Fatal Food-induced Anaphylaxis Research Articles

Edible Insects as an Alternative Source of Nutrients: Benefits, Risks, and the Future of Entomophagy in Europe—A Narrative Review

According to projections by the Food and Agriculture Organization of the United Nations, the global population will reach 9 billion by 2050. This raises concerns about the ability to feed such a population. In view of the above, it is necessary to search for alternative food sources. Edible insects are rich in complete protein, essential fatty acids, vitamins and micronutrients. Despite this, entomophagy is not common in Europe. In 2021, the European Union approved Acheta domesticus, Tenebrio molitor, Locusta migratoria, and Alphitobius diaperinus for consumption. However, their consumption may also be associated with certain hazards, e.g., food allergies. The purpose of this review is to present existing knowledge, discuss the possible dangers of consuming insects, and identify areas for further research. Studies in Asian populations indicate that edible insects may be responsible for 4.2–19.4% of food allergies and 18% of fatal food-induced anaphylaxis. There are also increasing reports from Europe of food allergies to edible insects. A thorough understanding of allergens, their properties, and the mechanisms of food allergies associated with edible insects’ consumption is essential for ensuring consumers’ safety. In the future, it would be worthwhile to investigate the effects of heat treatment on the allergenicity of insect proteins.

Food Allergy in At-Risk Adolescents With Asthma: A Key Area for Focus

To determine the prevalence of food allergies (FAs) in adolescents with persistent asthma and see whether concurrent FAs contributed to asthma morbidity.In the study, the researchers included 342 adolescents (12–16 years) with severe asthma who attended the Rochester City School District and participated in the School-Based Asthma Care for Teens (SB-ACT) trial from 2014 to 2018.The parent trial, SB-ACT, aimed to decrease asthma morbidity by directly observing asthma medication administration in the Rochester City School District to high-risk adolescents identified as having persistent symptoms or poor control. Additionally, an 18-item FA questionnaire was also administered to the participants and caregivers that assessed a history of physician-diagnosed FAs versus self-reported FAs, foods in question, status of allergy (current or previous), and whether diagnostic testing of FA (skin test, blood tests, or food challenges) was performed.A total of 101 (29%) respondents reported FAs, with shellfish being the most common (38%), followed by peanut (34%) and tree nut (30%). A total of 58% of the adolescents did not have an epinephrine autoinjector (EAI), and only 13% reported carrying their EAI daily. There was no statistically significant difference in the mean asthma symptom-free days in patients with and without FA, but those patients with FA had a higher fractional excretion of nitric oxide. In a linear regression analysis, adolescents with FAs had more days of activity limitation in a 2-week period because of asthma and a higher odds of missing school attributed to asthma than those without a FA did.FAs are commonly found in adolescents with severe asthma and can lead to negative impacts on their quality of life, including increased activity limitations as well as missed days of school. Less than one-half of this cohort with FA had access to an EAI, which may increase near fatal outcomes.In this study, the authors highlight the need to screen adolescents with severe asthma for other atopic diseases, including FAs, to minimize adverse outcomes. Adolescents are at higher risk for fatal food-induced anaphylaxis when they have asthma and if epinephrine administration is delayed. Therefore, it is of utmost importance to not only screen for FAs in this population but ensure both prescriptions for and counseling of proper use of an EAI to avoid adverse outcomes.

