Can we identify patients at risk of life-threatening allergic reactions to food?

Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.

The Prevalence of Grass Pollen-Related Allergic Rhinoconjunctivitis in Elite Amateur Irish Athletes.

Allergic rhinoconjunctivitis (AR/C), has been shown to impact upon athletic performance. The championships of the unique, amateur Irish sports of hurling and Gaelic football (collectively known as GAA) take place during the prime pollen months of summer. Elite GAA players must perform optimally when most exposed to pollen. Elite GAA subjects (n=254) underwent skin prick testing to 6 aeroallergens and completed a validated questionnaire (AQUA), producing a score indicating likelihood of having allergy. The prevalence of allergy (positive to at least one aeroallergen on SPT and positive AQUA score) was 27.1% (n=69). Sixteen and a half percent (n=42) of the subjects tested had grass pollen AR/C while 22% (n=54) had house dust mite AR/C, though none were on standard medical therapies or had used allergen-specific immunotherapy. Grass pollen AR/C prevalence appears as common in elite Irish athletes as it is in other countries. It appears to be mild rather than well controlled in these subjects.

Testing children for allergies: why, how, who and when: an updated statement of the European Academy of Allergy and Clinical Immunology (EAACI) Section on Pediatrics and the EAACI-Clemens von Pirquet Foundation.

Allergic diseases are common in childhood and can cause a significant morbidity and impaired quality-of-life of the children and their families. Adequate allergy testing is the prerequisite for optimal care, including allergen avoidance, pharmacotherapy and immunotherapy. Children with persisting or recurrent or severe symptoms suggestive for allergy should undergo an appropriate diagnostic work-up, irrespective of their age. Adequate allergy testing may also allow defining allergic trigger in common symptoms. We provide here evidence-based guidance on when and how to test for allergy in children based on common presenting symptoms suggestive of allergic diseases.

Complementary and alternative medicine use in Irish paediatric patients.

BACKGROUND: Although very little scientific data exists on the efficacy and side effects of complementary and alternative medicines, their profile and availability is increasing. Use among Irish children is unknown. AIMS: To determine the nature and prevalence of complementary and alternative medicines (CAM) use in our paediatric population. METHODS: Parental questionnaires were distributed in 13 paediatric settings over a 4-month period. RESULTS: There were 57% of parents reported using CAM for their child. Use was significantly higher in the 2-4 years age group (34/105, 32%, P = 0.005). The commonest medicinal CAMs used were vitamins (88%), fish oils (27%) and Echinacea (26%). The commonest non-medicinal CAMs used were homeopathy (16%) and craniosacral therapy (14%). Use varied between paediatric specialties, with the highest in neurological patients (23/25, 92%, P = 0.005). Only 13% of parents had informed their Paediatrician of their child's CAM use. CONCLUSIONS: More than half of the children surveyed had used some form of CAM, usually without their Paediatrician's knowledge.

The threshold concept in food safety and its applicability to food allergy.

Down the years there have been many clinical reports of exquisite sensitivity to low doses of food allergens. There are many factors that may contribute to a variation of threshold in an individual exposed to an allergen during the course of his or her daily life. Some of these factors are intrinsic and unavoidable. Other factors may be predictable but not easily controllable, such as asthma, exposure to allergens during the pollen season and predicting situations that may be risky. Other factors may be out of the control of the individual. The most important one of these is the adequate training and awareness of manufacturers and caterers who aim to provide safe and nutritious meals to their allergic and non-allergic customers alike. Clinical histories of reactions in the community and the use of labial exposure during food challenge show that most non-ingestion exposures to peanut usually result in easily treated minor reactions. Formal, oral food challenges have shown that low dose reactivity is relatively common but studies have not yet had the power to investigate whether peanut allergy is more commonly associated with very low dose reactivity than other foods. This means that industry must not concentrate only on peanut and tree nuts when looking at issues of contamination just because they are associated with the majority of severe reactions. There are more milk and egg allergic children in the general population and they deserve the same protection from allergen exposure as sufferers of peanut or tree nut allergies.