Causative Food Research Articles

Children with atopic dermatitis in Daejeon, Korea: individualized nutrition intervention for disease severity and nutritional status.

Atopic dermatitis is one of the most common pediatric chronic inflammatory skin diseases, and certain food allergens and nutrients are closely related to the development and severity of atopic dermatitis. While avoidance of the causative foods is considered the mainstay of treatment, unverified excessive restriction might induce unnecessary limitations in the food intake, consequently leading to nutritional deficiencies and poor growth. This study aimed to identify the characteristics and nutrient intake status in children with atopic dermatitis and to investigate the effects of individualized nutrition intervention. We retrospectively reviewed electronic medical records of 77 pediatric patients with atopic dermatitis who received 4 months of individualized nutrition intervention combined with an elimination diet. The patient characteristics, nutrient intake status, and clinical status were examined before and after the intervention. Before the intervention, 5 children had a weight for height z-score below -2.0, and 48.1% had experienced food restriction; these children showed a significantly higher SCORing of Atopic Dermatitis index than those without experiences, with the number of restricted foods before the intervention positively correlating with the disease severity. The intakes of n-6 and n-3 fatty acids, calcium, folate, and vitamin D were lower than the recommended nutrient intakes for Koreans. After the intervention, the weight for height z-score of 35 children was significantly increased and their SCORing of Atopic Dermatitis index was significantly reduced (p<0.05). Individualized nutrition intervention appears useful for alleviating the severity of atopic dermatitis and improving the growth status by improving the nutrient intake.

Oral challenge tests for soybean allergies in Japan: A summary of 142 cases

BackgroundSoybeans are one of causative foods for infantile onset allergies in Japan. This study aimed to analyze the results of soybean challenge tests that were conducted over approximately 7 years at our institution. Using the test data, we sought to identify the responses and clinical profiles of patients with soybean allergies, and to investigate the relationship between the responses and soybean sensitization status. MethodsBetween July 2004 and May 2010, 142 cases (125 patients) underwent food challenge tests (100 g of silken tofu) for the diagnosis of soybean allergy or confirmation of their tolerance. The patients' characteristics, soybean sensitization status, and responses to the challenge tests were retrospectively evaluated. ResultsAmong the subjects who underwent the soybean challenge test, the male/female ratio was 1.6 (87/55), and the mean age at the test was 2.8 ± 1.7 years. The positive rate for the challenge test was 38.7%. Induced symptoms were observed in the skin (81.8%), respiratory system (50.9%), and gastrointestinal system/mucosal membrane/anaphylaxis (12.7%). Intramuscular epinephrine was administered to all 7 patients who experienced an anaphylactic reaction. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic efficiency of soybean-specific IgE titers were low for predicting the responses to the challenge test. ConclusionsSoybean allergies were diagnosed in only 18% of the subjects with positive sensitization to soybeans. Therefore, soybean-specific IgE titers are not an effective predictor of a positive response to the challenge test.

Implicaciones nutricionales de las dietas de eliminación

BackgroundThe backbone of food allergy treatment is the restriction of causative foods. These interventions have shown that children who restrict the consumption of basic foods have a higher risk of malnutrition.The aim of the study was to identify the nutritional status of patients with elimination diet, characterizing their anthropometric indexes and identifying the percentage of patients in the group with true food allergies. MethodsA cross-sectional study was carried out from January to October 2014 at the Hospital Infantil de Mexico Federico Gomez. Patients 1 to 11 years of age with a history of elimination of at least one of five foods (eggs, milk, wheat, corn, soybeans) for a minimum of 6 months were included. Full nutritional assessment was performed by comparing the anthropometric indexes to z score for age. Data analysis used descriptive statistics. Kruskal-Wallis and Spearman correlation were performed. ResultsThe most frequent eliminated foods were milk, soy, eggs, corn, and wheat. Comparing the number of foods eliminated with different anthropometric indexes, with a greater amount of eliminated food, the z-score of weight/age (W/A), height/age (H/A) and weight/height (W/H) were lower and the most affected index was fat reserve. Only in 5% of children was food allergy confirmed. ConclusionsThe study confirms the need for nutrition counseling for patients who have elimination diets and overdiagnosis of food allergy.

Food allergy in the Netherlands: differences in clinical severity, causative foods, sensitization and DBPCFC between community and outpatients.

