Sesame-induced anaphylaxis in pediatric patients from the cross-Canada anaphylaxis registry

Benefits of Epinephrine for Anaphylaxis Outweigh Potential Harm-A Safety Review

Anaphylaxis is a potentially life-threatening allergic reaction that can progress quickly, and although fatal anaphylaxis is very rare, treatment should be given as soon as possible. The recommended first-line treatment for anaphylaxis is intramuscular (IM) epinephrine. Yet epinephrine for anaphylaxis is underused, which can have deleterious, or even tragic, consequences. Although fear of self-injection substantially affects adherence, hesitancy to use epinephrine for anaphylaxis may be linked to the common unsubstantiated perception that epinephrine is dangerous. Therefore, the objective of this narrative review is to describe the safety of epinephrine when administered for the treatment of anaphylaxis. Cardiovascular adverse events (AEs) are the greatest safety concern with epinephrine because of its known effects on cardiac output and vasoconstriction. Cardiovascular events and overdose are significantly more likely to occur with accidental intravenous bolus administration than IM administration. Although serious AEs have been reported with IM epinephrine, and there are potential risk factors for cardiovascular AEs for some patients, there are no absolute contraindications for its use in a life-threatening situation. Appropriately dosed and administered epinephrine should engender no fear of use for anaphylaxis. The potential harm of delaying or withholding epinephrine treatment for anaphylaxis far outweighs the potential risk of AEs.

Irradiation alters the structure and reduces the sensitization of sesame proteins in the liquid state

Irradiation is extensively utilized in food processing as an effective and convenient method. At present, numerous studies have investigated the potential of irradiation to reduce food allergenicity. The objective of this study was to investigate the effects of irradiation treatment on the structure and allergenicity of liquid and solid sesame proteins. Sesame protein extracts and lyophilized powders were irradiated at doses of 0, 2.5, 5, 7.5, and 10 kGy, respectively. The effects of irradiation on sesame proteins were investigated by CD spectroscopy, fluorescence spectroscopy, indirect competitive ELISA, western blot and degranulation experiments on KU812 cells. The experimental results demonstrated that irradiation had a more pronounced effect on liquid sesame proteins. Irradiation altered the secondary structure and increased the surface hydrophobicity, with the α-helix content decreasing from 14.27% to 13.53% and the β-sheet content increasing from 33.91% to 39.53%. Additionally, protein aggregation resulted in a reduction of free sulfhydryl groups. Following irradiation, the IC50 value obtained by indirect competitive ELISA increased from 0.695 μg mL-1 to 18.546 μg mL-1, while the release of cellular β-Hex and IL-6 was reduced, indicating that irradiation diminished the IgE binding capacity of liquid sesame proteins and their ability to induce cell degranulation. Western blotting results corroborated the findings from the ELISA assay. In conclusion, irradiation modifies the structure and reduces the potential allergenicity of liquid sesame proteins.

Natural history of sesame allergy in pediatric patients: Insight from a retrospective analysis

BACKGROUND

Sesame allergy (SA) is a growing concern because of its association with severe reactions and the limited knowledge of long-term outcomes.

OBJECTIVE

This retrospective study aimed to identify the risk factors influencing persistent SA (PSA) in children to improve management and select suitable candidates for oral immunotherapy (OIT).

METHODS

We analyzed the electronic medical records of 84 children with confirmed SA, as defined by consistent clinical reactions and immunoglobulin E (IgE)-mediated sensitization. Patients were followed for a median (IQR) of 56.5 (46.0-82.5) months.

RESULTS

Most participants were male (72.6%) with concurrent food allergies (71.4%). They experienced a median (IQR) of 3.0 (2.0-3.7) allergic episodes, with 46.4% experiencing at least one anaphylactic reaction. PSA was observed in 82.1% (69/84) of the patients. A larger skin prick test (SPT) wheal size at the first reaction (adjusted OR = 1.79, CI:1.05-3.04; p = .03) and allergic reaction grade≥2 (adjusted OR = 19.93, CI:1.37-289.13; p = .02) were independent risk factors for persistence. A 3-fold increase in the likelihood of persistence was observed in patients with SPT results greater than 6.7 mm at first reaction compared with those with results less than 6.7 mm during follow-up (HR = 3.08; CI:1.17-8.12; p = .02). Patients with sustained or increased SPT wheal size (93% remained allergic) and specific IgE (95% remained allergic) at the final visit were more likely to have PSA, whereas those with decreased levels (37% and 39% developed natural tolerance, respectively) were less likely to have resolved SA.

CONCLUSIONS

This study identified novel risk factors for PSA, including SPT wheal size at the first reaction, reaction severity, and sustained sensitization markers. These findings can inform management strategies and the selection of OIT candidates. Further long-term studies are crucial to elucidate the natural history of SA across populations and to evaluate early interventions, such as OIT.

Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024

BACKGROUND

Anaphylaxis represents the most severe end of the spectrum of allergic reactions. Frequent elicitors of anaphylaxis are insects, foods, and drugs. This paper summarizes recent development with regard to emerging and novel elicitors of anaphylaxis.

