ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

Managing Food Allergy When the Patient Is Not Highly Allergic Authors: Scott H. Sicherer, MD, Elissa M. Abrams, MD, Anna Nowak-Wegrzyn, MD, PhD, and Jonathan O’B. Hourihane, FRCPI Abstract: Few patients with food allergy are “highly allergic,” meaning they always have severe reactions and always react to very small amounts of allergen. Standard medical approaches for allergy management have focused on the safety and lifestyle modifications this group truly needs, but consequently families with food allergy are typically advised to strictly avoid any exposure to their implicated allergens. Most food-allergic subjects are actually not reactive to very low doses, and many never experience severe reactions. There are also notable conditions where a different care plan is already commonly offered: patients with pollen-related food allergy syndrome, with food-associated exercise-induced anaphylaxis, and with resolving or mild milk or egg allergy might be advised to ingest the allergens in sp...

 Latest Developments in the Management of Nut Allergies Authors:  H A Brough, R Gourgey, S Radulovic, J C Caubet, G Lack, A Anagnostou Abstract: Purpose of review: In this review, we sought to describe the most recent advances in the dietary and medical management of peanut and tree nut allergy, including selective introduction and immunotherapy. Recent findings: Dietary updates include changes to labeling laws, improved information sources, and new apps for buying foods in shops and overseas to better protect individuals with nut allergies. There are still issues in the management of nut allergies in schools, such as parents having to resort to packed lunches instead of school meals and patients experiencing bullying. Air travel also poses concern, but additional resources are now available to travelers, and recent evidence suggest limited airborne exposure to nuts. The medical management of anaphylaxis is use of epinephrine; however, this remains underutilized. Needle length...

Benefits of baked milk oral immunotherapy in French children with cow's milk allergy Authors:   Vianney Gruzelle, Agnès Juchet, Audrey Martin-Blonde, Marine Michelet, Anne Chabbert-Broue, Alain Didier Abstract:  Background: Introduction and gradual incremental escalation of a low dose of baked milk may accelerate the resolution of severe cow's milk (CM) allergy for some children. The purpose of our study was to evaluate the efficacy and safety of baked milk oral immunotherapy (OIT) in children with CM allergy after a low-dose baked milk oral food challenge (OFC). Methods: In a retrospective analysis of OFC performed between 2013 and 2018 at the Children's Hospital of Toulouse (France), we identified 64 children with CM allergy and high milk and casein-specific IgE levels, who underwent a total of 171 milk OFC. Mean age at 1st OFC was 4.8 years. Mean CM-specific IgE was 47.9 kUA/L, and mean casein-specific IgE was 42.3 kUA/L. Results: Most children were...

 Clinical and in vitro cross-reactivity of cereal grains in children with IgE-mediated wheat allergy Authors: Witchaya Srisuwatchari  1 , Surapon Piboonpocanun  2 , Unchalee Wangthan  1 , Orathai Jirapongsananuruk  1 , Nualanong Visitsunthorn  1 , Punchama Pacharn  3 Abstract Introduction and objectives: Wheat and cereal grains have a broad range of cross-reactivity, but the clinical relevance of this cross-reactivity is uncertain. This study aimed to evaluate clinical and in vitro cross-reactivity with barley, oat, and Job's tears among wheat-allergic patients. Materials and methods: Patients aged 5 to 15 years with IgE-mediated wheat allergy were enrolled. Skin prick test (SPT) and specific IgE (sIgE) to wheat, barley, and oat, and SPT to Job's tears were performed. Oral food challenge (OFC) was conducted if the SPT was ≤5 mm in size and there was no history of anaphylaxis to each grain. Profiles of sIgE bound allergens of wheat, barley, and oat, and...

