A Pilot Study to Evaluate the Dietary Intake of Adults Attending a Food Allergy Clinic, and Compare the Results Against the Final Diagnostic Outcome

Background: The impact of poor diet on growth and development in children with a food allergy is well-recognized and researched. Food allergy is an increasing problem in adults, as are food intolerances. Another issue is the rising number of individuals adopting a vegetarian or vegan lifestyle. Studies evaluating the diet of adolescents and adults with food allergy against controls suggest their dietary intakes are similar. We wished to evaluate all patients attending a food allergy clinic to determine whether there were dietary and nutritional differences between those with a food allergy or a food intolerance.Methods: All adults newly referred to a secondary care food allergy clinic in a UK hospital, in a 1-month period, were included in the study. Prior to their appointment, those who consented to take part had their height and weight documented and an assessment made of their habitual food intake. Their subsequent diagnosis was reviewed, and results for those with a confirmed diagnosis of food allergy were compared to those with a food intolerance or where the cause of symptoms was unknown.Results: Thirty subjects were recruited, with full results available for 29 subjects, 15 of whom (52%) were diagnosed with a new/existing food allergy (FA). For the whole cohort, dietary intake was sufficient for protein, and most vitamins and minerals, whereas energy, carbohydrate, unsaturated fat and fiber intakes were well-below the reference range. Those with a FA had lower intakes of iron, zinc and vitamin B12 compared to those with no FA. In addition, iron and energy intakes were depleted in those avoiding nuts, and wheat avoidance was linked to a lower intake of riboflavin.Conclusion: The results from this small exploratory study suggest that whilst the majority of nutrients in the diet are sufficient in adults presenting to the food allergy clinic, intakes of energy and fiber may be below the reference range. Those with a food allergy are more likely to have a reduced intake of iron, zinc and vitamin B12. As others have demonstrated, the exclusion of specific food groups can also affect nutritional intakes.

Clinical Characteristics and Allergen Detection of Perioperative Anaphylaxis: A 12-year Retrospective Analysis from an Anesthesia Clinic in China

Background: Anaphylaxis during anesthesia is a rare but often a potentially life-threatening event for patients. Identifying culprit agents responsible for anaphylaxis is of great important for avoiding potential re-exposure to allergens, but it poses great challenge for anesthetists. This retrospective study aimed to analyze the culprits of patients with a history of perioperative anaphylaxis referred to an anesthesia allergy clinic in China, and to evaluate the role of allergy diagnostic tests in clinical practice.Methods: A total of 145 patients (102 female/43 male) who attended the Anesthesia Allergy Clinic for allergen detection between 1 January 2009 and 31 December 2020 were reviewed retrospectively. Clinical characteristics, results of allergy diagnostic tests including skin and/or basophil activation tests, and the incidence of repeat anaphylaxis after use of recommended alternative anesthetics were obtained.Results: Of these 145 patients, 109 patients (75.2%, 74 females/35 males) were determined to experience perioperative anaphylaxis. The commonest presenting clinical feature was cardiovascular manifestations (n=63, 57.8%). According to diagnostic work up, the commonest culprits for perioperative anaphylaxis were neuromuscular blocking agents (n= 35, 32.1%). After diagnostic work up, 52 patients underwent repeat anesthesia, and none had recurrent anaphylaxis.Conclusions: This study suggests that neuromuscular blocking agents are the main culprits for perioperative anaphylaxis. For patients with perioperative anaphylaxis, allergy diagnostic tests are essential to identify causative agents, and to find suitable alternative drugs for the planning of repeat anesthesia.

Prevalence of Food Allergy in Egyptian Patients complaining of food adverse events attending allergy clinic at Ain Shams University Hospitals

Background Food allergy is defined as an immune reaction to proteins in the food and can be immunoglobulin (Ig)E-mediated or non–IgE-mediated. IgE-mediated food allergy is a worldwide health problem that affects millions of persons and numerous aspects of a person’s life. Allergic reactions secondary to food ingestion are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract. While all other non-allergic food reactions are categorized as “food intolerance”. Aims to assess prevalence of Food allergy among Egyptian patients complaining of food adverse events attending Allergy clinic at Ain Shams University Hospital. Methods This was a randomized cross sectional study involving 200 patients complaining of food adverse events attending Allergy clinic at Ain Shams University Hospitals between the first of February 2019 till the end of January 2020, 90 patents had confirmed food allergy Results The Total patients who were presented to the Allergy outpatient clinic at Ain Shams University hospital between the first of February 2019 and the end of January 2020 were 200 patients presented complaining of food adverse events with the percentage (9.5%). Among the 200 patients presented complaining of food adverse events, there were 90 patients who were confirmed food allergy. Conclusion food allergy may be over estimated along patient with food adverse events.

Allergic reactions due to concomitant administration of multiple drugs in intravenous fluid in emergency departments in Turkey

The present study aimed to evaluate patients who were referred to adult allergy clinic due to allergic reactions after concomitant multiple intravenous-drug administrations in Emergency Department (ED). Between January 2017 and January 2019, patients admitted to our allergy clinic with hypersensitivity reactions to intravenous drugs administered in ED were included retrospectively. Fifty-seven patients who developed allergic reactions after intravenous drug administration in EDs were evaluated. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) were the most common cause of allergic reactions (n = 40, 70.2%). Skin Prick Tests (SPT) were positive in 6 (10.5%) patients. Drug Provocation Tests (DPT) were positive in 10 (17.5%) patients. No significant correlation was found between the total number of drugs in the intravenous fluid and the degree of allergic reaction (r = -0.145, p = 0.282). There was no statistically significant difference between the degree of allergic reaction and history of atopic disease (p = 0.579). In conclusion, concomitant administration of multiple drugs in intravenous fluids may increase the risk of allergic reactions.

Psychological burden of anaphylaxis and the fight for an EpiPen

A university student with a background of atopy presented to her general practitioner (GP) 2 weeks following an episode of throat tightening and dizziness occurring after touching cashew nut to her lip. She took antihistamine medication immediately and went to sleep, fearing for her life. On waking, she felt astounded to be alive. Her symptoms resolved gradually over the following week. She waited 2 weeks for an appointment with her GP, who referred her to allergy clinic. Eight months later, she was still waiting for her clinic appointment, and was left fearing a future fatal reaction, having been provided with no interim treatment. Not all patients who have severe allergic reactions present to the emergency department. Living with the constant fear of anaphylaxis can be overwhelming for patients and their families, and it can negatively impact mental health. Therefore, we advise early allergy counselling and early EpiPen prescription.