Food allergy: is there a rising prevalence and if so why?

Lupin and Other Potentially Cross-Reactive Allergens in Peanut Allergy

PURPOSE OF REVIEW

The presence of IgE cross-reactivity between peanut allergens and allergens from other legumes and tree nuts has been demonstrated, but the identification of the involved individual allergens is still limited. The aim of this review is to describe new allergenic findings, of potential relevance for cross-reactivity among peanut and lupin.

RECENT FINDINGS

Seventeen allergens of peanut have been included in the official allergen nomenclature database to date. Lupin sensitization has been observed in 15-20% of individuals with known peanut allergy, The majority of lupin seed proteins are comprised of α-conglutins (legumin-like) and β-conglutins (vicilin-like), and to a lesser extent γ-conglutins (vicilin-like) and δ-conglutins (2S albumins). Several molecules may fuel peanut-lupin cross-reactivity. Awareness among physicians and general public could avoid unexpected allergic reactions. However, these do not appear frequent and no data suggest a precautionary labelling of lupin in foods.

Using skin for drug delivery and diagnosis in the critically ill

Skin offers easy access, convenience and non-invasiveness for drug delivery and diagnosis. In principle, these advantages of skin appear to be attractive for critically ill patients given potential difficulties that may be associated with oral and parenteral access in these patients. However, the profound changes in skin physiology that can be seen in these patients provide a challenge to reliably deliver drugs or provide diagnostic information. Drug delivery through skin may be used to manage burn injury, wounds, infection, trauma and the multisystem complications that rise from these conditions. Local anaesthetics and analgesics can be delivered through skin and may have wide application in critically ill patients. To ensure accurate information, diagnostic tools require validation in the critically ill patient population as information from other patient populations may not be applicable.

Maternal intolerance of uncertainty, anxiety, and adherence with food challenge referrals

Anxiety regarding food challenges may serve an important role in parents’ decisions to adhere to their child’s food challenge referrals. This study examined the role of intolerance of uncertainty in food challenge referral adherence by assessing state/trait anxiety among mothers whose children were referred for a food challenge. Mothers whose children passed a food challenge reported significant decreases in anxiety regarding allergic reactions, but intolerance of uncertainty did not predict adherence. Trust in the physician was a primary reason mothers attended the food challenge, suggesting that physicians should consider the impact of the physician–patient relationship when treating these families.