RESUMEN
Food allergy are triggered by an abnormal immune response to specific food components, with milk and eggs being the most common food allergens, especially in children. Food allergy can cause various symptoms such as rashes, difficulty breathing, and digestive issues. Allergen component diagnostics is a technique used to identify specific allergenic proteins, aiding doctors in providing more precise treatment and management recommendations for patients. This article analyzes the latest research developments and clinical significance of milk and egg allergen components based on the " Molecular Allergology User's Guide 2.0 (MAUG 2.0)" issued by the European Academy of Allergy and Clinical Immunology (EAACI), including their applications in clinical diagnosis, treatment, and management. This article aims to enhance healthcare professionals' understanding of milk and egg allergies, offering new perspectives and practical guidelines for research and clinical practice to promote accurate diagnosis and personalized treatment strategies.
Asunto(s)
Alérgenos , Hipersensibilidad al Huevo , Hipersensibilidad a los Alimentos , Hipersensibilidad a la Leche , Humanos , Alérgenos/análisis , Hipersensibilidad al Huevo/diagnóstico , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a la Leche/diagnóstico , Huevos , Animales , LecheRESUMEN
Food protein-induced enterocolitis syndrome (FPIES) caused by fish and others is prevalent in the Mediterranean regions but is less frequently reported in Japan. This case report describes a 3-year-old Japanese girl who developed FPIES triggered by multiple seafoods, including swordfish, cod, and squid. The diagnosis was confirmed through oral food challenge tests (OFC), which led to repeated vomiting and an increase in thymus and activation-regulated chemokine (TARC) levels. This case highlights the importance of considering fish-induced FPIES in the differential diagnosis of recurrent vomiting in children and suggests the potential utility of TARC levels in diagnosing and monitoring FPIES.
Asunto(s)
Enterocolitis , Hipersensibilidad a los Alimentos , Alimentos Marinos , Humanos , Enterocolitis/etiología , Enterocolitis/diagnóstico , Femenino , Preescolar , Alimentos Marinos/efectos adversos , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/etiología , Japón , Animales , Síndrome , Quimiocina CCL17/sangre , Decapodiformes , Pueblos del Este de AsiaRESUMEN
The prevalence of food allergy is increasing globally, becoming a significant public health issue that greatly impacts the quality of life for patients and their families. However, there is currently a problem with both underdiagnosis and overdiagnosis of food allergy. Therefore, accurate diagnosis of food allergy and personalized management based on accurate diagnosis are crucial. Over the past 10 years, there has been relevant research on food allergy diagnosis, particularly focusing on IgE-mediated food allergy diagnostic methods such as component resolved diagnosis and basophil activation test, since the launch of the European Academy of Allergy and Clinical Immunology(EAACI) Food Allergy Guidelines in 2014. In October 2023, EAACI published updated diagnostic guidelines for IgE-mediated food allergy. To help allergists and other medical professionals stay informed about the latest EAACI recommendations on the diagnosis of IgE-mediated food allergy, this guideline is now being interpreted.
Asunto(s)
Hipersensibilidad a los Alimentos , Inmunoglobulina E , Hipersensibilidad a los Alimentos/diagnóstico , Humanos , Inmunoglobulina E/inmunología , Alérgenos/inmunologíaRESUMEN
BACKGROUND: Allergy to lipid transfer proteins (LPT) is common in Mediterranean Europe, and it causes severe reactions in patients and affects multiple foods, impairing the quality of life. OBJECTIVE: This study aimed to describe the clinical and sensitization profile of patients with LTP syndrome and to determine a clinical pattern of severity. Molecular diagnosis is shown in a broad population through microarrays. MATERIAL AND METHODS: This study was performed at the LTP Allergy Consultation of the Reina Sofia Hospital in Murcia, Spain. We analyzed the patients' characteristics, reactions, cofactors, food implicated, quality of life, skin prick test to food and aeroallergens, and serologic parameters, such as total immunoglobulin E, peach LTP (Pru p 3 IgE) and immunoglobulin G4, and microarray Immuno Solid-phase Allergen Chip (ISAC). We related the severity of the reactions with other variables. RESULTS: We presented a series of 236 patients diagnosed with LTP allergy, 54.66% suffering from anaphylaxis, 36.02% from urticaria angioedema, and 9.32% from oral allergy syndrome. The most frequently implicated food was peach, producing symptoms in 70% of patients, followed by walnut in 55%, peanut in 45%, hazelnut in 44%, and apple in 38% patients. Regarding the food that provoked anaphylaxis, walnut was the most frequent instigator, along with peach, peanut, hazelnut, almond, sunflower seed, and apple. According to the severity of LPT reaction, we did not discover significant differences in gender, age, food group involved, and serologic parameters. We found differences in the presence of cofactors, with 48.84% of cofactors in patients with anaphylaxis, compared to 27.1% in patients without anaphylaxis and in family allergy background (P < 0.0001). CONCLUSION: In our series of patients, 54% presented anaphylaxis, and the foods that most frequently produced symptoms were peaches, apples, and nuts. Cofactors and family allergy backgrounds were associated with the severity of LPT reaction.
