The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18–75 incorporating a validated PFS diagnostic questionnaire

Skypala, Isabel; Bull, Samantha; Deegan, K.; Gruffydd-Jones, Kevin; Holmes, Steve; Small, Iain; Emery, Peter W.; Durham, Stephen R.

doi:10.1111/cea.12104

Cited by 58 publications

(53 citation statements)

References 41 publications

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“…It is currently reported in UK primary care practices as affecting approximately 2% of the population [7]. Although this can often easily be diagnosed from the history, there is significant demand for confirmatory tests from patients who have typical oral symptoms after eating raw fruit or vegetables and sometimes raw nuts.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Performance of Skin Prick, ImmunoCAP, and ISAC Tests in the Diagnosis of Patients with Allergy

Griffiths

El‐Shanawany

Jolles

et al. 2017

Int Arch Allergy Immunol

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Background: Allergy is diagnosed from typical symptoms, and tests are performed to incriminate the suspected precipitant. Skin prick tests (SPTs) are commonly performed, inexpensive, and give immediate results. Laboratory tests (ImmunoCAP) for serum allergen-specific IgE antibodies are usually performed more selectively. The immuno-solid phase allergen chip (ISAC) enables testing for specific IgE against multiple allergen components in a multiplex assay. Methods: We retrospectively analysed clinic letters, case notes, and laboratory results of 118 patients attending the National Adult Allergy Service at the University Hospital of Wales who presented diagnostic difficulty, to evaluate which testing strategy (SPT, ImmunoCAP, or ISAC) was the most appropriate to use to confirm the diagnosis in these complex patients, evaluated in a “real-life” clinical service setting. Results: In patients with nut allergy, the detection rates of SPTs (56%) and ISAC (65%) were lower than those of ImmunoCAP (71%). ISAC had a higher detection rate (88%) than ImmunoCAP (69%) or SPT (33%) in the diagnosis of oral allergy syndrome. ImmunoCAP test results identified all 9 patients with anaphylaxis due to wheat allergy (100%), whereas ISAC was positive in only 6 of these 9 (67%). Conclusions: In this difficult diagnostic group, the ImmunoCAP test should be the preferred single test for possible allergy to nuts, wheat, other specific foods, and anaphylaxis of any cause. In these conditions, SPT and ISAC tests give comparable results. The most useful single test for oral allergy syndrome is ISAC, and SPT should be the preferred test for latex allergy.

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Section: Introductionmentioning

confidence: 99%

Comparison of the Performance of Skin Prick, ImmunoCAP, and ISAC Tests in the Diagnosis of Patients with Allergy

Griffiths

El‐Shanawany

Jolles

et al. 2017

Int Arch Allergy Immunol

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“…It has been suggested that food allergy, like autoimmunity, may be more common in women (188). However, it has also been suggested that the way in which women deal with chronic disease differs and this may explain the higher presentation to health care providers (102). Although it seems unlikely that men and women will respond differently to the BP-SIT treatment the higher proportion of women enrolled in the trial was not ideal.…”

Section: Resultsmentioning

confidence: 99%

“…Approximately 2% of the surveyed population were deemed to suffer with PFS, though there were geographical variations (102).…”

Section: Pollen Food Syndromementioning

confidence: 99%

Can we help people with Oral Allergy Syndrome eat fresh fruit?

Frew¹

2012

http://isrctn.org/>

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The major birch allergen Betulae verrucosa 1, (Bet v 1), belongs to the proteinase 10 (PR-10) family of panallergens that are common to many fruits, nuts and vegetables. A high proportion of birch-sensitised individuals experience oral symptoms upon consumption of such foods. This has been termed 'oral allergy syndrome (OAS),' or 'pollen-food syndrome.' Birch pollen specific immunotherapy (BP-SIT) can successfully treat birchsensitive rhinitis; it has been postulated that BP-SIT might also reduce oral allergy symptoms. Previous studies have been small and contradictory, using differing methodology and primary outcome measures.We designed a placebo controlled, double blind, randomised study aiming to establish definitively whether BP-SIT can effectively treat the pollen-food However, a total of eight patients were noted to have an apple threshold of 100g or more at baseline, despite reacting to only 20g during screening. The clinical trial is on going and remains blinded; it is therefore impossible to draw any firm conclusions regarding the efficacy of BP-SIT to treat OAS at this time.However, the study has raised questions concerning the validity of DBPCFC as the gold standard test in oral allergy syndrome, something not previously reported.II II