 Peanut Allergy: New Advances and Ongoing Controversies Auhtors: Elissa M Abrams  1 , Edmond S Chan  2 , Scott Sicherer  3 Abstract Peanut allergy is one of the most common food allergies in children, with increasing prevalence over time. The dual-allergen exposure hypothesis now supports transcutaneous sensitization to peanut as a likely pathophysiologic mechanism for peanut allergy development. As a result, there is emerging evidence that early peanut introduction has a role in peanut allergy prevention. Current first-line diagnostic tests for peanut allergy have limited specificity, which may be enhanced with emerging tools such as component-resolved diagnostics. Although management of peanut allergy includes avoidance and carrying an epinephrine autoinjector, risk of fatal anaphylaxis is extremely low, and there is minimal risk related to cutaneous or inhalational exposure. Quality of life in children with peanut allergy requires significant focus. Moving forward...

Hypersensitivities to sesame and other common edible seeds Authors: A. Patel  S. L. Bahna Abstract Several seeds have been increasingly incorporated in various food items, with consequent risk of hypersensitivity reactions that are often severe. Identification of the specific seed as the culprit is often not explored or is difficult to verify. In this article, we reviewed the English literature from January 1930 to March 2016 using PubMed and Google Scholar searching for publications relevant to hypersensitivity to common edible seeds, namely sesame, sunflower seed, poppy seed, pumpkin seed, flaxseed, and mustard seed. Considering the worldwide consumption of those seeds, the number of published articles on the subject was relatively small and was mainly as case reports rather than large series. Allergy to sesame was more reported than to other seeds, with an estimated prevalence of 0.1–0.2%. In this review, we summarize the information relevant to each of the six seeds and t...

Risk Factors Influencing Tolerance and Clinical Features of Food Protein-induced Allergic Proctocolitis Authors: Betul Buyuktiryaki  1 , Ilknur Kulhas Celik  1 , Semiha B Erdem  2 , Murat Capanoglu  3 , Ersoy Civelek  1 , Belgin Usta Guc  4 , Hakan Guvenir  1 , Murat Cakir  5 , Emine Dibek Misirlioglu  1 , Omer Akcal  2 , Burcu Volkan  3 , Muge Toyran  1 , Elif Sag  5 , Alev C Kertel  3 , Tayfur Ginis  1 , Can N Kocabas  6 , Fazıl Orhan  5 , Demet Can  2   7 Abstract Objective: Continued progress in our understanding of the food protein-induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course since influencing parameters has not yet been established. ...

Hypersensitivity Reactions to Food Additives Authors: Guillermo Velázquez-Sámano 1, Rodrigo Collado-Chagoya, Rubén Alejandro Cruz-Pantoja, Andrea Aída Velasco-Medina, Juan Rosales-Guevara Abstract  Food additives are ingredients that are intentionally added to food in order to modify its physical, chemical, biological, or sensorial characteristics. Food additives may act as allergens and generate IgE-mediated immune reactions, or they may act as pseudo allergens and generate non-IgE-mediated immune reactions. Such reactions can generate diverse clinical pictures or they may exacerbate diseases as diverse as eosinophilic esophagitis, bronchial asthma, atopic dermatitis, contact dermatitis, chronic urticaria, or anaphylaxis. Thousands of food additives are being used daily in industrialized countries and, although their use has been globalized, there is not much science information about their adverse effects; especially about their hypersensitivity reactions that, despite be...

Diagnosis and prevention of food-dependent exercise-induced anaphylaxis Authors: Filipe Benito-Garcia, Ignacio Javier Ansotegui & Mário Morais-Almeida ABSTRACT Introduction: Food-dependent, exercise-induced anaphylaxis (FDEIA) is a rare type of anaphylaxis with a growing incidence. Although the precise mechanism by which the patient reacts only in a combination of a culprit food and cofactors are not currently understood, many advances in diagnosis and management have been made since their first description. Areas covered: A literature search in PubMed was performed to review the diagnosis and management of FDEIA. Clinicians should have a high level of suspicion for identification of the culprit foods and the cofactors involved. Component-resolved diagnosis and more accurate provocation tests have revolutionized the diagnosis accuracy. Management is not easy and involves educating the patient to evict the combination of exposure to the culprit foods and the cofactors t...

