Alergia Alimentaria, puntos clave para la práctica clínica

Food allergy is an immune reaction that occurs frequently in pediatric age, its prevalence is higher in industrialized countries, affecting 8% of the population, the most frequently involved foods are milk, hen’s egg, soybeans, peanuts, fish, wheat, seafood and tree nuts. Food allergy can be divided into three groups: IgE-mediated, non-IgE-mediated, and mixed food allergy. The symptoms will depend on the immunological mechanisms and can be divided into immediate or no immediate, the immediate symptoms appear in the first two hours of intake and the no immediate symptoms after the second hour and up to 72 hours. Diagnosis of food allergy requires a medical history, physical examination and laboratory tests; misdiagnosis can lead to unnecessary elimination diets. The gold standard is the double-blind placebo controlled oral food challenge. The main treatment is food restriction, the nutritional and psychological implications that this entails must be taken into account; Another treatment option is oral immunotherapy, it is recommended in patients who cannot carry out an elimination diet and it has a significant impact on quality of life.

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Oral immunotherapy for treatment of peanut allergy

Journal of Investigative Medicine ◽

10.1136/jim-2020-001422 ◽

2020 ◽

Vol 68 (6) ◽

pp. 1152-1155

Author(s):

Joan H Dunlop

Keyword(s):

Food Allergy ◽

Peanut Allergy ◽

Food Challenge ◽

Oral Immunotherapy ◽

Peanut Protein ◽

Subcutaneous Immunotherapy ◽

Double Blind ◽

The Us ◽

Allergy Prevalence

The US Food and Drug Administration’s approval of a peanut oral immunotherapy product in January 2020 is a landmark development in the field of food allergy therapy. While food allergy prevalence has been increasing, this product is the first approved therapy for food allergy. Oral immunotherapy has many similarities to subcutaneous immunotherapy and drug desensitization protocols, but does not lead to sustained unresponsiveness. The studies leading to approval of the Palforzia product demonstrated increase in the amount of peanut protein able to be consumed, with 67% of subjects randomized to the treatment arm able to consume 600 mg of peanut protein in double-blind placebo-controlled food challenge at study exit. However, side effects are an important consideration, and dropout rates in studies of Palforzia ranged from 11% to 21%. Postmarketing surveillance of this product will be critical in assessing its long-term risks and benefits.

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Prevalence and Clinical Impact of IgE-Mediated Food Allergy in School Children With Asthma: A Double-Blind Placebo-Controlled Food Challenge Study

Allergy Asthma and Immunology Research ◽

10.4168/aair.2015.7.6.547 ◽

2015 ◽

Vol 7 (6) ◽

pp. 547 ◽

Cited By ~ 8

Author(s):

Aneta Krogulska ◽

Jarosław Dynowski ◽

Marzena Funkowicz ◽

Beata Małachowska ◽

Krystyna Wąsowska-Królikowska

Keyword(s):

Food Allergy ◽

School Children ◽

Food Challenge ◽

Clinical Impact ◽

Double Blind ◽

Double Blind Placebo ◽

Challenge Study ◽

Children With Asthma ◽

Ige Mediated

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Using oral food challenges to provide clarity and confidence when diagnosing food allergies

