1
|
Weng BBC, Liu YC, White BL, Chang JC, Davis JP, Hsiao SH, Chiou RYY. Allergenicity reduction of the bio-elicited peanut sprout powder (BPSP) and toxicological acceptance of BPSP-supplemented diets assessed with ICR mice. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2022; 59:4583-4593. [PMID: 36276516 PMCID: PMC9579254 DOI: 10.1007/s13197-022-05537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 04/20/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
The allergenic and toxicological acceptances of the bio-elicited peanut sprout powder (BPSP) have not been assessed. BPSP was generated from peanut kernels germinated at 26–28 °C for 72 h (designated as 72 h-NGS). The 72 h-NGS were subsequently sliced, incubated, dried, defatted and pulverized to generate bio-elicited peanut sprout powder (BPSP). Protein solubility of BPSP increased 2.6-fold compared to 72 h-NGS. SDS-PAGE analysis revealed BPSP production triggered extensive degradation of the high-molecular weight peanut allergic proteins, mainly Ara h 1 and Ara h 3. Western blotting detected with peanut allergic patients’ IgE indicated decreased in vitro reactivity. Food safety assessment of BPSP was performed with ICR mice fed with basal (control) and three doses of formulated BPSP-supplemented diets containing 0.11 g (normal), 2.5 g (high) and 25 g (super high) BPSP /kg BW. Animals appeared healthy with steady body weight gain in all groups during the entire 35-day dietary intervention. Hematological and serum biochemical analyses revealed no significant difference among groups. Histopathological examination on the tissue sections of primary organs further supported safety with no pathologies. The in vitro allergic reduction and toxicological safety in the BPSP-supplemented dietary intervention in the ICR mice study, support moving forward with BPSP-involved product development.
Collapse
Affiliation(s)
- Brian B.-C. Weng
- Department of Microbiology, Immunology and Biopharmaceuticals, National Chiayi University, Chiayi, 60004 Taiwan, Republic of China
| | - Yu-Chia Liu
- Department of Food Science, National Chiayi University, Chiayi, 60004 Taiwan, Republic of China
| | - Brittany L. White
- Market Quality and Handling Research Unit, USDA ARS, North Carolina State University, Raleigh, NC 27607 USA
| | - Ju-Chun Chang
- Department of Food Science, National Chiayi University, Chiayi, 60004 Taiwan, Republic of China
| | - Jack P. Davis
- Market Quality and Handling Research Unit, USDA ARS, North Carolina State University, Raleigh, NC 27607 USA
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC 27607 USA
| | - Shih-Hsuan Hsiao
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802 USA
| | - Robin Y.-Y. Chiou
- Department of Food Science, National Chiayi University, Chiayi, 60004 Taiwan, Republic of China
| |
Collapse
|
2
|
|
3
|
Food-induced anaphylaxis and cofactors - data from the anaphylaxis registry. Allergol Select 2017; 1:21-27. [PMID: 30402598 PMCID: PMC6039999 DOI: 10.5414/alx01401e] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 01/04/2011] [Indexed: 11/18/2022] Open
Abstract
Food allergens are frequent causes of anaphylaxis. In particular in children and adolescents they are the most frequent elicitors of severe allergic reactions, and in adults food allergens rank third behind insect venom and drugs. Since July 2006 severe allergic reactions from Germany, Austria, and Switzerland are collected in the anaphylaxis registry. Currently 78 hospitals and private practises are connected. From July 2006 until February 2009 1,156 severe allergic reactions were registered. Among children and adolescents (n = 187, age range from 3 months to 17 years) food allergens were the most frequent triggers, comprising 58% of cases. In the adult group (n = 968, 18 – 85 years) food allergens were in the third position (16.3%) behind insect venom and drugs. In children legumes (31%) and in particular peanuts were frequently responsible food allergens, followed by tree nuts (25%) with hazelnut being the most frequent elicitor. In adults fruits (13.4%) most often induced severe food-dependent anaphylaxis, but also animal products (12.2%); among these most frequently crustaceans and molluscs. Cofactors were often suspected in food-dependent anaphylaxis, namely in 39% of the adult group and in 14% of the pediatric group. In adults drugs (22%) and physical activity (10%) were reported to be the most frequent cofactors, in children physical activity was suspected in 8.7% and drugs in 2.6%. Concomitant diseases like atopic dermatitis, allergic asthma, or allergic rhinoconjunctivitis were reported in 78% of children and adolescents and in 67% of the adults. In conclusion, food-induced anaphylaxis, its cofactors and concomitant diseases are age-dependent. The data offers to identify risk factors of anaphylaxis.
Collapse
|
4
|
Marra CA, Harvard S, Grubisic M, Galo J, Clarke A, Elliott S, Lynd LD. Consumer preferences for food allergen labeling. Allergy Asthma Clin Immunol 2017; 13:19. [PMID: 28392808 PMCID: PMC5379517 DOI: 10.1186/s13223-017-0189-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/22/2017] [Indexed: 12/02/2022] Open
Abstract
Background Food allergen labeling is an important tool to reduce risk of exposure and prevent anaphylaxis for individuals with food allergies. Health Canada released a Canadian food allergen labeling regulation (2008) and subsequent update (2012) suggesting that research is needed to guide further iterations of the regulation to improve food allergen labeling and reduce risk of exposure. Objective The primary objective of this study was to examine consumer preferences in food labeling for allergy avoidance and anaphylaxis prevention. A secondary objective was to identify whether different subgroups within the consumer population emerged. Methods A discrete choice experiment using a fractional factorial design divided into ten different versions with 18 choice-sets per version was developed to examine consumer preferences for different attributes of food labeling. Results Three distinct subgroups of Canadian consumers with different allergen considerations and food allergen labeling needs were identified. Overall, preferences for standardized precautionary and safety symbols at little or no increased cost emerged. Conclusion While three distinct groups with different preferences were identified, in general the results revealed that the current Canadian food allergen labeling regulation can be improved by enforcing the use of standardized precautionary and safety symbols and educating the public on the use of these symbols.
Collapse
Affiliation(s)
- Carlo A Marra
- School of Pharmacy, Otago University, Dunedin, New Zealand
| | - Stephanie Harvard
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC Canada
| | - Maja Grubisic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,BC Centre for Improved Cardiovascular Health, Vancouver, BC Canada
| | | | - Ann Clarke
- Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Susan Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON Canada
| | - Larry D Lynd
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC Canada.,Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| |
Collapse
|
5
|
Mahdavinia M, Fox SR, Smith BM, James C, Palmisano EL, Mohammed A, Zahid Z, Assa'ad AH, Tobin MC, Gupta RS. Racial Differences in Food Allergy Phenotype and Health Care Utilization among US Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:352-357.e1. [PMID: 27888035 DOI: 10.1016/j.jaip.2016.10.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/27/2016] [Accepted: 10/10/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Food allergy (FA) is a prevalent condition in the United States, but little is known about its phenotypes in racial minority groups. OBJECTIVE The objective of this study was to characterize disease phenotypes and disparities in health care utilization among African American (AA), Hispanic, and white children with FA. METHODS We conducted a large, 2-center, retrospective cohort study of children aged 0-17 years with FA seen in allergy/immunology clinics at 2 urban tertiary care centers in the United States. We used multiple logistic regression analyses adjusted for age, gender, and insurance. RESULTS The cohort of 817 children was composed of 35% AA, 12% Hispanic, and 53% non-Hispanic white. Compared with non-Hispanic white children, AA children had significantly higher odds of having asthma and eczema (P < .01), and significantly higher odds of allergy to wheat, soy, corn, fish, and shellfish (P < .01). Compared with non-Hispanic white children, Hispanic children had significantly higher odds of allergy to corn, fish, and shellfish (P < .01), and higher odds of eczema (P < .01), but a similar rate of asthma (P = .44). In this cohort, 55%, 18%, and 11% of AA, Hispanic, and white children were covered by Medicaid, respectively (P < .00001). Compared with whites, AA and Hispanic children had a shorter duration of follow-up for FA with an allergy specialist and higher rates of FA-related anaphylaxis and emergency department visits (P < .01). CONCLUSIONS FA phenotypes and health care utilization differ among children of different racial and/or ethnic backgrounds in the United States that put AA and Hispanic children at higher risks of adverse outcome than white children. These differences include coexistent atopic conditions, less well recognized food allergens, and higher rates of anaphylaxis.
