Allergy to Gibberellin-regulated proteins in an adolescent: A case of orange-induced anaphylaxis mediated by cofactors / Alergia a proteínas reguladas por giberelinas en un adolescente: un caso de anafilaxia inducida por naranja mediada por cofactores

This report is a case of anaphylaxis in an adolescent due to allergy to gibberellin-regulated proteins mediated by cofactors, in probable relation to a pollen/food allergy syndrome. It should also emphasizes the importance of obtaining a faithful clinical history, especially when it comes to adolescent patients as they tend to initiate toxic habits.(AU)

Primary, secondary and tertiary prevention of food allergy: current practices and future directions / Prevención primaria, secundaria y terciaria de la alergia alimentaria: prácticas actuales y direcciones futuras

The incidence of food allergies has risen around the globe, and experts have been exploring methods of preventing such allergies in young children to ease the burden of disease and reduce the morbidity and mortality caused by anaphylaxis to food allergens. Such preventative measures can be categorised as primary, secondary and tertiary prevention, which are discussed in detail in this review. Primary prevention is defined as the prevention of becoming sensitised towards specific allergens. The evidence suggests that avoiding common allergenic foods during pregnancy and breastfeeding is not protective against food allergies, and guidelines recommend weaning from 4 to 6 months of age, with recent studies supporting the early introduction of peanuts at 4 months to prevent peanut allergy. Secondary prevention targets patients who are already sensitised and aims to halt the progression of sensitisation, with evidence for high rates of success and safety in trials of early introduction to milk and peanuts using oral immunotherapy in sensitised infants. Tertiary allergy prevention focuses on reducing the risk of a patient having anaphylaxis, with oral immunotherapy being the most common method of promoting tolerance in allergic children. Several studies have demonstrated successful reintroduction for milk, egg and peanut; however, no such guidelines are recommended for other foods. Finally, dietary advancement therapy in the form of milk and egg ladders has been employed as a method of primary, secondary and tertiary prevention of allergies, particularly in Ireland, the UK and Canada.(AU)

Cosensitization to the 3 Nonhomologous Major Cashew Allergens Ana o 1, Ana o 2, and Ana o 3 Is Caused by IgE Cross-reactivity

Background: Cashew nuts often cause strong allergic reactions, which are even more severe than those of peanuts. Ana o 1 (vicilin), Ana o 2 (legumin), and Ana o 3 (2S albumin) are major cashew allergens. Cosensitization to all 3 nonhomologous cashew nut allergens has been observed. We hypothesize that this might be due to IgE cross-reactivity. Methods: IgE cross-inhibitions were performed with Ana o 1-3 using serum samples from cashew nut–allergic patients. The related hazelnut allergens Cor a 11, 9, and 14 were used as controls. For comparison, IgE cross-reactivity between the hazelnut allergens was investigated using serum samples from hazelnut-allergic patients. Results: The median percentages of cross-inhibition between Ana o 1, 2, and 3 were 84%-99%. In comparison, the median cross- inhibition values between hazelnut allergens were 33%-62%. The IC50 values revealed the highest IgE affinity to be to Ana o 3 and Cor a 14. Hazelnut legumin Cor a 9 inhibited IgE binding to Ana o 1, 2, and 3, with median percentages of 75%, 56%, and 48%, respectively. No cross-reactivity was observed between allergenic vicilins or between 2S albumins from cashew and hazelnut. Potentially cross-reactive peptides of Ana o 3 identified in silico overlapped with previously reported IgE epitopes of all 3 allergens. Conclusion: IgE with high affinity to Ana o 3 that cross-reacts with the other 2 major nonhomologous cashew nut allergens might be responsible for the high allergenic potency of cashew nut. These cross-reactive IgE types comprise the major fraction of specific IgE in cashew-allergic patients and might be responsible for cross-reactivity between unrelated tree nuts (AU)

