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DuToit G, Smith P, Muraro A, Fox AT, Roberts G, Ring J, Worm M. Identifying patients at risk of anaphylaxis. World Allergy Organ J 2024; 17:100904. [PMID: 38966605 PMCID: PMC11223123 DOI: 10.1016/j.waojou.2024.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 07/06/2024] Open
Abstract
Anaphylaxis is an acute, potentially fatal, systemic hypersensitivity reaction that warrants prompt diagnosis and management. It continues to be challenging to anticipate who may be at risk of a severe, life-threatening allergic reaction. Anaphylaxis can be caused by a range of allergens, such as certain foods, medications, latex, insect stings, etc. Cofactors that augment the severity of clinical symptoms and increase the risk of poor outcomes include exercise, stress, infectious diseases, underlying mast cell disease, active allergic disease such as asthma, advanced age, intake of certain medications, history of previous anaphylaxis, and delayed or missed administration of adrenaline. According to the European Anaphylaxis Registry, food is the major elicitor of anaphylaxis, especially eggs, cow milk, and nuts, in children and adolescents. Reaction to insect venom has also been noted in young adulthood. Early recognition of signs and symptoms and prompt treatment are crucial in anaphylaxis management to avoid serious and even fatal outcomes. It is crucial for both individuals and clinicians to identify the cause of anaphylaxis. Biomarkers of anaphylaxis, such as histamine, tryptase, platelet activation factor (PAF), chymase, carboxypeptidase A3, dipeptidyl peptidase I (DPPI), basogranulin, CCL-2, hsa-miR-451a, may be useful in diagnosis and management. The purpose of this review article is to present a comprehensive overview of current evidence and expert opinions regarding the risk factors that predispose individuals to anaphylaxis. Additionally, it provides insights into potential biomarkers and genetic markers for accurate diagnosis and management. This review underscores the significance of expert guidance in enhancing patient outcomes and enabling self-management of anaphylactic episodes.
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Affiliation(s)
- George DuToit
- Pediatric Allergy King's College London and Guy's and St Thomas', London, United Kingdom
| | - Pete Smith
- Clinical School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Antonella Muraro
- Food Allergy Referral Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Adam T. Fox
- Children's Allergy Service, Guy's and St Thomas' Hospitals NHS Foundation Trust, Westminster Bridge, London, United Kingdom
| | - Graham Roberts
- University of Southampton, Pediatric Allergy & Respiratory Medicine, Tremona Road, Southampton, United Kingdom
| | - Johannes Ring
- Technical University Munich (TUM), Dept Dermatology Allergology Biederstein, Germany
| | - Margitta Worm
- Allergologie und Immunologie, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Germany
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2
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Jiang N, Xiang L, Guan H, Zhang X. Blueberry ( Vaccinium myrtillus) Induced Anaphylaxis in a Chinese Child with Lipid Transfer Protein Sensitization. J Asthma Allergy 2023; 16:1253-1258. [PMID: 38022748 PMCID: PMC10664712 DOI: 10.2147/jaa.s436561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Fruits have been identified as the primary triggers of anaphylaxis in older children in the Chinese population, especially among individuals with pollen sensitization. To date, no allergies have been reported after blueberry ingestion in the Chinese population. Case Report A 12-year-old girl experienced one episode of anaphylaxis within 30 minutes of having breakfast (including milk, egg, wheat bread, and blueberry) while walking to school. She menstruated during this episode. Prompt treatment with epinephrine and fluid therapy led to full recovery within 24 h. Specific IgE was conducted using ImmunoCAP, and the patient exhibited sensitization to several pollens, mainly Japanese hop (74.3 kUa/L) and mugwort (26.5 kUa/L). Regarding specific IgE to allergen components, the patient showed sensitization primarily to lipid transfer protein (LTP) components from mugwort Art v 3 (79.7 kUa/L), wheat Tri a 14 (12.4 kUa/L) and peach Pru p 3 (2.15 kUa/L), but tested negative for omega-5 gliadin. The prick test results were positive for blueberries (wheal size 9.5 mm), cherries (wheal size 6.5 mm), kiwifruits (wheal size 6 mm), and pears (wheal size 4.5 mm). Our patient was provided with an epi-pen and was advised to avoid consuming relevant fruits. After four months of follow-up, the patient had not experienced any episodes of anaphylaxis since these recommendations were implemented. Conclusion We report for the first time a Chinese child with severe IgE-mediated immediate-type anaphylactic reaction to blueberries, in whom we identified LTP as the suspected allergen component.
