Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

Gáspár, Angéla; Santos, Natacha; Faria, Emília; Câmara, Rita; Rodrigues-Alves, Rodrigo; Carrapatoso, Isabel; Gomes, Eva; Pereira, Ana Margarida; Carneiro‐Leão, Leonor; Morais‐Almeida, Mário; Delgado, Luís; Pedro, Elisa; Ferreira, Mário B.

doi:10.18176/jiaci.0515

Cited by 12 publications

(18 citation statements)

References 39 publications

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“… 1 No fatalities in children due to HEA have been reported in these paediatric publications. 1 , 4 , 7 , 10 , 13 , 14 , 15 In this study predominance of infants and males was observed in both trigger groups. Age distribution with predominance of infants 4 , 13 , 14 , 15 and males (from 51% to 68%) 1 , 4 , 7 , 10 , 13 , 14 , 15 up to school age was also reported in other studies.…”

Section: Discussionsupporting

confidence: 55%

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Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Cichocka‐Jarosz

Dölle‐Bierke

Jedynak-Wąsowicz

et al. 2023

Clinical & Translational All

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Background Cow's milk (CM) and hen's egg (HE) are leading triggers of anaphylaxis in early childhood. The aim of this study was to identify clinical phenotypes and therapeutic measures for CM anaphylaxis (CMA) compared to HE anaphylaxis (HEA) in children up to 12 years of age, based on a large pan‐European dataset from the European Anaphylaxis Registry. Methods Data from 2007 to 2020 on clinical phenotypes and treatment from 10 European countries, as well as Brazil, were analysed. The two‐step cluster analysis was used to identify the most frequent phenotypes. For each trigger, three clusters were extracted based on sex, age, and existence of symptoms in four vitally important systems. Results Altogether 284 children with CMA and 200 children with HEA were identified. They were characterised as male (69% vs. 64%), infants (65% vs. 61%), with a most frequent grade III of Ring&Messmer classification (62% vs. 64%), in CMA versus HEA, respectively. Respiratory symptoms occurred more often in CMA (91% vs. 83%, p = 0.010), especially in infants (89% vs. 79%, p = 0.008). Cardiovascular symptoms were less frequent in CMA (30% vs. 44%, p = 0.002), in both infants (33% vs. 46%, p = 0.027), and older children (25% vs. 42%, p = 0.021). The clusters extracted in the CMA group were characterised as: (1) mild dermal infants with severe GI (40%), 2. severe dermal (35%), 3. respiratory (25%). While in HEA group: 1. infants with severe GI and/or reduction of alertness (40%), (2) conjunctival (16%), (3) mild GI without conjunctivitis (44%). The severity of the reaction was independent from the amount of ingested allergen protein, regardless of trigger. The first‐line adrenaline application differed between the countries (0%–92%, as well as the reasons for not administering adrenaline, p < 0.001). Conclusions Despite the similarity of their age, sex, and severity grade, the clinical profiles differed between the CMA and HEA children. Adrenaline was underused, and its administration was country dependent. Further studies are needed to assess to what extent the differences in the clinical profiles are related to matrix and/or absorption effects, and/or the allergen itself.

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Section: Discussionsupporting

confidence: 55%

“…Although CM and HE are common food allergens worldwide, especially in the population of young children, 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 10 , 13 , 14 , 15 there are no publications directly comparing their phenotypes. Our aim was to evaluate similarities and differences between these trigger groups.…”

Section: Discussionmentioning

confidence: 99%

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Cichocka‐Jarosz

Dölle‐Bierke

Jedynak-Wąsowicz

et al. 2023

Clinical & Translational All

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“…Therefore, it is recommended to prescribe an adrenaline autoinjector whenever a PEG allergy is confirmed (2,3,11,16). Education on when and how to use the autoinjector device must be provided (29,30), since there is an ongoing risk of accidental exposure, especially in patients with immediate SAR. In these patients, systemic mastocytosis or mast cell activation syndromes must be ruled out.…”

Section: Discussionmentioning

confidence: 99%

“…Patient education is paramount. Patients must have an allergy warning card and a written emergency treatment plan, and should always carry with them an adrenaline autoinjector (Figure 2) (2,16,29,30). They also need to be taught to check product labels, and should have access to advice from the allergy department.…”

