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Cela L, Gravina A, Semeraro A, Pastore F, Morelli R, Marchetti L, Brindisi G, Olivero F, Piccioni MG, Zicari AM, Anania C. Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests. Diagnostics (Basel) 2024; 14:2069. [PMID: 39335748 PMCID: PMC11431423 DOI: 10.3390/diagnostics14182069] [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: 08/07/2024] [Revised: 09/13/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
Food allergy (FA) affects approximately 6-8% of young children, with a peak prevalence at approximately one year of age. Tree nut and peanut allergies are among the main causes of anaphylaxis in the world. The gold standard for the diagnosis of FAs is the oral food challenge (OFC). Other diagnostic tests used in the clinical practice are skin prick tests (SPTs) and laboratory tests to measure out the presence of serum specific IgE (sIgE). In this narrative review, we collect the current evidence of the predictive value (PV) of SPTs and sIgE for the outcome of the OFCs. In literature, data are conflicting as to whether increasing sIgE concentration and wheal size in SPTs correlate with OFC outcomes. Most studies included in our review have shown that in vivo and in vitro tests may predict OFC outcomes with variable PV, but data are not conclusive; therefore, the OFC currently remains the gold standard for FA diagnosis.
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Affiliation(s)
- Ludovica Cela
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Alessandro Gravina
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Antonio Semeraro
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Francesca Pastore
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Rebecca Morelli
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Lavinia Marchetti
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Giulia Brindisi
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | | | - Maria Grazia Piccioni
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Anna Maria Zicari
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
| | - Caterina Anania
- Department of Maternal Infantile and Urological Science, Sapienza University of Rome, 00161 Rome, Italy; (L.C.); (A.G.); (A.S.); (F.P.); (R.M.); (L.M.) (G.B.); (M.G.P.); (A.M.Z.)
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Kiyama T, Kitazawa K. Macadamia Nut-Induced Anaphylactic Shock Requiring Repeated Intramuscular Adrenaline Administration in a Three-Year-Old Girl. Cureus 2024; 16:e60858. [PMID: 38910662 PMCID: PMC11192167 DOI: 10.7759/cureus.60858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Cases of macadamia nut-induced anaphylactic shock have been rarely reported. We report the case of a three-year-old girl with anaphylactic shock who presented with generalized erythema two hours after ingesting macadamia nuts. She required two doses of intramuscular adrenaline for the treatment of anaphylactic shock. The diagnosis of macadamia nut allergy was confirmed by a prick-by-prick skin test using roasted and raw macadamia nut paste extracts and elevated serum macadamia nut-specific immunoglobulin E (IgE) levels. Appropriately using a prick-by-prick test may contribute to accurately diagnosing macadamia nut allergy, thus preventing the unnecessary avoidance of other nuts. Considering the potential for severe shock induced by macadamia nut allergy, vigilant monitoring of blood pressure changes is imperative in children presenting with immediate-type allergic reactions, such as vomiting and skin symptoms, following macadamia nut ingestion.
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Affiliation(s)
- Takashi Kiyama
- Department of Pediatrics, Asahi General Hospital, Asahi, JPN
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Giovannini M, Skypala IJ, Caubet JC, Du Toit G, Nowak-Wegrzyn A. Diagnosis and Management of Pollen Food Allergy Syndrome to Nuts. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:599-604. [PMID: 38280450 DOI: 10.1016/j.jaip.2024.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
Oral allergy syndrome or pollen food allergy syndrome (PFAS) represents a common clinical conundrum when the reported trigger food is a tree nut (usually almond or hazelnut) or peanut. The PFAS may give rise to uncertainty about the potential severity of the future reactions, indications for prescribing epinephrine, and the extent of the necessary dietary avoidance. As a food allergy, secondary to cross-reactivity with airborne pollen, PFAS usually manifests toward the end of the first decade of life as contact urticaria of the oropharyngeal mucous membranes. Molecular allergology facilitates diagnosis and risk stratification by establishing the profile of sensitization. Exclusive sensitization to pathogenesis-related proteins family 10 (PR10) and profilins indicates that signs and symptoms are due to PFAS, whereas sensitization to seed storage proteins with or without sensitization to PR10 and profilins may indicate a more severe primary nut allergy phenotype. Management relies on avoidance of the specific nut trigger, advice on the likelihood of more severe local or systemic symptoms, and treatment of reactions according to the severity. Future studies are needed to better delineate the risk of systemic reactions in individuals with nut PFAS and to establish the role of food or pollen allergen immunotherapy for the prevention or moderation of this condition.
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Affiliation(s)
- Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guys & St Thomas NHS Foundation Trust, London, United Kingdom; Department of Inflammation and Repair, Imperial College, London, United Kingdom.
| | - Jean Christoph Caubet
- Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| | - George Du Toit
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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