Antecedentes: Los anacardos suelen provocar fuertes reacciones alérgicas, que son incluso más graves que las del maní. Ana o 1 (vicilina), Ana o 2 (legumina) y Ana o 3 (albúmina 2S) son los principales alérgenos del anacardo. Se ha observado cosensibilización a los 3 alérgenos no homólogos del anacardo. Nuestra hipótesis es que esto podría deberse a la reactividad cruzada de la IgE. Métodos : Se realizaron inhibiciones cruzadas de IgE con Ana o 1-3 utilizando muestras de suero de pacientes alérgicos al anacardo. Como controles se utilizaron los alérgenos de avellana relacionados Cor a 11, 9 y 14. A modo de comparación, se investigó la reactividad cruzada de IgE entre los alérgenos de la avellana utilizando muestras de suero de pacientes alérgicos a la avellana. Resultados : Los porcentajes medios de inhibición cruzada entre Ana o 1, 2 y 3 fueron del 84% al 99%. En comparación, los valores medios de inhibición cruzada entre alérgenos de avellana fueron del 33% al 62%. Los valores de IC50 revelaron que la mayor afinidad de IgE era Ana o 3 y Cor a 14. La legumina de avellana Cor a 9 inhibió la unión de IgE a Ana o 1, 2 y 3, con porcentajes medios de 75%, 56% y 48%. , respectivamente. No se observó reactividad cruzada entre vicilinas alergénicas ni entre albúminas 2S de anacardo y avellana. Los péptidos potencialmente de reacción cruzada de Ana o 3 identificados in silico se superpusieron con epítopos de IgE previamente informados de los 3 alérgenos. Conclusión : La IgE con alta afinidad por Ana o 3 que reacciona de forma cruzada con los otros 2 alérgenos principales no homólogos del anacardo podría ser responsable de la alta potencia alergénica del anacardo. Estos tipos de IgE de reacción cruzada comprenden la fracción principal de IgE específica en pacientes alérgicos al anacardo y podrían ser responsables de la reactividad cruzada entre frutos secos no relacionados (AU)

Alergia alimentaria: importancia de los cofactores / Food allergy: the importance of cofactors

Las LTP (lipid transfer proteins) son una familia de proteínas presentes en diferentes alimentos. La sintomatología de la alergia a las LTP es muy variable, desde clínica leve hasta sistémica, en ocasiones, presentando síntomas únicamente en presencia de cofactores. Se presenta el caso de una paciente de 11 años que acude a urgencias con clínica de anafilaxia tras ingesta previa de fruta mientras realizaba ejercicio físico, destacando la importancia de la historia clínica y la sospecha diagnóstica en el enfoque de esta entidad (AU)

LTP (lipid transfer proteins) are a family of proteins present in different foods. The symptomatology of allergy to LTP is highly variable, ranging from mild to systemic. Sometimes, symptoms are only present in the presence of cofactors.We present the case of an 11-year-old female patient who presented to the emergency department with anaphylaxis following previous ingestion of fruit while doing physical exercise, highlighting the importance of the clinical history and diagnostic suspicion in the approach to this entity. (AU)

Infarto de miocardio alérgico por consumo de ciruela, presentación de caso clínico / Allergic myocardial infarction due to plum consumption, case report

We present the case of an elderly patient who presented with an allergic reaction secondary to fruit consumption and subsequently developed a non-ST-elevation coronary syndrome. (AU)

Se presenta el caso de un paciente adulto mayor que presenta un reacción alergica secundaria al consumo de fruta y posteriormente desarrolla un sindrome coronario sin elevacion del ST. (AU)

Alergias alimentarias: revisión de la legislación correspondiente a la gestión y al etiquetado de alérgenos / Food allergies: review of legislation on allergen management and labelling

Introducción: La normativa existente que obliga a los establecimientos alimentarios a reflejar en el etiquetado la información sobre la presencia de alérgenos de declaración obligatoria no consigue evitar que puedan producirse reacciones adversas accidentales en los consumidores susceptibles. Por ello, en este trabajo se revisa la normativa europea existente en materia de alérgenos y se analizan las causas por las que sigue habiendo alertas sanitarias de alérgenos no declarados, proponiéndose posibles soluciones para solventar este problema. Método: Se ha llevado a cabo una investigación documental desarrollada en cinco etapas. Para ello, se recopiló literatura publicada hasta noviembre de 2022. Resultados: El Reglamento 1169/2011 sobre la información alimentaria facilitada al consumidor establece las normas de etiquetado aplicables a los alérgenos contenidos en los productos. En su artículo 36, una de las informaciones alimentarias voluntarias a incluir es la posible presencia no intencionada en el alimento de sustancias o productos que causen alergias o intolerancias, también conocido como etiquetado precautorio de alérgenos (EPA). Tanto la confusión que existe alrededor del uso del EPA, como la compleja estructura de la cadena alimentaria y, en algunos casos, la formación deficiente del personal, pueden aumentar el riesgo poner en el mercado productos inseguros al alcance de personas susceptibles. Conclusiones: Se considera conveniente intensificar la formación de los trabajadores de cualquier establecimiento alimentario y realizar actos de ejecución que regulen el EPA. (AU)