BackgroundIt is unknown whether food allergy (FA) in an unselected population is comparable to those from an outpatient clinic population.ObjectiveTo discover if FA in a random sample from the Dutch community is comparable to that of outpatients.MethodsThis study was part of the Europrevall-project. A random sample of 6600 adults received a questionnaire. Those with symptoms to one of 24 defined priority foods were tested for sIgE. Participants with a positive case history and elevated sIgE were evaluated by double-blind placebo-controlled food challenge (DBPCFC). Outpatients with a suspicion of FA were evaluated by questionnaire, sIgE and DBPCFC.ResultsIn the community, severe symptoms were reported less often than in outpatients (39.3% vs. 54.3%). Participants in the community were less commonly sensitized to any of the foods. When selecting only those with a probable FA (i.e. symptoms of priority food and elevation of sIgE to the respective food), no major differences were observed with respect to severity, causative foods, sensitization and DBPCFC between the groups.ConclusionIn the Netherlands, there are large differences in self-reported FA between community and outpatients. However, Dutch community and outpatients with a probable FA do not differ with respect to severity, causative foods, sensitization and DBPCFC-outcome.

Food-dependent exercise-induced anaphylaxis in Korean children: a single-center retrospective case study

Purpose: Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific clinical syndrome requiring both ingestion of an allergenic food and exercise to induce anaphylaxis. It may be underdiagnosed due to insufficient history taking in terms of the causes of anaphylaxis. This study aims to describe clinical characteristics and diagnostic results of FDEIA in children. Methods: We retrospectively reviewed the medical records of patients under 18 years old who were diagnosed with FDEIA at Asan Medical Center between January 2003 and August 2014. Results: Of the 170 children with anaphylaxis, 11 (6.5%) had FDEIA. The mean age at the onset of symptoms was 14.8±1.5 years. The causative foods were: wheat (n=4), meat (n=1), mung beans (n=1), rice (n=1), celery (n=1), cabbage (n=1), fish (n=1), and soy (n=1). The numbers of symptom development were: 7 (n=1), 6 (n=1), 3 (n=4), 2 (n=2), and 1 (n=3). The geometric mean (range of 1 standard deviation) of total serum IgE levels was 131.6 kU/L (53.5.324.2 kU/L). The skin prick test and immununoCAP were positive for causative foods in 3 of 6 patients (50.0%) and 7 of 10 patients (70.0%), respectively. The provocation test was performed in 8 of 11 patients and showed positive results except 1 patient. The interval between exercise and symptoms was 21.6±7.3 minutes. Conclusion: It is important to suspect FDEIA and take a detailed history in children with anaphylaxis. Provocation test should be considered to confirm the diagnosis. Further studies on disease course and long-term prognosis are warranted.(Allergy Asthma Respir Dis 2015;3:194-199)

Prevalence of self reported food allergy in US adults: 2001, 2006, and 2010.

Epidemiologic evidence indicates that food allergies are increasing in the population. Information on a change in self-reported food allergy (srFA) in adults over time is lacking. To report the prevalence of srFA and compare differences at three time points over a decade. We analyzed srFA and reported physician-diagnosed food allergy in 4000 U.S. adults who participated in the 2010 U.S. Food and Drug Administration Food Safety Survey. Information on causative food(s), reaction severity characteristics, and various diagnostic factors was also analyzed. We compared 2010 Food Safety Survey data with 2006 and 2001 data, and highlighted relevant differences. SrFA prevalence increased significantly, to 13% in 2010 and 14.9% in 2006 compared with 9.1% in 2001 (p less than 0.001). Physician diagnosed food allergy was 6.5% in 2010, which was not significantly different compared with 7.6% in 2006 and 5.3% in 2001. SrFA increased in both men and women, non-Hispanic white and black adults, 50-59 year olds, and in adults with a high school or lower education. In 2010, milk, shellfish, and fruits were the most commonly reported food allergens, similar to 2001. Also, in 2010, 15% of reactions reportedly required a hospital visit and 8.4% were treated with epinephrine. Minor differences in reaction severity characteristics were noted among the surveys. Analysis of survey results indicates that the prevalence of srFA increased among U.S. adults from 2001 to 2010 and that adults are increasingly self-reporting FAs without obtaining medical diagnosis. Improved education about food allergies is needed for this risk group.

Diversity of Food Allergy.