Food Anaphylaxis in the United Kingdom: Analysis of National Data, 1998–2018

To analyze trends in hospital admissions for food anaphylaxis in the United Kingdom from 1998 to 2018, including case-fatality rates.All patients admitted to hospitals for anaphylaxis in the United Kingdom (England, Scotland, Wales, and Northern Ireland) were studied. Children were identified as age ≤15 years.International Classification of Diseases, 10th Revision, codes were analyzed for all allergy-related admissions with both food-related and non–food-related causes, by using the Hospital Episodes Statistics database via the National Health Services. Fatal food-induced anaphylaxis data has been recorded through the UK’s Fatal Anaphylaxis Registry. Admission data were compared along time trends among different age groups, sex, and inciting triggers. Trends in the national case-fatality rate and epinephrine autoinjector (EAI) prescriptions were also analyzed.Across all age groups, allergy-related hospital admissions increased during the study period from 10 to 28 admissions per 100 000 population per year, at a rate ratio of 1.043 (1.042 to 1.043; P < .001). A total of 255 913 admissions occurred during the 10-year interval, of which 39.8% were due to anaphylaxis. The rate of anaphylaxis-associated admissions increased by 179%, with a rate ratio of 1.047 (1.046 to 1.048; P < .001) and was similar across all age groups. Girls had a higher rate of admission for nonfood anaphylaxis admissions. Boys (age: <15) had a higher rate of admission with food triggers, but this predominance dissipated into adulthood. A total of 30.1% of admissions for anaphylaxis were identified with a food trigger, with an annual rate ratio of 1.057 (1.055 to 1.059; P < .001). The greatest increase was observed in children, from 2.1 to 9.2 admissions per 100 000 or an increase of 339%. Individuals aged 15 to 59 years had an increase of 214%, whereas those aged >60 years had an increase of 78% over the same time interval. Despite a national recommendation in 2016 encouraging admission for children with suspected anaphylaxis, the admission rate for children did not significantly increase. The annual fatality rates from food-induced anaphylaxis were 0.009 and 0.008 per 100c000 population in 1998 and 2018, respectively, but the case-fatality rate had decreased from 0.70% to 0.19% in the same period. The highest rate of fatalities occurred in teenagers. Children <5 years of age were more likely to be admitted for anaphylaxis but had lower rates of death. A total of 46% of fatalities were associated with peanuts or tree nuts. Additionally, the fatality rate associated with cow’s milk increased since 1992, with 26% of deaths in children and 5% in adults caused by cow’s milk exposure. The rates of death from peanuts and tree nuts decreased during this interval. Prescriptions for EAI devices increased by 336% overall or by an 11% increase on a year-by-year basis.From 1998–2018, the number of hospital admissions for anaphylaxis and prescriptions for EAIs in the United Kingdom significantly increased, and the case-fatality rate for anaphylaxis decreased. Peanuts and tree nuts accounted for the greatest portion of fatal reactions, but among children <5 years of age, cow’s milk was the most common trigger.The strengths of this study include the use of 20 years of data and a national database that examined >255 000 admissions. This study also revealed the increasing role of cow’s milk anaphylaxis in food allergy fatalities. This study relied on International Classification of Diseases, 10th Revision, codes. It is possible that the data regarding admissions and fatalities are an underestimate because anaphylaxis and its triggers are often not coded accurately.

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Fatal Food Anaphylaxis: Distinguishing Fact From Fiction

Although there is a general perception that the prevalence of food allergy is increasing, data supporting this are limited. Food is the least common cause of fatal anaphylaxis, and fortunately, it is a very rare event; however, it is also unpredictable. There is widespread consensus that severe reactions cannot be predicted in a clinically meaningful way. Certain food triggers are more frequently associated with fatal anaphylaxis than others. In observational studies, peanut and tree nuts account for at least 30% to 50% of fatalities, with seafood and cow's milk also associated with fatal reactions. Fatal food-induced anaphylaxis is most likely to occur during adolescence and young adulthood, although the reasons for this are unclear. International guidelines agree that intramuscular (IM) epinephrine is the treatment of choice for managing food-triggered anaphylaxis and has a good safety profile when given by the IM route. However, fatalities still occur despite the timely administration of epinephrine. Food-allergic individuals must navigate a world that requires daily vigilance for allergens and preparedness for allergic reactions. Although the actual risk of fatal reactions is minimal, it is not zero, and severe reactions are unpredictable. Clinicians need to help patients better understand the very low but real risk of fatal reaction and enable them to lead as normal a life as possible through appropriate education, safety netting, and risk reduction.

Intestinal Barrier Dysfunction Accompanies Peanut Allergy in CC027/GeniUnc Mice

Peanut is the #1 cause of fatal food-induced anaphylaxis. Intestinal barrier dysfunction is a feature of peanut allergic patients and correlates with anaphylaxis severity; its relationship to pathogenesis is unknown. We investigated intestinal barrier dysfunction in the CC027/GeniUnc mouse, which develops peanut allergy by the oral route without adjuvant.

Food allergy: Diagnosis and treatment.