Introduction: Existing regulations requiring food establishments to label on the presence of mandatory declaration allergen fail to prevent accidental adverse reactions from occurring in susceptible consumers. Therefore, this paper reviews the existing European legislation on allergens and analyses the reasons why health alerts for undeclared allergens continue to occur, proposing possible solutions to solve this problem.Method: Documentary research was carried out in five stages. For this purpose, literature published up to Novem-ber 2022 was collected.Results: Regulation 1169/2011 on the provision of food information to consumers sets out the labelling rules appli-cable to allergens contained in products. In its article 36, one of the voluntary food information to be included is the possible unintended presence in the food of substances or products causing allergies or intolerances, also known as precautionary allergen labelling (PAL). Confusion surrounding the use of PAL, the complex structure of the food chain and, in some cases, poorly trained staff all can increase the risk of placing unsafe products on the market within the reach of susceptible people.Conclusions: It is considered appropriate to intensify the training of workers in all food establishments the PAL. (AU)

Quality of life in children with food allergies, psychiatric symptoms, and caregiving burden of their mothers

Objective: The present study aimed to evaluate the quality of life in children with food allergies, the accompanying depression and anxiety disorders, and caregiving burden of their mothers. Material and Methods: A total of 168 children with food allergy visiting our clinic and their mothers were included in the study group. The control group included 152 children who visited the healthy child follow-up clinic of our hospital and their mothers. Studying mothers’ opinions, the Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) was used for evaluating children, and the Beck’s Depression Inventory, Beck’s Anxiety Inventory, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Auto-questionnaire, and Zarit Caregiver Burden Scales were used for evaluating mothers. Results: No differences were noticed between the study and control group regarding mean age and gender distribution (P > 0.05). In the study, the FAQLQ-PF total and subscale scores of children with food allergies were determined according to the opinions of their mothers, and scores tended to increase with age (P < 0.0001). In addition, it was determined that mothers of children with food allergies had higher levels of anxiety, depression, and caregiving burden than mothers of the control group (P < 0.0001). Conclusion: In order to develop a multidisciplinary approach for children with food allergies, we conceived as appropriate to inform their families about the difficulties of caregiving and psychosocial disorders that could develop over time. They also must be informed to take preventive measures as well as the medical aspects of their children’s disease (AU)

Does the severity of atopic dermatitis change with allergic sensitization? Is it real or a myth?

Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disease that can occur at any age. This study aimed to evaluate the impact of food allergy on disease severity as well as clinical/laboratory findings in children with AD. Methods: Clinical and laboratory data of AD patients evaluated for food allergy between January 2021 and December 2022 were examined retrospectively. Results: Of the 52 patients evaluated, 32 (61.5%) were males, with a median age of 6 months (2–118 months). Among them, 26 (50%) had food allergies (FA) and five (9.6%) had inhalant allergen sensitivity. No significant difference in AD severity was observed between patients with and without FA. However, the FA group showed higher serum lactate dehydrogenase (LDH) levels (343.3 ± 81.5 U/L vs 297.7 ± 77.4 U/L; P = 0.011) and lower red cell distribution width (RDW). Inhalant allergen sensitivity was associated with higher AD severity. Conclusion: While guidelines recommend investigating food allergies in moderate to severe AD, this study found no significant difference in the relationship between AD severity and the presence of FA. However, inhalant allergen sensitivity was linked to increased AD severity. Therefore, a comprehensive patient history should include an evaluation of food allergies in children with AD, regardless of disease severity. Elimination and provocation tests related to suspected food items should be performed, and allergenic foods should be removed from the diet if they are found to contribute to the allergy (AU)