Food allergy is defined as an immune system-mediated adverse reaction to food components. Food allergic reactions are mostly IgE mediated and also known as immediate type hypersensitivity (type I reaction). There are several characteristic clinical types of food allergy, such as Anaphylaxis, Food-dependent exercise-induced anaphylaxis (FDEIA), and Oral allergy syndrome (OAS). In addition, food allergy is also classified into two types (class 1 and class 2) based on the pathophysiological mechanism. In the class 2 food allergy, pollen allergy causes plant food allergy; therefore this type of allergy is sometimes called Pollen-food allergy syndrome (PFAS). The risk of food allergy (allergenicity) may vary with the treatment of the food allergens. The formation or status of the causative food affects its allergenicity. Class 1 food allergens are generally heat-, enzyme-, and low pH-resistant glycoproteins ranging in size from 10 to 70 kD. Class 1 food allergens induce allergic sensitization via the gastrointestinal tract and are responsible for systemic reactions. Class 2 food allergens are generally heat-labile, susceptible to digestion, and highly homologous with pollen allergens. Taken together, it may be important to consider the diversity of food allergy in order to fight against food allergy.

食物アレルゲンの吸収機構の解明と食物アレルギーの発症に関する研究

Food–dependent exercise-induced anaphylaxis (FDEIA) is a peculiar form of food allergy, which is induced by physical exercise following the ingestion of causative food products. Patients with FDEIA typically exhibit generalized urticaria, dyspnea and anaphylaxis induced by the type–I allergic reaction. In addition to exercise, intake of nonsteroidal anti–inflammatory drugs, especially aspirin, is another well–documented trigger for FDEIA symptoms. The pathogenesis of aspirin–exacerbated FDEIA symptoms remains unclear. However, increases in the absorption of allergens via the intestinal tract and/or activation of inflammatory cells by aspirin are considered to be the underlying mechanisms for it. Recently, we found that food allergens including lysozyme and ovalbumin were absorbed via paracellular and transcytotic pathways, and aspirin facilitated the intestinal absorptions of these allergens via the paracellular pathway, resulting in the development and exacerbation of food–allergic symptoms. This review summarizes the pathogenesis of aspirin–induced FDEIA symptoms from the viewpoint of intestinal absorption pathway(s) of food allergens and the effect of aspirin on their absorptions.

Apple-dependent exercise-induced anaphylaxis

Food-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of anaphylaxis that requires both vigorous physical activity and the ingestion of specific causative foods. In particular, occurrence for FDEIA is rarely associated with apples. A 17-year-old male experienced generalized urticaria, dyspnea, headache, vomiting, and presyncope after ingestion of an apple and then 2 hours of exercise. The skin prick test showed a strong positive reaction to apple crude allergen extract, whereas the results of an open food challenge and exercise provocation tests were negative. However, the exercise test after apple consumption provoked a positive reaction with generalized urticaria, dyspnea, and presyncope. We detected 17 kD IgE-reactive protein band in immunoblotting assay with apple crude extract and patient’s serum. (Allergy Asthma Respir Dis 2015;3:224-227)

Food allergy preceded by contact urticaria due to the same food: Involvement of epicutaneous sensitization in food allergy

BackgroundThere have recently been reports suggesting that sensitization to food allergens may occur outside the intestinal tract, especially through the skin. To clarify the role of epicutaneous sensitization in food allergy, we investigated the clinical characteristics of adult patients with food allergies preceded by contact urticaria due to the same foods. MethodsWe investigated clinical characteristics of 15 patients (20–51 years of age; 5 men and 10 women), who had food allergies preceded by contact urticaria. ResultsFourteen patients were contact urticaria due to the causative foods during occupationally cooking, whereas 1 patient during face pack. In the occupational group, causative foods included rice, wheat, fruits, vegetables, fish, shrimp and cuttlefish; in the fresh cucumber paste case the cause was cucumber. In the 15 patients, the causative foods were fresh, not processed, and were tolerated by most (9/15, 60%) after heating. Regarding to symptoms after ingestion of the causative foods, the most frequently induced symptoms was oral symptoms (14/15, 93.3%), followed by urticaria (4/15, 26.7%), abdominal symptoms (3/15, 20%). The duration between the start of jobs or face pack, and the onset of contact urticaria was from 1 month to 19 years (mean, 8.7 years). The duration between the onset of contact urticaria and the onset of food allergy was from a few weeks to 6 years (mean, 11 months). One sushi cook experienced severe anaphylactic shock after ingestion of fish. In the occupational group, 13 of 15 patients (86.7%) had atopic dermatitis or hand eczema, indicating that the impaired skin barrier might be a risk for food allergies induced by epicutaneous sensitization. ConclusionsEpicutaneous sensitization of foods could induce food allergy under occupational cooking and skin-care treatment with foods in adults.