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Affiliation(s)
- Nannan Jiang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, People’s Republic of China
- China 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, Beijing, People’s Republic of China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, People’s Republic of China
- China National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Hui Guan
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, People’s Republic of China
- China National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Xudong Zhang
- Department of Allergy, Beijing Children′s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, People’s Republic of China
- China National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
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3
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Pałgan K, Tretyn A. Platelet-activating factor as an endogenous cofactor of food anaphylaxis. Biofactors 2023; 49:976-983. [PMID: 37203358 DOI: 10.1002/biof.1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/02/2023] [Indexed: 05/20/2023]
Abstract
Anaphylaxis is a severe, acute, life-threatening generalized or systemic hypersensitivity reaction. The incidence of anaphylaxis is increasing worldwide, with medications and food contributing to most cases. Physical exercise, acute infections, drugs, alcohol, and menstruation are the external cofactors associated with more severe systemic reaction. The aim of this review is to show that platelet-activating factor contributes to the development of severe anaphylactic reaction, and even to anaphylactic shock.
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Affiliation(s)
- Krzysztof Pałgan
- Department of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Andrzej Tretyn
- Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Toruń, Poland
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Abrams EM, Protudjer JLP. Factoring in cofactors in the diagnosis and management of anaphylaxis. Ann Allergy Asthma Immunol 2023; 130:695-696. [PMID: 37270227 DOI: 10.1016/j.anai.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jennifer L P Protudjer
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Faculty of Agricultural and Food Sciences, Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Warren C, Nimmagadda SR, Gupta R, Levin M. The epidemiology of food allergy in adults. Ann Allergy Asthma Immunol 2023; 130:276-287. [PMID: 36509408 DOI: 10.1016/j.anai.2022.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Christopher Warren
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois.
| | - Sai R Nimmagadda
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Chicago, Illinois
| | - Michael Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
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Cichocka-Jarosz E, Dölle-Bierke S, Jedynak-Wąsowicz U, Sabouraud-Leclerc D, Köhli A, Lange L, Papadopoulos NG, Hourihane J, Nemat K, Scherer Hofmeier K, Hompes S, Ott H, Lopes de Oliveira L, Spindler T, Vogelberg C, Worm M. Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry. Clin Transl Allergy 2023; 13:e12228. [PMID: 36973951 PMCID: PMC10040951 DOI: 10.1002/clt2.12228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/29/2022] [Accepted: 02/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Cow's milk (CM) and hen's egg (HE) are leading triggers of anaphylaxis in early childhood. The aim of this study was to identify clinical phenotypes and therapeutic measures for CM anaphylaxis (CMA) compared to HE anaphylaxis (HEA) in children up to 12 years of age, based on a large pan-European dataset from the European Anaphylaxis Registry. METHODS Data from 2007 to 2020 on clinical phenotypes and treatment from 10 European countries, as well as Brazil, were analysed. The two-step cluster analysis was used to identify the most frequent phenotypes. For each trigger, three clusters were extracted based on sex, age, and existence of symptoms in four vitally important systems. RESULTS Altogether 284 children with CMA and 200 children with HEA were identified. They were characterised as male (69% vs. 64%), infants (65% vs. 61%), with a most frequent grade III of Ring&Messmer classification (62% vs. 64%), in CMA versus HEA, respectively. Respiratory symptoms occurred more often in CMA (91% vs. 83%, p = 0.010), especially in infants (89% vs. 79%, p = 0.008). Cardiovascular symptoms were less frequent in CMA (30% vs. 44%, p = 0.002), in both infants (33% vs. 46%, p = 0.027), and older children (25% vs. 42%, p = 0.021). The clusters extracted in the CMA group were characterised as: (1) mild dermal infants with severe GI (40%), 2. severe dermal (35%), 3. respiratory (25%). While in HEA group: 1. infants with severe GI and/or reduction of alertness (40%), (2) conjunctival (16%), (3) mild GI without conjunctivitis (44%). The severity of the reaction was independent from the amount of ingested allergen protein, regardless of trigger. The first-line adrenaline application differed between the countries (0%-92%, as well as the reasons for not administering adrenaline, p < 0.001). CONCLUSIONS Despite the similarity of their age, sex, and severity grade, the clinical profiles differed between the CMA and HEA children. Adrenaline was underused, and its administration was country dependent. Further studies are needed to assess to what extent the differences in the clinical profiles are related to matrix and/or absorption effects, and/or the allergen itself.