Asunto(s)
Alérgenos , Antígenos de Plantas , Hipersensibilidad a los Alimentos , Inmunoglobulina E , Pruebas Cutáneas , Humanos , Masculino , Femenino , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/epidemiología , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Adulto , Persona de Mediana Edad , Antígenos de Plantas/inmunología , Alérgenos/inmunología , España/epidemiología , Adolescente , Proteínas de Plantas/inmunología , Adulto Joven , Proteínas Portadoras/inmunología , Niño , Inmunoglobulina G/sangre , Inmunoglobulina G/inmunología , Anciano , Calidad de Vida , Anafilaxia/inmunología , Anafilaxia/diagnóstico , Anafilaxia/etiología , PreescolarRESUMEN
PURPOSE OF THE REVIEW: With increased access and decriminalization of cannabis use, cases of IgE-dependent cannabis allergy (CA) and cross-reactivity syndromes have been increasingly reported. However, the exact prevalence of cannabis allergy and associated cross-reactive food syndromes (CAFS) remains unknown and is likely to be underestimated due to a lack of awareness and insufficient knowledge of the subject among health care professionals. Therefore, this practical roadmap aims to familiarize the reader with the early recognition and correct management of IgE-dependent cannabis-related allergies. In order to understand the mechanisms underlying these cross-reactivity syndromes and to enable personalized diagnosis and management, special attention is given to the molecular diagnosis of cannabis-related allergies. RECENT FINDINGS: The predominant signs and symptoms of CA are rhinoconjunctivitis and contact urticaria/angioedema. However, CA can also present as a life-threatening condition. In addition, many patients with CA also have distinct cross-reactivity syndromes, mainly involving fruits, vegetables, nuts and cereals. At present, five allergenic components of Cannabis sativa (Can s); Can s 2 (profilin), Can s 3 (a non-specific lipid protein), Can s 4 (oxygen-evolving enhancer protein 2 oxygen), Can s 5 (the Bet v 1 homologue) and Can s 7 (thaumatin-like protein) have been characterized and indexed in the WHO International Union of Immunological Sciences (IUIS) allergen database. However, neither of them is currently readily available for diagnosis, which generally starts by testing crude extracts of native allergens. The road to a clear understanding of CA and the associated cross-reactive food syndromes (CAFS) is still long and winding, but well worth further exploration.
Asunto(s)
Alérgenos , Cannabis , Reacciones Cruzadas , Inmunoglobulina E , Humanos , Reacciones Cruzadas/inmunología , Cannabis/inmunología , Cannabis/efectos adversos , Inmunoglobulina E/inmunología , Alérgenos/inmunología , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/terapia , Síndrome , Hipersensibilidad/inmunología , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapiaRESUMEN
Breastfeeding is the most important nutrition source for infants. However, managing breastfed infants with signs and symptoms related to food allergy can be difficult. Many studies have shown the presence of different food allergens in breast milk, but the clinical role of these antigens in human milk is still much debated. Milk is the main suspect in exclusively breastfed infants with signs and symptoms attributable to food allergy, even if other foods may be responsible. This narrative review analyzes the recommendations provided by international guidelines to determine the diagnosis and management of IgE-mediated and non-IgE-mediated food allergies in exclusively breastfed infants. Dietary restrictions in lactating mothers of infants with suspected FA are usually not necessary. Only in the very few cases where significant allergy signs and symptoms occur in the infant during exclusive breastfeeding should the lactating mother follow an elimination diet for the suspected food for a short period.