Collapse
Affiliation(s)
- Mahboobeh Mahdavinia
- Allergy/Immunology Section, Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Ill.
| | - Susan R Fox
- Allergy/Immunology Section, Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Ill
| | - Bridget M Smith
- Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Ill; Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Ill; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Christine James
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erica L Palmisano
- Allergy/Immunology Section, Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Ill
| | - Aisha Mohammed
- Allergy/Immunology Section, Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Ill
| | - Zeeshan Zahid
- Allergy/Immunology Section, Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Ill
| | - Amal H Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mary C Tobin
- Allergy/Immunology Section, Department of Immunology and Microbiology, Rush University Medical Center, Chicago, Ill
| | - Ruchi S Gupta
- Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| |
Collapse
|
6
|
Chen Q, Zhai Z, Xu J, Chen W, Chen S, Zhong H, Huang X, Hao F, Song Z. Basophil CD63 expression in chronic spontaneous urticaria: correlation with allergic sensitization, serum autoreactivity and basophil reactivity. J Eur Acad Dermatol Venereol 2016; 31:463-468. [PMID: 27518369 DOI: 10.1111/jdv.13912] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Q. Chen
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Z. Zhai
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - J. Xu
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - W. Chen
- IZZ Immunologie-Zentrum Zürich; Zürich Switzerland
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
| | - S. Chen
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - H. Zhong
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - X. Huang
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - F. Hao
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Z. Song
- Department of Dermatology; Southwest Hospital; Third Military Medical University; Chongqing China
| |
Collapse
|
7
|
Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, Ellis A, Golden DBK, Greenberger P, Kemp S, Khan D, Ledford D, Lieberman J, Metcalfe D, Nowak-Wegrzyn A, Sicherer S, Wallace D, Blessing-Moore J, Lang D, Portnoy JM, Schuller D, Spector S, Tilles SA. Anaphylaxis--a practice parameter update 2015. Ann Allergy Asthma Immunol 2016; 115:341-84. [PMID: 26505932 DOI: 10.1016/j.anai.2015.07.019] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 12/12/2022]
|
8
|
Prince BT, Mandel MJ, Nadeau K, Singh AM. Gut Microbiome and the Development of Food Allergy and Allergic Disease. Pediatr Clin North Am 2015; 62:1479-92. [PMID: 26456445 PMCID: PMC4721650 DOI: 10.1016/j.pcl.2015.07.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The impact of gut microbiome on human development, nutritional needs, and disease has become evident with advances in the ability to study these complex communities of microorganisms, and there is growing appreciation for the role of the microbiome in immune regulation. Several studies have examined associations between changes in the commensal microbiota and the development of asthma, allergic rhinitis, and asthma, but far less have evaluated the impact of the microbiome on the development of food allergy. This article reviews the human gastrointestinal microbiome, focusing on the theory and evidence for its role in the development of IgE-mediated food allergy and other allergic diseases.
Collapse
Affiliation(s)
- Benjamin T. Prince
- Department of Pediatrics, Division of Allergy and Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois,Department of Medicine, Division of Allergy and Immunology, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mark J. Mandel
- Department of Microbiology-Immunology, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kari Nadeau
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Anne Marie Singh
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, 225 East Chicago Avenue, #60, Chicago, IL 60611, USA; Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, #60, Chicago, IL 60611, USA.
| |
Collapse
|
9
|
Burnell FJ, Keijzers G, Smith P. Review article: quality of follow-up care for anaphylaxis in the emergency department. Emerg Med Australas 2015; 27:387-93. [PMID: 26315372 DOI: 10.1111/1742-6723.12458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/28/2022]
Abstract
The prevalence of allergic disorders is rising, with a corresponding increase in patients presenting to an ED with anaphylaxis. Appropriate follow up is required for patients with anaphylaxis. We reviewed two potential performance indicators for the quality of post-discharge care: (i) the rate of self-injectable adrenaline prescription; and (ii) the referral rate for follow-up care with allergy specialists. A search of Cochrane Library, PubMed and Google Scholar was performed using the following initial search string: anaphylaxis and 'emergency department'. We considered any (interventional or observational design) study assessing post-discharge care in anaphylaxis, measured by either adrenaline self-injection prescription or allergist referral. Subjects were patients with (suspected) anaphylaxis or severe allergic reaction, with no age limit. This review summarises findings from 16 relevant papers, all retrospective analyses of post-discharge care for anaphylaxis. Weighted arithmetic means were calculated for rates of prescription of adrenaline auto-injector and referral to an allergist following admission to an ED in patients with (suspected) anaphylaxis or severe allergic reaction. Prescription rates for self-injected adrenaline at the time of discharge following anaphylaxis varied from 0% to 68%, with a mean of 44%. Allergist referral rates ranged from 0% to 84%, with a mean of 33%. This review demonstrates that there is room for improvement in post-discharge care for patients who present to the ED with an anaphylactic reaction.
Collapse
Affiliation(s)
- Fiona J Burnell
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Pete Smith
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
10
|
|
11
|
Chandran M, Chu Y, Maleki SJ, Ozias-Akins P. Stability of transgene expression in reduced allergen peanut (Arachis hypogaea L.) across multiple generations and at different soil sulfur levels. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2015; 63:1788-1797. [PMID: 25616282 DOI: 10.1021/jf504892f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Transgenic peanut (Arachis hypogaea L.) containing a gene designed for RNA interference (RNAi) showed stable complete silencing of Ara h 2 and partial silencing of Ara h 6, two potent peanut allergens/proteins, along with minimal collateral changes to other allergens, Ara h 1 and Ara h 3, across three generations (T3, T4, and T5) under field conditions. Different soil sulfur levels (0.012, 0.3, and 3.0 mM) differentially impacted sulfur-rich (Ara h 2, Ara h 3, and Ara h 6) versus sulfur-poor (Ara h 1) proteins in non-transgenic versus transgenic peanut. The sulfur level had no effect on Ara h 1, whereas low sulfur led to a significant reduction of Ara h 3 in transgenic and non-transgenic seeds and Ara h 2 and Ara h 6 in non-transgenic but not in transgenic peanuts because these proteins already were reduced by gene silencing. These results demonstrate stability of transgene expression and the potential utility of RNAi in allergen manipulation.