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Affiliation(s)
- Ewa Cichocka-Jarosz
- Department of Paediatrics, Pulmonology, Allergy and Dermatology Clinic, Jagiellonian University Medical College, Krakow, Poland
| | - Sabine Dölle-Bierke
- Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Urszula Jedynak-Wąsowicz
- Department of Paediatrics, Pulmonology, Allergy and Dermatology Clinic, Jagiellonian University Medical College, Krakow, Poland
| | | | - Alice Köhli
- Division of Allergology, University Children's Hospital Zurich, Zürich, Switzerland
| | - Lars Lange
- Department of Paediatrics, St. Marien-Hospital, Bonn, Germany
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece
- Division of Infection Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Jonathan Hourihane
- Department of Paediatrics, University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Katja Nemat
- Children's Centre, Dresden - Friedrichstadt, Dresden, Germany
| | - Kathrin Scherer Hofmeier
- Allergy Unit, Department of Dermatology, University of Basel, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Stephanie Hompes
- Department of Paediatrics, Altona Children's Hospital, Hamburg, Germany
| | - Hagen Ott
- Division of Paediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Lucila Lopes de Oliveira
- Department of Paediatrics, Federal University of São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil
| | | | - Christian Vogelberg
- Department of Paediatric Pulmonology and Allergy, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Margitta Worm
- Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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7
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Feketea G, Lakoumentas J, Konstantinou GN, Douladiris N, Papadopoulos NG, Petrodimopoulou M, Tasios I, Valianatou M, Vourga V, Vassilopoulou E. Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis. Nutrients 2023; 15:nu15020425. [PMID: 36678296 PMCID: PMC9862452 DOI: 10.3390/nu15020425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Dietary and environmental factors may influence tolerance acquisition in food protein-induced allergic proctocolitis (FPIAP). This retrospective observational study explored the role of maternal diet during pregnancy and breastfeeding in tolerance acquisition in infantile FPIAP. METHODS Breastfed infants with FPIAP from six diverse regions in Greece were divided into two groups, based on development of tolerance to the trigger food: Group A (n = 43), before, and Group B (n = 53), after, the 6th month of age. Maternal diet during pregnancy and breastfeeding was elicited using the Mediterranean Diet Score Questionnaire and the Mediterranean Oriented Culture Specific Semi-Quantitative Food Frequency Questionnaire. RESULTS Mean age at diagnosis of FPIAP (1.5 months) and weaning (5.5 months) were the same in both groups. The main trigger was cow's milk. Group A received infant milk formula earlier than Group B. Group B had a higher incidence of asthma/wheeze, siblings with milk allergy, maternal smoking and rural residence. On multivariate analysis, earlier resolution of FPIAP was associated with higher maternal education and with salt intake and consumption of goat/sheep cheese during pregnancy and olive oil during breastfeeding. Consumption of multivitamins during pregnancy and meat, winter fruits, green vegetables, butter, salt, "ready-to-eat" meals and pastries during breastfeeding were correlated with longer duration of symptoms. CONCLUSIONS Mothers of children with FPIAP to cow's milk protein can be advised to eat more yogurt, cheese and olive oil during subsequent pregnancies, and avoid multivitamins, grilled food, "ready-to-eat" meals, pastries, meat and alcohol during breastfeeding, to reduce the duration of FPIAP presenting in future infants.
