Allergy Vigilance Network Research Articles

Food anaphylaxis in the elderly: Analysis of allergy vigilance network data from 2002 to 2021.

Few studies have focused on food allergies in the elderly, even though it may persist or appear de novo. We reviewed data for all cases of food-induced anaphylaxis in people age ≥ 60 reported to the French "Allergy Vigilance Network" (RAV) between 2002 and 2021. RAV collates data reported by French-speaking allergists regarding cases of anaphylaxis graded II to IV according to the Ring and Messmer classification. In total, 191 cases were reported, with an even sex distribution and mean age was 67.4 years (range 60 to 93). The most frequent allergens were mammalian meat and offal (31 cases, 16.2%), often associated with IgE to α-Gal. Legumes were reported in 26 cases (13.6%), fruits and vegetables in 25 cases (13.1%), shellfish 25 cases (13.1%), nuts 20 cases (10.5%), cereals 18 cases (9.4%), seeds 10 cases (5.2%), fish 8 cases (4.2%) and anisakis 8 cases (4.2%). Severity was grade II in 86 cases (45%), grade III in 98 cases (52%) and grade IV in 6 cases (3%) with one death. Most episodes occurred at home or in a restaurant and in most cases adrenaline was not used to treat the acute episode. Potentially relevant cofactors such as beta-blocker, alcohol or non-steroidal anti-inflammatory drug intake were present in 61% of cases. Chronic cardiomyopathy, present in 11.5% of the population, was associated with greater, grade III or IV reaction severity (OR 3.4; 1.24-10.95). Anaphylaxis in the elderly has different causes to younger people and requires detailed diagnostic testing and individualized care plans.

Vingt ans d’allergènes alimentaires rares déclarés au Réseau d’Allergo-Vigilance®

During its 20 years of existence, the Allergy-Vigilance Network® has identified 86 rare food allergens, each with a prevalence of less than 0.1% of the 2535 cases of severe food anaphylaxis reported. If they are in fact unknown, and revealed in this publication, their declaration has been a fundamental element for health monitoring and for the progression of knowledge in food allergy. The role of sentinel of the reporting physicians, to whom we pay tribute here, and the voluntary work they provide to feed this knowledge are precious and must continue more than ever in the years to come.

Food-induced Anaphylaxis in Infancy Compared with Preschool Age: A Retrospective Analysis

G Pouessel, C Jean-Bart, A Deschildre. Clin Exp Allergy. 2020;50(1):74–81 To characterize food anaphylaxis among infants and compare them to children 1–6 years of age. The Allergy Vigilance Network (AVN) in France is a registry to which French allergists voluntarily contribute data on anaphylaxis. Cases of children under the age of 7years, from 2002–2018, were analyzed. Children aged 1–6 years were labeled pre-school age. Infants were 12 months or younger. These groups were compared regarding demographics, atopic history, allergic triggers and anaphylactic reactions. From 2002 to 2018, 1951 …

Food-induced anaphylaxis in infancy compared to preschool age: A retrospective analysis.

Little is known regarding food anaphylaxis in infancy. We aimed to describe specificities of food anaphylaxis in infants (≤12months) as compared to preschool children (1-6years). We conducted a retrospective study of all food anaphylaxis cases recorded by the Allergy Vigilance Network from 2002 to 2018, in preschool children focusing on infants. Of 1951 food anaphylaxis reactions, 61 (3%) occurred in infants and 386 (20%) in preschool children. Two infants had two anaphylaxis reactions; thus, we analyzed data among 59 infants (male: 51%; mean age: 6months [SD: 2.9]); 31% had a history of atopic dermatitis, 11% of previous food allergy. The main food allergens were cow's milk (59%), hen's egg (20%), wheat (7%) and peanut (3%) in infants as compared with peanut (27%) and cashew (23%) in preschool children. Anaphylaxis occurred in 28/61 (46%) cases at the first cow's milk intake after breastfeeding discontinuation. Clinical manifestations were mainly mucocutaneous (79%), gastrointestinal (49%), respiratory (48%) and cardiovascular (21%); 25% of infants received adrenaline. Hives, hypotension and neurologic symptoms were more likely to be reported in infants than in preschool children (P=.02; P=.004; P=.002, respectively). Antihistamines and corticosteroids were more often prescribed in preschool children than in infants (P=.005; P=.025, respectively). Our study found that in infants presenting with their first food allergy, in a setting with a high rate of infant formula use, the most predominant trigger was cow's milk. As compared to older preschool children, hives, hypotonia and hypotension were more likely to be reported in infants. We believe that this represents a distinct food anaphylaxis phenotype that can further support developing the clinical anaphylaxis criteria in infants.

