Tag Archives: food allergies

Food Allergy and Anaphylaxis: Promotes Awareness and Understanding | Instant News


As May 9-15 2021 is Food Allergy Awareness Week, there is an opportunity to raise awareness food allergies and anaphylaxis. Fortunately, the incidence of food anaphylaxis that is fatal to a person is low and increases the risk of death slightly.1,2 However, because food allergy anaphylaxis can be fatal, it is important to highlight food allergy awareness in order to provide appropriate treatment and counseling for patients.

Food allergies are allergic reactions that involve the immune system. For food allergies – particularly food allergic reactions that are mediated by immunoglobulin E (IgE) – there are specific food proteins that are the basis for the body to increase the immune response. In the most common type of food allergy, IgE antibodies target specific proteins in food that are mistakenly perceived as a threat. Food-specific IgE antibodies are formed that bind to receptors on mast cells, basophils, macrophages, and dendritic cells, and when the allergens reach cell-bound IgE antibodies in susceptible individuals, mediators are released causing allergy symptoms. There are also non-IgE or mixed IgE-mediated reactions, but the immunological basis of IgE-mediated is key to understanding how food allergies work.

Research from 2019 shows that at least 10.7% (> 26 million) of US adults are allergic to food, whereas 19% of US adults believe they have a food allergy.3 Having a confirmatory test with a strong clinical history is important to avoid undue burdens of quality of life and to provide appropriate counseling, medication, and diet management, if necessary.

Anaphylaxis is a multisystemic, severe, and potentially life-threatening allergic reaction. Symptoms can vary from confusion and agitation to swelling of the lips and mouth, difficulty breathing, wheezing, hypotension / weak pulse, and / or itching or redness all over the body. Epinephrine is the treatment of choice for this reaction. Many patients with food allergies have epinephrine autoinjectors. Epinephrine is generally not needed for mild hives – but if there are concerns about respiratory symptoms or persistent vomiting or abdominal pain, epinephrine is usually needed. Delayed administration of epinephrine has been cited as the most common cause of death from food allergies.4.5 In addition, as we enter the summer months, patients and providers need to be aware that epinephrine autoinjectors can lose potency within hours if stored in a heated car.6

Any food can cause an allergic reaction. However, eight types of food cause about 90% of all reactions: milk, wheat, eggs, peanuts, tree nuts, fish, crustacean shellfish, and soy.7 For those affected, education in the treatment and prevention of food allergic reactions is essential – which is why patients should be provided with assistance in reading and understanding food labels.8 This is especially true for children with food allergies, who should be encouraged to start reading food labels as soon as they can read at home from a caregiver.

There are many organizations that can provide assistance with food allergy education, diagnosis, treatment, and advocacy. This includes, but is not limited to:

  1. American Academy of Allergy, Asthma & Immunology (AAAAI)
  2. American College of Allergy, Asthma & Immunology (ACAAI)
  3. World Allergy Organization (WAO)
  4. Food Allergy Research & Education Organization (FARE)
  5. Kids With Food Allergies (KFA), a division of the American Asthma and Allergy Foundation

This organization has a variety of online resources that are also available to patients and providers.9,10,11,12,13

Eevar Benjamin Rossavik, DO, is the chief resident of pediatrics who will soon join the faculty of his program to become a pediatrician. He has special interests in allergies, asthma and immunology.

Doctors and experts are interested in responding to these articles, or submitting their own articles to HCPLive, can contact the editorial team here.

Reference

  1. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract. 2017; 5 (5): 1169-1178. doi: 10.1016 / j.jaip.2017.06.031
  2. Umasunthar T, Leonardi-Bee J, Hodes M, et al. Incidence of fatal food anaphylaxis in people with food allergies: a systematic review and meta-analysis. Allergy Clin Exp. 2013; 43 (12): 1333-1341. two: 10.1111 / cea.12211
  3. Gupta RS, Warren CM, Smith BM, et al. Food Allergy Prevalence and Severity Among US Adults. JAMA Netw Open. 2019; 2 (1): e185630. Published 2019 January 4. Doi: 10.1001 / zamanetworkopen. 2018.5630
  4. Chooniedass R, Temple B, Becker A. Use of epinephrine for anaphylaxis: Too infrequent, too late: Current practices and guidelines in health care. Ann Allergy Asthma Immunol2017; 119 (2): 108-110. Doi: 10.1016 / j.anai.2017.06.004
  5. Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005; 95 (3): 217-258. doi: 10.1016 / S1081-1206 (10) 61217-3
  6. https://www.aaaai.org/about-aaaai/newsroom/news-releases/epipens-heat#:~:text=Epinephrine%20autoinjectors%20(EAIs)%20have%20recommended,59%20%E2%80% 93% 2086% 20degrees% 20Fahrenheit% 20permitted
  7. https://www.fda.gov/food/buy-store-serve-safe-food/food-allergies-what-you-need-know
  8. https://www.foodallergy.org/resources/how-read-food-label
  9. https://www.aaaai.org/conditions-and-treatments/library/allergy-library/food-allergy
  10. https://acaai.org/allergies/types/food-allergy
  11. https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/food-allergy
  12. https://www.foodallergy.org
  13. https://www.kidswithfoodallergies.org