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Lactancia Materna , Hipersensibilidad a los Alimentos , Lactancia , Leche Humana , Humanos , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/dietoterapia , Lactante , Femenino , Leche Humana/inmunología , Dieta , Recién Nacido , Madres , Dieta de EliminaciónRESUMEN
Background: Fruit allergy usually presents with mild-to-moderate symptoms but serious systemic reactions, e.g., anaphylaxis, may also occur. Objective: This study aimed to examine the clinical and laboratory characteristics of patients with fruit allergy and fruit-induced anaphylaxis. Methods: Patients diagnosed with fruit allergy at Diskapi Hematology and Oncology Hospital and Bilkent City Hospital between January 2017 and January 2023 were included in the study. The diagnosis of anaphylaxis was made according to the European Allergy and Clinical Immunology Anaphylaxis Guideline. Results: During the study period, skin-prick tests with food allergens were performed on 9432 patients in our clinic, and fruit allergy was detected in 78 patients (0.82%). Five patients with inaccessible medical records were excluded from the study. 40 (54.8%) were boys. The median (interquartile range) age at the onset of symptoms was 72 months (12.5-144 months). Sixty-eight of the patients (93.2%) had a concomitant allergic disease, the most common of which was allergic rhinitis (n = 48 [65.8%]). The 73 patients had a history of reaction to 126 fruits. Twenty-five patients (19.8%) were allergic to multiple fruits. The most common fruit allergen was banana (22/126 [17.4%]), followed by peach (18/126 [14.2%]) and kiwi (17/126 [13.5%]). Mucocutaneous findings were observed most frequently after fruit consumption (120/126 [95.2%]). Anaphylaxis occurred in 17 patients (23.2%) with 21 fruits.The fruits most commonly associated with anaphylaxis were banana (6/21 [28.6%]) and kiwi (6/21 [28.6%]). Conclusion: Fruit allergy generally presents with mild symptoms, e.g., oral allergy syndrome, but severe systemic symptoms, e.g., anaphylaxis, can also be observed. Kiwi and banana are the fruits that most commonly cause anaphylaxis. Although more comprehensive studies are needed to comment on the development of tolerance, especially in patients with anaphylaxis, responsible fruit avoidance is still the most important strategy.
Asunto(s)
Alérgenos , Anafilaxia , Hipersensibilidad a los Alimentos , Frutas , Pruebas Cutáneas , Humanos , Anafilaxia/diagnóstico , Anafilaxia/etiología , Anafilaxia/epidemiología , Masculino , Femenino , Niño , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/epidemiología , Frutas/efectos adversos , Frutas/inmunología , Preescolar , Alérgenos/inmunología , Lactante , AdolescenteAsunto(s)
Enterocolitis , Hipersensibilidad a los Alimentos , Humanos , Enterocolitis/diagnóstico , Enterocolitis/inmunología , Enterocolitis/etiología , Hipersensibilidad a los Alimentos/diagnóstico , Niño , Proteínas en la Dieta/efectos adversos , Proteínas en la Dieta/inmunología , Lactante , Preescolar , Masculino , Femenino , Síndrome , Enfermedad AgudaRESUMEN
Atopic diseases such as atopic dermatitis, food allergy, allergic rhinoconjunctivitis, and/or asthma are common. In Denmark, however, there are multiple referral pathways for these diseases in the healthcare system and they are poorly understood. To describe how children with atopic diseases navigate their way through the Danish healthcare system, a questionnaire was distributed to children aged ≤ 17 years, who were being treated for atopic diseases between August 2020 and June 2021, either by a practising specialist or a hospital department, in the Capital Region of Denmark. A total of 279 children completed the questionnaire and most were referred to a specialist or to a hospital by their general practitioner. No "common track" to hospital existed for patients with ≥ 3 atopic diseases. These patients were more often referred to a hospital compared with children with 2 atopic diseases or fewer (odds ratio [OR] 3.79; 95% CI 2.07-7.24). The primary determinants for hospital treatment were food allergy (OR 4.69; 95% CI 2.07-10.61) and asthma (OR 2.58; 95% CI 1.18-5.63). In conclusion, children with multiple atopic diseases were more likely to be referred to hospital departments than to practising specialists, mainly due to food allergies.
