Current update on anaphylaxis: anaphylaxis management in recent guidelines.

Summary: Anaphylaxis is a potentially fatal hypersensitivity reaction but frequently underrecognized. Although its incidence rates vary according to geographical location, it seems clear that there has been a general increase in recent years, either because of greater recognition of this entity or because it is progressing proportionally to the presence of allergic diseases in the world. The development of anaphylaxis management guidelines adapted to local or regional needs seems of utmost importance. Furthermore, it is necessary to assess their implementation and their positive effect regarding diagnosing and treating anaphylaxis. In this review we explore the currently existing definitions of anaphylaxis and its epidemiology, the potential triggers of anaphylaxis and guideline recommendations in terms of diagnosis and management, proposing a novel anaphylaxis calculator and reviewing the current scoring methods for anaphylactic episodes.

Hypersensitivity Reactions to Cancer Chemotherapy: Practical Recommendations of ARADyAL for Diagnosis and Desensitization.

Rapid drug desensitization has enabled first-line therapies in patients with drug hypersensitivity reactions to chemotherapeutic drugs including monoclonal antibodies. Desensitization is a safe and highly effective procedure, not only for IgE-mediated reactions, but also for those mediated by non-IgE mechanisms. The likelihood of breakthrough reactions during desensitization is low, and most are mild; in fact, moderate-to-severe reactions are infrequent. In this document, 16 allergy departments belonging to the Spanish research network ARADyAL present a review of the available scientific evidence and provide general guidelines for the diagnosis and management of drug hypersensitivity reactions to chemotherapeutic drugs and monoclonal antibodies. Emphasis is placed on the desensitization procedure.

Validation of Recipes for Double-Blind Placebo-Controlled Challenges With Milk, Egg White, and Hazelnut.

BACKGROUND: The double-blind, placebo-controlled food challenge (DBPCFC) is considered the definitive diagnostic test for food allergy. Nevertheless, validated recipes for masking the foods are scarce, have not been standardized, and differ between centers. Sensory evaluation techniques such as the triangle test are necessary to validate the recipes used for DBPCFC. METHODS: We developed 3 recipes for use in DBPCFC with milk, egg white, and hazelnut and used the triangle test to validate them in a 2-phase study in which 197 volunteers participated. In each phase, participants tried 3 samples (2 active-1 placebo or 2 placebo-1 active) and had to identify the odd one. In phase 1, the 3 samples were given simultaneously, whereas in phase 2, the 3 samples of foods that failed validation in phase 1 were given sequentially. A visual analog scale (VAS) ranging from 1 to 10 was used to evaluate how much participants liked the recipes. RESULTS: In phase 1, the egg white recipe was validated (n=89 volunteers, 38.9% found the odd sample, P=.16). Milk and hazelnut recipes were validated in phase 2 (for both foods, n=30 participants, 36.7% found the odd sample, P=.36). Median VAS scores for the 3 recipes ranged from 6.6 to 9.7. CONCLUSIONS: We used sensory testing to validate milk, egg white, and hazelnut recipes for use in DBPCFC. The validated recipes are easy to prepare in a clinical setting, provide the equivalent of 1 serving dose, and were liked by most participants.

Predictors of health-related quality of life of European food-allergic patients.

BACKGROUND: Although food allergy has universally been found to impair HRQL, studies have found significant differences in HRQL between countries, even when corrected for differences in perceived disease severity. However, little is known about factors other than disease severity which may contribute to HRQL in food-allergic patients. Therefore, the aim of this study was to identify factors which may predict HRQL of food-allergic patients and also to investigate the specific impact of having experienced anaphylaxis and being prescribed an EAI on HRQL. METHODS: A total of 648 European food-allergic patients (404 adults, 244 children) completed an age-specific questionnaire package including descriptive questions. Multivariable regression analyses were performed to develop models for predicting HRQL of these patients. RESULTS: For adults, the prediction model accounted for 62% of the variance in HRQL and included perceived disease severity, type of symptoms, having a fish or milk allergy, and gender. For children, the prediction model accounted for 28% of the variance in HRQL and included perceived disease severity, having a peanut or soy allergy, and country of origin. For both adults and children, neither experiencing anaphylaxis nor being prescribed an epinephrine auto-injector (EAI) contributed to impairment of HRQL. CONCLUSIONS: In this study, food allergy-related HRQL may be predicted to a greater extent in adults than in children. Allergy to certain foods may cause greater HRQL impairment than others. Country of origin may affect HRQL, at least in children. Experiencing anaphylaxis or being prescribed an EAI has no impact on HRQL in either adults or children.

