Prognosis of food-induced anaphylaxis in children: A single-center real-life study

Background: Food allergies are known to resolve over time, but there is little information on the natural history of food-induced anaphylaxis (FIA). Objective: This study aimed to evaluate the natural history of FIA in children and determine the factors that affect prognosis. Methods: Children with FIA who were followed up for at least 3 years, between 2010 and 2020, were included. Patients' families were contacted by telephone to question their child's tolerance status and invite them for reevaluation if uncertain. The patients were grouped as tolerant or persistent according to parent reports or reevaluation results. Logistic regression analysis was performed to determine the factors that affected persistence. Results: The study included 185 patients (62.2% boys) with 243 anaphylactic reactions to various foods. Fifty-eight patients (31%) gained tolerance within a 3-year follow-up period. Tolerance rates were higher in patients with FIA to milk (40%) and egg (43.9%) compared with to tree nuts (18.8%), legumes (5.6%), and/or seafood (11.1%) (p < 0.001). In a multivariate analysis, risk factors for persistent FIA were multiple food anaphylaxis (odds ratio [OR] 3.755 [95% confidence interval {CI}, 1.134‐12.431]; p = 0.030), total IgE > 100 kU/L (OR 5.786 [95% CI, 2.065‐16.207]; p = 0.001), and skin-prick test wheal size > 10 mm (OR 4.569 [95% CI, 1.395‐14.964]; p = 0 .012) at presentation. Conclusion: Approximately a third of the patients with FIA developed tolerance within 3 years. Clinicians should remember that children with food allergies, even anaphylaxis, may develop tolerance over time. Regular follow up and reevaluation of tolerance status are necessary to avoid unnecessary elimination.

Food allergies and acute allergic reactions: diagnostic options

Introduction. Anaphylaxis is a systemic potentially life-threatening hypersensitivity reaction featuring the rapid onset, manifestations of the respiratory tract and/or hemodynamics and usually, but not always, accompanied by changes in the skin and mucous membranes [1]. The cause of developing an acute generalized reaction in food anaphylaxis may be the minimum culprit product amount that has entered the patient's body through the mouth or through the skin/mucous membranes. Patients like these are, as a rule, first seen by a paediatrician, a related specialist, or a paramedic. Since the doctors often consider the symptoms of foodborne anaphylaxis separately, the latter does not cause proper suspicion: angioedema and/or acute urticaria accompanying rhinorrhea, acute bronchospasm or laryngitis developed extremely quickly or immediately after contact with an allergen.The aim of the work was to acquaint paediatricians and doctors of related specialties with the food anaphylaxis symptoms, to justify the need for an allergologist-immunologist to consult these patients in order to resolve the issue of required component-resolved diagnosis of allergy and development of an individual elimination diet, taking into account the patient's sensitization profile.Materials and methods. Clinical observation of a child (boy, age — 12 months) with symptoms of atopic dermatitis and episodes of food anaphylaxis in the anamnesis; general clinical examination and allergological examination of the patient by component allergodiagnostics were performed.Results. Sensitization to ovalbumin (Gald 2 -16.60 kU/l) and ovomucoid (Gald 1-9.01 kU/l) was established. The detected sensitization is a predictor of severe systemic allergic reactions to eggs.Discussion. Component diagnostics performed as prescribed by an allergologist not only confirms the causative allergen, but also evaluates the risks of developing acute reactions if the allergen is accidentally introduced to the child and the timing of the patient's tolerance formation. This sensitization will cause sudden systemic allergic reactions for years to come.Conclusion. It is important for a specialist to timely suspect food anaphylaxis, differentiate it from other emergency and urgent conditions, and give the patient the correct recommendations on the need for consultation with an allergologist-immunologist. Only a thoughtful, comprehensive medical approach to each acute condition in a child will significantly reduce the risk of repeated episodes of food anaphylaxis.

Nut Allergy: Clinical and Allergological Features in Italian Children

Background: Nut allergies are an increasingly frequent health issue in the pediatric population. Tree nuts (TN) and peanuts are the second cause of food anaphylaxis in Italy. Unfortunately, knowledge of the clinical characteristics of a TN allergy in Italian children is limited. Our study aimed to identify the clinical and allergological characteristics of Italian children with a nut allergy (TN and peanut). Methods: A retrospective observational analysis was performed on the clinical charts of children with a history of nut reaction referred to the allergy unit of the hospital from 2015 to 2019. The studied population was represented by children with a confirmed nut allergy based on positive prick by prick and/or serum-specific IgE to nut plus a positive nut oral food challenge. Demographic, clinical, and allergological features were studied and compared among different nuts. Results: In total, 318 clinical charts were reviewed. Nut allergy was confirmed in 113 patients. Most patients (85/113, 75%) had a familial history of allergy and/or a concomitant allergic disorder (77/113, 68%). Hazelnut and walnut were the more common culprit nuts observed in allergic children. Anaphylaxis was the first clinical manifestation of nut allergy in a high percentage of children (54/113, 48%). The mean age of the first nut reaction was statistically higher with pine nuts. Over 75% of children reported a single nut reaction. During the OFCs, the signs and symptoms involved mainly the gastrointestinal system (82/113, 73%) and resolved spontaneously in most cases. Severe reactions were not frequent (22/113, 19%). Conclusion: To our knowledge, this is the first Italian study that provided a comprehensive characterization of children with a nut allergy. These results are important for clinicians treating children with a nut allergy.