Anaphylaxis to diclofenac: nine cases reported to the Allergy Vigilance Network in France.

Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge (OC) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE-dependent anaphylaxis was confirmed in six cases: positive intradermal tests (n=4), a syndromic reaction during skin tests (n=1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC. A nonimmune reaction was suspected in one case. An IgE-dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BATs may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAIDs. Tests for specific IgEs to most frequently used NSAIDs such as diclofenac and ibuprofen are urgently needed.

Emergency treatment of food anaphylaxis: a report of 152 cases registered by the Allergy Vigilance Network

Results 78 paediatric and 74 adult cases were reported. Two deaths occurred. Personnel and emergency centres involved in the management were known in 147 cases, and treatment in 136 cases. First-aid was provided at home by patients themselves on 43 occasions or by the family physician 12 times. 49 called for an ambulance. 89 required hospitalisation in an Emergency Department. Epinephrine auto-injectors were used by 4 patients only. Medicalized ambulances treated 23 patients, and used epinephrine in 11/23 cases. Emergency departments treated 58 patients and used epinephrine in 19 cases. When epinephrine had been injected before arriving at the ED, no further injection in hospital was necessary. In total, epinephrine was given to 37 patients (27.2%). The observation period was much shorter than recommended in the Directives. Patients were discharged without care summaries. Allergists implemented school management plans for all children. 68 to 80% of patients were prescribed self-injectable epinephrine.

Severe drug‐induced anaphylaxis: analysis of 333 cases recorded by theAllergyVigilanceNetwork from 2002 to 2010

A few series of well-documented cases of severe drug-induced anaphylaxis (SDA) are available. Cases collected by the Allergy Vigilance Network from 2002 to 2010 were analyzed for clinical signs, causative drugs, and efficacy of a stepwise approach to diagnosis, using skin tests, laboratory tests, and oral challenges. Three hundred and thirty-three cases concerned 300 adults (90.1%) and 33 children (9.9%): 206 females (61.9%) and 127 males (38.1%). Mean age was 42.7 ± 18 years. Anaphylactic shock (76.6%), severe systemic reactions (10.5%), acute laryngeal edema (9%), severe bronchospasm (2.1%), and six fatal cases (1.8%) were recorded. There were 270 cases (81.1%) of ambulatory anaphylaxis. Sixty-three cases (18.9%) occurred during anesthesia. Hospitalization was required in 94.8% of cases. 23.7% of patients were admitted to an intensive care unit. Epinephrine was used in 57.9% of cases. Eighty-four drugs were incriminated: antibiotics (49.6%), muscle relaxants, latex and anesthetics (15%), nonsteroidal anti-inflammatory drugs (10.2%), acetaminophen (3.9%), iodinated or magnetic resonance imaging contrast media (4.2%), immunotherapy and vaccines (3.9%), and other drugs (13%). Among antibiotics, amoxicillin (97 cases), other penicillins (four cases), cephalosporins (41 cases), quinolones (15 cases), and pristinamycin (seven cases) were the most common. The diagnosis of drug hypersensitivity was obtained by skin tests in 72.9%, laboratory tests only in 2.4% of cases, and oral challenges (OCs) only in 3.9% of cases. Three hundred and thirty-three case reports provided data on drugs involved in severe anaphylaxis. The efficacy of skin tests and poor use of laboratory tests are underlined. Further progress may depend on OCs.

