Food allergy in adults: an over- or underrated problem?

Food allergy in the Netherlands: differences in clinical severity, causative foods, sensitization and DBPCFC between community and outpatients

BACKGROUND

It is unknown whether food allergy (FA) in an unselected population is comparable to those from an outpatient clinic population.

OBJECTIVE

To discover if FA in a random sample from the Dutch community is comparable to that of outpatients.

METHODS

This study was part of the Europrevall-project. A random sample of 6600 adults received a questionnaire. Those with symptoms to one of 24 defined priority foods were tested for sIgE. Participants with a positive case history and elevated sIgE were evaluated by double-blind placebo-controlled food challenge (DBPCFC). Outpatients with a suspicion of FA were evaluated by questionnaire, sIgE and DBPCFC.

RESULTS

In the community, severe symptoms were reported less often than in outpatients (39.3% vs. 54.3%). Participants in the community were less commonly sensitized to any of the foods. When selecting only those with a probable FA (i.e. symptoms of priority food and elevation of sIgE to the respective food), no major differences were observed with respect to severity, causative foods, sensitization and DBPCFC between the groups.

CONCLUSION

In the Netherlands, there are large differences in self-reported FA between community and outpatients. However, Dutch community and outpatients with a probable FA do not differ with respect to severity, causative foods, sensitization and DBPCFC-outcome.

Update on food allergy in adults

Though much has been studied and written about food allergy, the majority of the available literature focuses on food allergies in the pediatric population. Unfortunately, it is likely that in regard to food allergies, adults are not just big children, and extrapolating findings from pediatric to adult patient populations might lead to erroneous assumptions. Thus, it is important to validate the correlation between pediatric and adult data, gather data regarding adult food allergy and understand the specific nuances of subsets of adults to better treat their food allergy. This review was conducted by identifying potentially relevant studies regarding food allergies in adults through electronic databases, including PubMed, Medline, and Google Scholar. The search terms included "allergy", "food" and "adults". Parameters of 19+ years of age were added to search terms and all journals were written in or translated to English. From these search results, focus was placed on studies from 2010 to 2012. This systematic update on food allergy in adults found that the evidence regarding prevalence, diagnosis and management of food allergies is very limited, with the majority of data derived from children and young adults.

Mopane worm allergy in a 36-year-old woman: a case report

INTRODUCTION

The increasing incidence of new diseases as well as changing features of known diseases has partly been attributed to the impact of environmental changes. As a result, there have been calls from health experts for proper surveillance and monitoring of these changes.This is a report of mopane worm allergy in a 36 year old female from the Tswana tribe in Botswana. Mopane worm, the caterpillar stage of Gonimbrasia belina moths, is a seasonal delicacy to people in many communities in southern Africa. As a result, by adulthood, many residents of these communities have had substantial exposure to the worm. Gonimbrasia belina moths belong to the Lepidoptera order of insects. Though some members of this order are known to induce contact allergy, there is no reported incidence of ingestion allergy from mopane worm. Therefore, it is important to track this case for its epidemiological significance and to alert both clinicians and the vulnerable public on the incidence of mopane worm allergy in this region.

CASE PRESENTATION

This is a case of a 36 year old woman from the Tswana ethnic group in Botswana, who was diagnosed with food allergy. She presented with itchy skin rash, facial swelling, and mild hypotension after eating mopane worm. She had no previous history of allergic reaction following contact or ingestion of mopane worm and had no atopic illness in the past. She was treated and her symptoms resolved after 4 days.

CONCLUSION

The proper management of allergy involves patients' avoidance and clinicians' predictability. Though hypothetical, this report is expected to sensitize clinicians to anticipate and properly manage subsequent occurrence, as well as educate the public in these communities. In addition, tracking new disease patterns, with relationship to environmental changes, will compliment existing evidence in validating the importance of proper environmental surveillance and management.