Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Arasi, Stefania; Nurmatov, Ulugbek; DunnGalvin, Audrey; Daher, Shahd; Roberts, Graham; Turner, Paul J.; Shinder, Sayantani B.; Gupta, Ruchi S.; Eigenmann, Philippe; Nowak‐Węgrzyn, Anna; Borges, Mario A. Sánchez; Ansotegui, Ignacio J.; Fernández‐Rivas, Montserrat; Petrou, Stavros; Tanno, Luciana Kase; Vazquez‐Ortiz, Marta; Vickery, Brian P.; Wong, Gary; Ebisawa, Motohiro; Fiocchi, Alessandro

doi:10.1016/j.waojou.2020.100503

Cited by 42 publications

(49 citation statements)

References 73 publications

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“…In the present situation, a precise classification of the different phenotypes of food allergy in a homogeneous way between different caseloads is not possible. The imminent definition of severe food allergy could help fill this unmet need [32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Threshold of Reactivity and Tolerance to Precautionary Allergen-Labelled Biscuits of Baked Milk- And Egg-Allergic Children

Fierro¹,

Marzano²,

Monaci³

et al. 2021

Preprint

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Extremely sensitive food-allergic patients may react to very small amounts of allergenic foods. Precautionary allergen labelling (PAL) warns from possible allergenic contaminations. We explored the ability of proteomic methods to identify minute amounts of milk/egg allergens in a brand of PAL-labelled milk- and egg-free biscuits. We evaluated the reactivity of children with severe milk and egg allergy, by oral food challenge. Traces of milk and/or egg allergens in biscuits were measured by two different liquid-chromatography-mass spectrometry methods. The binding of patient's serum with egg/milk proteins was assessed at immunoblotting. None of the patients reacted to biscuits. Egg and milk proteins were found under the limit of detection of 0.6 µg/g for milk and egg (method A), and of 0.1 and 0.3 µg /g for milk and egg, respectively (method B). The immunoblots did not show milk/egg proteins in the studied biscuits. Our biscuits did not contain allergens of clinical significance. Their milk/egg content is far lower than 4 µg of milk or egg protein per gram of product, the minimal doses considered theoretically capable of causing reactions. With high sensitivity, proteomic assessments predict the harmlessness of very small amount of allergenic foods and can be used to avoid unnecessary PAL.

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Section: Discussionmentioning

confidence: 99%

Threshold of Reactivity and Tolerance to Precautionary Allergen-Labelled Biscuits of Baked Milk- And Egg-Allergic Children

Fierro¹,

Marzano²,

Monaci³

et al. 2021

Preprint

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“…21 For this reason, according to the different sociocultural and economic situations, when the indications are placed each national health system will have to foresee the appropriate cases in the specific context. To this end, the definition severity of food allergy being processed 9 will represent a service offered by the World Allergy Organization to the community of patients, regulators, industries around the world.…”

Section: Con Clus Ionsmentioning

confidence: 99%

“…20 SFA, in particular, reduces the quality of life and increases costs of living in patients and their families. 9,21,22 Hence, different approaches to the management of food allergy, aimed to reach some degree of tolerance to the offending food, have been developed.…”

Section: The Limits Of Food Avoidan Cementioning

confidence: 99%

“…8 Most of the allergic reactions to food are mild or moderate, but some become severe and potentially life-threatening, culminating in IgE-mediated anaphylaxis. 9 Death from anaphylaxis is a rare occurrence, 10 which most probably happen among patients with severe food allergy (SFA), 11 but is a public health concern. 12 To reduce the risk of allergic reactions, strict avoidance of the offending food is advised.…”

Section: Introductionmentioning

confidence: 99%

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The use of biologics in food allergy