Immunoglobulin E-mediated food reactions usually develop within minutes of food ingestion. Although most reactions are not life-threatening, fatalities do occur. Risk factors for fatal food-induced anaphylaxis include the presence of asthma (a risk factor for anaphylaxis in general), failure to use epinephrine autoinjectors promptly, a history of severe reactions, known food allergy, denial of symptoms, and adolescent and young adult age. The most commonly implicated foods are cow's milk, egg, peanut, soy, tree nuts, fish, shellfish, and wheat. Peanut, tree nuts, and seafood are the most common food allergens in adults, whereas cow's milk, peanut, egg, soy, and wheat are more common in children. The major food allergens are glycoproteins, which are generally water soluble and stable to the effects of heat, proteases, and acids. Recent studies showed that natural tolerance can be acquired at a later age than previously thought, even during adolescence. Allergies to peanut, tree nuts, and seafood are frequently life-long. Patients and their caregivers should be taught when and how to administer injectable epinephrine. In terms of primary prevention, there is evidence that early introduction, followed by ongoing regular consumption of peanut has a protective effect on the development of peanut allergy.

Safety and Efficacy of Peanut Oral Immunotherapy

Peanut allergy affects 2% of children and is the most common cause of fatal food-induced anaphylaxis. Several studies have shown that patients can be

Patterns of Carriage of Prescribed Adrenaline Autoinjectors in 10- to 14-Year-Old Food-Allergic Students: A Population-Based Study

Adolescence is well recognized as a period of increased risk for severe and fatal food-induced anaphylaxis. Current Australian adrenaline autoinjector (AAI) prescription guidelines therefore suggest that consideration be given to AAI prescription in all adolescents with a food allergy. To date, however, few studies have assessed the AAI carriage behavior of adolescents prescribed AAI devices. To determine the carriage behavior of prescribed AAI devices in a population-based sample of young Australian adolescents. Students aged 10 to 14 years (and their parents) from randomly selected schools in metropolitan Melbourne completed self-administered questionnaires regarding the history and management of food allergy, including prescription and carriage of AAI device in different domains of school and social life. A total of 9816 students completed the questionnaire (46% response): 620 students were assessed to have likely IgE-mediated food allergy and 234 (38%) of these had been prescribed an AAI. Most students (93%; 95% CI, 89%-96%) who were prescribed AAIs reported that they provided their AAI and anaphylaxis action plan to their school. Adherence to AAI carriage in other domains of social life was poor, with 49% (95% CI, 42%-56%) never carrying their AAI in 1 or more locations. Carriage of the AAI device was particularly poor when students were independent of parental supervision: 32% (95% CI, 25%-39%) never carried it when they were by themselves, 28% (95% CI, 22%-36%) never carried it while out with friends, and 36% (95% CI, 30%-43%) never carried their AAI to sporting activities. Carriage of AAI devices is suboptimal in young adolescents prescribed AAIs, particularly when young adolescents are independent of parental supervision.

Leaving the nest: Improving food allergy management on college campuses

BackgroundThe transition from adolescence to young adulthood marks a developmental period in which responsibility for management of chronic conditions such as food allergy shifts from the caregiver to the young adult. Fatal food-induced anaphylaxis is most common among adolescents and young adults. However, colleges are currently not well positioned to provide integrated support for students with food allergies. ObjectiveThe study objective was to explore the systems, structures, and policies that currently support students with food allergies at college, assess unmet needs, and develop pilot interventions through the use of patient-centered design processes. MethodsKey informant interviews were conducted with stakeholders in the campus management of food allergies (n = 26) between April and May 2016. Data were coded and assessed for relative frequencies of each code to determine challenges and potential solutions. ResultsThe convergence of stakeholder-identified themes indicated that the transition to college for students with food allergy would be improved by providing support for: (1) Notification of others in the student's campus network about food allergy; (2) Establishing clearly defined roles/responsibilities; and (3) Increasing campus awareness of food allergy signs, symptoms, and lethality. To better provide comprehensive support for students, 5 interventions—collectively called Spotlight—were developed. ConclusionThe use of qualitative research methods, patient-centered design processes, and collaborations with diverse stakeholders—including pediatricians that care for adolescents—can provide a framework for designing coordinated systems and policies to provide comprehensive support to college students with food allergy. Next steps include rigorously testing implementation of the Spotlight intervention prototypes.