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Milk Overtaking Nuts as the Best Food Allergy Threat | Instant News


April 16, 2021 – When Lesley Solomon’s son is 10 years old, he is standing in an unfavorable spot on the playground when a schoolmate kicks a cup of hot chocolate which sends the droplets flying through the air. For a boy with a severe milk allergy, splashing hot liquids is less dangerous than milk stirring into a drink.

Solomon’s son quickly washed his clothes and skin from the liquid, took some Benadryl, and called his parents. But on the way home in the car, his throat started to close and his heart beat fast. It was one of about a dozen times she needed epinephrine injections, which increase blood flow, reduce swelling, and reverse anaphylaxis.

“Until you see a child having anaphylaxis and can’t breathe, or vomiting so much they can’t breathe, you don’t understand” how serious a food allergy can be, said Solomon, who is also the senior representative. president and chief innovation officer of the Dana-Farber Cancer Institute in Boston; and co-founder of the Food Allergy Science Initiative, an independent nonprofit that funds food allergy research.

The rate of children hospitalized for food-induced anaphylaxis rose by 25% from 2006 to 2012 – from 1.2 to 1.5 per 100,000 – according to an analysis of 2019 data from children’s hospitals in the United States. And severe symptoms are more often associated with milk than peanuts or tree nuts, research shows.

Cow’s milk is the most common food allergy in children under 5 years, and accounts for about half of all food allergies in children under 1 year. Most children grow from these allergies, but when a milk allergy persists into adolescence and adulthood, it is likely to cause a severe reaction.

Allergies Are Dangerous

“Cow’s milk allergy is the most troublesome food allergy. Many people don’t realize that it can cause such severe anaphylaxis,” says Carla Davis, MD, director of the food allergy program at Texas Children’s Hospital in Houston. “People don’t think about how much of this is in our diet.”

And cow’s milk has been shown to be the food allergy most likely to cause death in school-age children in the UK, according to an analysis of national data. reported by Medscape.

This lack of awareness is what makes a milk allergy so dangerous, says Paul Turner, PhD, of Imperial College London, who was involved in the UK analysis. “We need to spread that information to the public and businesses so they take the same level of concern they have with peanuts, and when someone says they have a milk allergy, they take it seriously.”

In food allergies, the body treats certain proteins such as casein and whey in milk as invaders, increasing the immune response. An antibody known as immunoglobulin (Ig) E, which normally protects against bacteria, viruses, and parasites, triggers inflammation, releases histamine, and can cause symptoms, usually within minutes, from rash and swelling to vomiting, difficulty swallowing, and difficulty swallowing. breathe.

So, what makes milk a healthy choice for kids – its high protein content – can cause serious reactions in a minority of children and adults. “You don’t need a lot of milk to get a decent dose” of allergens, says Turner.

The mechanism of milk allergy is very complex, even compared to other food allergens. This can be detected with a skin-prick test or blood test, but some people get positive results even if they are not allergic. To complicate matters further, people can also have a milk allergy that cannot be detected by testing and can cause symptoms that appear hours or even days after exposure.

More Serious than Lactose Intolerance

Unfortunately, milk allergies are often mistaken for digestive problems related to milk. Globaly, about 70% of people lack of enzymes to break down sugar in milk; This condition, known as lactose intolerance, can cause bloating, stomach cramps, and diarrhea, but is not life-threatening.

“Because lactose intolerance is so common, people don’t perceive a milk allergy as significant or severe,” says Ruchi Gupta, MD, director of the Center for Food Allergy and Asthma Research at Northwestern University Feinberg’s School of Medicine. in Chicago.

In infants, colic, formula regurgitation, and rash occasionally mistaken for a milk allergy, directing parents to unnecessarily purchase expensive special formulas.

