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Babbel J, Ramos C, Wangberg H, Luskin K, Simon R. Adverse reactions to food additives. JOURNAL OF FOOD ALLERGY 2021; 3:8-23. [PMID: 39022633 PMCID: PMC11250194 DOI: 10.2500/jfa.2021.3.210004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Food additives are naturally occurring or synthetic substances that are added to food to modify the color, taste, texture, stability, or other characteristics of foods. These additives are ubiquitous in the food that we consume on a daily basis and, therefore, have been the subject of much scrutiny about possible reactions. Despite these concerns, the overall prevalence of food additive reactions is 1-2%, with a minority of the wide variety of symptoms attributed to food-additive exposure being reproduced by double-blind placebo controlled challenges. Reactions can be broadly classified into either immunoglobulin E (IgE)- and non-IgE-mediated reactions, with natural additives accounting for most IgE-mediated reactions, and both natural and synthetic additives being implicated in the non-IgE-mediated reactions. Reactions that include asthma exacerbations, urticaria and/or angioedema, or anaphylaxis with ingestion of a food additive are most deserving of further allergy evaluation. In this article, we discussed the different types of adverse reactions that have been described to various food additives. We also reviewed the specifics of how to evaluate and diagnose a food additive allergy in a clinic setting.
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Affiliation(s)
- Justin Babbel
- Scripps Clinic Department of Allergy and Immunology, San Diego, California
| | - Courtney Ramos
- Scripps Clinic Department of Allergy and Immunology, San Diego, California
| | - Hannah Wangberg
- Scripps Clinic Department of Allergy and Immunology, San Diego, California
| | - Kate Luskin
- Scripps Clinic Department of Allergy and Immunology, San Diego, California
| | - Ronald Simon
- Scripps Clinic Department of Allergy and Immunology, San Diego, California
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Lemoine A, Pauliat-Desbordes S, Challier P, Tounian P. Adverse reactions to food additives in children: A retrospective study and a prospective survey. Arch Pediatr 2020; 27:368-371. [PMID: 32807620 DOI: 10.1016/j.arcped.2020.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Allergic reactions to food additives are often suspected by families. The aim of this study was to describe oral food challenge (OFC) outcomes in a pediatric cohort with a suspected diagnosis of allergy to food additives (food dyes or sodium benzoate). METHODS All patients who underwent an open OFC to carmine red, cochineal red, erythrosine, patent blue V, tartrazine, yellow sunset S, and/or sodium benzoate were included. A survey was sent to families after testing to evaluate whether the OFC results had altered feeding behaviors with food additives. RESULTS Twenty-three patients were included. The main suspected food was candy (n=11/23; 48%). Only one OFC out of 45 was formally positive for the carmine and cochineal red. Subsequently, most OFCs were negative (44/45; 97.8%). Despite the negativity of the challenge, four families out of 14 reported occurrences of supposed allergic reactions to food additives and six out of 15 continued to completely avoid the additive of concern in their children's diet. CONCLUSIONS Allergies to food additives remain rare. Even if an IgE-mediated allergy was excluded with a negative OFC, families remained suspicious about ready-made products. Health professionals and parents should be reassured about the low risk of food dye intolerance or allergies.
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Affiliation(s)
- A Lemoine
- Department of Paediatric Nutrition and Gastroenterology, Trousseau Hospital, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, 21, rue de l'École-de-Médecine, 75006 Paris, France.
