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Leung ASY, Tham EH, Pacharn P, Xing Y, Trinh HKT, Lee S, Ahn K, Chatchatee P, Sato S, Ebisawa M, Lee BW, Wong GWK. Disparities in pediatric anaphylaxis triggers and management across Asia. Allergy 2024; 79:1317-1328. [PMID: 38462795 DOI: 10.1111/all.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The epidemiology and management of anaphylaxis are not well-reported in Asia. METHODS A regional pediatric anaphylaxis registry was established by the Asia-Pacific Research Network for Anaphylaxis (APRA), using standardized protocols for prospective data collection, to evaluate the triggers and management of anaphylaxis in the Asia-Pacific region. Pediatric patients below 18 years presenting with anaphylaxis across four Asian countries/cities (Thailand, Singapore, Hong Kong (HK), and Qingdao) were included. Allergen triggers, symptoms, anaphylaxis severity, and management were compared. RESULTS Between 2019 and 2022, 721 anaphylaxis episodes in 689 patients from 16 centers were identified. The mean age at anaphylaxis presentation was 7.0 years (SD = 5.2) and 60% were male. Food was the most common trigger (62%), particularly eggs and cow's milk in children aged 3 years and below. In school-age children, nut anaphylaxis was most common in HK and Singapore, but was rare in the other countries, and wheat was the top allergen in Bangkok. Shellfish anaphylaxis was most common in children aged 7-17. Adrenaline was administered in 60% of cases, with 9% given adrenaline before hospital arrival. Adrenaline devices were prescribed in up to 82% of cases in Thailand but none in Qingdao. CONCLUSIONS The APRA identified food as the main trigger of anaphylaxis in children, but causative allergens differed even across Asian countries. Fewer than two-thirds of cases received adrenaline treatment, pre-hospital adrenaline usage was low, and adrenaline device prescription remained suboptimal. The registry recognizes an unmet need to strengthen anaphylaxis care and research in Asia-Pacific.
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Affiliation(s)
- Agnes Sze Yin Leung
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoang Kim Tu Trinh
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pantipa Chatchatee
- Department of Pediatrics, Division of Allergy and Immunology, Faculty of Medicine, HAUS IAQ Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
| | - Sakura Sato
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Kanagawa, Japan
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gary Wing Kin Wong
- Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Foti Randazzese S, Panasiti I, Caminiti L, Catamerò F, Landi M, De Filippo M, Votto M, Olcese R, Favuzza F, Giovannini M, Barberi S. Current state and advances in desensitization for peanut allergy in pediatric age. Pediatr Allergy Immunol 2024; 35:e14127. [PMID: 38646959 DOI: 10.1111/pai.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/15/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
Peanut allergy affects about 1%-3% of the pediatric population in the world, with an important increase in the last decades. Nowadays, international guidelines recommend the early introduction of peanuts in the infant diet, with poor information about the quantity and the frequency of the intake. Allergen immunotherapy may represent the only therapeutic strategy able to modify the natural history of peanut allergy. In particular, oral immunotherapy showed the most promising results in terms of efficacy, but with significant rates of adverse reactions, mostly gastrointestinal. In 2020, the Food and Drug Administration and the European Medicines Agency approved Palforzia®, an oral drug for patients aged 4-17 years. Several studies are ongoing to improve the tolerability of oral immunotherapy and standardize the desensitization protocols. Sublingual immunotherapy permits to offer much lower doses than oral immunotherapy, but fewer adverse events are shown. Subcutaneous immunotherapy is associated with the greatest systemic adverse effects. Epicutaneous immunotherapy, for which Viaskin® patch was approved, has the highest safety profile. Innovative studies are evaluating the use of biological drugs, such as omalizumab or dupilumab, and probiotics, such as Lactobacillus rhamnosus, in monotherapy or associated with oral immunotherapy. Therapy for peanut allergy is constantly evolving, and new perspectives are ongoing to develop.