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Affiliation(s)
- Gavriela Feketea
- Department of Hematology, “luliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
- “Karamandaneio” Children’s Hospital of Patra, 26331 Patra, Greece
| | - John Lakoumentas
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, 56429 Thessaloniki, Greece
| | - Nikolaos Douladiris
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Petrodimopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Ioannis Tasios
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Mina Valianatou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasiliki Vourga
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
- Correspondence:
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Vander Does A, Ju T, Yosipovitch G. When Foods Cause Itch: Clinical Characteristics, Pathophysiology, and Recommendations for Food-Induced Skin and Mucosal Pruritus. Dermatitis 2023; 34:13-20. [PMID: 36705658 DOI: 10.1089/derm.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in dermatology on food-induced pruritus. In addition, itch severity is rarely mentioned. Food can induce pruritus through either ingestion or direct contact with skin or mucosal membranes. The most common type of itch provoked by food is acute urticaria, often through the classical immunoglobulin E (IgE)-mediated pathway. Other mechanisms include non-IgE-mediated, mixed (IgE-mediated and non-IgE-mediated), T-cell-mediated, and nonimmune reactions. For patients presenting with urticaria, generalized pruritus, oral pruritus, or dermatitis, a thorough history is warranted, and possible food associations should be considered and assessed. Although any food seems to have the potential to elicit an immune response, certain foods are especially immunogenic. Treatment includes avoidance of the trigger and symptom management. Careful consideration should be used as to avoid unnecessarily restrictive elimination diets.
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Affiliation(s)
- Ashley Vander Does
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
| | - Teresa Ju
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
| | - Gil Yosipovitch
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
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Kopko C, Garthoff J, Zhou K, Meunier L, O'Sullivan A, Fattori V. Are alternative proteins increasing food allergies? Trends, drivers and future perspectives. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Alves PB, Pereira HP, Alves MP, Roseta L, Tavares B, Loureiro G, Carrapatoso I, Todo-Bom A, Regateiro FS. Predictors of anaphylaxis to peanut and tree nuts in a Mediterranean population. Allergy Asthma Proc 2022; 43:533-542. [PMID: 36335421 DOI: 10.2500/aap.2022.43.220060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Peanuts (PN) and tree nuts (TN) are major causes of anaphylaxis worldwide. We aimed to determine the clinical and demographic characteristics associated with anaphylaxis in patients sensitized to PN and/or TN in a Mediterranean population. Methods: We conducted a retrospective study, which included 198 patients allergic to PN and/or TN (allergy symptoms plus specific immunoglobulin E [sIgE] sensitization), evaluated in consultations from January 2015 to December 2020. Univariate analysis and multivariate logistic regression models were developed, including demographic, clinical, and laboratory data as independent variables, and anaphylaxis to each PN and/or TN as a dependent variables. Results: Anaphylaxis was associated with an earlier age of onset of allergy to PN, cashew and/or pistachio, and pine nut allergy but not to other TN allergies. Gender, atopic comorbidities, and cofactors were not associated with PN and/or TN anaphylaxis. Anaphylaxis to PN, cashew and/or pistachio, and pine nut were associated with reactivity to a fewer number of PN and/or TN foods. Although sIgE sensitization to lipid transfer proteins (LTP) was highly prevalent in our population, only seed storage protein (SSP) positivity was associated with anaphylaxis in PN allergy. The absence of pathogenesis-related protein family 10 sensitization correlated with PN and hazelnut anaphylaxis. A higher level of sIgE to almond extract predicted anaphylaxis but the level of sIgE to other PN and/or TN extracts did not predict it. Conclusion: The high prevalence of sensitization to the pan-allergen LTP did not seem to have a significant impact in PN and/or TN allergy severity in our study. Instead, other factors, such as early age of onset and positivity for SSPs, seem to strongly associate with anaphylaxis to specific PN and/or TN. These findings may contribute to individual risk assessment in these populations.