Asunto(s)
Derivación y Consulta , Humanos , Dinamarca/epidemiología , Niño , Masculino , Femenino , Adolescente , Preescolar , Hipersensibilidad a los Alimentos/epidemiología , Hipersensibilidad a los Alimentos/diagnóstico , Lactante , Asma/epidemiología , Asma/diagnóstico , Asma/terapia , Encuestas y Cuestionarios , Dermatitis Atópica/epidemiología , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/terapia , Departamentos de HospitalesRESUMEN
The recognition of constipation as a possible non-Immunoglobulin E (IgE)-mediated allergic condition is challenging because functional constipation (unrelated to food allergies) is a common health problem with a reported worldwide prevalence rate of up to 32.2% in children. However, many studies in children report challenge proven cow's milk allergy and constipation as a primary symptom and have found that between 28% and 78% of children improve on a cow's milk elimination diet. Due to the paucity of data and a focus on IgE-mediated allergy, not all food allergy guidelines list constipation as a symptom of food allergy. Yet, it is included in all cow's milk allergy guidelines available in English language. The Exploring Non-IgE-Mediated Allergy (ENIGMA) Task Force (TF) of the European Academy for Allergy and Clinical Immunology (EAACI) considers in this paper constipation in the context of failure of standard treatment and discuss the role of food allergens as culprit in constipation in children. This position paper used the Delphi approach in reaching consensus on both diagnosis and management, as currently published data are insufficient to support a systematic review.
Asunto(s)
Estreñimiento , Hipersensibilidad a los Alimentos , Humanos , Estreñimiento/diagnóstico , Estreñimiento/terapia , Estreñimiento/etiología , Niño , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/terapia , Preescolar , Hipersensibilidad a la Leche/diagnóstico , Hipersensibilidad a la Leche/terapia , Hipersensibilidad a la Leche/complicaciones , Hipersensibilidad a la Leche/inmunología , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Técnica Delphi , Guías de Práctica Clínica como Asunto , Lactante , Alérgenos/inmunología , Animales , PrevalenciaRESUMEN
Food allergies severely impact the health-related quality of life (HRQoL) of patients and their caregivers (family or informal caregivers). Currently there is no comprehensive review to provide an overview and critical assessment of the instruments in the field. Six databases were searched from inception until 10 August 2023, and a combination of subject terms and free words was used to search the literature. We used the COnsensus-based Standards for the selection of health Measurement INstruments methodology (COSMIN) to evaluate the measurement properties of the instruments. Forty-one studies reported on ten eligible instruments. Based on COSMIN guidelines, one instrument was recommended for Grade A, and the remaining nine instruments were recommended for Grade B. The Grade A instrument identified, the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF), can help researchers assess the effectiveness of treatment for patients with food allergy and to understand the psychosocial impact of the disease on patients.
Asunto(s)
Consenso , Hipersensibilidad a los Alimentos , Psicometría , Calidad de Vida , Humanos , Hipersensibilidad a los Alimentos/psicología , Hipersensibilidad a los Alimentos/diagnóstico , Psicometría/métodos , Encuestas y Cuestionarios , Cuidadores/psicología , NiñoRESUMEN
BACKGROUND: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. In the last few years, after the publication of the consensus guidelines, with refined diagnostic criteria and improved awareness, FPIES is diagnosed with increased frequency. However, despite having a background of immune dysregulation, this complication has just been described once in the posttransplant setting, in an adult patient. To the best of our knowledge, there are no reports of pediatric patients developing FPIES after a hematopoietic stem cell transplant (HCT). METHODS: Retrospective review of a pediatric patient who developed severe FPIEs after a HCT. RESULTS: In this case report, the clinical presentation and diagnosis challenges of a pediatric patient who developed severe FPIES after HCT are described. The patient developed severe vomiting, diarrhea, lethargy, and shock and required admission to the pediatric intensive care unit in three occasions before the diagnosis was made. CONCLUSIONS: To the best of our knowledge, this is the first report of severe FPIES post-HCT in a pediatric patient. Physicians who are looking after pediatric patients in the post-HCT setting need to be aware of this possibility and include this entity in the differential diagnosis in order to reduce its associated morbidity.