Analysis of the prevalence of food hypersensitivity and food anaphylaxis in the children’s population of Ekaterinburg

BACKGROUND: In recent decades, the number of patients experiencing food allergies and food anaphylaxis has been increasing worldwide. However, at present, epidemiological data on this problem are unclear. Anaphylaxis is an acute, potentially life-threatening pathological reaction of systemic hypersensitivity with various clinical symptoms, which can be coded under different diagnoses and conditions. Its acute onset and transient nature make it difficult to obtain prospective data. Thus, it appears realistic to conduct retrospective studies using a questionnaire analysis to identify children who have undergone such reactions for further examination and observation. AIM: This study aimed to investigate the prevalence of food hypersensitivity and food anaphylaxis in the pediatric population of Ekaterinburg. MATERIALS AND METHODS: A total of 5,000 parents with children aged 217 years were surveyed. The children attend preschool or school general educational institutions (childrens education institution (ChEI) of the city. ChEIs were randomized, and the parent survey was anonymous and voluntary. Respective parents were asked to complete the questionnaire, which asks them whether their children have skin lesions, wheezing, and clinical presentations of allergic rhinitis or food allergy. The developed questionnaire was based on the ISAC questionnaire translated into Russian. In the questionnaires, the parents gave only those symptoms that arose in children against the background of somatic health at normal body temperature. RESULTS: A total of 2,400 questionnaires were analyzed: 1,196 questionnaires were filled by parents of boys (49.9%) and 1,204 questionnaires by parents of girls (50.1%) aged 217 years (average age 10.31 0.30 years). Data collected from questionnaire revealed that skin rashes in 17% of the children were associated with products: most often, these were obligate allergens and histamine liberators. Additionally, 6.8% of the parents noted that persistent rhinitis in their children was associated with consumption of milk/fish/fruit/nuts. Symptoms of respiratory obstruction after eating fish/cows milk/nuts were described by parents of 2.7% of the children. Association of urticarial manifestations with food was noticed by parents of 194 (8.1%) children. Moreover, 0.96% of children experienced symptoms of anaphylaxis to food, 0.3% to cows milk, 0.12% to chicken eggs and fruit, and 0.08% to wheat, nuts, and fish. CONCLUSIONS: Epidemiological studies help understand the spread and nature of allergic diseases in a region. Moreover, identification of children who have had episodes of food-borne anaphylaxis helps prevent recurrent cases by conducting case follow-up of these patients.

Food anaphylaxis in toddlers: own clinical experience in diagnostic measurement and identification of underlying causes

The article presents current data on the reasons for the occurrence, peculiarities of the course, and diagnostic principles of anaphylaxis in toddlers. The determination of protein group enables to prognosticate the risk of development of food anaphylaxis. A comprehensive method is the ALEX in vitro multiplex allergy test. In the first reported case, anaphylaxis appeared after the consumption of a milk formula (cutaneous and respiratory symptoms; five months) and buckwheat (cutaneous, gastrointestinal, and respiratory symptoms; 11 months). On examination, the storage proteins of buckwheat Fag e 2 were detected – 22.82 kUA/L and major components of milk Bos d 4 (α-lactalbumin) – 41.37 kUA/L, Bos d 5 (β-lactoglobulin) – 41.12 kUA/L, Bos d 8 (casein) – 32.84 kUA/L. In the second case, anaphylaxis (cutaneous, gastrointestinal, respiratory, and neurological symptoms) developed after eating cake. On examination, the following storage proteins were detected: hazelnut Cor a 14 – 6.80 kUA/L, walnut Jug r 1 – 3.76 kUA/L. In the third case, anaphylaxis (cutaneous and respiratory symptoms) occurred after contact with dried fish (carp, cod) which the affected child was holding in the hands. On examination, parvalbumins were detected, including Atlantic cod – Gad m 1 – 46.67 kUA/L, carp – Cyp c 1 – 42.61 kUA/L, Atlantic herring – Сlu h 1 – 49.05 kUA/L, Sal s 1– 45.58 kUA/L, Atlantic mackerel – Sco s 1 – 48.82 kUA/L, tuna – Thu a 1 – 43.12 kUA/L, and swordfish – Хір g 1 – 43.83 kUA/L. Based on a complex examination, the patients received thorough dietary and lifestyle recommendations, as well as information about health risks and the need for an epinephrine autoinjector.

Immune Response to SARS-CoV-2 in an Asymptomatic Pediatric Allergic Cohort

Disease-specific COVID-19 pediatric comorbidity has not been studied effectively to date. Atopy and food anaphylaxis disease states require improved characterization of SARS-CoV-2 infection risk. To provide the first such characterization, we assessed serum samples of a highly atopic, food anaphylactic, asymptomatic pediatric cohort from across the US during the height of the pandemic. From our biobank, 172 pediatric patient serum samples were characterized specific to atopic, food anaphylactic, and immunologic markers in the US at the beginning of the pandemic, from 1 February to 20 April 2020. Clinical and demographic data were further analyzed in addition to sample analysis for SARS-CoV-2 IgM and IgG ELISA. SARS-CoV-2 antibody results were positive in six patients (4%). Nearly half of the pediatric patients had a history of asthma (49%). Total IgE, total IgG, and IgG1-3 were similar in those positive and negative to SARS-CoV-2. Median total IgG4 in the SARS-CoV-2 positive group was nearly three times (p-value = 0.02) that of the negative group. Atopy controller medications did not confer additional benefit. Our data suggest that food anaphylaxis and highly atopic children are not at increased risk for SARS-CoV-2 seropositivity. This specific population appears either at equal or potentially less risk than the general population. Total and specific IgG4 may be a novel predictor of SARS-CoV-2 infection risk specific to the allergic pediatric population.