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Affiliation(s)
- Simone Foti Randazzese
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Ilenia Panasiti
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Lucia Caminiti
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Francesco Catamerò
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Massimo Landi
- Institute of Biomedicine and Molecular Immunology, Pediatric National Healthcare System, Turin, Italy
| | - Maria De Filippo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Filippo Favuzza
- Pediatric Unit, Hospital Holy Family Fatebenefratelli Company, Erba, Italy
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Treudler R. Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024. Int Arch Allergy Immunol 2024:1-9. [PMID: 38527454 DOI: 10.1159/000537958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
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.
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Affiliation(s)
- Regina Treudler
- Charité - Universitätsmedizin Berlin, Institute of Allergology IFA, Berlin, Germany
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4
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Faihs V, Schmalhofer V, Kugler C, Bent RK, Scherf KA, Lexhaller B, Mortz CG, Bindslev-Jensen C, Biedermann T, Skov PS, Eberlein B, Brockow K. Detection of Sensitization Profiles with Cellular In Vitro Tests in Wheat Allergy Dependent on Augmentation Factors (WALDA). Int J Mol Sci 2024; 25:3574. [PMID: 38612386 PMCID: PMC11012217 DOI: 10.3390/ijms25073574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024] Open
Abstract
Wheat allergy dependent on augmentation factors (WALDA) is the most common gluten allergy in adults. IgE-mediated sensitizations are directed towards ω5-gliadin but also to other wheat allergens. The value of the different in vitro cellular tests, namely the basophil activation test (BAT) and the active (aBHRA) and passive basophil histamine-release assays (pBHRA), in the detection of sensitization profiles beyond ω5-gliadin has not been compared. Therefore, 13 patients with challenge-confirmed, ω5-gliadin-positive WALDA and 11 healthy controls were enrolled. Specific IgE (sIgE), skin prick tests, BATs, aBHRA, and pBHRA were performed with allergen test solutions derived from wheat and other cereals, and results were analyzed and compared. This study reveals a distinct and highly individual reactivity of ω5-gliadin-positive WALDA patients to a range of wheat allergens beyond ω5-gliadin in cellular in vitro tests and SPT. In the BAT, for all tested allergens (gluten, high-molecular-weight glutenin subunits, α-amylase/trypsin inhibitors (ATIs), alcohol-free wheat beer, hydrolyzed wheat proteins (HWPs), rye gluten and secalins), basophil activation in patients was significantly higher than in controls (p = 0.004-p < 0.001). Similarly, significant histamine release was detected in the aBHRA for all test substances, exceeding the cut-off of 10 ng/mL in all tested allergens in 50% of patients. The dependency of tests on sIgE levels against ω5-gliadin differed; in the pBHRA, histamine release to any test substances could only be detected in patients with sIgE against ω5-gliadin ≥ 7.7 kU/L, whereas aBHRA also showed high reactivity in less sensitized patients. In most patients, reactivity to HWPs, ATIs, and rye allergens was observed. Additionally, alcohol-free wheat beer was first described as a promising test substance in ω5-gliadin-positive WALDA. Thus, BAT and aBHRA are valuable tools for the identification of sensitization profiles in WALDA.
