Food allergies and food-induced anaphylaxis: role of cofactors

Shin, Meeyong

doi:10.3345/cep.2020.01088

Cited by 23 publications

(12 citation statements)

References 51 publications

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“…peanuts), the second to the personal susceptibility due to comorbidities and cofactors. Pathophysiological role of cofactors is due to a decrease in the threshold for allergen tolerance 18,19 . In this study, cofactors, mainly physical exercise, differed between the triggers only in repeated reactors and accompanied up to one fourth of HEA reactions.…”

Section: Discussionmentioning

confidence: 68%

“…Pathophysiological role of cofactors is due to a decrease in the threshold for allergen tolerance. 18,19 In this study, cofactors, mainly physical exercise, differed between the triggers only in repeated reactors and accompanied up to one fourth of HEA reactions. In comparison to previous paediatric EAR data, physical exercise accompanied the anaphylaxis episode in about one fifth of children aged up to 12 years 1…”

Section: Epidemiology and Demographymentioning

confidence: 69%

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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: Discussionmentioning

confidence: 68%

Section: Epidemiology and Demographymentioning

confidence: 69%

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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“…Increased consumption of certain vegetables provides insoluble fiber that can increase gut motility, causing incomplete digestion and permeability of the gastrointestinal mucosa to allergenic proteins [ 48 ]. Vegetables may thus act as a co-factor in the activation of allergic reactions, similar to co-factors in IgE-mediated FA [ 49 ] or anaphylaxis [ 50 , 51 ]. Consumption of alkaline boiled vegetables, such as cabbage, onion and broccoli, could increase stomach pH.…”

Section: Discussionmentioning

confidence: 99%

Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis

et al. 2023

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Background: Dietary and environmental factors may influence tolerance acquisition in food protein-induced allergic proctocolitis (FPIAP). This retrospective observational study explored the role of maternal diet during pregnancy and breastfeeding in tolerance acquisition in infantile FPIAP. Methods: Breastfed infants with FPIAP from six diverse regions in Greece were divided into two groups, based on development of tolerance to the trigger food: Group A (n = 43), before, and Group B (n = 53), after, the 6th month of age. Maternal diet during pregnancy and breastfeeding was elicited using the Mediterranean Diet Score Questionnaire and the Mediterranean Oriented Culture Specific Semi-Quantitative Food Frequency Questionnaire. Results: Mean age at diagnosis of FPIAP (1.5 months) and weaning (5.5 months) were the same in both groups. The main trigger was cow’s milk. Group A received infant milk formula earlier than Group B. Group B had a higher incidence of asthma/wheeze, siblings with milk allergy, maternal smoking and rural residence. On multivariate analysis, earlier resolution of FPIAP was associated with higher maternal education and with salt intake and consumption of goat/sheep cheese during pregnancy and olive oil during breastfeeding. Consumption of multivitamins during pregnancy and meat, winter fruits, green vegetables, butter, salt, “ready-to-eat” meals and pastries during breastfeeding were correlated with longer duration of symptoms. Conclusions: Mothers of children with FPIAP to cow’s milk protein can be advised to eat more yogurt, cheese and olive oil during subsequent pregnancies, and avoid multivitamins, grilled food, “ready-to-eat” meals, pastries, meat and alcohol during breastfeeding, to reduce the duration of FPIAP presenting in future infants.

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“…This combination of symptoms is a cessation criterion in line with the general understanding of when to stop an OFC ( 31 ). Rescue medication administered in OFCs reflects the severity of the clinical reaction, but the use is influenced by the patients' comorbidity and prior allergic reactions to other foods ( 49 ). Factors, such as a high cumulative threshold dose or food retention caused by nausea ( 50 ), which could lead to prolonged allergen exposure, could also have affected the readiness to administer rescue medication and thereby pose a bias.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Clinical Reactivity in a Danish Cohort of Tree Nut Allergic Children, Adolescents, and Young Adults

et al. 2022

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BackgroundTree nut allergy is associated with severe reactions and poly-sensitization to other nuts and peanuts often occurs. There are regional differences in sensitization profiles that result in differences in clinical presentation. Denmark is located in a birch pollen endemic area, which could influence the allergy patterns due to pollen cross-sensitization.ObjectiveThis study aimed to investigate patterns of sensitization and clinical reactivity to tree nuts and peanuts and threshold levels for oral food challenges (OFCs) in a Danish cohort of tree nut allergic children, adolescents, and young adults.MethodsForty tree nut allergic subjects were assessed for clinical reactivity to six nuts, i.e., hazelnut, walnut, pistachio, cashew, almond, and peanut, by OFCs or convincing medical history of an immediate allergic reaction or tolerance. Clinical presentation and allergen-specific immunoglobulin E (sIgE) levels together with eliciting dose and rescue medication in OFCs were furthermore assessed.ResultsAllergy to two or more tree nuts was observed in most cases. Hazelnut-walnut dual allergy was common but not exclusively observed as concomitant allergies. Allergy to cashew was coincided in all but one of the assessed subjects with pistachio allergy. Half of all assessed subjects were allergic to peanuts. Oral symptoms followed by a skin reaction were the most common symptomatology that lead to OFC cessation and subjects often presented with symptoms from two or more organ systems. OFC threshold levels were within the same range, but cashew was distinguished from other nuts by causing allergic symptoms at the lowest dose. Clinical reactivity and the allergy patterns were to some extent reflected by sIgE levels and by correlations in sIgE between the nuts.ConclusionsIn this Northern European cohort, subjects with clinically relevant tree nut allergy were generally allergic to two or more tree nuts and close to half of them also to peanuts. There were two distinct and independent allergic phenotypes; the majority of hazelnut allergic subjects were also allergic to walnut, and all but one subject with cashew allergy were dual allergic to pistachio. These findings are consistent with a strong sIgE correlation between hazelnut and walnut and a close to total sIgE correlation between cashew and pistachio.

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Food allergies and food-induced anaphylaxis: role of cofactors

Cited by 23 publications

References 51 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

Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis

Patterns of Clinical Reactivity in a Danish Cohort of Tree Nut Allergic Children, Adolescents, and Young Adults

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