Risk factors predisposing children to food allergies

Background: Food allergies are the most common cause of anaphylaxis in children, and their incidence is increasing globally. The aim of this study was to determine the risk factors leading to food allergies in childhood. Methods: Children with food allergies and non-atopic healthy children were compared using a questionnaire that included prenatal, neonatal, and postnatal risk factors. Results: A total of 314 subjects, 155 patients and 159 healthy children for the control group, were enrolled in the study. The median age of patients with a food allergy at diagnosis was 6 months (1–156 months), and 71 patients (45.8%) were males. The median age of the control group was 12 months (1–61 months), and 67.0% were males. Older maternal age (P = 0.023), birth by caesarean section (P = 0.001), birth in the summer or autumn (P = 0.011), crowded housing (P = 0.001), damp houses (P = 0.001), being fed with breast milk and complementary food (P = 0.001), use of synthetic bedding (P = 0.024), and being the oldest child in the family (P = 0.001) were the considered risk factors for an immunoglobulin-E (IgE)-mediated food allergy. A low frequency of yoghurt consumption by mother (P = 0.001) and use of wool bedding (P = 0.018) were identified as risk factors for non-IgE-mediated food allergies. Low socioeconomic status (P = 0.001) played a protective role against both IgE- and non-IgE-mediated food allergies whereas breastfeeding played a protective role against IgE-mediated food allergies (P = 0.030). Conclusion: The most important aspect of this study was that it separately identified prenatal, neonatal, and postnatal risk factors for IgE- and non-IgE-mediated food allergies (AU)

The prevalence of sensitization to food allergens in children with atopic dermatitis

Introduction: Atopic dermatitis (AD) has a complex pathophysiology. The course of the disease is affected by both environmental factors and allergen hypersensitivities. Food and aeroallergens have a significant role in the pathogenesis and disease control. Objective: In this study, it was aimed to determine the prevalence of food and aeroallergen sensitivity of children with AD. Methods: Children under 18 years with AD who applied to pediatric allergy and immunology outpatient clinics were evaluated. All patients had a skin prick test (SPT) within most common food and aeroallergens. Results: One hundred seventy three patients were studied. Most of the moderate and severe AD patients were boys (boys 64% vs. girls 47%). Symptoms started earlier and positive results in SPTs with food allergens were more common in patients with SCORAD (SCORing Atopic Dermatitis) >25 (p < 0.0001). Egg white (39%), egg yolk (31%), cow’s milk (13%) and wheat flour (5%), were the most common allergens, respectively. The SCORAD scores were higher in multiple food sensitized patients’ groups (p < 0.001). Although, food sensitizations were prevalent in patients who had higher SCORAD scores (p = 0.001), there was no significant difference in sensitization with aeroallergens. (p = 0.392). Conclusion: Sensitizations to both food and aeroallergens are common in patients with AD. In addition, sensitization to these allergens and SCORAD severity in patients with AD have positive correlation (AU)

Associations between functional constipation and non-IgE-mediated food allergy in infants and children

Background: The non-IgE-mediated food allergy (non-IgE-FA) is less prevalent than IgE-mediated food allergy, and their relationship with functional constipation (FC) needs to be clarified. Methods: A total of 305 infants and children with constipation treated in the Department of Pediatric Gastroenterology, Children’s Hospital of Nanjing Medical University, from July 2020 to December 2021 were included in this study. Four cases with organic lesions were excluded. Among 301 diagnosed with FC, according to ROME IV criteria, 81 cases with allergy-related indicators were further evaluated for food allergy by food-specific IgG antibody test, allergen- specific IgE antibody detection, skin prick test, and food avoidance and reintroduction. Results: A total of 45 cases with FC were diagnosed with food allergy, and the incidence rate was 15%. Among the 45 patients, 35 cases (77.8%) had FC with non-IgE-FA. The main clinical symptoms or signs included anal fissure, abdominal pain, and pain during defecation. The most prevalent allergic foods were cow’s milk, eggs, fish, and shrimp. Ten (22.2%) cases reported FC with mixed food allergy, including both non-IgE-mediated and IgE-mediated food allergy. This study focused on non-IgE-mediated food allergy–related FC. Conclusion: Our results showed that the incidence of food allergy in infants and children with FC was 15%, which was mainly mediated by non-IgE-FA. The main clinical symptoms or signs in these cases included anal fissure, abdominal pain, and pain during defecation, and the main allergens included milk, eggs, fish, and shrimp (AU)