| | - S Pauliat-Desbordes
- Department of Paediatric Nutrition and Gastroenterology, Trousseau Hospital, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P Challier
- Department of Paediatric Nutrition and Gastroenterology, Trousseau Hospital, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - P Tounian
- Department of Paediatric Nutrition and Gastroenterology, Trousseau Hospital, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne Université, 21, rue de l'École-de-Médecine, 75006 Paris, France
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Biological Effects of Food Coloring in In Vivo and In Vitro Model Systems. Foods 2019; 8:foods8050176. [PMID: 31137639 PMCID: PMC6560448 DOI: 10.3390/foods8050176] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The suitability of certain food colorings is nowadays in discussion because of the effects of these compounds on human health. For this reason, in the present work, the biological effects of six worldwide used food colorings (Riboflavin, Tartrazine, Carminic Acid, Erythrosine, Indigotine, and Brilliant Blue FCF) were analyzed using two model systems. (2) Methods: In vivo toxicity, antitoxicity, and longevity assays using the model organism Drosophila melanogaster and in vitro cytotoxicity, DNA fragmentation, and methylation status assays using HL-60 tumor human cell line were carried out. (3) Results: Our in vivo results showed safe effects in Drosophila for all the food coloring treatments, non-significant protective potential against an oxidative toxin, and different effects on the lifespan of flies. The in vitro results in HL-60 cells, showed that the tested food colorings increased tumor cell growth but did not induce any DNA damage or modifications in the DNA methylation status at their acceptable daily intake (ADI) concentrations. (4) Conclusions: From the in vivo and in vitro studies, these results would support the idea that a high chronic intake of food colorings throughout the entire life is not advisable.
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Andreozzi L, Giannetti A, Cipriani F, Caffarelli C, Mastrorilli C, Ricci G. Hypersensitivity reactions to food and drug additives: problem or myth? ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:80-90. [PMID: 30830065 PMCID: PMC6502174 DOI: 10.23750/abm.v90i3-s.8168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/01/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The possibility of an allergic reaction or an intolerance to additives is frequently suspected by parents, especially for chronic illness with frequent exacerbations such as atopic dermatitis or chronic urticaria. For more than 50 years, potential adverse reactions to additives have been suggested, but to date data are conflicting. The purpose of this article is to provide the clinicians with general information about additives and adverse reactions to them and to suggest a practical approach to children suspected to have reactions to food additives. METHODS We performed an extensive research on all English-language Medline articles, case reports and reviews published online until December 2018. Used search terms were: food additives, food dye, adverse reactions, food allergy, food hypersensitivity, intolerance, drugs, children. RESULTS There are only few case reports of adverse reactions in childhood with a clear involvement of additives. In this review article we reported the associations between additives and adverse reactions described in literature, in order to inform the pediatrician about the potential clinical manifestations. CONCLUSIONS Prior to suspect an adverse reaction to additives, it is important to rule out other possible causes: the diagnostic process is complicated and rarely conclusive. The gold standard is the double-blind placebo controlled oral challenge after an exclusion diet.
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Affiliation(s)
- Laura Andreozzi
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital.
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Lemoine A, Tounian P. Allergie aux colorants alimentaires : une pathologie à évoquer avec parcimonie. REVUE FRANÇAISE D'ALLERGOLOGIE 2018. [DOI: 10.1016/j.reval.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Feketea G, Tsabouri S. Common food colorants and allergic reactions in children: Myth or reality? Food Chem 2017; 230:578-588. [DOI: 10.1016/j.foodchem.2017.03.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 01/15/2023]
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Rovina K, Prabakaran PP, Siddiquee S, Shaarani SM. Methods for the analysis of Sunset Yellow FCF (E110) in food and beverage products- a review. Trends Analyt Chem 2016. [DOI: 10.1016/j.trac.2016.05.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Powell RJ, Leech SC, Till S, Huber PAJ, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy 2015; 45:547-65. [PMID: 25711134 DOI: 10.1111/cea.12494] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/11/2014] [Accepted: 01/09/2015] [Indexed: 12/11/2022]
Abstract
This guidance for the management of patients with chronic urticaria and angioedema has been prepared by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a Web-based system. Their comments and suggestions were carefully considered by the Standards of Care Committee. Where evidence was lacking, a consensus was reached by the experts on the committee. Included in this management guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria and the use of antihistamines in women who are pregnant or breastfeeding. Finally, we have made recommendations for potential areas of future research.