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Affiliation(s)
- Valentina Faihs
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany
| | - Viktoria Schmalhofer
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany
| | - Claudia Kugler
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany
| | - Rebekka K. Bent
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany
| | - Katharina A. Scherf
- Department of Bioactive and Functional Food Chemistry, Institute of Applied Biosciences, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Barbara Lexhaller
- Department of Bioactive and Functional Food Chemistry, Institute of Applied Biosciences, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Charlotte G. Mortz
- Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark
| | - Carsten Bindslev-Jensen
- Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany
| | - Per S. Skov
- Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark
- RefLab ApS, 2200 Copenhagen, Denmark
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine and Health, Technical University of Munich, 80802 Munich, Germany
- Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Centre, Odense University Hospital, 5000 Odense, Denmark
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Pouessel G, Sabouraud-Leclerc D, Beaumont P, Divaret-Chauveau A, Bradatan E, Dumond P, Karaca Y, Renaudin JM, Metz-Favre C, Delalande D, Correard AK, Tscheiller S, Van der Brempt X. Lupin, a potential "hidden" food anaphylaxis allergen: An alert from the Allergy-Vigilance Network®. Allergy 2024. [PMID: 38516981 DOI: 10.1111/all.16107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Guillaume Pouessel
- CH Roubaix, Department of Pediatrics, Children's Hospital, Roubaix, France
- CHU Lille, Pediatric Pulmonology and Allergy Department, Pôle Enfant, Hôpital Jeanne de Flandre, Lille, France
- Univ Lille, ULR 2694: METRICS, Lille, France
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
| | | | - Pascale Beaumont
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Medical Office, Saint Maur des Fossés, France
| | - Amandine Divaret-Chauveau
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Paediatric Allergology, Children's Medicine, CHRU, Nancy, France
| | - Eléna Bradatan
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Department of Paediatrics, CHRU, Namur, Belgium
| | - Pascale Dumond
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Paediatric Allergology, Children's Medicine, CHRU, Nancy, France
| | - Yasemin Karaca
- CH Roubaix, Department of Pediatrics, Children's Hospital, Roubaix, France
| | - Jean-Marie Renaudin
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Allergology Department, CH Durkheim, Epinal, France
| | - Carine Metz-Favre
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Department of Pneumology and Allergology, Strasbourg University Hospital, Strasbourg, France
| | - Delphine Delalande
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Departement of Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Anne-Karine Correard
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Pediatric Pulmonology and Allergology Department, Pediatric Cystic Fibrosis Center, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | | | - Xavier Van der Brempt
- Allergy-Vigilance Network®, Vandoeuvre-les-Nancy, France
- Allergopôle, Clinique Saint-Luc, Namur, Belgium
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6
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Magen E, Merzon E, Green I, Golan-Cohen A, Magen I, Vinker S, Israel A. A case-control study for comorbidity and laboratory factors associated with food-induced anaphylaxis. Allergy Asthma Proc 2024; 45:53-60. [PMID: 38151728 DOI: 10.2500/aap.2024.45.230076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Background: Food-induced anaphylaxis (FIA) is a serious and potentially life-threatening allergic reaction triggered by food allergens. Objective: This case-control study aimed to investigate comorbidities and laboratory factors associated with FIA in the pediatric population of Israel. Methods: Retrospective data from the electronic health records of Leumit Health Care Services were used to identify 711 pediatric patients with FIA and 2560 subjects with food allergy and without anaphylaxis matched for age, gender, and ethnicity. Comorbidities were identified based on medical billing diagnosis codes, and laboratory characteristics were compared between the two groups. Results: The mean ± standard deviation age of patients with FIA was 4.1 ± 4.1 years, and 37.3% were girls. Laboratory analysis revealed increased eosinophil counts (p < 0.001), elevated immunoglobulin E (IgE) (p < 0.001), and IgA levels (p = 0.001) in the FIA group compared with the controls. With regard to comorbidities, the FIA group had higher prevalence rates of allergic diseases, including allergic rhinitis (odds ratio [OR] 1.72; p < 0.001), allergic conjunctivitis (OR 1.84; p = 0.001), asthma (OR 1.36; p < 0.001), angioedema (OR 6.37; p < 0.001), atopic dermatitis (OR 1.77; p < 0.001), and contact dermatitis (OR 1.42; p = 0.001). There was a trend toward significance for chronic spontaneous urticaria (p = 0.051). There was a significant negative association between helminthiases, particularly enterobiasis, and FIA (OR 0.76 [95% confidence interval, 0.59-0.98]; p = 0.029). Conclusion: This study provides valuable epidemiologic evidence on the associations among FIA, comorbidities, and laboratory factors in the pediatric population.