SUMMARY

Food allergens on the rise include pulses (like pea, chickpea), seeds (hemp, chia), nuts (cashew), pseudograins (buckwheat, quinoa), fruits, and microalgae. Novel foods are foods that were not consumed to any significant extent in the European Union before May 1997, which includes four edible insects (mealworm, migratory locust, house cricket, and buffalo worm). Recent investigations have pointed out the risk of anaphylaxis associated with the consumption of yellow mealworm for people allergic to shellfish and house dust mites. In Europe, fire ants (mostly Solenopsis invicta) and Vespa velutina nigrithorax represent invasive species, which account for increasing numbers of anaphylactic reactions. Also, several new drugs, especially biologicals, have been associated with anaphylaxis.

KEY MESSAGES

Elicitors of anaphylaxis are changing as a result of (i) increase in demand for plant-based food, (ii) introduction of novel foods, (iii) spreading of allergens by climate changes and globalization, or (iv) due to exposure to newly developed drugs.

Comprehensive Diagnosis, Management, and Treatment of Sesame Allergy

Sesame allergy prevalence varies regionally and by age, in the range of 0.1% to 0.9%. Reactions can be severe and potentially fatal. Resolution rates are in the range of 20% to 50%. The diagnosis requires a careful history and the use of tests, such as skin prick tests and serum sesame-specific IgE. The availability of serum IgE testing for the sesame protein Ses i 1 has improved diagnostic accuracy. The emerging potential for sesame basophil activation tests and additional new tests will likely improve diagnosis in coming years, further reducing the need for diagnostic oral food challenges. Although sesame proteins share homology with those in many foods, clinically relevant cross-reactivity appears uncommon. Nevertheless, sesame is a prominent allergen for those with multiple food allergies. Management may include strict avoidance, but sesame products vary dramatically in protein content. Many people with sesame allergy tolerate forms that are low in protein, such as scattered seeds, rather than sesame paste that is protein-dense. Thus, options in the approach to avoidance are possible. Studies suggest that sesame oral immunotherapy may be safe and effective, and this and additional treatment options are emerging. Here, we review the current comprehensive diagnosis, management, and treatment for sesame allergy.

Epinephrine treatment of food-induced and other cause anaphylaxis in United States and Canadian Emergency Departments: a systematic review and meta-analysis

INTRODUCTION

Studies from more than 10 years ago showed epinephrine treatment of food-induced anaphylaxis in the emergency department (ED) was unacceptably low. We investigated whether epinephrine treatment of food-induced and other cause anaphylaxis in United States and Canadian EDs has changed over time.

METHODS

Guided by a health sciences librarian, we performed a systematic search in Medline, Embase, and Web of Science on 11 January 2023. We included observational studies that reported epinephrine use to treat anaphylaxis in the ED. We stratified by anaphylaxis etiology (food-, venom-, medication-induced, or any cause). Associations between year and epinephrine use were tested using Spearman correlation and proportional meta-analysis.

RESULTS

Of 2458 records identified in our initial search, 40 met inclusion criteria. Of these, 14 examined food-induced, 4 venom-induced, 0 medication-induced, and 24 any cause anaphylaxis. For epinephrine treatment of food-induced anaphylaxis in the ED, among studies using similar definition of anaphylaxis, meta-analysis showed a pooled value of 20.7% (95% CI 17.8, 23.8) for studies performed >10 years ago and 45.1% (95% CI 38.4, 52.0) from those in the last 10 years. For anaphylaxis of any cause, there was no change over time, with a pooled value of 45.0% (95% CI 39.8, 50.3) over the last 10 years.

DISCUSSION

Epinephrine treatment of food-induced anaphylaxis in the ED has increased over time. There was no clear change for anaphylaxis of any cause. Over the last 10 years, approximately 45% of ED patients with anaphylaxis received epinephrine. A limitation of the evidence is heterogeneity in anaphylaxis definitions.

Open sesame: Shedding light on an emerging global allergen

BACKGROUND

Sesame allergy has been characterized in the Middle East for some time. However, it has become more widely recognized as foods containing sesame and sesame seeds have become increasingly available in Australia, Europe, and North America. With the passage of the Food Allergy Safety, Treatment, Education, and Research Act in 2021, the United States will join other countries in identifying sesame as a major food allergen and require sesame to be labeled as a food allergen beginning in 2023.

OBJECTIVE

To review the literature related to sesame allergy as an increasingly recognized food allergen around the world.

DATA SOURCES

English-language articles retrieved by PubMed searches with relevance to sesame allergy.

STUDY SELECTIONS

Articles were included using the search terms "sesame allergy" and "sesame seed allergy."

RESULTS

A total of 69 relevant articles regarding sesame allergy, relating to its prevalence, clinical presentation, natural history, allergenic epitopes, diagnosis, and treatment, were selected.

CONCLUSION

In recent decades, considerable gains have been made in determining prevalence and natural history of sesame allergy. With increased recognition and prevalence come the need for reliable methods of identification of sesame allergy and approaches for management.