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Affiliation(s)
- R J Powell
- Department of Clinical Immunology and Allergy, Nottingham University, Nottingham, UK
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Abstract
For centuries, food additives have been used for flavouring, colouring and extension of the useful shelf life of food, as well as the promotion of food safety. During the last 20 years, the studies implicating the additives contained in foods and medicine as a causative factor of allergic reactions have been proliferated considerably. In this review, we aimed to overview all of the food additives which were approved to consume in EU and find out how common and serious allergic reactions come into existence following the consuming of food additives.
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Affiliation(s)
- Fatih Gultekin
- Medical Biochemistry Department, Medical Faculty, Suleyman Demirel University, Cunur, Isparta, Turkey.
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Caldas ED, Jardim ANO. Exposure to toxic chemicals in the diet: is the Brazilian population at risk? JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2012; 22:1-15. [PMID: 21989502 DOI: 10.1038/jes.2011.35] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 07/18/2011] [Indexed: 05/31/2023]
Abstract
In Brazil, in the last 20 years, dietary risk assessments have been conducted on pesticides, mycotoxins, food additives, heavy metals (mainly mercury), environmental contaminants (mainly DDT) and acrylamide, a compound formed during food processing. The objectives of this paper were to review these studies, discuss their limitations and uncertainties and identify the most critical chemicals that may pose a health risk to Brazilian consumers. The studies have shown that the cumulative intake of organophosphorus and carbamate pesticides by high consumers of fruits and vegetables may represent a health concern (up to 169% of the ARfD), although the benefits of consuming large portions of those foods most probably overcome the risks. High consumers of maize products may also be at risk due to the presence of fumonisin (355% of the PMTDI), a mycotoxin present at high levels in Brazilian maize. The studies conducted in the Brazilian Amazon have shown that riparian fish consumers are exposed to unsafe levels of mercury. However, this is a more complex issue, as mercury levels in the region are naturally high and the health benefits of a fish-based diet are well known. Studies conducted both in Brazil and internationally on acrylamide have shown that the exposure to this genotoxic compound, mainly from the consumption of French fries and potato chips, is of health concern. Reducing the population dietary exposure to toxic chemicals is a challenge for government authorities and food producers in all countries. Management strategies aimed at decreasing exposure to the critical chemicals identified in this review involve limiting the use or eliminating highly toxic pesticides, implementing good agricultural practices to decrease maize contamination by fumonisins, educating local fish-eating communities toward a fish diet less contaminated by mercury, and changing dietary habits concerning the consumption of fried potatoes, the main processed food containing acrylamide.
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Affiliation(s)
- Eloisa Dutra Caldas
- Laboratory of Toxicology, Department of Pharmaceutical Sciences, Faculty of Health Sciences, University of Brasília, Brasília, DF, Brazil.
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Scientific Opinion on the appropriateness of the food azo-colours Tartrazine (E 102), Sunset Yellow FCF (E 110), Carmoisine (E 122), Amaranth (E 123), Ponceau 4R (E 124), Allura Red AC (E 129), Brilliant Black BN (E 151), Brown FK (E 154), Brown HT (E 155. EFSA J 2010. [DOI: 10.2903/j.efsa.2010.1778] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Pestana S, Moreira M, Olej B. Safety of ingestion of yellow tartrazine by double-blind placebo controlled challenge in 26 atopic adults. Allergol Immunopathol (Madr) 2010; 38:142-6. [PMID: 20106580 DOI: 10.1016/j.aller.2009.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/09/2009] [Accepted: 09/10/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Yellow dye tartrazine is a potential cause of exacerbations of asthma, allergic rhinitis and urticaria in atopic patients. The Brazilian Sanitary Surveillance Agency (ANVISA) published a consultation about the possibility of issuing a label warning addressing these potential effects of food and drugs containing tartrazine. The present study aims to evaluate tartrazine dye safety in atopic subjects suffering from allergic rhinitis, asthma, urticaria or sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs). METHODS Atopic patients with allergic rhinitis, asthma, urticaria or pseudo-allergic reactions to non-steroidal anti-inflammatory drugs were studied (n=26). The gold standard, double-blind placebo controlled, crossed-over challenge was used RESULTS There were no statistical differences between placebo and drug in cutaneous, respiratory or cardiovascular aspects. CONCLUSIONS In a group of atopic subjects with allergic rhinitis, asthma, urticaria or pseudo-allergic reactions to non-steroidal anti-inflammatory drugs, the administration of 35 mg of the tartrazine dye did not precipitate any kind of significant cutaneous, respiratory or cardiovascular reactions when compared to placebo.