Validation of the Spanish Version of the Food Allergy Quality of Life Questionnaire-Adult Form (S-FAQLQ-AF).

INTRODUCTION: Specific food allergy quality of life questionnaires have been developed within the context of the EuroPrevall project. We aimed to adapt and validate the Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF) in the Spanish language. METHODS: The original English questionnaire was translated and culturally adapted into Spanish following World Health Organization guidelines. The final Spanish version of the FAQLQ-AF (S-FAQLQ-AF) was approved by the original authors. Consecutive patients ( 18 years old) who fulfilled the following criteria were recruited: 1) diagnosis of food allergy defined as immediate allergic symptoms and a positive prick test or IgE against the culprit food(s) and 2) physician-assessed ability to complete the questionnaires. Patients completed the S-FAQLQ-AF and a Spanish version of the SF-12 questionnaire. Reliability was assessed 10 to 14 days after completion of the first questionnaire. RESULTS: Eighty-two consecutive outpatients were recruited and cross-sectional validity was.assessed based on the correlation between the S-FAQLQ-AF and the Food Allergy Independent Measure (FAIM) in this population (rho = 0.83, P < .0001). The S-FAQLQ-AF showed excellent internal consistency (Cronbach α, 0.95). S-FAQLQ-AF domains also had excellent internal consistency: α = 0.93 for allergen avoidance-dietary restrictions; α = 0.83 for emotional impact; α = 0.85 for risk of accidental exposure, and α = 0.66 for food allergy related health. Limited correlation was found between the S-FAQLQ-AF and the SF-12. CONCLUSION: The S-FAQLQ-AF is a valid, short, easy-to-use, and reliable instrument that discriminates between patients with different atopic phenotypes and is suitable for assessing the impact of IgE-mediated food allergy on patient quality of life.

Safety and efficacy profile and immunological changes associated with oral immunotherapy for IgE-mediated cow's milk allergy in children: systematic review and meta-analysis.

BACKGROUND: Cow's milk allergy (CMA), one of the main types of childhood allergy, considerably impairs patient quality of life. Allergen avoidance is difficult, and mistakes are common. Therefore, new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. Our objective was to review current evidence on immunological changes, efficacy, and safety when using OIT as an alternative to an avoidance diet in the treatment of children with IgE-mediated CMA. METHODS: We performed a systematic review and subsequent meta-analysis of all randomized controlled studies published to date in which OIT is used to treat CMA in children.We evaluated immunological effects, acquisition of desensitization, and adverse events. Immunological changes were examined by means of a meta-analysis of individual patient data. RESULTS: Desensitization using OIT to cow's milk is 10.2 times more likely than in non-0IT-treated patients. The decrease in cow's milk-specific IgE levels was found to differ by 8.1 kUA/L between OIT-treated patients and those on an avoidance diet. This difference was not statistically significant (P=.318). Although side effects are common, they usually involve mild reactions that are easy to manage without parenteral epinephrine. CONCLUSION: OIT can be considered safe and effective (in terms of acquiring desensitization) and reasonably safe (mild-to-moderate adverse events, little need for parenteral epinephrine) in patients with CMA. Although OIT leads to changes in cow's milk-specific IgE levels, the differences between OIT-treated and non-0IT-treated patients are not significant. More studies are needed to evaluate other immunological changes that may occur, such as the increase in IgG4 levels.