Fiocchi

Vickery

Wood

2021

Clin Experimental Allergy

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Background Food allergy continues to pose problems due to its increased frequency and its increasingly high severity. In this context, alongside the traditional avoidance strategies of allergenic foods and desensitization through the cautious progression of exposure to foods in the context of oral immunotherapy (OIT), alternative strategies have made their way in the last decades. We review the possibilities of intervention in food allergy with the use of biological drugs capable of interfering with the synthesis of IgE, with their mechanisms of action, or with complex biological mechanisms that lead to the establishment of a food allergy. Methods Repeated Entrez PubMed searches using the template algorithm “Food allergy” and “biologics” or “Omalizumab” or “Dupilumab” or “milk desensitization” or “oral tolerance induction” or “oral immunotherapy” or “Etokimab” or “Tezepelumab” or “Quilizumab” or “Ligelizumab” or “Tralokinumab” or “Nemolizumab” or “Mepolizumab” or “Reslizumab” or “Benralizumab”. The authors’ clinical experience in paediatric allergy units of University hospitals was also drawn upon. Results The landscape in this context has changed dramatically over the past 10 years. We have acquired knowledge mainly on the effect of different types of anti‐IgE treatments in poliallergic patients with food allergy, and in patients treated with OIT. However, other mediators are being targeted by specific biologic treatments. Among them, the alarmins Il‐33 and TSLP, IL‐4 and IL‐13, eosinophil‐related molecules as IL‐6, IL‐8, IL‐10, IL‐12, and mostly IL‐5, and integrins involved in the pathogenesis of eosinophilic gastrointestinal diseases (EGIDs), as SIGLEC‐8. Conclusions The ever‐better knowledge of the mechanisms of food allergy allowing these developments will improve not only the perspective of patients with the most serious immediate food allergies such as anaphylaxis, but also those of patients with related diseases such as atopic dermatitis, eosinophilic esophagitis, and EGIDs. Biologics are also intended to complement OIT strategies that have developed over the years.

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“…Questions such as "when", "what", "why", "how much", plague the sufferers' life leading to uncertainty, fear, and anxiety. 8 A decrease of HRQL is common among patients with food allergy and their caregivers. 9 , 10 The Food Allergy Quality of Life Questionnaire (FAQLQ) series of age-appropriate and disease specific measures have been used in general and treatment settings, cross-sectionally, and longitudinally.…”

Section: Quality Of Life In People With Severe Food Allergymentioning

confidence: 99%

Food labeling issues for severe food allergic patients

Fiocchi

Risso²,

DunnGalvin

et al. 2021

World Allergy Organization Journal

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Food allergy carries high importance and responsibility, affecting an estimated 220 million people worldwide. It is a frequent cause of food-induced anaphylaxis, a life-threatening condition requiring a toll of about one death per 50 million people a year worldwide. In order to help patients to identify allergenic foods and thus avoid anaphylactic reactions, 66 countries over the 5 continents require by law that allergenic ingredients must be declared when used in prepackaged foods. Unfortunately, the mandatory allergen list is not uniform, but varies among different countries. The widespread adoption of Precautionary Allergen Labeling (PAL) results in a proliferation of unregulated PALs with different informative statements. In this situation, the need of a scientific consensus on the definition of food allergy and the identification of a tolerable risk with routinely used detection assays, considering not only the eliciting dose but also the food source, is urgent. The aim of this manuscript is: 1) to draw a picture of the global situation in terms of PALs, and 2) to highlight new approaches that could aid in tackling the problem of regulating the labeling of allergens. These include the Voluntary Incidental Trace Allergen Labelling (VITAL) system, which intersects reference doses and labelling decisions, and a direct quantification of trace amounts of allergens at lower limit of detection (LOD) levels in the food itself through proteomics. We here highlight how, although with some limitations, the steady advances in proteomic approaches possess higher sensitivity than the recommended VITAL reference doses, allowing the identification of allergens at much lower LOD levels than VITAL. Considering that each assay used to detect allergen in food products carries method-specific issues, a more comprehensive and harmonized approach implementing both quantitative and qualitative methods could help overcoming the risk stratification approach and the overuse of PALs, offering promise as the field moves forward towards improving consumers’ quality of life.

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Consensus on DEfinition of Food Allergy SEverity (DEFASE) an integrated mixed methods systematic review

Cited by 42 publications

References 73 publications

Threshold of Reactivity and Tolerance to Precautionary Allergen-Labelled Biscuits of Baked Milk- And Egg-Allergic Children

Threshold of Reactivity and Tolerance to Precautionary Allergen-Labelled Biscuits of Baked Milk- And Egg-Allergic Children

The use of biologics in food allergy

Food labeling issues for severe food allergic patients

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