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Polônio MLT, Peres F. Consumo de aditivos alimentares e efeitos à saúde: desafios para a saúde pública brasileira. CAD SAUDE PUBLICA 2009; 25:1653-66. [DOI: 10.1590/s0102-311x2009000800002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 04/20/2009] [Indexed: 11/22/2022] Open
Abstract
Este estudo visa a contextualizar por meio de uma revisão sistemática da literatura, os riscos acarretados pelo consumo de aditivos alimentares. Em relação aos resultados dos estudos associando o consumo de aditivos ao aparecimento do câncer, os efeitos adversos à saúde foram observados principalmente nos estudos em que a Ingestão Diária Aceitável (IDA) foi excedida. Também apontou uma carência de pesquisas sobre o transtorno do déficit de atenção e hiperatividade. Já em relação à hipersensibilidade não específica, o número de estudos foi significativo e os resultados mais consistentes quanto às manifestações clínicas de rinite, urticária e angioedema provocadas pelos aditivos, em particular pelos os corantes artificiais. As crianças aparecem como grupo vulnerável, em razão do consumo potencial de alimentos com aditivos alimentares, particularmente corantes artificiais. Os resultados indicam que estudos de consumo de aditivos alimentares deveriam servir de base para a elaboração de estratégias de vigilância alimentar e nutricional, com a finalidade de promover hábitos alimentares saudáveis.
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Park HW, Park CH, Park SH, Park JY, Park HS, Yang HJ, Ahn KM, Kim KH, Oh JW, Kim KE, Pyun BY, Lee HB, Min KU. Dermatologic adverse reactions to 7 common food additives in patients with allergic diseases: a double-blind, placebo-controlled study. J Allergy Clin Immunol 2008; 121:1059-61. [PMID: 18325576 DOI: 10.1016/j.jaci.2007.12.1162] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 11/14/2007] [Accepted: 12/18/2007] [Indexed: 12/01/2022]
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Powell RJ, Du Toit GL, Siddique N, Leech SC, Dixon TA, Clark AT, Mirakian R, Walker SM, Huber PAJ, Nasser SM. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy 2007; 37:631-50. [PMID: 17456211 DOI: 10.1111/j.1365-2222.2007.02678.x] [Citation(s) in RCA: 197] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This guidance for the management of patients with chronic urticaria and angio-oedema has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking a consensus was reached by the experts on the committee. Included in this guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria, and the use of antihistamines in women who are pregnant or breastfeeding. Finally, we have made recommendations for potential areas of future research.
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Affiliation(s)
- R J Powell
- Clinical Immunology Unit, Queen's Medical Centre, Nottingham, UK
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Hermes B, Hein UR, Henz BM. Assessment of psychological aspects during systemic provocation tests in patients with pseudoallergic drug reactions. J Eur Acad Dermatol Venereol 2007; 20:800-3. [PMID: 16898901 DOI: 10.1111/j.1468-3083.2006.01634.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Basic mechanisms of pseudoallergic drug reactions as well as a possible role of the psyche are currently unknown. OBJECTIVE Examination of psychological status and reactions during diagnostic provocation tests in patients with previous pseudoallergic reactions to drugs. SUBJECTS AND METHODS Ten inpatients, admitted for provocation tests, were studied in a double-blind, placebo-controlled setting, with inventories of anxiety and depression being measured at baseline and psychological reactions and symptoms being recorded daily by patients and the attending physician. RESULTS Patients reported more than twice as many symptoms as the physician, independent of the type of exposure. While the basic psychological profile of the patients was normal, anxiety trait and state values were high during testing, with a significant increase depending on whether the patients thought they had received a drug or a placebo. Similarly, frequency of symptoms was dependent on the patients' perception of the type of exposure. CONCLUSION These findings demonstrate a high level of anxiety during systemic provocation tests in patients with previous pseudoallergic drug reactions, raising serious questions as to the diagnostic validity of the routine application of this testing.