Collapse
Affiliation(s)
- Manju Chandran
- Department of Horticulture, University of Georgia , Tifton, Georgia 31793-5766, United States
| | | | | | | |
Collapse
|
12
|
Laviolette M, Gossage DL, Gauvreau G, Leigh R, Olivenstein R, Katial R, Busse WW, Wenzel S, Wu Y, Datta V, Kolbeck R, Molfino NA. Effects of benralizumab on airway eosinophils in asthmatic patients with sputum eosinophilia. J Allergy Clin Immunol 2013; 132:1086-1096.e5. [PMID: 23866823 DOI: 10.1016/j.jaci.2013.05.020] [Citation(s) in RCA: 367] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many asthmatic patients exhibit sputum eosinophilia associated with exacerbations. Benralizumab targets eosinophils by binding IL-5 receptor α, inducing apoptosis through antibody-dependent cell-mediated cytotoxicity. OBJECTIVES We sought to evaluate the safety of benralizumab in adults with eosinophilic asthma and its effects on eosinophil counts in airway mucosal/submucosal biopsy specimens, sputum, bone marrow, and peripheral blood. METHODS In this multicenter, double-blind, placebo-controlled phase I study, 13 subjects were randomized to single-dose intravenous placebo or 1 mg/kg benralizumab (day 0; cohort 1), and 14 subjects were randomized to 3 monthly subcutaneous doses of placebo or 100 or 200 mg of benralizumab (days 0, 28, and 56; cohort 2). Cohorts 1 and 2 were consecutive. RESULTS The incidence of adverse events was similar between groups. No serious adverse events related to benralizumab occurred. In cohort 1 intravenous benralizumab produced a median decrease from baseline of 61.9% in airway mucosal eosinophil counts (day 28; placebo: +19.6%; P = .28), as well as an 18.7% decrease (day 21) in sputum and a 100% decrease (day 28) in blood counts. Eosinophils were not detectable in bone marrow of benralizumab-treated subjects (day 28, n = 4). In cohort 2 subcutaneous benralizumab demonstrated a combined (100 + 200 mg) median reduction of 95.8% in airway eosinophil counts (day 84; placebo, 46.7%; P = .06), as well as an 89.9% decrease (day 28) in sputum and a 100% decrease (day 84) in blood counts. CONCLUSION Single-dose intravenous and multiple-dose subcutaneous benralizumab reduced eosinophil counts in airway mucosa/submucosa and sputum and suppressed eosinophil counts in bone marrow and peripheral blood. The safety profile supports further development. Additional studies are needed to assess the clinical benefit in asthmatic patients.
Collapse
Affiliation(s)
- Michel Laviolette
- Faculté de médecine, département de médecine, Université Laval, Quebec City, Quebec, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
Recently, the National Institute of Allergy and Infectious Diseases sought to establish consistency in definitions, diagnostic criteria, and management practices concerning food allergies (FAs). This review aimed to summarize and highlight the relevant findings of these guidelines for the emergency department provider, as pediatric patients often present to the emergency department with FAs or other disorders mimicking FAs.
Collapse
|
14
|
Topal E, Bakirtas A, Yilmaz O, Ertoy IH, Arga M, Demirsoy MS, Turktas I. A real-life study on acquired skills from using an adrenaline autoinjector. Int Arch Allergy Immunol 2012; 160:301-6. [PMID: 23095342 DOI: 10.1159/000341367] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Training programs performed by allergists have increased the ability of patients' recognition and management of anaphylaxis. We aim to investigate the permanence of effect of an anaphylaxis training program and to determine the factors affecting it beyond training given by allergists. METHODS Children and/or their caregivers who had been prescribed an adrenaline autoinjector at least 1 year before were invited to take part in the study. The knowledge about anaphylaxis was assessed using a questionnaire and the skills were practically tested. RESULTS Sixty-four (50 caregivers/14 children >12 years of age) of 80 patients who accepted the invitation were included in the study. Fifty-nine patients obtained the autoinjector after initial prescription. Among them, 42 (71%) still had the device at the time of the study. The most common reason for not having the autoinjector was no longer feeling it was necessary (54.6%). Of the cases, 39.4% were competent in autoinjector use. There was a significant relation between adrenaline autoinjector competency and regular allergy visits (p = 0.010), believing that it is necessary (p = 0.04), having an adrenaline autoinjector (p = 0.003), and previous history of severe anaphylaxis (p = 0.010). Autoinjector competency score decreased as time elapsed from the last visit (rho = -0.382; p = 0.002) and the first instruction (rho = -0.317; p = 0.01). Regular visits (p = 0.009) and history of severe anaphylaxis (p = 0.007) were found as independent factors having an effect on adrenaline autoinjector competency. CONCLUSIONS Training of patients/caregivers by allergists does not guarantee the permanence of acquired skills on anaphylaxis in the long run. Regular follow-up visits should be fostered.
Collapse
Affiliation(s)
- Erdem Topal
- Department of Pediatric Allergy and Asthma, Gazi University Faculty of Medicine, Ankara, Turkey. erdemtopal44 @ gmail.com
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
The aim of this review was to describe the current evidence-based knowledge of the epidemiology, prevalence, incidence, risk factors and genetic associations of drug allergy. Articles published between 1966 and 2010 were identified in MEDLINE using the key words adult, adverse drug reaction reporting systems, age factors, anaphylactoid, anaphylaxis, anaesthetics, antibiotics, child, drug allergy, drug eruptions, ethnic groups, hypersensitivity, neuromuscular depolarizing agents, neuromuscular nondepolarizing agents, sex factors, Stevens Johnson syndrome and toxic epidermal necrolysis. Additional studies were identified from article reference lists. Relevant, peer-reviewed original research articles, case series and reviews were considered for review. Current epidemiological studies on adverse drug reactions (ADRs) have used different definitions for ADR-related terminology, often do not differentiate immunologically and non-immunologically mediated drug hypersensitivity, study different study populations (different ethnicities, inpatients or outpatients, adults or children), utilize different methodologies (spontaneous vs. non-spontaneous reporting, cohort vs. case-control studies), different methods of assessing drug imputability and different methods of data analyses. Potentially life-threatening severe cutaneous adverse reactions (SCAR) are associated with a high risk of morbidity and mortality. HLA associations for SCAR associated with allopurinol, carbamazepine and abacavir have been reported with the potential for clinical use in screening prior to prescription. Identification of risk factors for drug allergy and appropriate genetic screening of at-risk ethnic groups may improve the outcomes of drug-specific SCAR. Research and collaboration are necessary for the generation of clinically-relevant, translational pharmacoepidemiological and pharmacogenomic knowledge, and success of health outcomes research and policies on drug allergies.
Collapse
Affiliation(s)
- Bernard Y-H Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.
| | | |
Collapse
|
16
|
Abstract
Food allergies are immune-mediated responses to food proteins. Because of differences in the underlying immunologic mechanisms, there are varying clinical presentations of food allergy. This article discusses the manifestations of IgE-mediated disorders, including urticaria and angioedema, rhinoconjunctivitis, asthma, gastrointestinal anaphylaxis, generalized anaphylaxis, food-dependent exercise-induced anaphylaxis, and oral allergy syndrome. It also reviews the presentations of mixed IgE- and cell-mediated disorders, including atopic dermatitis and eosinophilic gastrointestinal disorders. Finally, the manifestations of cell-mediated food allergies are discussed, including dietary protein-induced proctitis and proctocolitis, food protein-induced enterocolitis syndrome, celiac disease, and food-induced pulmonary hemosiderosis.