Frustrated by the lack of data on food allergies, Gupta and his colleagues launched a national representative survey of 38,480 American parents in 2009, that is updated in 2015 and 2016.

On average, children who are allergic to milk have their first reaction before the age of 2. The most common reactions are vomiting, diarrhea, hives, and eczema. And children with milk allergies are twice as likely to grow from it as children with other allergies.

However, about a third of the children who were allergic to milk in the study were 11 years of age and older. And among adults who reported symptoms themselves, milk allergy was as common as peanut allergy (1.9% vs 1.8%). “We don’t know why milk allergies have become more persistent,” says Gupta. And, he warns, only 1 in 4 children with a milk allergy have a current prescription for an epinephrine autoinjector, compared to about 70% of children with a peanut allergy.

Christine Olsen, MD, co-founder and chief executive officer of the food allergy initiative says this can’t just be genetic. “There may be a genetic predisposition, but there must be something environmental” that predisposes the development of food allergies.

One theory is that the body’s natural defenses against harmful substances include an immune response, but this is compromised in the modern world by processed foods, chemical additives and hygienic environments.

Olson’s own son vomited when he tasted hummus for the first time as a baby; he is very allergic to sesame. His body’s quick reaction made Olsen think his response involved neurons, not just the immune system.

“If you think about the fact that some children get over their allergies and some adults get allergies, it shows there are some levers you can turn on and off,” said Olsen, who is also a radiation oncologist.

Prevent Allergies

Meanwhile, the food allergy prevention approach has been changed with Early Learning About Peanut Allergy (LEAP) learn done in Great Britain. LEAP researchers randomly assigned 640 babies to ingest regular amounts of peanuts or to avoid peanut products until they reached 5 years of age. Babies who are regularly exposed to peanuts from an early age are much less likely to develop a peanut allergy than those who avoid peanuts.

National Institute of Allergy and Infectious Diseases revise the guidelines and now recommends that all babies be exposed to foods containing peanuts at about 6 months of age; for high-risk babies, it can be started as early as 4 months.

Allergy experts plan to study the concept again with other foods, including cow’s milk. 5 years iREACH learn, launched by the Food Allergy & Asthma Research Center at Northwestern and Lurie Children’s Hospital, currently enrolls 10,500 babies to test for early exposure to nuts, milk, eggs and cashews. Some babies will develop severe eczema, putting them at high risk for food allergies, and others low risk, said Gupta, who is iREACH’s principal investigator.

“Hopefully in the next 5 years we will have data showing whether this prevention technique will work for other common food allergens, apart from peanuts,” he said.

In the future, rather than just diagnosing and treating food allergies, allergists may work with pediatricians to help prevent them from occurring.

Medscape Medical News

© 2021 WebMD, LLC. All rights reserved.

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Edwin Kim, MD, MS: Development of Food Allergy Research | Instant News


As discussed previously, new data from the American Academy of Allergy, Asthma & Immunology (AAAAI) 2021 Virtual Sessions shows sublingual immunotherapy (SLIT) in children under five with peanut allergy results in significant desensitization to allergens and a sustained inresponsiveness to allergen exposure several months after one ends. time. Daily SLIT.

Research presented by Edwin Kim, MD, MS, of the University of North Carolina School of Medicine, proves that even younger patients benefit more and last longer.

In the second segment Interview with HCPLive, Kim discusses the next steps of research and application of food allergy immunotherapy.

HCPLive: Something that is highlighted in the AAAAI discussion every year now is the risk of cross-allergic and cross-inflammatory disease. As you said, the patient may suffer from multiple allergies. They can also suffer from asthma, allergies, atopic dermatitis, and others.

We talked a lot about effectively treating something like asthma and what benefits it has for other conditions. But if we were to say that we could treat food allergies better at this early age, how would that affect other comorbid conditions that children often face?

Kim: I mean, that’s a fantastic question. And sadly, I didn’t know that we had a clue at all. I would say that for pollen allergies, your usual environmental allergy, there is a thought that starting to focus on allergy shots younger so that it can prevent the onset of asthma. I don’t know if we have any common sense when it comes to food allergies, whether we would have the same preventive effect on other diseases. We hope so. I personally haven’t seen the data to back it up at this point.

You mentioned the Stanford nut allergy research that comes up quite frequently. Is there anything else you look forward to regarding developments in the field of food allergy treatment?

Kim: First, with our sublingual research: PALFORZIA’s getting that approval is huge, right? I see this as validating food allergy as a real problem, something that needs treatment. And it also, for me, validates the concept of immunotherapy as something that actually works and can provide protection.