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Affiliation(s)
- Eli Magen
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | - Eugene Merzon
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | - Ilan Green
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | | | - Israel Magen
- Medicine A Department, Assuta Ashdod University Hospital Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel
| | - Shlomo Vinker
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
| | - Ariel Israel
- From the Leumit Health Services, Tel Aviv-Yafo, Israel
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7
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Brockow K, Faihs V, Kugler C, Biedermann T. Correct nomenclature of wheat allergy dependent on augmentation factors. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3562-3563. [PMID: 37945213 DOI: 10.1016/j.jaip.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/16/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Valentina Faihs
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claudia Kugler
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
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8
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Dölle-Bierke S, Worm M. Reply to "Correct nomenclature of wheat allergy dependent on augmentation factors". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3563-3564. [PMID: 37945214 DOI: 10.1016/j.jaip.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Sabine Dölle-Bierke
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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9
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Tanno LK, Caminati M, Pouessel G, Senna G, Demoly P. Epidemiology of anaphylaxis: is the trend still going up? Curr Opin Allergy Clin Immunol 2023; 23:349-356. [PMID: 37548324 DOI: 10.1097/aci.0000000000000933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
PURPOSE OF REVIEW To understand the current global scale of anaphylaxis and identify possible strategies to increase the accuracy of epidemiological data. RECENT FINDINGS Anaphylaxis mortality and morbidity statistics may gain new perspectives with the global implementation of the ICD-11. Improving the quality of epidemiological data related to anaphylaxis should clarify some areas of uncertainty about risk factors, leading to better targeting of strategies to protect those patients at risk, and support decision-making to facilitate health care planning and implementation of public health measures to prevent anaphylaxis. SUMMARY The true rate of anaphylaxis is unknown due to a number of factors, such as misdiagnosis, miscoding and undernotification. Moreover, there is lack of information about anaphylaxis epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged and anaphylaxis data can vary widely. Currently, most robust data are derived from hospitalization datasets and national mortality databases. Anaphylaxis accounts for up to 0.26% of overall hospital admissions. It is suggested that the number of hospital admissions for anaphylaxis is increasing in many countries, both with respect to all-causes of anaphylaxis and by trigger, but the mortality rate remains low. However, there are still great challenges in capturing quality anaphylaxis mortality and morbidity statistics. Better understanding of anaphylaxis trends should clarify some areas of uncertainty about risk factors and prospect effective prevention strategies. As the knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to anaphylaxis in the ICD-11 will allow the collection of more accurate epidemiological data to support high quality management of patients, and to better facilitate health care planning to implement public health measures, reduce the morbidity and mortality attributable to anaphylaxis.