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Affiliation(s)
- Pedro B Alves
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Helena P Pereira
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Marta P Alves
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Luis Roseta
- Clinical Pathology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Beatriz Tavares
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Graça Loureiro
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Isabel Carrapatoso
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Ana Todo-Bom
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
| | - Frederico S Regateiro
- From the Allergy and Clinical Immunology Unit, University Hospital of Coimbra, Coimbra, Portugal
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11
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Vander Does A, Ju T, Yosipovitch G. When Foods Cause Itch: Clinical Characteristics, Pathophysiology, and Recommendations for Food-Induced Skin and Mucosal Pruritus. Dermatitis 2022; Publish Ahead of Print:01206501-990000000-00036. [PMID: 35839419 DOI: 10.1097/der.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in dermatology on food-induced pruritus. In addition, itch severity is rarely mentioned. Food can induce pruritus through either ingestion or direct contact with skin or mucosal membranes. The most common type of itch provoked by food is acute urticaria, often through the classical immunoglobulin E (IgE)-mediated pathway. Other mechanisms include non-IgE-mediated, mixed (IgE-mediated and non-IgE-mediated), T-cell-mediated, and nonimmune reactions. For patients presenting with urticaria, generalized pruritus, oral pruritus, or dermatitis, a thorough history is warranted, and possible food associations should be considered and assessed. Although any food seems to have the potential to elicit an immune response, certain foods are especially immunogenic. Treatment includes avoidance of the trigger and symptom management. Careful consideration should be used as to avoid unnecessarily restrictive elimination diets.
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Affiliation(s)
- Ashley Vander Does
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
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12
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Ensina LF, Min TK, Félix MMR, de Alcântara CT, Costa C. Acute Urticaria and Anaphylaxis: Differences and Similarities in Clinical Management. FRONTIERS IN ALLERGY 2022; 3:840999. [PMID: 35958944 PMCID: PMC9361476 DOI: 10.3389/falgy.2022.840999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Acute urticaria is a common condition that presents with wheals and/or angioedema. However, these symptoms are also frequent in anaphylaxis, a life-threatening reaction that should be immediately diagnosed and treated. In both, mast cells play a central role in the physiopathology. Causes and triggers of acute urticaria and anaphylaxis are similar in general, but some peculiarities can be observed. The diagnostic approach may differ, accordingly to the condition, suspicious causes, age groups and regions. Adrenaline is the first-line treatment for anaphylaxis, but not for acute urticaria, where H1-antihistamines are the first choice. In this paper, we review the main aspects, similarities and differences regarding definitions, mechanisms, causes, diagnosis and treatment of acute urticaria and anaphylaxis.
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Affiliation(s)
- Luis Felipe Ensina
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
- *Correspondence: Luis Felipe Ensina
| | - Taek Ki Min
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Mara Morelo Rocha Félix
- Division of Allergy and Immunology, Department of General Medicine, School of Medicine and Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Célia Costa
- Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Universitario de Lisboa Norte (CHLN), EPE, Lisbon, Portugal
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Lamara Mahammed L, Belaid B, Berkani LM, Merah F, Rahali SY, Ait Kaci A, Berkane I, Sayah W, Allam I, Djidjik R. Shrimp sensitization in house dust mite algerian allergic patients: A single center experience. World Allergy Organ J 2022; 15:100642. [PMID: 35432714 PMCID: PMC8988002 DOI: 10.1016/j.waojou.2022.