Accidental Reactions to Foods: Frequency, Causes, and Severity

Standardizing outcomes in food allergy research: aligning clinical trials with patient priorities

PURPOSE OF REVIEW

This review explores the clinical outcomes used in immunoglobulin E (IgE)-mediated food allergy (FA) intervention studies, emphasizing unmet need for patient-centred outcomes. Standardizing outcome measurement is critical as research into FA treatments, particularly food immunotherapy, expands. Here we discuss how outcomes should reflect the multidimensional impact of FA on people's lives.

RECENT FINDINGS

Current evidence reveals a discrepancy between clinical trial outcomes and those most valued by patients and carers. While trials often prioritize changes in reactivity thresholds or immunological markers, patients and carers emphasize need in reducing severe reactions, improving quality of life, and enhancing confidence in disease management. This disparity highlights importance of harmonization efforts to guide FA research.The Core Outcome Measures for Food Allergy (COMFA) initiative recently identified two core outcomes - 'allergic symptoms' and 'quality of life' - through an international consensus process involving patients, caregivers, clinicians, and researchers. Outcomes like 'desensitization' and 'remission/sustained unresponsiveness' were considered important but were not seen as the most critical.

SUMMARY

Developing and implementing a COS for FA intervention studies is essential to align research with patient priorities, ensuring meaningful improvements in routine clinical care. Standardized outcome measurement will generate robust evidence, inform clinical practice, and empower patients and caregivers in decision-making about FA management.

Microbial metabolism of food allergens determines the severity of IgE-mediated anaphylaxis

Anaphylaxis is an acute, potentially life-threatening reaction, often triggered by foods and largely mediated by IgE. A critically important aspect of anaphylaxis pertains to the factors that modulate its severity. The human microbiota is known to influence oral tolerance, but the microbial mechanisms directly involved in IgE-mediated anaphylaxis remain unknown. Here, we demonstrate that human saliva harbors peanut-degrading bacteria that metabolize immunodominant allergens (Ara h 1 and Ara h 2) and alter IgE binding. Additionally, we provide in vivo evidence showing that oral bacteria metabolize peanut allergens, influencing systemic allergen exposure and the severity of anaphylaxis. Finally, in a clinical study, we observe that common peanut-degrading bacteria, such as Rothia, from the oral cavity, are more abundant in peanut-allergic patients who exhibit better tolerance to allergen exposure. Altogether, these results demonstrate the role of the human microbiota in modulating IgE-mediated reactions through allergen metabolism. These findings reveal a novel microbial mechanism with potential to prevent, or reduce, the severity of IgE-mediated anaphylaxis.

Prevalence and Characteristics of Accidental Ingestions Among Pediatric Food Allergy Patients

BACKGROUND

Despite a known diagnosis of food allergy, accidental ingestions continue to occur.

OBJECTIVE

To characterize accidental ingestions, including prevalence, risk factors, food allergen triggers, and severity of reactions.

METHODS

A prospective monthly survey developed by the Food Allergy Consortium at Northwestern University was administered to parents of food-allergic children between April 2015 and April 2017. The monthly survey included questions on any allergic reactions experienced in the previous month. In addition, chart reviews of 100 pediatric participants from Lurie Children's Hospital of Chicago allergy clinics (typical clinical encounters) were compared with the prospective survey results.

RESULTS

A total of 196 survey participants and 100 retrospective review subjects were analyzed-31.1% of participants from the surveyed cohort and 19.0% of participants from the retrospective review reported at least 1 accidental ingestion over 1 year. The rate of accidental ingestions reported in the prospective survey was high: 10% to 25% of participants each month reported an accidental ingestion, and multiple ingestions were common. Common triggers were milk, wheat, and tree nuts. In the retrospective cohort, the highest rate of accidental ingestion (25.0%) occurred for milk, followed by sesame (20.0%) and egg (18.8%). Rates of anaphylaxis after exposure were high in both the prospective and retrospective cohorts (33.1% and 16.7%, respectively).

CONCLUSIONS

Accidental ingestion rates were high among food-allergic patients. Multiple exposures, especially to milk, were common. Incidence of anaphylaxis was also high, suggesting that ongoing patient education on allergen avoidance and accidental exposure is imperative.

Biologics in Food Allergies: Emerging Therapies

Immunoglobuin E (IgE)-mediated food allergies greatly impact patients and their families, causing financial and emotional stress, and placing them at risk for lifethreatening reactions. Until recently, food allergies have been treated with allergen avoidance and emergency treatment of allergic reactions. Omalizumab was recently approved in adults and children greater than one year who are allergic to one or more foods for the prevention of serious allergic reactions in the setting of accidental exposure. Omalizumab also shows promise when combined with oral immunotherapy for possible allergen ingestion. Other classes of biologics and small molecule inhibitors have also demonstrated potential for use in preventing and treating food allergy.

The risk of anaphylaxis on holidays

PURPOSE OF REVIEW

The goal of this review is to summarize the potential causes of anaphylaxis in the different holiday contexts, providing practical suggestions aimed to mitigate the stress challenged by allergic patients because of unfamiliar situations.

RECENT FINDINGS

A regard was reserved to potential food triggers, particularly uncommon ones and typical of certain destinations, and to arthropods responsible for anaphylaxis.

SUMMARY

This review highlights the potential risk of anaphylaxis due to the unusual contexts more experienced during holidays (i.e., travels, outdoor activities and eating out). Moreover, it underlines the need for a further allergological education in these cases, in order to prepare allergic patients to avoid and manage undesired situations.