice patterns on OAS are not well known among otolaryngologists. Our study is designed to understand the practice patterns of otolaryngologists in screening, testing, and treating OAS through a web-based survey.

METHODS

Three thousand otolaryngologists were randomly selected from a membership list of the American Academy of Otolaryngology - Head and Neck Surgery. A survey was designed to include demographic questions and questions about OAS understanding, screening, and management. Surveys were sent to selected otolaryngologists via mail. Responses were de-identified and analyzed using SPSS.

RESULTS

Out of the 50 survey responses, 46 reported treating environmental allergy in their practices. Twenty eight out of 46 reported knowing about OAS (60.9%). Fifteen out of the 28 physicians screened for OAS (53.6%). Out of the responders who knew about OAS, 12 (42.9%) reported diagnosing under 5 cases in the past year, 7 (25%) diagnosed 5 to 10 cases, and 7 (25%) reported diagnosed more than 10 cases in the past year. Eleven (39.3%) reported ordering component allergy testing for food allergies. Twenty six (92.9%) reported using avoidance, 18 (64.3%) prescribed oral antihistamine medications, 14 (50%) prescribed epi-pen, and 19 (67.9%) desensitized patients to environmental allergies as a treatment for OAS. 26 (93%) reported using more than one of the listed treatments. 10 (36%) reported using all four methods.

CONCLUSION

Only 60.9% of the responders had a knowledge of OAS. Only 53.6% of those screened for OAS. Current treatment for OAS includes avoidance of allergens, desensitization of environmental allergens, prescription of oral antihistamine and epi-pen. Nearly everyone (93%) reported using more than one treatment method.

Frequency and clinical features of pollen-food syndrome in children

BACKGROUND

Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known.

OBJECTIVE

The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR).

METHOD

This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables.

RESULTS

Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n=13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95%CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively].

CONCLUSION

PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed.

Pollen-Food Allergy Syndrome: A not so Rare Disease in Childhood

Seasonal allergic rhinoconjunctivitis (SAR) affects millions of people worldwide, particularly in childhood and adolescence. Pollen food allergy syndrome (PFAS) is a common adverse reaction occurring few minutes after the consumption of vegetable foods in patients with pollen-induced SAR. PFAS has rarely been investigated in the pediatric population, as it has been mainly examined as an adult disease. Recent studies suggested that PFAS might be more frequent in childhood than previously recognized. The present review aims to give an overview of the epidemiology, pathophysiology, diagnosis, management and prognosis of PFAS in children with SAR-induced by pollens.

Pollen food allergy syndrome (PFAS): A review of current available literature

OBJECTIVE

Pollen food allergy syndrome (PFAS) is a complex syndrome posing a diagnostic and therapeutic challenge. Our objective was to summarize the available literature regarding its prevalence, pathogenesis, diagnosis, and treatment.

DATA SOURCES

A PubMed search was performed to include English language articles with the following search terms: pollen food syndrome, pollen food allergy syndrome, PFAS, oral allergy syndrome, OAS, food anaphylaxis, food components.

STUDY SELECTIONS

Human articles discussing PFAS.

RESULTS

Varying reports have been made of the prevalence of PFAS, ranging from 4.7% to greater than 20% in children and 13% to 58% in adults. Prevalence varies widely by geographic region. PFAS is typically the results of class II food allergens (e.g. sensitized to anaeroallergen, but reaction occurs due to cross reactivity from a food allergen). Commonly these reactions are limited to the oropharynx due to the lability of the proteins causing the reaction. As multiple families of proteins with varying stability cause PFAS, severe systemic reactions are also possible, as anaphylactic shock has been documented in up to 1.7% of reactions.

CONCLUSION

Pollen food allergy syndrome therefore cannot be dismissed as a benign food allergy, but it needs to be approached individually based on known risk factors.

Clinical Characteristics of Oral Allergy Syndrome in Children with Atopic Dermatitis and Birch Sensitization: a Single Center Study

BACKGROUND

Oral allergy syndrome (OAS) is an immunoglobulin E (IgE)-mediated hypersensitivity that occurs frequently in older children with pollen sensitization. This study focused on the clinical characteristics of OAS in children with atopic dermatitis (AD) and birch sensitization.

METHOD

s: A total of 186 patients aged 2-18 years with AD and birch sensitization were enrolled in this study between January 2016 and March 2017. Their levels of serum total IgE and birch- and ragweed-specific IgE (sIgE) were measured using ImmunoCAP (Thermo Fisher Scientific, Uppsala, Sweden). Information regarding causative foods and symptoms were obtained via interviews. The patients were divided into 3 groups according to their ages (group 1, 2-6 years; group 2, 7-12 years; and group 3, 13-18 years).

RESULTS

Eighty-one of the 186 (43.5%) children with AD who were sensitized to birch pollen were diagnosed as having OAS. The prevalence of OAS in group 1 (the children who had AD and birch sensitization aged 2-6 years) was 36.6%. A greater predominance of men was noted in the non-OAS group (77.1%) compared to the OAS group (60.5%). Apples were the most common causative food in group 2 and 3 while kiwis were the most common cause of OAS in group 1. There was a statistically significant correlation between birch-sIgE levels and the prevalence of OAS (P = 0.000). The cut-off value was 6.77 kU_A/L with 55.6% sensitivity and 79.0% specificity (area under the curve 0.653).