At the same time, I think COVID-19 has made it clear that oral immunotherapy is difficult. And it won’t be for everyone. I think it’s important not only to research the application of this treatment to other foods and to make them last longer, but also to find ways to make them more practical. So, I was looking for that. I would love to see questions around, ‘Do we have to do this every day? Is this something that can be a once a week type of treatment? Once a month?’

You know, just thinking from the patient’s point of view: how do we actually make this accessible to the patient? We know it’s working now, and it’s out there. But we are looking for a verbal, hopefully sublingual, and epikutan way. Is there a way forward for that? Because it will represent a simplified version of immunotherapy which may be a good choice for some patients.

So, I’m really looking at the future for not only improvements to science, but also options for patients, because at this point, nothing looks like it’s going to be a cure. With that in mind, any treatment that fits the patient’s goals, I think it will be very important if we are to make a real difference to food allergies.

This basically sounds like the next step of any new therapy: what’s the optimization? What guarantees patient benefit and compliance?

Kim: Correct. I think it’s an amazing time in our field right now. And I think the next few years will really last, because I think the doors are now wide open for new treatments.

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Deaths from anaphylaxis have halved even though the number of patients in hospital is increasing: Study | Instant News


A study published in the journal BMJ describes the death rate from food-induced anaphylaxis that has halved despite the greatly increased hospital admission rates in the UK due to this life-threatening allergic reaction disease.

Food allergies are the most common cause of a potentially life-threatening allergic reaction, known as anaphylaxis. Substantial increases in hospital admissions due to food anaphylaxis have been reported globally, but it is unclear whether this trend continues, and if so, whether it has led to an increase in fatal reactions.

To explore this further, researchers from Imperial College London’s National Heart & Lung Institute began describing trends in hospital admission times for food anaphylaxis in the UK over the past 20 years.

They studied data between 1998 and 2018, measured trends in time, age, and sex distribution for anaphylactic admissions due to food and non-food triggers, and then compared them to reported deaths.

Between 1998 and 2018, 101,891 people were hospitalized for anaphylaxis. Of these, 30,700 (30%) were coded for food triggers.

Acceptance of food anaphylaxis increased from 1.23 to 4.04 per 100,000 population per year (from 1998 to 2018), an annual increase of 5.7%.

The largest increase in hospital admissions was seen for children under 15 years, with an increase from 2.1 to 9.2 admissions per 100,000 population per year (an annual increase of 6.6%, compared to 5.9% for people aged 15-59 years and 2.1% in those aged 60 years and over).

Over a 20 year period, 152 deaths were identified in which the fatal event may have been due to food-induced anaphylaxis.

The case-fatality rate (number of deaths as a proportion of admissions) decreased from 0.7% to 0.19% for confirmed fatal food anaphylaxis and to 0.3% for food anaphylaxis that was suspected to be fatal.

At least 86 (46%) of all deaths between 1992-2018 were triggered by peanuts or tree nuts, while cow’s milk was responsible for 17 (26%) deaths in school-age children.

The data also show that over the same time period, prescriptions for adrenaline autoinjectors increased 336% – an increase of 11% per year.

The investigators say that improvements in the introduction and management of anaphylaxis may partially explain the reduction in case mortality despite increasing hospital admissions for anaphylaxis.

There is no evidence to suggest that the clinical criteria used to diagnose anaphylaxis have changed in the UK over the study period, they added. Although the National Institute for Health and Care Excellence (NICE) introduced national guidelines in 2011, which could result in an increase in the number of hospitalized patients, year-on-year increases have continued since then.

The authors acknowledged some of the study limitations, such as the possibility of some miscoded or misdiagnosed anaphylaxis cases, and they were unable to include anaphylaxis cases seen in an emergency department that did not require hospital admission.

However, they do use national data sets in the context of the UK health system, which provides an opportunity to draw strong conclusions compared to other countries.

Thus, the researchers conclude: “Cow’s milk is increasingly being identified as an allergen cause for fatal food reactions, and is now the most common cause of fatal anaphylaxis in children. More education is needed to highlight the specific risks that cow’s milk poses to people. -people who are allergic to raise awareness among the food business. “

They added: “Further work is needed to assess evidence of age-related susceptibility to severe anaphylaxis in young adults, thereby increasing our ability to stratify the risk of patients with food allergies and to reduce the risk of fatal outcomes.”

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This story has been published from wire agent bait without modification to the text.