Red Meat Allergy in Children and Adults Authors: Jeffrey M Wilson  1 , Thomas A E Platts-Mills Abstract Purpose of review: To highlight recent advances in our understanding of the clinical features, prevalence, and pathophysiology of red meat allergy. Recent findings: Allergic reactions to red (i.e. mammalian) meat have historically been considered rare and described primarily in young atopic children. It is now clear that red meat allergy is not uncommon in some parts of the world in other age groups. Strikingly, the majority of these cases relate to specific IgE to galactose-α-1,3-galactose, an oligosaccharide of nonprimate mammals. The mechanism of sensitization in this syndrome relates to bites of certain hard ticks and the clinical reactions often have a delay of 3 to 6 h. An additional form of red meat allergy relates to inhalant sensitization to mammalian proteins. The best characterized example involves cat-sensitized patients with specific IgE to cat serum albumin...

Pro/Con Debate CON: Skin testing with fresh foods Aikaterini Anagnostou, MD, PhD Texas Children’s Hospital Division of Immunology, Allergy and Rheumatology; Baylor College of Medicine Division of Immunology, Allergy and Rheumatology, Houston, Texas 10.1016/j.anai.2019.12.010 Pro/Con Debate Pro: Skin prick testing with fresh foods Arnon Elizur, MD *, y; Michael R. Goldberg, MD * * Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel 10.1016/j.anai.2019.11.032

Peanut allergy diagnosis moving from basic to more elegant testing Autor: Dr. Steven Fuentes 

Risk Factors for Hen's Egg Allergy in Europe: EuroPrevall Birth Cohort Authors: Kate E.C. Grimshaw, PhD Graham Roberts, MD  Anna Selby, BM E.N. Clare Mills, PhD Thomas Keil, MD Kirsten Beyer, MD Abstract Background Hen's egg is one of the commonest causes of food allergy, but there are little data on its risk factors. Objective To assess the risk factors, particularly eczema, for hen's egg allergy in the EuroPrevall birth cohort. Methods In the pan-European EuroPrevall birth cohort, questionnaires were undertaken at 12 and 24 months or when parents reported symptoms. Children with suspected egg allergy were invited for skin prick testing, specific IgE assessment, and double-blind, placebo-controlled food challenge (DBPCFC) as indicated. Each egg allergy case (positive DBPCFC or egg-induced anaphylaxis) was allocated up to 2 age- and country-matched controls. Results A total of 12,049 infants were recruited into the EuroPrevall birth cohort, and 9,336 (...

Secondary prevention measures in anaphylaxis patients: Data from the anaphylaxis registry Authors: Magdalena Kraft et al. Abstract Background Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. Methods Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. Results The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, masto...

Anaphylaxis-a 2020 Practice Parameter Update, Systematic Review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Analysis Authors: Marcus S Shaker 1, Dana V Wallace 2, David B K Golden 3, John Oppenheimer 4, Jonathan A Bernstein 5, Ronna L Campbell 6, Chitra Dinakar 7, Anne Ellis 8, Matthew Greenhawt 9, David A Khan 10, David M Lang 11, Eddy S Lang 12, Jay A Lieberman 13, Jay Portnoy 14, Matthew A Rank 15, David R Stukus 16, Julie Wang 17, Collaborators; Natalie Riblet 18, Aiyana M P Bobrownicki 18, Teresa Bontrager 19, Jarrod Dusin 19, Jennifer Foley 19, Becky Frederick 19, Eyitemi Fregene 18, Sage Hellerstedt 18, Ferdaus Hassan 19, Kori Hess 19, Caroline Horner 20, Kelly Huntington 19, Poojita Kasireddy 18, David Keeler 19, Bertha Kim 18, Phil Lieberman 13, Erin Lindhorst 19, Fiona McEnany 18, Jennifer Milbank 18, Helen Murphy 19, Oriana Pando 18, Ami K Patel 18, Nicole Ratliff 19, Robert Rhodes 19, Kim Robertson 19, Hope Scott 19, Audrey Snell 19, ...