CONCLUSION

In our study, the prevalence of OAS in children with AD and birch sensitization was 43.5%. Even in the preschool age group, the prevalence of OAS was considerable. Patients with high levels of birch-sIgE were more likely to have OAS. Clinicians should therefore be vigilant about OAS in patients with a high degree of sensitization to birch pollen and even young children if they have birch sensitization.

The Role of Allergy in Phonation

BACKGROUND

Allergies are among the most common chronic conditions worldwide affecting 10%-30% of adult individuals and 40% of children. Phonation can be affected by different allergic conditions in various ways. The role of allergy in phonation has been under-researched and poorly understood and the respective literature is poor. Several studies have investigated the role of certain allergic diseases in phonation. In this review, we tried to include all allergic conditions that can affect voice production.

METHODS

We conducted a bibliography review looking for allergic conditions that can affect phonation. Allergic asthma, allergic laryngitis, allergic rhinitis and sinusitis, oral allergy syndrome, and angioedema were included in our search.

RESULTS

The literature on the impact of allergy in phonation remains poor and many key questions concerning basic information for epidemiology, pathophysiology, and larynx pathology in allergic patients with phonation problems still remain unanswered.

CONCLUSIONS

The role of allergy in voice production remains underinvestigated and many basic questions still remain open. Further research is needed to improve our understanding for these very common conditions.

Patterns of sensitization to inhalant and food allergens among pediatric patients from the Moscow region (Russian Federation)

The immunological profiles of human specific IgE (sIgE) and specific IgG4 (sIgG4) vary by genetic predisposition, living conditions in different geographical locations and patient’s age. The aim of our study was to analyze sIgE and sIgG4 patterns and their age-dependent changes in patients from the Moscow region. For identifying sIgE and sIgG4 profiles the blood samples from 513 patients aged 6 months to 17 years who were showing symptoms of allergic diseases were analyzed using microarrays containing 31 allergens. The highest sIgE prevalence was observed for birch pollen (32%) among pollen allergens, cat dander (24%) among indoor allergens, and egg whites (21%) among food allergens. The most common sIgG4 response was developed toward egg whites (80% of patients). Age-related elevation was identified for patients with increased sIgE to pollen allergens and indoor allergens (cat or dog dander and house dust mites). For each allergen, the proportion of cases with significant levels of sIgG4 appeared to increase with patients’ age. The data on allergen-specific sIgE and sIgG4 prevalence show both general trends and some local special aspects that are indicative for the Moscow region. This information should be useful in terms of epidemiology of allergic diseases.

Prevalence of oral allergy syndrome in children with allergic diseases

INTRODUCTION

The oral allergy syndrome (OAS) is a particular type of food allergy rarely explored in the paediatric population that is already considered an adult problem.

OBJECTIVE

Identify the prevalence of OAS, symptoms and pollen species associated with its presence in children affected by allergic diseases.

METHODS

A cross-sectional study was conducted. Consecutive sampling included children from 6 to 14 years who needed allergy treatment for the first time. A structured questionnaire was carried out to collect demographic and clinical data and history of OAS. Besides sensitisation to various allergens, the skin prick-by-prick test was performed to corroborate sensitisation to food related to OAS. Prevalence of OAS and its association with pollens was established following the covariate adjusted logistic regression.

RESULTS

267 subjects were included. Overall prevalence of OAS was 8.9% (95%CI 6.1-13.1%). Prevalence of OAS for allergic rhinitis and asthma were 8.8% and 9.1%, respectively. In patients sensitised to pollen, the prevalence ranged from 9.6% to 12.2% depending on the type of pollen. 62.5% of children with OAS were sensitive to pineapple. After adjusting for gender and family history of atopic disease, trees from the Quercus species showed an association with OAS (OR=2.7, 95%CI 1.2-6.2).

CONCLUSIONS

OAS is not uncommon in our environment. Pineapple, a typical fruit from the region, was the main food related. Quercus sp., but not birch nor olive, was the pollen associated with this syndrome.

Food allergy: immune mechanisms, diagnosis and immunotherapy

Food allergy is a pathological, potentially deadly, immune reaction triggered by normally innocuous food protein antigens. The prevalence of food allergies is rising and the standard of care is not optimal, consisting of food-allergen avoidance and treatment of allergen-induced systemic reactions with adrenaline. Thus, accurate diagnosis, prevention and treatment are pressing needs, research into which has been catalysed by technological advances that are enabling a mechanistic understanding of food allergy at the cellular and molecular levels. We discuss the diagnosis and treatment of IgE-mediated food allergy in the context of the immune mechanisms associated with healthy tolerance to common foods, the inflammatory response underlying most food allergies, and immunotherapy-induced desensitization. We highlight promising research advances, therapeutic innovations and the challenges that remain.

Diagnosis of Food Allergy

The prevalence of food allergies has been on the increase over the last 2 decades. Diagnosing food allergies can be complicated, as there are multiple types that have distinct clinical and immunologic features. Food allergies are broadly classified into immunoglobulin E (IgE)-mediated, non-IgE-mediated, or mixed food allergic reactions. This review focuses on the clinical manifestations of the different categories of food allergies and the different tests available to guide the clinician toward an accurate diagnosis.