Collapse
Affiliation(s)
- Darlene K Mansoor
- Division of Allergy and Immunology, Center for Cancer and Blood Disorders, Children's National Medical Center, 111 Michigan Avenue, North West, Washington, DC 20010, USA
| | | |
Collapse
|
17
|
Abstract
Food-induced anaphylactic reactions are common and increasing in frequency. Despite the existence of a consensus definition of anaphylaxis, many cases are missed, recommended treatments are not given, and follow-up is inadequate. New aspects of its pathophysiology and causes, including atypical food-induced causes, are still being uncovered. Epinephrine remains the cornerstone for successfully treating anaphylaxis; H1 and H2 antihistamines, glucocorticoids, and β-agonists are ancillary medications that may be used in addition to epinephrine. Early recognition of anaphylaxis, appropriate emergency treatment, and follow up, including prescription of self-injectable epinephrine, are essential to prevent death and significant morbidity from anaphylaxis.
Collapse
Affiliation(s)
- Corinne Keet
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, CMSC 1102, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| |
Collapse
|
18
|
Abstract
Anaphylaxis is a clinical emergency, and recent reports suggest increased prevalence. A diverse set of primary genetic and environmental influences may confer susceptibility to anaphylactic reactions. Anaphylaxis presents diagnostic and therapeutic challenges. It often manifests with a broad array of symptoms and signs that might be similar to other diseases. The management of anaphylaxis consists of emergency treatment of acute episodes as well as preventive strategies to avoid recurrences. Treatment is complicated by its rapid onset and progression, presence of concurrent diseases or medications, and need for long-term allergen avoidance. Health care professionals must be able to recognize the signs of anaphylaxis, treat an episode promptly and appropriately, and provide preventive recommendations. Recognizing the gaps in our understanding and management of anaphylaxis may help identify promising targets for future treatment and prevention and areas that require further study.
Collapse
Affiliation(s)
- M Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
| | | |
Collapse
|
19
|
Lieberman P, Nicklas RA, Oppenheimer J, Kemp SF, Lang DM, Bernstein DI, Bernstein JA, Burks AW, Feldweg AM, Fink JN, Greenberger PA, Golden DBK, James JM, Kemp SF, Ledford DK, Lieberman P, Sheffer AL, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles S, Wallace D. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010; 126:477-80.e1-42. [PMID: 20692689 DOI: 10.1016/j.jaci.2010.06.022] [Citation(s) in RCA: 460] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 04/27/2010] [Accepted: 06/08/2010] [Indexed: 11/19/2022]
Abstract
These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "The Diagnosis and Management of Anaphylaxis Practice Parameter: 2010 Update." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, or the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.
Collapse
Affiliation(s)
- Phillip Lieberman
- JointCouncil of Allergy, Asthma&Immunology, 50NBrockway St, #3-3, Palatine, IL 60067, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Worm M, Timmermans F, Moneret-Vautrin A, Muraro A, Malmheden Yman II, Lövik M, Hattersley S, Crevel R. Towards a European registry of severe allergic reactions: current status of national registries and future needs. Allergy 2010; 65:671-80. [PMID: 20148805 DOI: 10.1111/j.1398-9995.2010.02332.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incidence of severe allergic reactions is largely unknown and information about triggering allergens, aggravating factors, demography of patients and medical care is lacking. A European wide registry could provide a powerful tool to improve the management of severe allergic reactions from both a medical and a public health perspective. Analysis of existing registries regarding the type and quality of data being collected was used to develop a plan for a pan-European registry, including the type of system to be used and the range of data to be entered. Surveillance will provide evidence for the efficacy of risk management measures and may identify the emergence of new allergenic foods, and aid monitoring of novel foods, ingredients and technologies. Patients need a clear indication of factors that may increase their risk of having an adverse reaction, which such a registry can help compile. Based on the collected data, food businesses will be able to develop educational programmes for allergen risk assessment and allergen risk communication. Finally, and most importantly preventive measures can be developed and government agencies receive population based data which may be relevant for legislative purposes.
Collapse
Affiliation(s)
- M Worm
- Department for Dermatology and Allergy, Allergy-Center-Charité, Charité Campus Mitte, Medical University Berlin, Germany
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Ben-Shoshan M, Harrington DW, Soller L, Fragapane J, Joseph L, St Pierre Y, Godefroy SB, Elliot SJ, Clarke AE. A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada. J Allergy Clin Immunol 2010; 125:1327-35. [DOI: 10.1016/j.jaci.2010.03.015] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 03/11/2010] [Accepted: 03/19/2010] [Indexed: 11/26/2022]
|
22
|
Khachman D, Gandia P, Sallerin F, Mailly N. [Immediate and delayed hypersensitivity reactions to iodinated radiographic contrast agents: an update]. Therapie 2009; 64:331-9. [PMID: 19863909 DOI: 10.2515/therapie/2009040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnostic and interventional radiology of patients is nowadays crucial with increasing requirement for iodinated contrast agents infusion. Besides adverse reactions after administration of the iodinated contrast agents due to their toxicity, immediate hypersensitivity reactions and reactions resembling delayed hypersensitivity appearing from 1 hour to several days later, have been reported. Patients at high risk to develop such adverse events have to be detected on the basis of their risk factors in order to prevent or limit serious outcomes. Previous reactions to contrast media, asthma, atopy and cardiovascular disorders are risk factors for anaphylactic or anaphylactoid reactions. Female gender, age and beta-blockers increase the severity. This article aims to summarize the risk of allergic reactions related to the use of iodinated contrast agents and to suggest a way for diagnosis, treatment and prevention according to each clinical situation.
Collapse
Affiliation(s)
- Dalia Khachman
- Laboratoire de Pharmacocinétique et Toxicologie Clinique, Hôpital Purpan, Institut Fédératif de Biologie, Toulouse, France
| | | | | | | |
Collapse
|
23
|
Atkins D, Bock SA. Fatal anaphylaxis to foods: epidemiology, recognition, and prevention. Curr Allergy Asthma Rep 2009; 9:179-85. [PMID: 19348717 DOI: 10.1007/s11882-009-0027-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The inability to accurately predict the severity of future allergic reactions to foods in a given individual coupled with the real--although usually remote--risk of a fatal anaphylactic reaction complicates care and remains a constant source of concern to food-allergic patients, their family members, and health care providers. Current epidemiologic evidence suggests that the incidence of food-induced anaphylaxis is increasing, although confidently approximating the incidence of fatal allergic reactions to foods remains difficult. This article briefly reviews the epidemiology of fatal anaphylactic reactions to foods, discusses factors that may aid in identifying individuals at higher risk, emphasizes important aspects of patient education and prevention, and touches on the psychological impact of having a family member with food allergy.