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study

Eosinophilic esophagitis (EoE) is an esophageal disorder predominantly triggered by food antigens. A six-food group elimination diet (SFGED) achieves remission in more than 70% of adult patients with EoE. After individual food reintroduction, just 1 or 2 food triggers for EoE can be identified in 65% to 85% of the patients, so some dietary restrictions and endoscopies after food challenge may be unnecessary. To evaluate the efficacy of a four-food group elimination diet (FFGED) (dairy products, wheat, egg, and legumes) for adult patients with EoE. Prospective multicenter study. All patients were reevaluated after 6 weeks on an FFGED. Response to the FFGED was defined by clinical and histologic (<15 eos/hpf) remission. Responders underwent reintroduction of each individual food over 6 weeks followed by endoscopy and esophageal biopsies. Nonresponders were offered a rescue SFGED. A total of 52 adult patients were included, of whom 12 patients (23%) had previous failure to topical steroid therapy. Twenty-eight of the 52 patients (54%) achieved clinicopathologic remission on the FFGED and 6 of the 19 (31%) nonresponders to the FFGED were successfully rescued with the SFGED. Twenty-two of 28 responders to the FFGED (78%) finished the individual food reintroduction challenge. Milk was identified as an EoE trigger in 11 patients (50%), egg in 8 (36%), wheat in 7 (31%), and legumes in 4 (18%). All patients had just 1 or 2 food triggers, with milk being the only causative food in 27% of the patients. An FFGED achieved clinicopathologic remission in 54% of adult patients with EoE. An SFGED was effective in almost a third of FFGED nonresponders, resulting in a combined efficacy of 72% of both strategies.

Mo1830 Optimized Four-Food Elimination Diet (Dairy, Gluten, Egg and Legumes) Followed by Rescue Six-Food Elimination Diet for Adult Eosinophilic Esophagitis: A Spanish Multicenter Study

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disorder triggered by food antigens. A six-food elimination diet (SFED) achieves histological remission in around 75% of adult EoE patients. The most common food triggers identified have been milk, wheat, egg and soy and/or legumes, with a minor role for nuts and fish/ seafood. Less restrictive dietary interventions might improve patient acceptance of dietary limitations and reduce the number of endoscopies and overall time to complete the food reintroduction process. Methods: Prospective multicenter study in consecutive adult patients with EoE, defined by consensus guidelines. An optimized four-food elimination diet (FFED) (dairy products, gluten, egg and legumes, including soy and peanut) was designed to avoid to the maximum cross-reactivity between food allergens. All patients underwent histological re-evaluation after 6 weeks on FFED. Response to FFED was defined by clinical and histological ( 50% reduction in their peak eosinophil density, whereas clinical and histological remission was accomplished in 22 patients (51%). To date, 10 patients have finished the food reintroduction process (5 patients with a single food trigger, 5 patients with two food triggers). The most common causative food allergens have been dairy (58%), egg (50%), gluten (26%) and legumes (20%). Among 21 non-responders to FFED, 12 patients underwent rescue SFED, of whom 6 (50%) achieved clinico-pathological remission. Conclusion: Clinico-pathologic remission was accomplished in 50% of EoE patients following a FFED and in 50% of FFED non-responders undergoing rescue SFED. FFED is a cheaper, faster and less inconvenient dietary intervention, effective in 2 out of every 3 adult EoE patients responder to SFED.

Mo1831 Trans-Nasal Gastroscopy Without Sedation for Eosinophilic Esophagitis; Safe, Effective and the Ideal Method of Assessment?