Journal of Food Allergy ◽

10.2500/jfa.2021.3.210002 ◽

2021 ◽

Vol 3 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Justin Greiwe

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Food Challenge ◽

Clinical History ◽

The United States ◽

Oral Immunotherapy ◽

Food Allergies ◽

Ige Mediated ◽

Challenge Education ◽

Food Challenges

A verified food allergy can be an impactful life event that leads to increased anxiety and measurable effects on quality of life. Allergists play a key role in framing this discussion and can help alleviate underlying fears by promoting confidence and clarifying safety concerns. Correctly diagnosing a patient with an immunoglobulin E (IgE) mediated food allergy remains a nuanced process fraught with the potential for error and confusion. This is especially true in situations in which the clinical history is not classic, and allergists rely too heavily on food allergy testing to provide a confirmatory diagnosis. A comprehensive medical history is critical in the diagnosis of food allergy and should be used to determine subsequent testing and interpretation of the results. Oral food challenge (OFC) is a critical procedure to identify patients with an IgE-mediated food allergy when the history and testing are not specific enough to confirm the diagnosis and can be a powerful teaching tool regardless of outcome. Although the safety and feasibility of performing OFC in a busy allergy office have always been a concern, in the hands of an experienced and trained provider, OFC is a safe and reliable procedure for patients of any age. With food allergy rates increasing and analysis of recent data that suggests that allergists across the United States are not providing this resource consistently to their patients, more emphasis needs to be placed on food challenge education and hands-on experience. The demand for OFCs will only continue to increase, especially with the growing popularity of oral immunotherapy programs; therefore, it is essential that allergists become familiar with the merits and limitations of current testing modalities and open their doors to using OFCs in the office.

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Efficacy and safety of allergen immunotherapy for IgE-mediated food allergy: systematic review and meta-analysis

10.22541/au.163700696.66686852/v1 ◽

2021 ◽

Author(s):

Debra de Silva ◽

Pablo Rodriguez del Rio ◽

Nicolette w Jong ◽

Ekaterina Khaleva ◽

C. Singh ◽

...

Keyword(s):

Food Allergy ◽

Adverse Reactions ◽

Meta Analysis ◽

Oral Immunotherapy ◽

Cow’S Milk ◽

Egg Allergy ◽

Efficacy And Safety ◽

Cow's Milk ◽

Hen’S Egg ◽

Ige Mediated

Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. Results We included 36 trials with 2,126 participants, mainly children. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5. to 21.4, high certainty); cow’s milk (RR 5.7, 1.9 to 16.7, moderate certainty) and hen’s egg allergy (RR 8.9, 4.4 to 18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300mg or 1000mg peanut protein was 2. In peanut allergy, oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0 to 1.2, low certainty) or severe reactions (RR 1,6, 0.7 to 3.5, low certainty). It may increase adverse reactions in cow’s milk (RR 3.9, 2.1 to 7.5, low certainty) and hen’s egg allergy (RR 7.0, 2.4 to 19.8, moderate certainty), but reactions tended to be mild and gastrointestinal. Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8 to 3.8, moderate certainty). Results were unclear for other allergies and administration routes. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow’s milk and hen’s egg allergy. However, our review found little about whether this improves quality of life, is sustained or cost-effective.

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Oral food challenge in IgE mediated food allergy in eastern Mediterranean children

Allergologia et Immunopathologia ◽

10.15586/aei.v49i3.189 ◽

2021 ◽

Vol 49 (3) ◽

pp. 185-192

Author(s):

Hilal Unsal ◽

Gokce Ozyilmaz Bozat ◽

Melike Ocak ◽

Aysegul Akarsu ◽

Umit Murat Sahiner ◽

...

Keyword(s):

Food Allergy ◽

Preschool Children ◽

Food Challenge ◽

Oral Food Challenge ◽

Cow’S Milk ◽

Cow's Milk ◽

Tree Nuts ◽

Increased Risk ◽

Hen’S Egg ◽

Ige Mediated

Background: The oral food challenge (OFC) in IgE mediated food allergy causes anxiety both in parents and in patients due to its inherent risks.Objective: Documentation of the rate, spectrum, and predictors of positive reactions is instructive.Methods: Children, who underwent OFC between January 1, 2017 and December 31, 2019 were analyzed.Results: A total of 1361 OFCs in 613 cases were reviewed. Most of them were performed in preschool children (≤2 years 50%) and 55% of them had more than one OFC. Mainly consid-ered food groups were cow’s milk (31.8%), hen’s egg (28.5%), tree nuts (20%), legumes (7%), seeds (4.9%), and wheat (2.7%). The overall OFC positivity was 9.6%, whereas 6.7% with cow’s milk, 4.9% with hen’s egg, 16.1% with tree nuts, 21.6% with wheat, and 32.8% with seeds. The severity scoring revealed grade I (24.4%), II (45.8%), and III (29.7%) reactions. Fifty (38%) cases required epinephrine and four cases required hospitalization. OFCs with sesame seeds (odds ratio [OR]: 7.747, [confidence interval (CI) 95%: 4.03–14.90]), wheat (OR: 3.80, [CI: 1.64–8.84]), and tree nuts (OR: 2.78, [CI: 1.83–4.23]) predicted a positive OFC while a concomitant asthma (OR: 3.61 [CI: 1.27–10.28]) was more likely to elicit anaphylaxis.Conclusion: In OFC practice, priority is given to basic nutritional sources and the most frequent food allergens, where preschool children with multiple sensitizations are the primary subjects. Increased risks of positive reactions with sesame, tree nut, and wheat and increased risk of anaphylaxis with concomitant asthma should be considered while performing OFC.