Collapse
Affiliation(s)
- Dan Atkins
- National Jewish Health, 1400 Jackson Street, J301, Denver, CO 80206, USA.
| | | |
Collapse
|
24
|
Abstract
Anaphylaxis is a source of anxiety for patients and healthcare providers. It is a medical emergency that presents with a broad array of symptoms and signs, many of which can be deceptively similar to other diseases such as myocardial infarction, asthma, or panic attacks. In addition to these diagnostic challenges, anaphylaxis presents management difficulties due to rapid onset and progression, lack of appropriate self-treatment education and implementation by patients, severity of the allergic response, exacerbating medications or concurrent disease, and unpredictability. The most common causes of anaphylaxis are food allergies, stinging insects and immunotherapy (allergy shots) but idiopathic anaphylaxis, latex allergy and drug hypersensitive all contribute to the epidemiology. Reactions to IVP and other dyes are coined anaphylactoid reactions but have identical pathophysiology and treatment, once the mast cell has been degranulated. As many antigens can be the trigger for fatal anaphylaxis, it is useful to examine the features of each etiology individually, highlighting factors common to all fatal anaphylaxis and some specific to certain etiologies. Generally what distinguishes a fatal from non fatal reaction is often just the rapidity to apply correct therapy. Prevention is clearly the key and should identify high-risk patients in an attempt to minimize the likely of a severe reaction. Although fatal anaphylaxis is rare, it is likely underreported.
Collapse
Affiliation(s)
- Arvind Kumar
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Internal Medicine, University of California at Davis School of Medicine, CA 95616, USA
| | | | | |
Collapse
|
25
|
Commins SP, Satinover SM, Hosen J, Mozena J, Borish L, Lewis BD, Woodfolk JA, Platts-Mills TAE. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J Allergy Clin Immunol 2009; 123:426-33. [PMID: 19070355 PMCID: PMC3324851 DOI: 10.1016/j.jaci.2008.10.052] [Citation(s) in RCA: 459] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/26/2008] [Accepted: 10/28/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Carbohydrate moieties are frequently encountered in food and can elicit IgE responses, the clinical significance of which has been unclear. Recent work, however, has shown that IgE antibodies to galactose-alpha-1,3-galactose (alpha-gal), a carbohydrate commonly expressed on nonprimate mammalian proteins, are capable of eliciting serious, even fatal, reactions. OBJECTIVE We sought to determine whether IgE antibodies to alpha-gal are present in sera from patients who report anaphylaxis or urticaria after eating beef, pork, or lamb. METHODS Detailed histories were taken from patients presenting to the University of Virginia Allergy Clinic. Skin prick tests (SPTs), intradermal skin tests, and serum IgE antibody analysis were performed for common indoor, outdoor, and food allergens. RESULTS Twenty-four patients with IgE antibodies to alpha-gal were identified. These patients described a similar history of anaphylaxis or urticaria 3 to 6 hours after the ingestion of meat and reported fewer or no episodes when following an avoidance diet. SPTs to mammalian meat produced wheals of usually less than 4 mm, whereas intradermal or fresh-food SPTs provided larger and more consistent wheal responses. CAP-RAST testing revealed specific IgE antibodies to beef, pork, lamb, cow's milk, cat, and dog but not turkey, chicken, or fish. Absorption experiments indicated that this pattern of sensitivity was explained by an IgE antibody specific for alpha-gal. CONCLUSION We report a novel and severe food allergy related to IgE antibodies to the carbohydrate epitope alpha-gal. These patients experience delayed symptoms of anaphylaxis, angioedema, or urticaria associated with eating beef, pork, or lamb.
Collapse
Affiliation(s)
- Scott P. Commins
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville
| | - Shama M. Satinover
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville
| | - Jacob Hosen
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville
| | | | - Larry Borish
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville
| | | | - Judith A. Woodfolk
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville
| | | |
Collapse
|
26
|
Abstract
Anaphylaxis is a severe, life-threatening immunoglobulin E (IgE)-mediated hypersensitivity reaction. The key to successful management of anaphylaxis involves rapid diagnosis, assessment, and early initiation of therapy. Epinephrine is the undisputed initial therapy for anaphylaxis, and its administration should never be delayed. In most cases, additional interventions such as oxygen therapy, fluid resuscitation, beta-agonists, antihistamines, and corticosteroids should be strongly considered. Although hospital course must be individualized to meet each patient's needs, a minimum of 4 to 6 hours of observation period after complete symptom resolution may be reasonable to monitor for recurrence of symptoms and biphasic reaction. Before discharge, every patient should receive patient education about anaphylaxis, a prescription for self-injectable epinephrine, and instructions for follow-up care.
Collapse
|
27
|
Kulthanan K, Jiamton S, Rutnin NO, Insawang M, Pinkaew S. Prevalence and relevance of the positivity of skin prick testing in patients with chronic urticaria. J Dermatol 2008; 35:330-5. [PMID: 18578709 DOI: 10.1111/j.1346-8138.2008.00477.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many patients with chronic urticaria (CU) worry that foods or other allergens are responsible for their urticaria. Skin prick testing (SPT) may be one of the investigations used to provide a clear illustration. The purpose of our study was to assess the prevalence of positivity of SPT to food allergens and aeroallergens and their relevance in patients with CU, in order to demonstrate the diagnostic value of SPT in CU. We retrospectively reviewed case record forms of patients with chronic ordinary urticaria who underwent SPT in the Urticaria Clinic, Siriraj Hospital, during the period 2000-2004. The studied allergens included 16 food allergens and 12 aeroallergens. Eighty-eight patients were enrolled. The prevalence of positive SPT among patients with CU was 47.7%. Patients who had personal histories of atopy had statistically significant positive SPT results compared with patients who had negative SPT. Of 88 patients, 26 patients (30%) gave positive results to food allergens, 36 patients (41%) gave positive results to aeroallergens and 20 patients (22.7%) gave positive results to both food and aeroallergens. One-third of the subjects (34.6%) who had positive SPT results to food allergens had clinical relevance of food allergy in some systems but only one patient had clinical relevance of food-induced urticaria. Half of the patients who had a history of aeroallergen sensitivity gave a positive SPT response for aeroallergens; however, there was no clinical relevance to their CU. Our study showed that the prevalence of positive SPT to food allergens and aeroallergens in patients with CU was common but had little clinical relevance to CU.
Collapse
Affiliation(s)
- Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | | | | | | | |
Collapse
|
28
|
Khalid I, Zoratti E, Stagner L, Betensley AD, Nemeh H, Allenspach L. Transfer of peanut allergy from the donor to a lung transplant recipient. J Heart Lung Transplant 2008; 27:1162-4. [PMID: 18926410 DOI: 10.1016/j.healun.2008.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 07/02/2008] [Accepted: 07/17/2008] [Indexed: 01/29/2023] Open
Abstract
Among solid organs, transfer of peanut allergy from donor to recipient has been implicated after liver transplantation. We report the first case in which such transfer occurred after a lung transplant. A 42-year-old woman with history of sarcoidosis underwent a successful bilateral lung transplant from a donor who died from anaphylactic shock after eating peanut-related food. Seven months later, she ate a peanut butter cookie at a transplant support group meeting. Immediately thereafter, she developed an anaphylactic reaction, but survived with prompt treatment. During subsequent follow-up, she could recall three prior episodes of wheezing and difficulty breathing after eating peanut-related foods. The first episode occurred 4 days after the transplant. Prior to her transplant, she never had problems eating peanuts. Skin-prick testing confirmed peanut sensitization. She avoided peanuts and, although her skin-prick test became negative, she still manifested peanut allergy when formally challenged orally with the food. She was advised to continue abstaining from all peanut-related foods. This case emphasizes the importance of considering donor allergy transfer when caring for all solid-organ transplant recipients in order to avoid a life-threatening event.