Food Allergy–Related Risk-Taking and Management Behaviors Among Adolescents and Young Adults

Food allergy (FA) affects 8% of children and adolescents in the United States. Nearly 40% of those affected have experienced severe reactions. Fatal food-induced anaphylaxis is most common among adolescents and young adults (AYA); however, FA-related risk behaviors persist in this population and factors associated with these behaviors remain unclear. To characterize FA-related risk-taking and self-management behaviors of AYA with FA. A cross-sectional survey was administered to 200 AYA with FA. Latent class analysis was used to identify distinct behavioral risk classes and predictors of risk class membership. Two distinct FA behavioral risk classes were identified, representing less (N= 120) and more (N= 80) risky subpopulations. After adjusting for age, sex, and anaphylaxis history, odds of more risky class membership were significantly reduced for AYA with peanut allergy (odds ratio [OR], 0.27; 95% CI, 0.11-0.65), supportive female friends (OR, 0.27; 95% CI, 0.07-0.99), overprotective mothers (OR, 0.42; 95% CI, 0.18-0.97), teachers who are aware of their FA (OR, 0.39; 95% CI, 0.17-0.91), a history of being bullied (OR, 0.22; 95% CI, 0.09-0.51), and an established 504 education plan (OR, 0.35; 95% CI, 0.15-0.81). AYA also reported numerous positive outcomes of their FA, such as greater responsibility, empathy, and improved diet, which was significantly associated with reduced odds of risky class membership (OR, 0.38; 95% CI, 0.18-0.80). Among AYA, increased FA-related risk-taking was associated with clinical, demographic, and social factors, including peanut allergy, greater age, as well as absence of social support and specific school FA policies. These associations may be used to inform future interventions designed to address FA-related risk and management behaviors.

Prevention of Anaphylaxis Based on Risk Factors and Cofactors

Anaphylaxis is most commonly caused by drugs, food, and hymenoptera stings, or in certain instances may be idiopathic. A variety of risk factors, cofactors, and augmenting factors may act together to trigger anaphylaxis. Patients with certain underlying medical conditions may be at increased risk of anaphylaxis of certain etiologies, e.g., monoclonal mast cell activation syndromes and insect venom anaphylaxis, asthma, and fatal food-induced anaphylaxis especially in adolescents. Identification of risk factors, cofactors, and augmenting factors during clinical assessment is key to determining the type of in vitro and in vivo diagnostic tests that would be most appropriate in accurately identifying the putative allergen(s). Provocation tests, despite being the gold standard in allergy diagnosis, should be avoided in anaphylaxis as the risks outweigh the benefits. Accurate diagnosis of the putative allergen and cofactor is key to both prevention of recurrence of anaphylaxis, avoidance measures, and interventions like allergen-specific immunotherapy, which may impact the quality of life of allergy sufferers and their family members.

A retrospective study of peanut and tree nut allergy: Sensitization and correlations with clinical manifestations.

Peanut (PN) and tree nut (TN) allergies are among the leading causes of fatal food-induced anaphylaxis and are increasing in prevalence, especially in children. Their cosensitization and concurrent clinical allergy have been understudied. This retrospective study investigated the correlation between PN and TN allergy, both in terms of in vitro sensitization (IVS) and clinical allergic manifestations. We conducted a retrospective medical record review at the Allergy Clinic at University Hospital of Brooklyn. Fourteen hundred six charts were reviewed, of which 76 (5.4%) had documented relevant clinical allergy: PN allergy but not TN allergy (n = 29) or TN allergy but not PN allergy (n = 11) or both (n = 30). Six patients with PN allergy but no TN exposure history were not included in the analysis. The majority of patients (67/76, 88.1%) had a concurrent history of asthma, rhinoconjunctivitis, or AD. Sensitivity of TN IVS predicting PN IVS was 38/39 (97%). Similarly, sensitivity of PN IVS predicting TN IVS was 38/42 (91%). Sensitivity of TN clinical allergy predicting PN allergy was 30/59 (51%). Sensitivity of PN clinical allergy predicting TN allergy was 30/41 (73%). The total number of organ systems involved in reported clinical reactions correlated with IVS to TN (p = 0.004) but not IVS to PN (p = 0.983). In summary, we found PN sensitization predicts TN sensitization in vitro, with lower predictability for clinical reactions.

A retrospective study of peanut and tree nut allergy: Sensitization and correlations with clinical manifestations.