Anaphylaxie à la mangue : dix cas rapportés au Réseau allergovigilance aspects cliniques et fréquence actuelle

The prevalence of mango allergy is about 0.2 % out of all food allergies. The Allergy vigilance network reports 10 cases of severe mango anaphylaxis. Nine patients are women. Eight subjects are sensitized to mugwort pollen, and two to birch pollen. Six patients have food allergy to Apiaceae and two to pistachio, another Anacardiacea. The reaction was elicited by an industrial juice in four cases. Data about cross-reactivity with Art v 1, Bet v 1, Bet v 6, Api g 1, Api g 2, Dau c 1 and two thermostable major allergens are discussed as well as the cross reactivity between mango seeds and cashew nut. The potential risk of cross allergy between mango and tree nuts that are Anacardiaceae is a source of concern, because of the increasing consumption of cashew nut in France.

Ber e 1, allergène majeur de la noix du Brésil : intérêt de l’allergène recombinant pour le diagnostic in vitro

Ber e 1 is a thermostable albumin 2S protein, a major allergen of Brazil nut (BN). Homology with 2S albumins from other tree and ground nuts is known: Ara h 2 (40%), Ara h 6 (48%), Ana o 3 (61%), Car i 1 (66%) and Jug r 1 (68%). The sensitization to BN, explored by prick tests, is frequent in patients allergic to other nuts: 19%. Allergy to NB is rare: 0.48% of 1047 cases of food allergy recorded in the CICBAA data bank. Severe anaphylaxis to BN represents 0.8% of cases declared to the Allergy Vigilance Network. The good sensitivity of prick tests and of the determination of specific IgE to BN makes sure the diagnosis of BN allergy when there is a conclusive clinical history, but the lack of specificity does not allow a predicitive value for the diagnosis of allergy when the history is lacking. The new ImmunoCAP ® using a recombinant allergen will gain more specificity, discarding the risk of positivity linked to anticarbohydrate IgE. However, the possible cross reactivity between 2S albumins is a non-solved issue that deserves further studies.

Original article: The economic costs of severe anaphylaxis in France: an inquiry carried out by the Allergy Vigilance Network

Background: The prevalence of severe anaphylaxis, between 1 and 3 per 10 000, has increased sharply over recent years, with a rate of lethality of 1%. The economic burden is unknown.Objective: The aim of this study was to estimate the economic costs of anaphylaxis, including direct costs of treatment, hospitalization, preventive and long‐care measures, and the indirect cost: absenteeism.Methods: Analysis of 402 patients of anaphylaxis declared by 384 allergists was reported to the Allergy Vigilance Network. The global cost was estimated from the national data of hospital admissions: ICD‐10 coding available for 2003, 2004 and 2005.Results: Three work/classroom days were lost per patient. Diagnosis required oral challenge with hospitalization in 18% of cases. The estimated mean total cost was 1895€ for food‐ and drug‐related anaphylaxis (5610€ for the most severe), and 4053€ for Hymenoptera anaphylaxis. National statistics recorded 2575 patients in 2005; 22% more than in 2003. The estimated annual cost was 4 789 500 €. The possible reasons for this being an under‐estimate include: data coming only from hospitalized patients, poor identification by medical teams unfamiliar with ICD‐10 codes, peri‐operative anaphylaxis being insufficiently declared, rush‐immunotherapy and maintenance treatments for Hymenoptera anaphylaxis. Similarly, the extra cost of cow milk substitutes, as well as insurance costs where deaths are followed by litigation were not taken into account.Conclusions: The mean cost of anaphylaxis was 1895–5610€ in nonfatal patients. The prevalence was under‐estimated because of many biases, leading to under‐estimation of the national cost. Further studies would be necessary to evaluate the value of preventive strategies.