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Affiliation(s)
- Luciana Kase Tanno
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
| | - Guillaume Pouessel
- Department of Paediatrics, CH Roubaix
- Paediatric Pneumology and Allergology Unit, CHRU Lille, France
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
- Department of Medicine, University of Verona, Verona, Italy
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier - INSERM
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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10
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Skypala IJ, Reese I, Durban R, Hunter H, Podesta M, Chaddad MCC, Santos AF, Agache I. Food allergy-A holistic approach to dietary management. A joint EAACI Research & Outreach Committee and INDANA review. Pediatr Allergy Immunol 2023; 34:e14019. [PMID: 37747742 DOI: 10.1111/pai.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Abstract
Following a diagnosis of IgE-mediated food allergy, to secure the best outcome, the patient should receive individualized advice tailored to their specific needs, which considers the type and presentation of the food involved, level of exclusion required, risk of cross-contamination and any variance required for age, ethnicity, financial issues, and lifestyle. Issues such as food labels "may contain" statements, and variation in the threshold of reaction and impact of cofactors should also be considered. Most important is the need to ensure that the diagnosis is robust, especially given the nutritional, psychological, and socioeconomic issues that can affect an individual with a diagnosis of food allergy. Unnecessary exclusion of one or more foods that have not triggered allergic reactions, especially in individuals with allergic comorbidities, can result in severe IgE-mediated reactions on re-exposure. Given that food allergies may change over time, the diagnosis should be reviewed, to determine whether resolution is likely, or new-food triggers are reported. Regular assessment is vital, especially during childhood, to ensure reintroduction occurs at an appropriate time, thus enabling increased diversity of the diet and improvement in the quality of life. For some, an IgE-mediated food allergy may necessitate the life-long exclusion of foods, and for others, a food habitually eaten suddenly triggers an allergic reaction in adult life. People of all ages, ethnicities, and socioeconomic backgrounds deserve individual advice on the management of their food allergy to support a healthy diet and improve quality of life.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, part of Guys & St Thomas NHS Foundation Trust, London, UK
- Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK
| | - Imke Reese
- Nutritional Counseling and Therapy, Focus on Allergology, Munich, Germany
| | - Raquel Durban
- Carolina Asthma & Allergy Center, Charlotte, North Carolina, USA
| | - Hannah Hunter
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK
- Kings College, London, UK
| | | | | | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
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11
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Anagnostou A, Muraro A. Can we identify patients at risk of severe reactions to food? Expert Rev Clin Immunol 2023; 19:1427-1430. [PMID: 37753864 DOI: 10.1080/1744666x.2023.2265069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Aikaterini Anagnostou
- Department of Pediatrics, Division of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Houston, TX, USA
- Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, TX, USA
| | - Antonella Muraro
- UOSD Department of Pediatric and Adult Food Allergies, University Hospital of Padua
- Center for the Study and Cure of Allergies and Food Intolerance of the Veneto Region, University Hospital of Padua
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Malkovics T, Joura MI, Koszorú K, Sárdy M. [Dermatitis herpetiformis and other forms of wheat sensitivity]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 74:955-960. [PMID: 37882829 PMCID: PMC10661880 DOI: 10.1007/s00105-023-05243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Wheat sensitivity is a collective term for several, especially gastrointestinal, diseases that occur as part of a hypersensitivity reaction after wheat consumption. The symptoms, which are mostly similar to those of irritable bowel syndrome, are often accompanied by skin lesions. In addition to celiac disease and dermatitis herpetiformis, the cutaneous manifestation of celiac disease, wheat sensitivity also includes nonceliac gluten sensitivity (NCGS), allergic nickel contact mucositis, wheat allergy, amylase-trypsin inhibitor intolerance, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) intolerance. OBJECTIVES This review article aims to provide an overview of the clinical, especially dermatological and gastrointestinal features of the different forms of wheat sensitivity. Diagnosis and therapeutic management are also discussed. MATERIALS AND METHODS A selective literature search was carried out with evaluation of our own clinical data. RESULTS The skin lesions in dermatitis herpetiformis are very disease-specific. In contrast, wheat allergy often shares signs and symptoms with many other diseases. Other forms of wheat sensitivity cause primarily gastrointestinal abnormalities, but extra-intestinal manifestations can also occur. Their diagnosis is often complex and requires cross-disciplinary collaboration with experts in gastroenterology. The therapy consists of a wheat- or gluten-free diet. CONCLUSIONS Knowledge of the different and frequently occurring dermatological signs of wheat sensitivity is of great importance, because dermatological manifestations associated with gastrointestinal pathology, intolerance reactions, and allergies appear more and more frequently.
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Affiliation(s)
- T Malkovics
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn.
| | - M I Joura
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - K Koszorú
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn
| | - M Sárdy
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Fakultät für Medizin, Semmelweis Universität, Mária u. 41, 1085, Budapest, Ungarn
- Klinik für Dermatologie und Allergologie, Klinikum der Universität München (LMU), München, Deutschland
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