Peanut (PN) and tree nut (TN) allergies are among the leading causes of fatal food-induced anaphylaxis and are increasing in prevalence, especially in children. Their cosensitization and concurrent clinical allergy have been understudied. This retrospective study investigated the correlation between PN and TN allergy, both in terms of in vitro sensitization (IVS) and clinical allergic manifestations. We conducted a retrospective medical record review at the Allergy Clinic at University Hospital of Brooklyn. Fourteen hundred six charts were reviewed, of which 76 (5.4%) had documented relevant clinical allergy: PN allergy but not TN allergy (n = 29) or TN allergy but not PN allergy (n = 11) or both (n = 30). Six patients with PN allergy but no TN exposure history were not included in the analysis. The majority of patients (67/76, 88.1%) had a concurrent history of asthma, rhinoconjunctivitis, or AD. Sensitivity of TN IVS predicting PN IVS was 38/39 (97%). Similarly, sensitivity of PN IVS predicting TN IVS was 38/42 (91%). Sensitivity of TN clinical allergy predicting PN allergy was 30/59 (51%). Sensitivity of PN clinical allergy predicting TN allergy was 30/41 (73%). The total number of organ systems involved in reported clinical reactions correlated with IVS to TN (p = 0.004) but not IVS to PN (p = 0.983). In summary, we found PN sensitization predicts TN sensitization in vitro, with lower predictability for clinical reactions.

Age As a Risk Factor For Fatal Food-Induced Anaphylaxis: An Analysis Of UK and Australian Fatal Food Anaphylaxis Data

Small case series suggest that teenagers and young adults may be at higher risk of fatal food-induced anaphylaxis than other age groups, but this has not been confirmed in large population-based datasets. We extracted data from national databases for hospital admissions and fatalities due to anaphylaxis in England and Wales for the period 1992-2011, and cross-checked fatalities against a prospective fatal anaphylaxis registry. We examined time trends and age distribution for fatal reactions caused by food, drugs and insect stings, and compared these to equivalent data previously published from Australia. Hospital admissions due to anaphylaxis admissions increased steadily over the time periods studied in both the UK and Australia, but fatality rates have remained stable at around 0.04 (UK) and 0.05 (Aus) cases per 100,000 population per annum. Fatalities and admissions were most common in older people for drug- and insect sting-induced anaphylaxis. For food-triggered reactions, fatalities were most common in teenagers and young adults, in both countries. These findings are not explained by age-related differences in the prevalence of food anaphylaxis requiring hospitalisation. In the UK and Australia, hospitalisations for anaphylaxis have increased, but fatal anaphylaxis has not. Possible explanations include increasing recognition of anaphylaxis, improved management and a real increase in the prevalence of food allergy. Of note, the age-distribution of fatal cases varies significantly according to the nature of the eliciting agent, and raises important questions about the differences in the pathogenesis of anaphylaxis between different triggers.

Chapter 23: Food allergy

The onset of IgE-mediated food allergy is usually within minutes to 2 hours of food ingestion. Risk factors for fatal food-induced anaphylaxis include presence of asthma (which is a risk factor for anaphylaxis in general), failure to use epinephrine autoinjectors promptly, history of prior severe reactions, known food allergy, denial of symptoms, and adolescent/young adult age. The most commonly implicated foods are cow's milk, eggs, peanuts, soy, tree nuts, fish, shellfish, and wheat. Allergies to peanut, tree nuts, and seafood are the most common food allergens in adults. The major food allergens are glycoproteins that are generally water soluble and stable to the effects of heat, proteases, and acids. Food proteins that escape proteolysis are taken up by intestinal epithelial cells and presented to primed T cells. This process leads to the generation of T-helper type 2 (Th2) cells that produce IL-4, IL-5, and IL-13. Recent studies have found that tolerance can be acquired with >70% of children becoming tolerant to cow's milk and eggs by age 16 years. Allergies to peanuts, tree nuts, and seafood are frequently lifelong. Food-allergic patients or their care givers should be taught when and how to administer injectable epinephrine. In terms of prevention, the American Academy of Pediatrics concluded that there is no convincing evidence that delaying the introduction of solid foods, including common allergens, beyond 4-6 months of age has a protective effect on the development of atopic disease.