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disorder triggered by food antigens. A six-food elimination diet (SFED) achieves histological remission in around 75% of adult EoE patients. The most common food triggers identified have been milk, wheat, egg and soy and/or legumes, with a minor role for nuts and fish/ seafood. Less restrictive dietary interventions might improve patient acceptance of dietary limitations and reduce the number of endoscopies and overall time to complete the food reintroduction process. Methods: Prospective multicenter study in consecutive adult patients with EoE, defined by consensus guidelines. An optimized four-food elimination diet (FFED) (dairy products, gluten, egg and legumes, including soy and peanut) was designed to avoid to the maximum cross-reactivity between food allergens. All patients underwent histological re-evaluation after 6 weeks on FFED. Response to FFED was defined by clinical and histological ( 50% reduction in their peak eosinophil density, whereas clinical and histological remission was accomplished in 22 patients (51%). To date, 10 patients have finished the food reintroduction process (5 patients with a single food trigger, 5 patients with two food triggers). The most common causative food allergens have been dairy (58%), egg (50%), gluten (26%) and legumes (20%). Among 21 non-responders to FFED, 12 patients underwent rescue SFED, of whom 6 (50%) achieved clinico-pathological remission. Conclusion: Clinico-pathologic remission was accomplished in 50% of EoE patients following a FFED and in 50% of FFED non-responders undergoing rescue SFED. FFED is a cheaper, faster and less inconvenient dietary intervention, effective in 2 out of every 3 adult EoE patients responder to SFED.

Clinical manifestations of food protein-induced enterocolitis syndrome

Purpose of reviewTo raise awareness among healthcare providers about the clinical and laboratory findings in acute and chronic food protein-induced enterocolitis syndrome (FPIES).Recent findingsFPIES can be caused by trivial exposure or rare foods.SummaryFPIES is a non-IgE-mediated reaction that usually presents with acute severe repetitive vomiting and diarrhea associated with lethargy, pallor, dehydration, and even hypovolemic shock. Manifestations resolve usually within 24–48 h of elimination of the causative food. In chronic cases, symptoms may include persistent diarrhea, poor weight gain, failure to thrive, and improvement may take several days after the food elimination. In the acute cases, laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking about 6 h postingestion. Depending on the severity, metabolic acidosis and methemoglobinemia may occur. In chronic cases, anemia, hypoalbuminemia and eosinophilia may be seen. Radiologic evaluation or other procedures, such as endoscopy and gastric juice analysis may show nonspecific abnormal findings. The diagnosis is based on clinical manifestations. Further studies looking at the phenotypes of FPIES are needed to identify clinical subtypes, and to understand the predisposing factors for developing FPIES compared with immediate-type, IgE-mediated gastroenteropathies.

Longitudinal Effect Of Food Allergy Education On Epinephrine Availability In Public Schools

RationaleThe effect of school nursing food allergy education is unknown. We hypothesized that a didactic educational session for nurses would increase the identification of food allergic children, decrease allergic reactions, and increase the availability of epinephrine injectors.MethodsA survey pre and post a didactic session was administered in 2011 to school nurses addressing causative foods, allergic reactions, and appropriate treatment. A survey one year later was completed by school nurses and outcomes measured. Statistical analysis was performed with the Wilcoxon signed rank test and McNemar’s test. The correlation between the number of food allergic students and number of epinephrine injectors was estimated using Spearman’s rank correlation.ResultsA total of 197 school nurses responded to the survey in at least one year (2010,2012,2013). Sixty-two nurses responded to the survey before and after education with 39 responding all 3 years. The percent of schools with allergic reactions decreased (15% in 2010,0% in 2012,p=0.0143) and the decrease was sustained in 2013 (5%,p=0.1537). Epinephrine injectors increased (median:1/school in 2010,2 in 2012,p<0.001). The correlation between the number of students with food allergies and epinephrine injectors increased from 2010(r2=0.43) to 2012(r2=0.82).ConclusionsEducation significantly impacted school preparedness for food allergic reactions, evidenced by increased correlation between the number of food allergic students and number of epinephrine injectors. Food allergic reactions significantly decreased after education. This data showed a longitudinal effect, supporting implementation of standardized nursing education programs in public schools. RationaleThe effect of school nursing food allergy education is unknown. We hypothesized that a didactic educational session for nurses would increase the identification of food allergic children, decrease allergic reactions, and increase the availability of epinephrine injectors. The effect of school nursing food allergy education is unknown. We hypothesized that a didactic educational session for nurses would increase the identification of food allergic children, decrease allergic reactions, and increase the availability of epinephrine injectors. MethodsA survey pre and post a didactic session was administered in 2011 to school nurses addressing causative foods, allergic reactions, and appropriate treatment. A survey one year later was completed by school nurses and outcomes measured. Statistical analysis was performed with the Wilcoxon signed rank test and McNemar’s test. The correlation between the number of food allergic students and number of epinephrine injectors was estimated using Spearman’s rank correlation. A survey pre and post a didactic session was administered in 2011 to school nurses addressing causative foods, allergic reactions, and appropriate treatment. A survey one year later was completed by school nurses and outcomes measured. Statistical analysis was performed with the Wilcoxon signed rank test and McNemar’s test. The correlation between the number of food allergic students and number of epinephrine injectors was estimated using Spearman’s rank correlation. ResultsA total of 197 school nurses responded to the survey in at least one year (2010,2012,2013). Sixty-two nurses responded to the survey before and after education with 39 responding all 3 years. The percent of schools with allergic reactions decreased (15% in 2010,0% in 2012,p=0.0143) and the decrease was sustained in 2013 (5%,p=0.1537). Epinephrine injectors increased (median:1/school in 2010,2 in 2012,p<0.001). The correlation between the number of students with food allergies and epinephrine injectors increased from 2010(r2=0.43) to 2012(r2=0.82). A total of 197 school nurses responded to the survey in at least one year (2010,2012,2013). Sixty-two nurses responded to the survey before and after education with 39 responding all 3 years. The percent of schools with allergic reactions decreased (15% in 2010,0% in 2012,p=0.0143) and the decrease was sustained in 2013 (5%,p=0.1537). Epinephrine injectors increased (median:1/school in 2010,2 in 2012,p<0.001). The correlation between the number of students with food allergies and epinephrine injectors increased from 2010(r2=0.43) to 2012(r2=0.82). ConclusionsEducation significantly impacted school preparedness for food allergic reactions, evidenced by increased correlation between the number of food allergic students and number of epinephrine injectors. Food allergic reactions significantly decreased after education. This data showed a longitudinal effect, supporting implementation of standardized nursing education programs in public schools. Education significantly impacted school preparedness for food allergic reactions, evidenced by increased correlation between the number of food allergic students and number of epinephrine injectors. Food allergic reactions significantly decreased after education. This data showed a longitudinal effect, supporting implementation of standardized nursing education programs in public schools.