Section: Discussionmentioning

confidence: 99%

Polythylene glycol severe allergy and SARS-CoV-2 vaccines: usefulness of testing with PEG 1500 extract

Gaspar

Moura

Cruz

et al. 2023

Eur Ann Allergy Clin Immunol

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Background: Polyethylene glycol (PEG) is being used for first time as an excipient for mRNA anti-SARS-CoV-2 vaccines containing-PEG2000, highlighting it as a potential cause of anaphylaxis. Objective: To assess the usefulness of skin tests using PEG1500 extract in patients with suspected allergy to SARS-CoV-2 vaccines. Methods: We evaluated 126 patients with moderate-high risk of allergy to SARS-CoV-2 vaccines referred to our department from March-December 2021. Skin tests were performed with PEG1500 extract (Roxall), using a stepwise approach, with readings at 30 minutes: prick tests with 0.1%, 1% and 10% concentrations; if negative, intradermal tests with 0.0001%, 0.001% and 0.01% concentrations. The same protocol was applied to 5 healthy controls. Results: Six patients had positive immediate intradermal tests with PEG1500, all with severe PEG allergy: one with a near-fatal anaphylaxis after glucocorticoid injection containing-PEG3350 and five with systemic allergic reactions after mRNA vaccines containing-PEG2000 (Pfizer-BioNTech or Moderna). One patient developed anaphylaxis during intradermal test. These six patients were negative to polysorbate 80. The remaining 120 patients had negative tests to PEG1500; seven had positive tests to polysorbate 80. All controls had negative tests. Conclusions: To our knowledge this is the first study describing the allergy work-up testing with PEG1500 commercial extract in the scope of SARS-CoV-2 vaccination. The algorithm designed for skin tests revealed to be a useful tool. Severe PEG allergy was diagnosed in 5% of patients, contraindicating PEG-containing vaccines. PEG allergy was excluded in one hundred patients that afterwards took SARS-CoV-2 vaccines containing-PEG2000. Investigation should be conducted in specialized drug allergy centres.

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“…Single-blind placebo-controlled food challenge. The test provides more objective results compared to the previous one because the food is not served in its natural form, it is hidden in a capsule [46][47][48]. The control food (placebo) is chosen so that it is as similar as possible in taste, smell, and texture.…”

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confidence: 99%

Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

Sur

Armat

Duca

et al. 2021

Life

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Food allergy (FA) is a condition with a growing incidence and is a constant concern for the medical world and healthcare providers. With potential symptoms including anaphylaxis, in the event of an allergic reaction the patient’s life may well be endangered. The diagnosis of FA is a continuous challenge because mild cases tend to be ignored or diagnosed late and young children with allergies are cared for by parents, who are not always able to accurately interpret symptoms. It is very important to be able to differentiate FAs from food intolerance and toxic reactions to food. An accurate diagnosis is required to provide personalized management of an FA. More sophisticated and accurate diagnostic tests, including component diagnosis and epitope reactivity, allow the provision of a directed diagnosis, a more accurate therapeutic approach, and a useful prognostic evaluation. Tests used in current practice include the specific search for serum IgE, elimination diets, oral food challenges, single, blind, and double-blind (DBPCFC) tests, as well as skin tests. The risk of anaphylaxis can be assessed by molecular diagnostics/component-resolved diagnosis (CRD) and by conducting a basophilic activation test (BAT). These tests allow a planned, personalized treatment based on molecular and clinical profiles. CRD can determine the individual profile of allergic molecular reactivity and enable the formulation of a prognostic judgment. Our article highlights the importance of knowing the immune mechanisms, diagnostics, and immunotherapies in FAs. Starting from observing exposure to food allergens, to identifying allergic reactions, analysing the severity of clinical manifestations, noting the possibilities of diagnosis, and illustrating adequate management strategies.

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Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 12 publications

References 39 publications

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Cow's milk and hen's egg anaphylaxis: A comprehensive data analysis from the European Anaphylaxis Registry

Polythylene glycol severe allergy and SARS-CoV-2 vaccines: usefulness of testing with PEG 1500 extract

Food Allergy a Constant Concern to the Medical World and Healthcare Providers: Practical Aspects

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