Severe Drug-Induced Anaphylaxis: Survey of Case Reports by Allergy Vigilance Network

Severe Drug-Induced Anaphylaxis: Survey of Case Reports by Allergy Vigilance Network

Severe drug allergy: The first 100 cases declared to allergy vigilance network

Severe drug allergy: The first 100 cases declared to allergy vigilance network

Anaphylaxie alimentaire sévère et léthale : cas rapportés en 2002 par le réseau d’allergovigilance

The prevalence of food allergy in the French population is estimated to be 3.24%. The constant increase in this prevalence is related to environmental factors: drugs, tobacco, new foods, new food ingredients and new food technology, all leading to increased allergenicity of ingredients. We decided that it was necessary to develop a system of food allergy vigilance to provide a continuous flow of information about the risk of allergy to new foods and data on the incidence of serious food-induced anaphylaxis. Therefore, a French Allergy Vigilance Network was set up in 2001; it now involves 250 French allergists. One hundred and seven cases of severe anaphylaxis (including two deaths) in 33 children and 74 adults were reported in 2002. Anaphylactic shock was reported in 59.8% of the cases involved (one fatal, to peanut); 18.7% were other systemic reactions, including 15.9% with laryngeal angioedema, 5.6% with serious acute asthma (one fatal, to soy). The most frequent allergens were peanut (14 cases), other nuts (16 cases), shellfish (nine cases), the latex-fruit group (nine cases), lupine flour (seven cases), wheat flour (seven cases), celery (five cases) and snails (five cases). The seriousness of these reactions was underestimated, as epinephrine was administered in only 59% of the cases. Several public interest measures should now be taken: communicate information about the new risk factors to the food industry, advise them to improve labelling, and encourage hospital catering services to set up guidelines for food safety. Setting up the same sort of network in other European countries could lead to a significant advance in knowledge with regard to the peculiarities of allergies relating to a wide variety of eating habits. Data that would be obtained by allergy networks similar to ours would be useful to French and other European health agencies responsible for making decisions concerning the safety of foods.

Accidents graves par allergie alimentaire en France : fréquence, caractéristiques cliniques et étiologiques. Première enquête du Réseau dˈallergovigilance, avril–mai 2001

The first questionnaire of the ‘Allergy Vigilance Network’ concerns severe anaphylactic reactions that occurred during 1 month (April or May 2001). The first results obtained from 100 members of the Network (74 allergologists-GPs, 15 pediatricians-allergologists, eight lung specialists-allergologists and three dermatologists-allergologists) were collected. The analysis of these 100 answers reveals the occurrence of 163 severe reactions: laryngeal angioedema (51.5%), anaphylactic shock (39.9%), acute asthma (8.6%). These reactions concern 46.6% children under 15 years of age and 53.4% adults. The most frequent allergens are peanuts and nuts (27.6%), food cross-reacting with latex (11%), egg (8.6%), fish (6.7%), crustaceans (5.5%), milk (4.3%), sesame (4.3%), wheat (3.6%), legumes (3.6%), shellfish (3%), mustard (1.8%), celery (1.8%), and additives (carmine, alpha-amylase and sulfites: 1.8%). Severe reactions in France could be estimated between 15,000 and 30,000 per year. Acute asthma is less commonly reported, mainly by lung specialists, and is probably underestimated. The ability of nuts to induce severe allergic reactions is confirmed. This survey underlines the increased frequency of severe reactions to food cross-reacting with latex and to sesame. The frequency of food allergens could be influenced by the season; this enquiry will be renewed in January 2002.

Présentation du Réseau d’Allergovigilance

The increased prevalence of food allergy and reports of allergy to novel foods led to the development of an “Allergy Vigilance Network.” This network is composed of 195 trained allergologists extending to 73% of the departments in France. Communications are carried out by e-mail or fax. The three objectives of this structure are: 1) to index the cases of lethal or prelethal anaphylaxis; 2) to evaluate the prevalence of food allergies, clinical pictures and allergens; and 3) to evaluate the allergic risk of novel foods. This network is composed of 195 allergologists as of 29 August 2001 (175 French, 11 Belgians, two from Fort-de-France, two from Luxembourg, one from Reunion island, one Greek, one Swiss, one Moroccan, two Poles). This network composed of trained allergologists appears to be essential in order to precisely evaluate the prevalence and allergic risk of food. It would be a helpful tool for public health organisms.