Hypersensitivity Reactions: An Everyday Occurrence in Pediatric Allergy Clinics

Abstract

The explanation of hypersensitivity reactions has long relied on the classification of Gell and Coombs, originally proposed in the 1960s. However, their concepts were predated by other authors by at least 50 years. A 21st century pediatric allergy clinic provides multiple examples of these basic concepts on a daily basis. We review classic and less classic examples of the original criteria, highlight where current disease pathophysiology does not always fit the original model, and provide updated language for common and uncommon immunologically driven hypersensitivity diseases.

Allergic Food Sensitization and Disease Manifestation in the Fetus and Infant: A Perspective

“…The TH2 (T2) immune system is the critical component of the newborn through adult life that drives the atopic response and contributes to the development of an allergic disease [18]. TH2 lymphocytes are characterized by the prostaglandin D2 receptor CRTH2 [11].…”

A clinical perspective on food-relatA Clinical Perspective on Food-Related Diseases in the First Year of Lifeed diseases in the first year of life

“…A background of hypersensitivity reactions in children has been recently reviewed. 2 IgE-mediated anaphylaxis to food occurs when the allergic diathesis is sufficient to result in 2 or more organ systems to be involved. The topic of anaphylaxis in children was reviewed by Simons and Sampson in 2015.…”

“…Atopic dermatitis is a clinically diagnosed disease that has strong atopic concerns (IgE), but is immunologically more complex than IgE-mediated food allergy. 2 There are strong ethnic differences in the dermal and epidermal compartments, and the degree which barrier integrity and immunological dysfunction occur. 6 These marked differences have been recently outlined, but are beyond the scope of the discussion here.…”

“…Although severe FPIAP can have colonic eosinophilia, the true eosinophilic enteritis diseases are considered in the atopic disease family. 2,[8][9][10] The atopic march has now been updated to include eosinophilic esophagitis (EOE) the most common eosinophilic enteritis. 8 Eosinophilic infiltration into any gastrointestinal compartment, including stomach, duodenum, jejunum, ileum, cecum or colon can occur (EGID).…”

“…10 These eosinophilic processes have been recently discussed. 2 As food exposure is considered a paramount concern, especially in EoE, a reasonable time of exposure is required to generate an eosinophilic infiltration. The fact that milk protein can appear in breast milk may provide a temporal issue with exposure time, as milk itself is the critical protein in many young EoE children.…”