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/19/2022] [Accepted: 03/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cross-reactivity between shrimp and house dust mite (HDM) proteins has been widely documented. However, a significant geographical variability in sensitization patterns and cross-reactive allergens has been reported which may impact the diagnosis and management of shrimp allergy among HDM-shrimp co-sensitized patients. This study aimed to investigate the prevalence of shrimp and tropomyosin sensitization among HDM-allergic patients in order to understand the local epidemiology to inform the development of targeted diagnostic and therapeutic tools. Methods Four hundred forty-six (446) HDM-allergic patients and 126 atopic controls were screened for shrimp-specific IgE using the IMMULITE 2000 XPI® System. HDM-shrimp sensitized subjected were also tested for IgE tropomyosin (nPen m 1) and thoroughly interviewed about their shellfish consumption habits. Tropomyosin sensitized patients were subjected to further analysis including measurement of IgE specific to squid and crab. Results The prevalence of shrimp sensitization in the HDM-allergic population was 20.4% vs 0% in the control group. Of them 63.7% were clinically allergic to shrimp, while 9 cases had no history of allergic reaction to this food and 24 patients reported not having consumed shrimp before. Besides, 72.5% of the HDM-shrimp sensitized subjects had tropomyosin-specific IgE with a positivity rate of 82.8% among shrimp-allergic patients. Among tropomyosin reactors, 95.5% were sensitized to crab and 89.5% to squid, none of them had previously ingested neither crab nor squid. Nevertheless, one-third of HDM-shrimp sensitized patients who never consumed shrimp before did not react to tropomyosin. Conclusions Shrimp allergy seems to be strictly dependent on HDM sensitization, at least in this geographical area. Therefore, HDM allergic patients should be systematically screened for shrimp sensitization and asked about the consumption of shellfish. Tropomyosin is a major and clinically relevant shrimp allergen that accounts for shellfish-HDM cross-reactivity. However, other components could be involved.
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Juel-Berg N, Larsen LF, Küchen N, Norgil I, Hansen KS, Poulsen LK. Patterns of Clinical Reactivity in a Danish Cohort of Tree Nut Allergic Children, Adolescents, and Young Adults. FRONTIERS IN ALLERGY 2022; 3:824660. [PMID: 35958942 PMCID: PMC9361471 DOI: 10.3389/falgy.2022.824660] [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: 11/29/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tree nut allergy is associated with severe reactions and poly-sensitization to other nuts and peanuts often occurs. There are regional differences in sensitization profiles that result in differences in clinical presentation. Denmark is located in a birch pollen endemic area, which could influence the allergy patterns due to pollen cross-sensitization. Objective This study aimed to investigate patterns of sensitization and clinical reactivity to tree nuts and peanuts and threshold levels for oral food challenges (OFCs) in a Danish cohort of tree nut allergic children, adolescents, and young adults. Methods Forty tree nut allergic subjects were assessed for clinical reactivity to six nuts, i.e., hazelnut, walnut, pistachio, cashew, almond, and peanut, by OFCs or convincing medical history of an immediate allergic reaction or tolerance. Clinical presentation and allergen-specific immunoglobulin E (sIgE) levels together with eliciting dose and rescue medication in OFCs were furthermore assessed. Results Allergy to two or more tree nuts was observed in most cases. Hazelnut-walnut dual allergy was common but not exclusively observed as concomitant allergies. Allergy to cashew was coincided in all but one of the assessed subjects with pistachio allergy. Half of all assessed subjects were allergic to peanuts. Oral symptoms followed by a skin reaction were the most common symptomatology that lead to OFC cessation and subjects often presented with symptoms from two or more organ systems. OFC threshold levels were within the same range, but cashew was distinguished from other nuts by causing allergic symptoms at the lowest dose. Clinical reactivity and the allergy patterns were to some extent reflected by sIgE levels and by correlations in sIgE between the nuts. Conclusions In this Northern European cohort, subjects with clinically relevant tree nut allergy were generally allergic to two or more tree nuts and close to half of them also to peanuts. There were two distinct and independent allergic phenotypes; the majority of hazelnut allergic subjects were also allergic to walnut, and all but one subject with cashew allergy were dual allergic to pistachio. These findings are consistent with a strong sIgE correlation between hazelnut and walnut and a close to total sIgE correlation between cashew and pistachio.
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Affiliation(s)
- Nanna Juel-Berg
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lau Fabricius Larsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
| | - Niels Küchen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Ida Norgil
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Kirsten Skamstrup Hansen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lars K. Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- *Correspondence: Lars K. Poulsen
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