Oral immunotherapy for the treatment of immediate type food allergy

Food allergies continue to increase exponentially and therapies that can modify the natural course of disease is a recent top priority of the research. IgE-mediated food allergy represents both a promising and an intriguing disease of application for allergen specific immunotherapy. In particular, oral immunotherapy (OIT) may offer a novel effective therapeutic modality for persistent and severe forms of food allergies. In such patients, avoidance of the causative foods only may be insufficient because of the risk of unplanned exposure to causative foods. In patients with cow`s milk, hen`s egg, and peanut allergies, several recently published studies, including meta-analysis, confirmed the overall benefit of OIT. However, the definitive evidence of efficacy and safety with long-term therapeutic or disease-modifying effects is limited. In current protocols, entry indications, and initial-escalating-maintenance doses, the form of antigens, durations, and follow-up periods await to be standardized. Most of the clinical trials of OIT demonstrate effective desensitization, but the ability for inducing long-term tolerance remains to be improved, and the ratio of risks versus benefits of OIT should be considered in detail. The ultimate goal is extending OIT to primary care practice, but at this time, OIT remains within the purview of allergy specialists in terms of associated risk-benefit ratios, related safety, and long-term tolerance induction.

Pancake syndrome induced by ingestion of tempura

Funding sources: none. Conflicts of interest: none declared. Dear Editor, Pancake syndrome is oral mite anaphylaxis caused by eating food prepared with wheat flour contaminated with mites. More than 135 cases occurring in various countries located in tropical and subtropical areas have been reported.1 The most common culprit food is a pancake, although various foods containing flour have reportedly been causative. In cases of this disease in Japan, the causative foods have been confined to okonomiyaki and takoyaki, both of which are popular in the Kansai region of Japan.2 To our knowledge, this is the first report of pancake syndrome induced by ingestion of tempura, a well‐known Japanese dish. A 16‐year‐old girl suddenly felt obstruction of the throat and developed facial oedema 2 min after ingestion of shrimp tempura, and was transferred by ambulance to the emergency outpatient service of our hospital. She had mild atopic eczema but no history of anaphylaxis or allergic reaction to seafood. Her level of consciousness was slightly depressed at that time. Her systolic/diastolic blood pressures were 101/76 mmHg and her pulse rate was 100 beats per minute. Oxygen saturation was 93%. Her face was markedly swollen but no weals were observed. Laboratory tests (haemogram and blood chemistry) showed no abnormal findings. A diagnosis of anaphylaxis was made, and she received an infusion of extracellular fluid and an antihistamine with quick relief of symptoms.