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Affiliation(s)
- B Hermes
- Department of Dermatology, Charité, Humboldt University, Berlin, Germany
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Elhkim MO, Héraud F, Bemrah N, Gauchard F, Lorino T, Lambré C, Frémy JM, Poul JM. New considerations regarding the risk assessment on Tartrazine An update toxicological assessment, intolerance reactions and maximum theoretical daily intake in France. Regul Toxicol Pharmacol 2007; 47:308-16. [PMID: 17218045 DOI: 10.1016/j.yrtph.2006.11.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Indexed: 10/23/2022]
Abstract
Tartrazine is an artificial azo dye commonly used in human food and pharmaceutical products. Since the last assessment carried out by the JECFA in 1964, many new studies have been conducted, some of which have incriminated tartrazine in food intolerance reactions. The aims of this work are to update the hazard characterization and to revaluate the safety of tartrazine. Our bibliographical review of animal studies confirms the initial hazard assessment conducted by the JECFA, and accordingly the ADI established at 7.5mg/kg bw. From our data, in France, the estimated maximum theoretical intake of tartrazine in children is 37.2% of the ADI at the 97.5th percentile. It may therefore be concluded that from a toxicological point of view, tartrazine does not represent a risk for the consumer. It appears more difficult to show a clear relationship between ingestion of tartrazine and the development of intolerance reactions in patients. These reactions primarily occur in patients who also suffer from recurrent urticaria or asthma. The link between tartrazine consumption and these reactions is often overestimated, and the pathogenic mechanisms remain poorly understood. The prevalence of tartrazine intolerance is estimated to be less than 0.12% in the general population. Generally, the population at risk is aware of the importance of food labelling, with the view of avoiding consumption of tartrazine. However, it has to be mentioned that products such as ice creams, desserts, cakes and fine bakery are often sold loose without any labelling.
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Affiliation(s)
- Mostafa Ould Elhkim
- Chemicals Risk Assessment Unit, French Food Safety Agency (Afssa), 27-31 avenue du Général Leclerc, 94701 Maisons-alfort Cedex, France.
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Abstract
Urticaria has been called a vexing problem and remains so today. The most important part of the diagnostic evaluation remains a comprehensive and detailed history and physical examination, supplemented with limited laboratory testing. Although acute urticaria has been relatively well understood for some time, significant and important recent advances in under-standing the pathogenesis of chronic urticaria are beginning to provide insight in this challenging field, notably the identification of many of these patients with an autoimmune etiology. Antihistamines of various types continue to represent the keystone of symptomatic treatment, with adjunctive support from medications of other classes, such as antileukotrienes, adrenergics, and immunosuppressive and anti-inflammatory agents (including steroids and cyclosporine). Although some progress has been made at improving symptomatic control of urticaria, further research and discovery are necessary before there can yet be an effective impact on the underlying course and natural history of this condition.
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Affiliation(s)
- Donald A Dibbern
- Division of Allergy and Clinical Immunology, Oregon Health and Sciences University, Portland, OR 97239-3098, USA.
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Wang J, Sicherer SH. Anaphylaxis following ingestion of candy fruit chews. Ann Allergy Asthma Immunol 2005; 94:530-3. [PMID: 15945554 DOI: 10.1016/s1081-1206(10)61128-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Mount Hospital, New York, New York 10029, USA.
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