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Hospitalizations for Food Anaphylaxis Threefold, But Deaths Decreased | Instant News


UK hospital admission rates for food-induced anaphylaxis more than tripled over the 20 years from 1998 to 2018, but the case fatality rate fell by more than half, the researchers report in BMJ.

“Cow’s milk is increasingly being identified as an allergen to fatal food reactions, and is now the most common cause of fatal anaphylaxis in children,” writes Alessia Baseggio Conrado, PhD, a biochemist from the National Heart and Lung Institute at Imperial College London, United States. Kingdom, and colleagues. “Further education is needed to highlight the specific risks that cow’s milk poses to allergic people to raise awareness among the food business.”

While recognition of the risks posed by peanut allergies has increased, people think dairy allergies are mild, says senior author Paul. J. Turner, BM BCh, PhD, allergist / immunologist at Imperial College. “This often occurs in very young children, but school-age children who still have a milk allergy tend to have a larger allergy profile, often with other allergies, including asthma, “Said Turner Medscape Medical News. “Additionally, milk is very common in our diet, and you don’t need a lot of milk to reach a decent dose of allergens.”

During the study period, 101,891 people were hospitalized for anaphylaxis; 30,700 cases (30%) were coded as being triggered by food.

This food-related income showed an increase from 1.23 to 4.04 per 100,000 population per year, with an annual increase of 5.7% (95% CI, 5.5 – 5.9; P. <0.001), write the authors.

The greatest jump was among children under 15, whose enrollment increased from 2.1 to 9.2 per 100,000 population per year, an annual increase of 6.6% (95% CI, 6.3 – 7.0) . The annual increase was 5.9% (95% CI, 5.6 – 6.2) among people aged 15 to 59 years and 2.1% (95% CI, 1.8 – 3.1) among people those aged 60 years and over.

Researchers used data from England, Scotland, Wales, and Northern Ireland to track temporal trends and age and sex distribution for admissions to hospital admissions whose primary diagnosis was anaphylaxis due to food and non-food triggers. These data are compared with nationally reported deaths.

Over a 20 year period, 152 deaths were associated with possible food-induced anaphylaxis. During that time, the case fatality rate for confirmed fatal food anaphylaxis fell from 0.7% to 0.19% (rate ratio, 0.931; 95% CI, 0.904 – 0.959; P. <0.001) and fell to 0.30% for suspected fatal food anaphylaxis (rate ratio, 0.970; 95% CI, 945 - 0.996; P. = 0.024).

Between 1992 and 2018, at least 46% of all anaphylactic deaths were thought to be triggered by peanuts or tree nuts. Among school-aged children, 26% of deaths from anaphylaxis are caused by cow’s milk.

Not surprisingly, during the study period, there was a 336% increase in prescriptions for adrenaline autoinjectors. Such prescriptions increase by 11% per year.

Global Trends

The data extends the findings of Turner and colleagues reported for England and Wales in 2014 about the entire population of England and in line with epidemiological trends in hospital admissions for anaphylaxis in the United States and Australia.

The investigators say better recognition and management of anaphylaxis could partially explain the reduction in mortality, but the increase in hospitalizations remains confusing. “Whether an actual increase in the prevalence of anaphylaxis has occurred (rather than a decrease in the threshold for admitting patients with anaphylaxis) is unclear due to a lack of evidence for an increase in the prevalence of food allergy in the UK (and elsewhere) over the same time period,” they wrote.

Ronna L. Campbell, MD, PhD, an emergency doctor at the Mayo Clinic in Rochester, Minnesota, has noted a similar trend in the United States. “Perhaps the introduction and diagnosis of anaphylaxis has increased, so the drug administration is earlier epinephrine, “Said Campbell Medscape Medical News. “So, as cases increased, earlier recognition and treatment resulted in reduced mortality.” He is not aware of any new guidelines recommending increased hospitalizations that would explain the confusing increase in admissions.

According to the study authors, the clinical criteria used to diagnose anaphylaxis in the UK did not change during the study period. Although national guidelines recommend that hospitalization of children under 16 years of age suspected of having anaphylaxis were introduced in 2011 and may have increased patient admissions, the year-over-year rate of increase has persisted since 2014. “Therefore the increase over the past five years cannot associated with the impact of the guide, “they wrote.

The study was funded by grants from the UK Medical Research Council and the UK Food Standards Agency. Two co-authors have disclosed financial links to industry outside of the jobs that are sent. Conrado did not disclose the relevant financial relationships.

BMJ. Published online February 17, 2021. Full text

Diana Swift is a medical journalist based in Toronto.

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