AR101 Oral Immunotherapy for Peanut Allergy Authors:  The PALISADE Group of Clinical Investigators Abstract  BACKGROUND Peanut allergy, for which there are no approved treatment options, affects patients who are at risk for unpredictable and occasionally life-threatening allergic reactions. METHODS In a phase 3 trial, we screened participants 4 to 55 years of age with peanut allergy for allergic dose-limiting symptoms at a challenge dose of 100 mg or less of peanut protein (approximately one third of a peanut kernel) in a double-blind, placebo-controlled food challenge. Participants with an allergic response were randomly assigned, in a 3:1 ratio, to receive AR101 (a peanut-derived investigational biologic oral immunotherapy drug) or placebo in an escalating-dose program. Participants who completed the regimen (i.e., received 300 mg per day of the maintenance regimen for approximately 24 weeks) underwent a double-blind, placebo-controlled food challenge at tria...

Can Food Allergy Be Cured? What Are the Future Prospects? Authors: Vanitha Sampath 1 2, Sayantani B Sindher 1 2, Andres M Alvarez Pinzon 1 2, Kari C Nadeau 1 2 Abstract Food allergies have become a significant heath burden as prevalence continues to rise, affecting 6%-13% of the global population. In the absence of drugs approved by regulatory agencies, the current standard of care remains avoidance of allergenic foods and management of acute allergic reactions with antihistamines and epinephrine autoinjectors. Allergen immunotherapy has been shown to increase the threshold of reactivity in the majority of food-allergic individuals. However, challenges include long treatment periods, high rates of adverse reactions, and lack of permanence of desensitization and established protocols. To address these limitations, adjunctive allergen-specific immunotherapy, vaccines, and non-allergen-specific therapies (eg, monoclonal antibodies) are being explored. The future of food allergy t...

An algorithm for diagnosing IgE-mediated food allergy in study participants who do not undergo food challenge. Authors: Kelleher MM1, Jay N2, Perkin MR3, Haines RH4, Batt R5, Bradshaw LE4, Montgomery AA4, Chalmers JR6, Williams HC6, Boyle RJ1,6. Abstract BACKGROUND: Food allergy diagnosis in clinical studies can be challenging. Oral food challenges (OFC) are time-consuming, carry some risk and may, therefore, not be acceptable to all study participants. OBJECTIVE: To design and evaluate an algorithm for detecting IgE-mediated food allergy in clinical study participants who do not undergo OFC. METHODS: An algorithm for trial participants in the Barrier Enhancement for Eczema Prevention (BEEP) study who were unwilling or unable to attend OFC was developed. BEEP is a pragmatic, multi-centre, randomized-controlled trial of daily emollient for the first year of life for primary prevention of eczema and food allergy in high-risk infants (ISRCTN21528841). We built on the Europea...

Mast cell disorders and idiopathic anaphylaxis: Evaluation and management. Authors: Khalid MB1, Lieberman P2. Abstract Background: Our understanding of mast cell activation disorders continues to grow, and our management of these syndromes is improving with this increase in knowledge. Despite these advances, there remain some areas of confusion. Conclusion: In this article, we discussed these areas and offered thoughts about establishing the diagnosis and management. DOI:  10.2500/aap.2020.41.190023

EoE disease monitoring: Where we are and where we are going. Authors: Godwin, Wilkins, Muir A Abstract OBJECTIVE:  To review literature on various methods of monitoring and characterizing eosinophilic esophagitis (EoE) with respect to their validity as well as risk to the patient. DATA SOURCES:  A literature search was performed using PubMed with keyword combinations of EoE and monitoring as well as various techniques used for monitoring, including but not limited to, symptoms, endoscopy, histology, fluoroscopy, FLIP, noninvasive monitoring, and biomarkers. STUDY SELECTIONS:  Case-control studies, observational studies, peer-reviewed reviews and guidelines, and systematic reviews were selected, reviewed, and summarized here. RESULTS:  A wealth of research regarding monitoring of EoE is currently being undertaken and published. Our review highlights those that have been validated and are currently being used, as well as some that show promise for future m...