Elicitors and phenotypes of adult patients with proven IgE‐mediated food allergy and non‐immune‐mediated food hypersensitivity to food additives

Abstract

Background Food allergy is a growing health concern with a prevalence of 2%–3% in the adult population in Europe. Non‐immune‐mediated food hypersensitivities, which include reactions after ingestion of food additives, affect 1% of adults and may resemble IgE‐induced allergic reactions without identifiable immunologic sensitization. A double‐blind placebo‐controlled food challenge (DBPCFC) is the gold standard for the diagnosis of any food hypersensitivity. Objective We analysed a large group of adult patients with suspected food hypersensitivity, who had undergone DBPCFC, to better understand IgE‐mediated food allergy and non‐immune‐dependent food hypersensitivity to food additives in adults regarding elicitors, symptoms and positivity rates of oral challenges. Methods Data from 541 patients with suspected food hypersensitivity were analysed, who underwent an oral food challenge between 2010 and 2019. Results IgE‐dependent food allergy was confirmed in 114 of 329 adult patients (34.6%). The confirmation rate was lower in the group of patients with suspected non‐immune‐mediated reactions to food additives (65 of 286, 22.7%). Urticaria and angioedema appeared more frequently in patients with IgE‐mediated food allergies. By contrast, flush and diarrhoea were the most frequent symptoms after a challenge in the group with the non‐immune‐mediated reactions to food additives. Wheat and celery were the most frequently identified food allergens in adults, whereas colourings and preservatives were the most frequent elicitors of non‐immune‐mediated food hypersensitivity. Conclusion The importance of oral food challenges for the diagnosis of food hypersensitivity is confirmed. IgE‐dependent food allergy is more frequently proven, reaching a positivity rate of one‐third and only about 20% for non‐immune‐mediated hypersensitivity. Future studies should elaborate on the mechanisms of non‐immune‐mediated food hypersensitivity and the clinical impact of cofactors in this setting.

HERV-W ENV antigenemia and correlation of increased anti-SARS-CoV-2 immunoglobulin levels with post-COVID-19 symptoms

“…Two parameters appear to emerge from this pilot study, beyond a mere interest as biomarkers, as potential contributors in the pathogenic pathways involved in long/post-COVID: (i) HERV-W ENV, known to be a potent TLR4 agonist in immunopathogenic as well as in neurotoxic processes ( 48 – 50 ), and (ii) IgE antibodies known to be strong effectors of immunoallergic conditions as well as anti-parasite humoral responses ( 51 , 52 ). Thus, the present study strongly suggests focussing further studies on their potential role in certain forms and/or symptoms of post-COVID syndrome.…”

Ultra-processed foods and allergic symptoms among children and adults in the United States: A population-based analysis of NHANES 2005–2006

“…Considering the results from previous studies, higher levels of total IgE at baseline in participants were associated with increased intake of food proteins, such as egg, milk, peanut, and tree nuts ( 36 ). Because of the characteristics of UPFs ( 37 ), in patients with a higher intake of UPFs, it is difficult for the body to produce an allergic reaction ( 38 , 39 ). On the other hand, it was reported that IgE sensitization and food hypersensitivity declined with increasing age ( 40 ).…”

Do advanced glycation end products contribute to food allergy?

“…The consumption of increasing amounts of dietary sugars and fast food is to be factored with studies showing that there is ingestion of 7–8 kg per person per year of synthetic chemical additives including preservatives, acidity regulators, colorants and emulsifiers ( 90 ). These additives have been linked to allergic outcomes, most likely via their alteration of microbiome composition and function ( 91 , 92 ). The Western diet has less omega 3 fatty acids ( 93 ) and dietary fiber ( 94 ), both of which have been suggested to further contribute to risk of allergic disease ( 95 , 96 ).…”