Food protein-induced enterocolitis syndrome due to buckwheat: A case report

Buckwheat is a rare causative food for food protein–induced enterocolitis syndrome (FPIES). To date, it is unknown what laboratory data patients with FPIES caused by buckwheat show. We report a 4-year-old female with FPIES caused by buckwheat and the laboratory results. Skin prick, specific IgE antibody, and basophil activation tests were negative; however, the lymphocyte stimulation test (LST) revealed a 10.2-fold increase in activation compared with the negative control. In an open-label oral food challenge (OFC) of 80 g boiled buckwheat noodles, 3 hours after ingestion, vomiting occurred four times in a 2-hour duration. Therefore, we diagnosed the patient with FPIES caused by buckwheat. Her neutrophil count, C-reactive protein, and thymus and activation-regulated chemokine were elevated after the OFC. Moreover, the patient had a positive reaction to the LST, which may theoretically be useful in diagnosing non-immunoglobulin E-mediated gastrointestinal food allergies. FPIES caused by buckwheat is rare; however, we found that the same laboratory results were observed in a comparison of FPIES cases caused by other foods (AU)

Evolution of laboratory parameters in patients with lipid transfer protein syndrome after 3 years of immunotherapy

Lipid transfer protein (LTP) syndrome is an increasingly prevailing disease, especially in the young population, with severely affected quality of life. Since 2013, a specific treatment, called sublingual immunotherapy (SLIT), with peach extract (SLIT-peach®) has been used, but with no long-term effectiveness studies. The main objective of the present study was to assess the long-term effectiveness of SLIT-peach® and to relate the clinical evolution of patients. This was an ambispective study conducted for 3 years. A total of 25 patients with LTP syndrome were selected and treated with SLIT-peach®. They underwent a provocation test in the first year with reintroduced foods that had produced symptoms in the past. Analytical determination of specific immunoglobulin E (IgE) and immunoglobulin G4 (IgG4) to peach (Pru p 3) was performed at the beginning of treatment, at the first year of initiation, and at the end of treatment. These data were compared with the control group comprising 14 patients with LTP syndrome without treatment. A statistically significant decrease in specific IgE to Pru p 3 at the end of the treatment and an increase in specific IgG4 to Pru p 3 1 year after treatment initiation were observed in the active group in relation to tolerance to foods with LTPs. These results indicate that food tolerance begins after the first year and is maintained after the end of 3 years of treatment. In conclusion, treatment with SLIT-peach® for 3 years is effective for patients with LTP syndrome, preventing the evolution of the disease, allowing patients to restart a diet with plant foods, and improving their quality of life (AU)

Food allergy in adolescents: validation of the food allergy independent measure and the EuroPrevall food allergy quality of life questionnaire into Spanish

Background: Different questionnaires have been developed globally to assess and compare the impact of food allergy on the quality of life. The aim of this study was to validate a Spanish translation of the Food Allergy Independent Measure (FAIM) and the EuroPrevall Food Allergy–Quality of Life Questionnaire–Teenage Form (FAQLQ-TF) for adolescents aged 13–17 years. Methods: Sixty adolescents diagnosed with immunoglobulin E-mediated allergy to food completed the questionnaires. Cronbach’s alpha was used to assess internal consistency; correlation between FAQLQ-TF and FAIM was used to test construct validity. The discriminant validity was evaluated by comparison with the number of offending foods, the perceived impact on social life, the diagnosis of anaphylaxis, and the previous prescription of adrenaline auto--injectors (AAI). Results: No question fulfilled criteria to be removed from the questionnaire. For FAIM, Cronbach’s alpha = 0.763, and for the four domains of FAQLQ-TF, Cronbach’s alpha = 0.797–0.847. A significant correlation existed between FAQLQ-TF and FAIM, and of both of them with anaphylaxis and the prescription of AAI (P ˂ 0.05 for all comparisons). Conclusions: This Spanish translation of FAIM and FAQLQ-TF for adolescents had good internal consistency and construct validity as well as ability to discriminate patients according to the number of foods to avoid, impact on social life, diagnosis of anaphylaxis, and AAI prescription (AU)