Collapse
Affiliation(s)
- Imran Khalid
- Department of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan 48202, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Ben-Shoshan M, Kagan R, Primeau MN, Alizadehfar R, Verreault N, Yu JW, Nicolas N, Joseph L, Turnbull E, Dufresne C, St. Pierre Y, Clarke A. Availability of the epinephrine autoinjector at school in children with peanut allergy. Ann Allergy Asthma Immunol 2008; 100:570-5. [DOI: 10.1016/s1081-1206(10)60056-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Talley NJ. Gut eosinophilia in food allergy and systemic and autoimmune diseases. Gastroenterol Clin North Am 2008; 37:307-32, v. [PMID: 18499022 DOI: 10.1016/j.gtc.2008.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Eosinophilic gastroenteritis is a rare disease characterized by striking tissue eosinophilia in any layer of the gut wall; however, many diseases can cause increased gut eosinophilia. Allergic reactions to food are an important cause of gut eosinophilia. Not all adverse reactions to food are IgE mediated, and most cases of IgE-mediated food allergy do not have eosinophilic gastroenteritis. Parasitic, bacterial, and viral pathogens as well as certain systemic diseases such as vasculitis can cause gut eosinophilia. These heterogeneous conditions are reviewed in this article.
Collapse
Affiliation(s)
- Nicholas J Talley
- Division of Gastroenterology and Hepatology, Mayo Clinic Campus, Mayo Clinic, Jacksonville, FL 32224, USA.
| |
Collapse
|
31
|
|
32
|
Yang MS, Lee SH, Kim TW, Kwon JW, Lee SM, Kim SH, Kwon HS, Park CH, Park HW, Kim SS, Cho SH, Min KU, Kim YY, Chang YS. Epidemiologic and clinical features of anaphylaxis in Korea. Ann Allergy Asthma Immunol 2008; 100:31-6. [PMID: 18254479 DOI: 10.1016/s1081-1206(10)60401-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the characteristics of anaphylaxis in Korea or even in Asia. OBJECTIVE To evaluate the incidence of anaphylaxis and the clinical features of patients with anaphylaxis in a Korean tertiary care hospital. METHODS We performed a retrospective review from January 1, 2000, through July 31, 2006, of 138 patients with anaphylaxis, including inpatients, outpatients, and emergency department visitors, in the Seoul National University Hospital. RESULTS Among 978,146 patients, 138 (0.014%) had anaphylaxis. Two cardiopulmonary resuscitations were performed and 1 death occurred. The total mortality rate of anaphylactic patients was 0.0001%. The causes of anaphylaxes were drug (35.3%), food (21.3%), food-dependent exercise-induced (13.2%), idiopathic (13.2%), insect stings (11.8%), exercise induced (2.9%), blood products (1.5%), and latex (0.7%). Radiocontrast media and buckwheat were the leading causes of drug and food anaphylaxis, respectively. The organs most frequently involved in the anaphylaxis were cutaneous (95.7%), cardiovascular (76.8%), and respiratory (74.6%). The most common manifestations were dyspnea (71.3%), urticaria (81.9%), and angioedema (69.4%). Three of 138 patients (2.2%) had biphasic reactions. CONCLUSIONS The incidence, mortality rate, and clinical features of Korean patients with anaphylaxis were similar to rates for patients from other countries, despite some differences in causative agents.
Collapse
Affiliation(s)
- Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Brzoza Z, Kasperska-Zajac A, Rogala E, Rogala B. Anaphylactoid reaction after the use of sodium tetradecyl sulfate: a case report. Angiology 2007; 58:644-6. [PMID: 18024951 DOI: 10.1177/0003319706291170] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sodium tetradecyl sulfate is a sclerosing agent that has been widely used to treat varicose veins of the legs and digestive tract. Despite the multitude of side-effects of sclerotherapy procedures and sclerosing-drug administration, the medical literature reports only on a few cases of life-threatening hypersensitivity reactions resulting from sodium tetradecyl sulfate therapy. A case is reported of a 49-year-old woman who developed anaphylactoid reaction after the administration of the Fibro-vein for varicose veins in the legs. Attention is drawn to this adverse event and underlines the necessity for potential hypersensitivity assessment before the drug application.
Collapse
Affiliation(s)
- Zenon Brzoza
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
| | | | | | | |
Collapse
|
34
|
Abstract
Food allergy is a common cause of anaphylaxis, and its incidence is rising. The development of allergy is multifactorial, and the mechanisms of tolerance are complex. The natural history of food allergy varies by causative food; some allergies are mostly outgrown, while others are usually life-long. Anaphylaxis caused by food allergy may differ clinically from other causes of anaphylaxis. Death is usually caused by respiratory failure, and patients who have asthma are at greatest risk for severe reactions. At this time, avoiding allergenic triggers, and when that fails, timely administration of epinephrine, are the main approaches to food allergy. Although several experimental medications promise to dramatically change the field of food allergy, none of these treatments are currently available outside of research settings.
Collapse
Affiliation(s)
- Corinne A Keet
- Department of Pediatrics, Johns Hopkins School of Medicine, CMSC 1102, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | | |
Collapse
|
35
|
Kang IH, Srivastava P, Ozias-Akins P, Gallo M. Temporal and spatial expression of the major allergens in developing and germinating peanut seed. PLANT PHYSIOLOGY 2007; 144:836-45. [PMID: 17468222 PMCID: PMC1914213 DOI: 10.1104/pp.107.096933] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Peanut (Arachis hypogaea) seed proteins Ara h 1, Ara h 2, and Ara h 3 are considered to be the major peanut allergens. However, little is known about their temporal and spatial expression during seed development and upon germination and seedling growth. In this study, transcript levels of the three major peanut allergen genes, ara h 1, ara h 2, and ara h 3, and their corresponding proteins were found in all cultivars. Expression patterns were heterogeneous depending on the specific peanut allergen gene and the cultivars tested. However, ara h 3 expression patterns among the cultivars were more variable than ara h 1 and ara h 2. Transcripts were tissue specific, observed in seeds, but not in leaves, flowers, or roots, and were undetectable during seed germination. In situ hybridizations and immunotissue prints revealed that both embryonic axes and cotyledons expressed the allergens. However, more ara h 1 and ara h 3 messenger RNA was detected in cotyledons relative to embryonic axes. Allergen polypeptide degradation patterns were different in embryonic axes compared with cotyledons during germination and seedling growth, with levels of Ara h 1 and Ara h 2 dramatically reduced compared to the Ara h 3 polypeptides in embryonic axes. These characterization studies of major peanut allergen genes and their corresponding seed storage proteins can provide the basic information needed for biochemical and molecular approaches to obtain a hypoallergenic peanut.