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“…Those falling in the intermediate zone may undergo OFC or DBPCFC for risk stratification. This approach, however, would not be feasible in most UK NHS allergy clinics given the high prevalence of PFS (it is estimated that birch pollen allergy affects 5%–7% of UK subjects with PFS affecting 2%–3% of UK adult population)3 and the unmet need for allergy services. To put this into perspective further, a recent study by Skypala et al reported that 27% and 12% of British patients with PFS reported allergic reactions to hazelnuts and peanuts, respectively 3.…”

Section: Discussionmentioning

confidence: 99%

“…This approach, however, would not be feasible in most UK NHS allergy clinics given the high prevalence of PFS (it is estimated that birch pollen allergy affects 5%–7% of UK subjects with PFS affecting 2%–3% of UK adult population)3 and the unmet need for allergy services. To put this into perspective further, a recent study by Skypala et al reported that 27% and 12% of British patients with PFS reported allergic reactions to hazelnuts and peanuts, respectively 3. With appropriate risk stratification, a process of home challenge may be possibly with patients following a defined protocol for self-administration of nuts, documentation of any reactions and communication with allergy specialists.…”

Section: Discussionmentioning

confidence: 99%

The concordance between component tests and clinical history in British adults with suspected pollen-food syndrome to peanut and hazelnut

et al. 2017

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BackgroundMild oropharyngeal symptoms to peanut/hazelnut occur in ~30% of patients with pollen-food syndrome (PFS). Component tests are considered a useful adjunct to the diagnosis and may help differentiate PFS from those at a risk of anaphylaxis due to storage protein/lipid transfer protein (LTP) sensitisation.AimsTo assess concordance between component tests and clinical history in suspected PFS to peanut/hazelnut in a specialist clinic.MethodsAdult patients were classified into PFS (group 1, n=69) and PFS with mild systemic symptoms (group 2, n=45) based on clinical history. Specific IgE (sIgE) of ≥0.35 kUA/L was considered positive as per manufacturers’ recommendation. Kappa (κ) inter-rater agreement was calculated for concordance between clinical classification and test profiles.ResultsGroup 1 hazelnut: 85% monosensitised to Cor a1, 12% to storage protein/s or LTP and 3% negative to all components. Group 1 peanut: 41% monosensitised to Ara h8, 44% to storage protein/s or ±LTP and 15% negative to all components. Group 2 hazelnut: 67% monosensitised to Cor a1, 16% sensitised to storage protein/s and 17% negative to all components. Group 2 peanut: 19% monosensitised to Ara h8, 62% sensitised to storage protein/s and/or LTP and 19% negative to all components.SIgE to Ara h8 and Cor a1 were greater in group 1 versus group 2: (median (IQR) kUA/L; hazelnut: 12.1 (7.8-25.2) vs 2.4 (0.36-6.3), p<0.001; peanut: 2.4 (0.10-21.1) vs 0.3 (0-3), p<0.01)).ConclusionConcordance between component tests and clinical history for adults with PFS was good for hazelnut (κ=0.63) but poor for peanut (κ=−0.12). Food challenges are warranted in discordant cases for an accurate diagnosis.

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The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18–75 incorporating a validated PFS diagnostic questionnaire

Cited by 58 publications

References 41 publications

Comparison of the Performance of Skin Prick, ImmunoCAP, and ISAC Tests in the Diagnosis of Patients with Allergy

Comparison of the Performance of Skin Prick, ImmunoCAP, and ISAC Tests in the Diagnosis of Patients with Allergy

Can we help people with Oral Allergy Syndrome eat fresh fruit?

The concordance between component tests and clinical history in British adults with suspected pollen-food syndrome to peanut and hazelnut

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