Epidemiology of food allergy in the community

Food allergy is the most common cause of anaphylaxis outside the hospital setting. Peanut, tree nuts, milk, egg, and shellfish are the most commonly implicated foods. Most cases of anaphylaxis are reported to occur in the home, but one-fifth of the reactions occur at school or work and a similar proportion in restaurants and other food establishments. Although the majority of reactions in schools occur in subjects with known food allergies, nearly 25% of peanut/tree nut-induced allergic reactions were reported before the diagnosis. The majority of reactions occur in the classroom (many due to craft projects), followed by health office, playground, and cafeteria. Numerous studies have identified deficiencies in establishing and implementing written emergency action plans (EAP) and general or individualized plans for prevention in schools, and inadequacies in recognizing and treating anaphylaxis. Although there are no studies directly comparing the effect of banning peanut schools on the incidence of reactions, such practice from preschool to lower elementary school is not uncommon. Reactions to nuts occurring in food establishments most commonly include Asian food restaurants, ice cream parlors and bakeries/dough nut shops. Allergen is commonly found in dessert foods or hidden in sauce, dressing etc. Cross-contamination during preparation and serving is another important source of error, in addition to reactions due to ingestion of food not intended for the subject, buffet items, or casual contact. Importantly, the establishment is often not notified of the allergy. Lack of timely treatment with epinephrine is a universal risk factor and adolescents/young adults are the peak age group for a fatal food-induced anaphylaxis. Furthermore, up to one-fifth of food-induced anaphylactic reactions may need more than 1 dose of epinephrine. Therefore, there is an urgent need for education and access to epinephrine in food-induced reactions occurring in the communal setting.

Allergie alimentaire et manifestations respiratoires : des signes parfois trompeurs

Asthma and rhinitis are both expressions of food allergy (FA). When they are not associated with other allergic symptoms, their importance in FA is sometimes underrated, although the literature shows that most cases of fatal food-induced anaphylaxis begin with the sudden onset of a respiratory distress syndrome. Moreover, recent analyses of fatal asthma among children and young adults have shown the essential place of allergy to peanut and tree nuts. To optimize the basic treatment of asthma is therefore an indispensible corollary of the management of FA. Laryngeal edema is another mode of expression of food-induced anaphylaxis. Investigation of nasosinusoidal dysfunction and anomalies of kinin metabolism are part of the new diagnostic and therapeutic strategies.

Food-induced Anaphylaxis: Who, What, Why, and Where?

Food-induced anaphylaxis is a leading cause of anaphylaxis treated in emergency departments and hospitals around the world. Peanuts, tree nuts, fish, and shellfish are the most commonly implicated foods. Food-induced anaphylaxis may occur in any age group and with any food. However, food-induced anaphylaxis fatalities disproportionately affect adolescents and young adults with peanut and tree nut allergy. Individuals who have both IgE-mediated food allergy and asthma are at a higher risk for food-induced anaphylaxis fatality. Delayed administration of epinephrine is also associated with fatal outcome. Often, in fatal reactions, the food allergen is unknowingly ingested away from home, in settings such as restaurants and schools. Although avoidance of food allergens is critical, timely administration of epinephrine is also of great importance in the treatment of food-induced anaphylaxis. Patients, families, and caregivers must be well educated regarding the signs, symptoms and risk factors for anaphylaxis. They must also be counseled on the importance of strict food avoidance of the implicated food allergens, compliance with having self-injectable epinephrine available at all times, and the importance of timely administration of epinephrine, even when cutaneous symptoms are lacking.

Pathophysiology of food-induced anaphylaxis

Food-induced anaphylaxis is a steadily increasing problem in westernized countries and now represents the leading cause of anaphylaxis in the outpatient setting, particularly in children. Much of our knowledge of the pathophysiology of food-induced anaphylaxis comes from animal studies. Food anaphylaxis in humans is thought to be entirely IgE mediated. Several features appear to be unique to these reactions; factors such as exercise can lower the "threshold" for anaphylaxis in certain susceptible individuals. Different methods of thermal processing can modify the allergenicity of food proteins. Alteration of stomach pH can allow for incomplete digestion of food proteins, leading to increased absorption of intact food allergens. Low serum platelet-activating factor acetylhydrolase may predispose to fatal food-induced anaphylaxis. With a greater understanding of the pathophysiology of food-induced anaphylaxis, novel approaches not only to identify those at risk, but to treat and ultimately prevent food-induced anaphylaxis, are on the horizon.