Collapse
Affiliation(s)
- Il-Ho Kang
- Department of Biology, University of Utah, Salt Lake City, Utah 84112, USA
| | | | | | | |
Collapse
|
36
|
Lieberman P, Camargo CA, Bohlke K, Jick H, Miller RL, Sheikh A, Simons FER. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2007; 97:596-602. [PMID: 17165265 DOI: 10.1016/s1081-1206(10)61086-1] [Citation(s) in RCA: 308] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To improve understanding of the epidemiology of anaphylaxis. DATA SOURCES We performed a qualitative review by hand of the major epidemiology studies of anaphylaxis. This review was restricted to articles in the English language. STUDY SELECTION Articles chosen were selected by the committee and dated back to 1968. There was no specific criterion used for selection except the determination of the members of the committee. RESULTS Data on anaphylaxis incidence and prevalence are sparse and often imprecise. Findings are based on diverse study designs and are not entirely comparable. These factors have contributed to widely varying estimates of the frequency of this important condition. The roundtable discussion led to an improved estimation of the frequency of anaphylaxis: approximately 50 to 2,000 episodes per 100,000 persons or a lifetime prevalence of 0.05% to 2.0%. The largest number of incident cases is among children and adolescents. In addition to underdiagnosis, we noted undertreatment, especially for those at highest risk (ie, those without immediate access to treatment with epinephrine). CONCLUSIONS Anaphylaxis is a relatively common problem, affecting up to 2% of the population. Further data on epinephrine dispensing could improve current estimates. Another way to improve current understanding would be through better population-based study designs in different geographic regions. A recurring theme was the importance of broader access to self-injectable epinephrine for high-risk populations. An improved epidemiologic understanding of this disorder would aid ongoing efforts to reduce morbidity and mortality from anaphylaxis and could provide important clues for primary prevention.
Collapse
Affiliation(s)
- Phil Lieberman
- Division of Allergy/Immunology, Department of Medicine, University of Tennessee College of Medicine, Germantown, Tennessee, USA.
| | | | | | | | | | | | | |
Collapse
|
37
|
Ioannidis TI, Mazarakis A, Notaras SP, Karpeta MZ, Tsintoni AC, Kounis GN, Rallis DG, Kounis NG. Hymenoptera sting-induced Kounis syndrome: effects of aspirin and beta-blocker administration. Int J Cardiol 2006; 121:105-8. [PMID: 17097168 DOI: 10.1016/j.ijcard.2006.08.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 08/04/2006] [Indexed: 11/21/2022]
Abstract
Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with activation of interacting inflammatory cells including allergic or hypersensitivity and anaphylactic or anaphylactoid insults. It is caused via inflammatory mediators released during inflammatory cell activation. A variety of conditions, drugs, and environmental exposures can induce Kounis syndrome. A patient suffering from coronary artery disease and taking metoprolol and aspirin was stung by wasps and developed cutaneous allergic signs including rash, urticaria and orbital oedema. This was followed by retrosternal pain, chest discomfort and electrocardiographic changes compatible with acute myocardial ischemia. Cardiac enzymes, troponins and blood pressure remained normal but serum tryptase was raised. The clinical implications and pathophysiology of this rare association are discussed.
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Food allergy is increasing in prevalence in Western populations, but little is known about it in Asia. The perception is that the prevalence in this region is low, but is likely to increase with the global increase in allergy. Asia is unique because of the many different cultures and eating habits, with the resulting occurrence of unique food allergens. This review describes the epidemiology and clinical features of food allergy, and introduces some of the unusual food allergens in Asia. RECENT FINDINGS Recent studies describing the pattern of anaphylaxis and the role of food triggers show that food is an important cause of severe allergic reactions in Asia. Progress has been made on the characterization of unique food allergens from the region. Peanut and tree nuts are rarely the cause of allergic reactions in Asia. The lack of availability of epinephrine auto-injectors in many countries is an important issue that needs to be addressed. SUMMARY The pattern of food allergy in Asia is unique. Unfortunately, data from many parts of Asia are still lacking. Large, well-designed epidemiological studies are needed so that the scale of the problem can be understood, public awareness can be increased and important food allergens in the region can be identified.
Collapse
Affiliation(s)
- Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore.
| | | |
Collapse
|
39
|
|
40
|
VAN DER KLAUW MM, WILSON JHP, STRICKER BHCH. Drug-associated anaphylaxis: 20 years of reporting in the Netherlands (1974-1994) and review of the literature. Clin Exp Allergy 2006. [DOI: 10.1111/j.1365-2222.1996.tb00536.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
41
|
|
42
|
Abstract
Adverse reactions to foods, aside from those considered toxic, are caused by a particular individual intolerance towards commonly tolerated foods. Intolerance derived from an immunological mechanism is referred to as Food Allergy, the non-immunological form is called Food Intolerance. IgE-mediated food allergy is the most common and dangerous type of adverse food reaction. It is initiated by an impairment of normal Oral Tolerance to food in predisposed individuals (atopic). Food allergy produces respiratory, gastrointestinal, cutaneous and cardiovascular symptoms but often generalized, life-threatening symptoms manifest at a rapid rate-anaphylactic shock. Diagnosis is made using medical history and cutaneous and serological tests but to obtain final confirmation a Double Blind Controlled Food Challenge must be performed. Food intolerances are principally caused by enzymatic defects in the digestive system, as is the case with lactose intolerance, but may also result from pharmacological effects of vasoactive amines present in foods (e.g. Histamine). Prevention and treatment are based on the avoidance of the culprit food.
Collapse
Affiliation(s)
- Claudio Ortolani
- Istituto Allergologico Lombardo, Piazza Monsignor Moneta 1, 20090 Cesano Boscone, Milan, Italy.
| | | |
Collapse
|
43
|
Chu KH, Tang CY, Wu A, Leung PSC. Seafood allergy: lessons from clinical symptoms, immunological mechanisms and molecular biology. ADVANCES IN BIOCHEMICAL ENGINEERING/BIOTECHNOLOGY 2005; 97:205-35. [PMID: 16261809 DOI: 10.1007/b135827] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Food allergy consists of a wide range of disorders that result from adverse immune responses to dietary antigens. Manifestations of allergic response includes acute, potentially fatal anaphylactic reactions and a variety of chronic diseases that mainly affect the gastrointestinal tract, skin, and respiratory tract. Tools for clinical diagnosis and management, which have not changed much in the past two decades, include the clinical history, tests for specific IgE antibody to suspected foods, elimination diets, oral food challenges, and provision of medications such as epinephrine for emergency treatment. On the other hand, recent immunological and molecular biological research have enhanced our understanding of the mechanisms of these disorders and revealed the identities of many food allergens. Here, we will discuss seafood allergies with respect to the clinical manifestations, diagnosis, immunological mechanisms, and molecular biology of seafood allergens. Furthermore, potential applications and future directions in the clinical management of seafood allergies are discussed.