The reported prevalence of food allergy among school-aged children in Bahrain

Allergic diseases have been continuously studied and monitored, while the topic of food allergy (FA) lags with only a few prevalence studies conducted in certain countries. The main aim of this study was to estimate the prevalence of FA in school-aged children in the Kingdom of Bahrain. A cross-sectional design was used on a randomized sample of school-aged children in Bahrain. An electronic questionnaire inquiring about demographic data and history of FA and its details was administered through school administrations between October and December 2020. Data was obtained from 1370 participants, comprising 822 males and 548 females. The prevalence of a reported history of FA in school-aged children in Bahrain was calculated as 15.5%. Furthermore, 9.9% of children reported a current FA. The most common experienced symptoms were skin symptoms followed by gastrointestinal symptoms. Moreover, 7% of children reported experiencing anaphylaxis, low blood pressure, or shock. This research concluded that the reported prevalence of FA history among school-aged children in Bahrain was higher than that observed in other studies estimating at 15.5%, with 9.9% persisting up to the time of the study. The most common single food allergen was found to be egg. The findings of this study provide a baseline for future larger studies to obtain more in-depth results (AU)

Appearance of food-dependent exercise-induced anaphylaxis as an inflammatory disease: a pediatric case report and differential diagnosis

Anaphylaxis is the most serious of all allergic reactions. Despite advances in the knowledge of anaphylaxis, its clinical manifestations continue to be under-recognized. Indeed, proper diagnosis of anaphylaxis is often missed, and the treatment is delayed. The underlying causes are still under investigation globally. Inflammation represents the cornerstone of pathophysiology of anaphylaxis. Food-dependent exercise-induced anaphylaxis (FDEIA) is a rare clinical manifestation characterized by a chronological sequence in which food ingestion followed by physical exercise leads to anaphylaxis. Its mechanisms are yet to be fully explained. We report the case of a 14-year-old Chinese male who lost consciousness while undergoing physical activity at school. Several differential diagnoses were considered such as hypovolemic shock, septic shock, anaphylactic shock or neurological adverse event. Finally, the diagnosis of FDEIA was made. This case highlights the difficulties in diagnosing FDEIA and its management, especially when the clinical history is not complete and detailed (AU)

Assessment of intracellular zinc levels in infants with food protein–induced allergic proctocolitis

Background: Food protein–induced allergic proctocolitis (FPIAP) is characterized by bloody stools in well-appearing infants. Zinc is a micronutrient that plays a crucial role in immune modulation and is essential for cellular function during immune response. Although there are studies on the assessment of intracellular zinc levels in allergic diseases, no data is available on erythrocyte zinc levels of patients with FPIAP. Objective: This study aimed to assess the erythrocyte zinc levels of children with allergic proctocolitis and compare zinc levels with clinical and demographic characteristics. Methods: This was a case–control study that prospectively compared 50 patients with FPIAP and 50 healthy children without malnutrition. The erythrocyte zinc levels of children were determined using atomic absorption spectrophotometry. Results: Fifty patients with FPIAP, including 28 (51%) girls, with median age of 7.1 ± 2.9 (3–14) months and 50 healthy children, including 26 (53.1%) girls, with median age of 7.7 ± 2.8 (3–13) months were included in the study. Seventy percent (n = 35) of the patients with FPIAP started to have symptoms while they were exclusively breastfeeding. Offending allergen foods were cow’s milk (78%), egg (40%), sesame (10%), hazelnut (8%), almond (6%), beef (6%), and peanuts (6%, n = 3). Intracellular (erythrocyte) zinc levels in patients with FPIAP were lower than in the healthy control group (495.5 ± 134 µg/dL, 567.3 ± 154.4 µg/dL, respectively, P = 0.01). Patients with FPIAP aged younger than 6 months had lower intracellular zinc levels compared with those aged above 6 months (457 ± 137 µg/dL; 548 ± 112 µg/dL, respectively, P = 0.01). There was no relationship between zinc levels and time of symptom onset, presence of concomitant disease, being allergic to multiple foods, and family history of atopy (P > 0.05). Conclusions: FPIAP is a food allergy with limited information on its pathogenesis (AU)