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Immunoglobulin E (IgE)-Mediated Food Allergy in Children: Epidemiology, Pathogenesis, Diagnosis, Prevention, and Management

Medicina ◽

10.3390/medicina56030111 ◽

2020 ◽

Vol 56 (3) ◽

pp. 111 ◽

Cited By ~ 1

Author(s):

Simona Barni ◽

Giulia Liccioli ◽

Lucrezia Sarti ◽

Mattia Giovannini ◽

Elio Novembre ◽

...

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Public Health Problem ◽

Elimination Diet ◽

Food Allergies ◽

Major Public Health Problem ◽

Double Blind ◽

Detailed Medical History ◽

Ige Mediated

A food allergy is an immunoglobulin E (IgE)-mediated hypersensitive reaction to food, which consists in the appearance of allergic symptoms; it can vary from common urticaria to even fatal anaphylaxis. The prevalence of food allergies has been increasing in the past twenty years and it represents a major public health problem in industrialized countries. The mechanism that leads to food allergies is the lack of immunologic and clinical tolerance to food allergens. The diagnosis of IgE-mediated food allergies is based on the combined use of a detailed medical history, in-vivo, and in-vitro research of specific IgE, the elimination diet, and the double-blind placebo-controlled food challenge. The only currently available treatment for allergies is the strict elimination diet. This type of attitude, which we could define as “passive”, does not overcome the risk of accidental reactions due to involuntary intake of the culprit food. For food allergy management, an “active” approach is urgently needed, such as specific allergen immunotherapy, which is currently under development and only used for research purposes. This article aims to give an updated review of IgE-mediated food allergies in pediatric populations in terms of epidemiology, pathogenesis, prevention, diagnosis, and management.

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Influence of Antihistamines on Basophil Activation Test in Food Allergy to Milk and Egg

Diagnostics ◽

10.3390/diagnostics11010044 ◽

2020 ◽

Vol 11 (1) ◽

pp. 44

Author(s):

Eleonora Nucera ◽

Riccardo Inchingolo ◽

Rosario Nicotra ◽

Manuela Ferraironi ◽

Anna Giulia Ricci ◽

...

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Basophil Activation Test ◽

Basophil Activation ◽

Double Blind ◽

Positive Skin ◽

Activation Test ◽

History Of ◽

Ige Mediated ◽

Food Allergy Diagnosis

Background: The basophil activation test (BAT) is used to improve the accuracy of food allergy diagnosis. To date, the influence of antiallergic drugs on BAT reactivity is poorly investigated. The aim of the study was to investigate if BAT results were influenced by antihistamine intake for 3 months in a cohort of patients with IgE-mediated food allergy to milk or egg. Methods: A retrospective, single-center, observational study was performed. We enrolled subjects with history of hypersensitivity reaction after specific food ingestion, positive skin prick tests and specific IgEs, concomitant allergic rhinitis, and, contraindication to the double-blind, placebo-controlled food challenge due to personal history of systemic reactions related to the ingestion of culprit food. Validated allergens (α-lactoalbumin, β-lactoglobulin, casein, egg white, and yolk) for BAT were used. Results: Thirty-nine patients with well-documented food symptoms and positive allergological workup were included in the study. BAT was positive in 29 patients. The mean percentages of CD63+ expression to specific culprit allergen did not change after the administration of drugs. Conclusions: This was the first study assessing the effects of oral antihistamines on basophil reactivity in cow’s milk and egg food allergy. Antihistamines do not interfere with BAT results.

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