Collapse
Affiliation(s)
- Ka Hou Chu
- Department of Biology, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | |
Collapse
|
44
|
Hannaway PJ, Connelly ME, Cobbett RM, Dobrow PJ. Differences in race, ethnicity, and socioeconomic status in schoolchildren dispensed injectable epinephrine in 3 Massachusetts school districts. Ann Allergy Asthma Immunol 2005; 95:143-8. [PMID: 16136763 DOI: 10.1016/s1081-1206(10)61203-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Published surveys depicting the increase in the incidence of food allergy, especially peanut or tree nut allergy, in children have not reported any differences in race, ethnicity, or socioeconomic status. OBJECTIVE To analyze the demographics of schoolchildren with diverse racial, ethnic, and socioeconomic characteristics dispensed injectable epinephrine. METHODS School nurses in 44 schools enrolling 21,875 students recorded the characteristics of students dispensed injectable epinephrine in the 2003-2004 school year. Surveyed school districts included 2 affluent suburban districts enrolling 5,855 students (> 92% white) and 1 urban district enrolling 16,020 students (60% nonwhite). RESULTS A total of 181 students in all 3 districts were dispensed injectable epinephrine; 118 of these children had peanut or tree nut allergy. Males were more likely to be dispensed injectable epinephrine than females (odds ratio [OR], 1.44; P < .02). Whites were more likely to have been dispensed injectable epinephrine than nonwhites (OR, 4.76; P < .001). Whites were nearly 5 times more likely to be dispensed injectable epinephrine for peanut or tree nut allergy than nonwhites (OR, 4.5; P < .001). Most students (75%) dispensed injectable epinephrine for peanut or tree nut allergy were enrolled in prekindergarten through grade 5 (P < .001). Whites were more likely than nonwhites to be dispensed injectable epinephrine for stinging insect allergy (OR, 8.7; P < .001). CONCLUSIONS This study found significant racial, ethnic, and socioeconomic differences in the prevalence of childhood allergic disorders, especially peanut or tree nut allergy, requiring prescribed injectable epinephrine in a school setting. Additional studies are needed to determine whether minority children are being underdiagnosed or undertreated for allergic disorders requiring injectable epinephrine or whether they truly have a lower incidence of such allergic disorders.
Collapse
Affiliation(s)
- Paul J Hannaway
- Division of Allergy and Immunology, North Shore Medical Center, Salem, Massachusetts, USA.
| | | | | | | |
Collapse
|
45
|
Lin RY, Cannon AG, Teitel AD. Pattern of hospitalizations for angioedema in New York between 1990 and 2003. Ann Allergy Asthma Immunol 2005; 95:159-66. [PMID: 16136766 DOI: 10.1016/s1081-1206(10)61206-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The epidemiologic characteristics of angioedema have not been well described in the United States, especially regarding hospitalization patterns. This fact is particularly relevant given the increased use of angiotensin-converting enzyme inhibitors, a known cause of angioedema. OBJECTIVE To profile hospital admissions for angioedema in New York State with respect to age, sex, race, comorbidities, and year. METHODS A database of all acute hospitalizations in New York State was examined between 1990 and 2003. Patient admissions that had the principal admission diagnoses of angioedema and other acute allergic disorders (anaphylaxis, urticaria, or allergy unspecified) were extracted. Characteristics of angioedema admissions were tabulated and compared with those of other acute allergic disease admissions with respect to demographic variables and comorbidities. RESULTS There were 6,775 hospitalizations for angioedema during the study period. The number of angioedema hospitalizations increased progressively from 293 in 1990 to 636 in 2003, which exceeded the number of hospitalizations for anaphylaxis that year. African Americans constituted 42% of the angioedema admissions despite being less than 16% of the state population. The increase in hospitalizations for angioedema was most marked in patients with a diagnosis of hypertension, and for each study year, patients admitted with angioedema were consistently older than those admitted with other allergic disorders. CONCLUSIONS Angioedema has become the most common nonasthmatic acute allergic disorder that results in hospitalization in New York State. The predilection for angioedema occurring in patients with hypertension suggests that angiotensin-converting enzyme inhibitor use may play a role in this trend.
Collapse
Affiliation(s)
- Robert Y Lin
- New York Medical College, Valhalla, New York, USA.
| | | | | |
Collapse
|
46
|
Wen HW, Borejsza-Wysocki W, DeCory TR, Baeumner AJ, Durst RA. A novel extraction method for peanut allergenic proteins in chocolate and their detection by a liposome-based lateral flow assay. Eur Food Res Technol 2005. [DOI: 10.1007/s00217-005-1202-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
47
|
Nancey S, Moussata D, Roman S, Andre F, Bouvier M, Claudel S, Descos L, Andre C, Flourie B. [Food and digestive allergies in adults]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:255-65. [PMID: 15864175 DOI: 10.1016/s0399-8320(05)80758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Stéphane Nancey
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
I. Malmheden Yman. Detection of inadequate labelling and contamination as causes of allergic reactions to food. ACTA ALIMENTARIA 2004. [DOI: 10.1556/aalim.33.2004.4.5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
49
|
Abstract
PURPOSE OF REVIEW Anaphylaxis is frightening and patients commonly fear their next reaction will be fatal. This review looks at the characteristics of fatal reactions to find if a fatal recurrence is predictable. RECENT FINDINGS Most publications on fatal anaphylaxis are case reports that do not help predict risks. Most epidemiological studies focus on non-fatal reactions. The UK fatal anaphylaxis register demonstrates that over two-thirds of those dying from sting reactions and over four-fifths dying from drug anaphylaxis had no previous indication of their allergy, whereas those dying from food allergy had usually had previous reactions but these were typically not severe. Recent reports of anaphylaxis epidemiology based on diagnostic coding or attendance for treatment may be biased by differences in health service resource utilization according to the cause and course of the reaction. SUMMARY Most fatal anaphylactic reactions are unpredictable. The appropriate management after recovery from a severe reaction may be protective against a fatal recurrence. An accurate identification of the cause and effective avoidance is a crucial part of this management, together with effective treatment of asthma for those with food allergy, immunotherapy for sting allergy, the avoidance of drugs that potentiate anaphylaxis, and effective training in self-treatment.
Collapse
|
50
|
Sicherer SH, Muñoz-Furlong A, Sampson HA. Prevalence of seafood allergy in the United States determined by a random telephone survey. J Allergy Clin Immunol 2004; 114:159-65. [PMID: 15241360 DOI: 10.1016/j.jaci.2004.04.018] [Citation(s) in RCA: 336] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Seafood allergy is potentially severe, but the prevalence of this group of food allergies in the US population has not been determined. OBJECTIVE To estimate the prevalence of seafood (fish, shellfish) allergy in the United States. METHODS We performed a nationwide, cross-sectional, random telephone survey by using a standardized questionnaire. Criteria were established in advance to define seafood allergy by report of convincing symptoms and physician evaluation. RESULTS A total of 5529 households completed the survey (67.3% participation rate), representing a census of 14,948 individuals. Fish or shellfish allergy defined by established criteria was reported in 5.9% (95% CI, 5.3%-6.6%) of households and among individuals as follows: 2.3% (95% CI, 2%-2.5%) for any seafood allergy, 2% for shellfish, 0.4% for fish, and 0.2% for both types. Seafood allergy was more common in adults compared with children (2.8% vs 0.6%; P <.001) and in women compared with men (3.6% vs 2%; P <.001). Recurrent reactions were reported by 58%, dyspnea or throat tightness was reported by more than 50%, and 16% were treated with epinephrine. Despite this level of acuity, only 8.6% were prescribed self-injectable epinephrine. The rate of reactions to multiple fish among those with any fish allergy was 67%; for Crustacea the rate was 38%, and for mollusks the rate was 49%; only 14% with crustacean allergy reported a mollusk allergy. CONCLUSIONS Physician-diagnosed and/or convincing seafood allergy is reported by 2.3% of the general population, or approximately 6.6 million Americans. Affected individuals typically report recurrent and sometimes severe reactions, indicating that seafood allergy represents a significant health concern.
Collapse
Affiliation(s)
- Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
| | | | | |
Collapse
|