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Enterocolitis , Hipersensibilidad a los Alimentos , Trasplante de Células Madre Hematopoyéticas , Humanos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enterocolitis/etiología , Enterocolitis/diagnóstico , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/etiología , Masculino , Proteínas en la Dieta , Síndrome , Estudios Retrospectivos , Femenino , Preescolar , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapiaRESUMEN
Background: Alpha-gal allergy or red meat allergy is a rare yet potentially severe allergy. Sensitisation usually occurs when alpha-gal present in the tick's saliva is transferred to humans during a tick bite, prompting the production of IgE antibodies to alpha-gal. Subsequent exposure to mammalian meat or other products containing alpha-gal can lead to allergic reactions. Case presentation: A previously healthy man in his sixties was admitted with acute anaphylaxis. A history of multiple tick bites and recent consumption of mammalian meat raised suspicion of anaphylaxis caused by alpha-gal syndrome. Interpretation: A diagnosis of alpha-gal syndrome was given based on elevated alpha-gal IgE antibodies, and further supported by medical history and clinical assessment. He was discharged with dietary instructions to eliminate food and products containing alpha-gal, and to manage allergy symptoms and anaphylaxis according to local guidelines.
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Anafilaxia , Hipersensibilidad a los Alimentos , Inmunoglobulina E , Mordeduras de Garrapatas , Humanos , Anafilaxia/etiología , Anafilaxia/inmunología , Anafilaxia/diagnóstico , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/etiología , Hipersensibilidad a los Alimentos/diagnóstico , Masculino , Inmunoglobulina E/inmunología , Inmunoglobulina E/sangre , Mordeduras de Garrapatas/inmunología , Mordeduras de Garrapatas/complicaciones , Persona de Mediana Edad , Carne Roja/efectos adversosRESUMEN
Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by gastrointestinal symptom onset within 1-4 hours from trigger food ingestion. In the literature, some authors have previously described the possibility that a patient with FPIES may develop an IgE-mediated allergy to the same trigger food, especially cow's milk (CM). Case Presentation: We reported five cases of CM-FPIES converting to IgE-mediated CM allergy presented at our tertiary pediatric Allergy Unit and performed a review of the literature, aiming to characterize the clinical features of patients who are at risk of developing such conversion. Conclusions: This phenomenon raises the question of whether IgE-mediated and non-IgE-mediated allergies represent a spectrum of the same disease and highlights the need for further investigation to understand the pathophysiological mechanisms of this process.
Asunto(s)
Enterocolitis , Inmunoglobulina E , Hipersensibilidad a la Leche , Humanos , Enterocolitis/inmunología , Enterocolitis/etiología , Enterocolitis/diagnóstico , Hipersensibilidad a la Leche/inmunología , Hipersensibilidad a la Leche/diagnóstico , Inmunoglobulina E/inmunología , Inmunoglobulina E/sangre , Femenino , Lactante , Masculino , Animales , Proteínas de la Leche/efectos adversos , Proteínas de la Leche/inmunología , Síndrome , Preescolar , Bovinos , Leche/efectos adversos , Leche/inmunología , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/etiología , Hipersensibilidad a los Alimentos/diagnósticoRESUMEN
BACKGROUND: Current clinical criteria for identifying anaphylaxis do not account for unique aspects of infant anaphylaxis presentation and have not been validated in patients younger than 2 years of age. This may contribute to under recognition and is thus an unmet need. OBJECTIVE: To demonstrate age-specific signs and symptoms that more accurately identify anaphylaxis in young children and to develop and compare modified criteria for "likely anaphylaxis" against the widely used 2006 National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network (NIAID/FAAN) criteria. METHODS: Retrospective chart review of 337 clinical encounters presenting with suspected allergic or anaphylactic reactions to a pediatric emergency department. Modified criteria for likely anaphylaxis were developed and evaluated against the NIAID/FAAN criteria. RESULTS: The study population included 33% infants (age < 12 mo), 39% toddlers (age 12 mo to < 36 mo), and 29% children (age ≥ 36 mo). The NIAID/FAAN criteria captured 85% of all patient encounters in the study and the modified criteria captured 98% (P < .001). Compared with NIAID/FAAN criteria, modified criteria had 22.8% improved performance among infants (p < .001) and 10.3% improved performance among toddlers (P = .04). CONCLUSIONS: We developed modified anaphylaxis clinical criteria that incorporated symptoms specific to infants and young children. The modified criteria increased identification of anaphylaxis in infants and potentially toddlers. Future research is needed to validate our findings on a larger cohort.