Approach to Epidemiological Mechanism of Infection or Colonization of Egg-Laying Chicken Farms by &lt;i&gt;Salmonella enterica&lt;/i&gt; Serovar Enteritidis (SE) Becoming the Main Source of Contamination in Food Poisoning (Review)

Salmonella enterica serovar Enteritidis (SE)-induced diarrhea in humans is the typical non-typhoid diarrhea. It develops acutely or subacutely and may be fatal. This SE infectious disease suddenly became a major public health issue worldwide in the 1980s. The main causative food material of SE food poisoning is chicken eggs, and many outbreaks of food poisoning caused by chicken eggs occurred throughout the world. SE epidemics occurred in layer farms, and this was the main cause of SE-induced food poisoning in humans. The major subject of our epidemiological study described in this report is why SE-contaminated eggs became the main causative food. In this study, we focused on difference of molecular expression for farm-isolated SEs. That is because recent studies have demonstrated that O-antigen enlargement may be related to pathogenicity in mice as well as 22-kDa polypeptide-expression (SEp22). We have discovered that many SE strains isolated from chicken farms do not express SEp22, and a deficiency or decreased level of cellular antigen 0-12 in SE strains isolated from chicken farms was clarified in a report. Additionally, SEp22 was deficient in SE strains passaged through chickens, whereas SEp22 was expressed at a high level in SE strains passaged through mice. These findings suggest that SE infection and retention more effectively occur in layer farms than in other animal maintenance environments, which may be a basis of the epidemiological hypothesis to explain the high-levelproduction of SE-contaminated eggs (the presence of mice may be the basis of the retention of SE infection in layer farms, and this may also be the mechanism causing the high-level production of SE-contaminated eggs).

Prevalence of Immediate-Type Food Allergy in Early Childhood in Seoul

PurposeThere are scanty epidemiologic data on the prevalence of food allergy (FA) among preschool children in Asia. We performed this study to determine the prevalence and causative foods of immediate-type FA in early childhood in Korea.MethodsA questionnaire-based, cross-sectional study was performed between September and October 2011. Children aged 0-6 years were recruited from 301 public child care centers in Seoul. Parents were asked to complete a questionnaire on FA. Children with FA were classified into "perceived FA, ever," "immediate-type FA, ever," and "immediate-type FA, current" according to the algorithm.ResultsA total of 16,749 children were included in this study. The prevalence of "perceived FA, ever," "immediate-type FA, ever," and "immediate-type FA, current" was 15.1%, 7.0%, and 3.7%, respectively. "Immediate-type FA, current" was reported by 182 (4.9%) out of 3,738 children aged ≤2 years, 262 (3.4%) of 7,648 children aged 3-4 years, and 177 (3.3%) of 5,363 children aged 5-6 years. Hen's egg (126/621) was the most frequent cause as the individual food item, followed by cow's milk (82/621) and peanut (58/621). Among the food groups, fruits (114/621), tree nuts (90/621) and crustaceans (85/621) were the most common offending foods. The three leading causes of food-induced anaphylaxis were hen's egg (22/47), cow's milk (15/47), and peanut (14/47).ConclusionsThe prevalence of immediate-type FA in early childhood is 3.7%, and is higher in younger children. The most common offending foods differed with age.

Improvement of Teacher Food Allergy Knowledge in Socioeconomically Diverse Schools After Educational Intervention

Increasingly, teachers are the first respondents to food allergic reactions in schools. Studies of food allergy in school settings have identified deficiencies in teacher recognition and treatment of reactions. We sought to determine the effect of a didactic session on teacher knowledge of the causative foods, symptoms, and treatment of reactions in diverse elementary schools. An educational intervention project using a pretest-posttest control group design was performed. Teacher knowledge about food allergy causes, symptoms, and treatment of food allergic reactions was assessed. The average percentage of correctly answered questions by teachers at baseline for each school ranged from 60% to 68%. After education, teachers at the intervention schools answered 24.6% to 34.6% (confidence interval = 21.5-74.1 and 32.1-103.9, respectively) more questions correctly compared with 4.0% to 4.3% (confidence interval = 2.5-21.6 and 0.9-31.0, respectively) in control schools. Education significantly increased teacher knowledge of food allergy causes, symptoms, and treatment of food allergic reactions in diverse schools.