Food-induced Anaphylaxis In Children Research Articles

Natural course of IgE-mediated food allergy in children.

The prevalence of food allergy and food-induced anaphylaxis in children is increasing worldwide. Cow's milk, hen's eggs, and wheat allergies in young children have a more favorable prognosis with a relatively early outgrow, while allergies to peanuts, tree nuts, and seafood are more likely to be persistent. Although our understanding of the mechanism underlying the resolution of food allergy is incomplete, the roles of dendritic cells, regulatory T cells, and regulatory B cells are important. Many past studies on the natural course of food allergy were retrospective analyses of specific study groups, but large-scale population-based prospective studies are now being published. This review summarizes recent studies of the natural course of cow's milk, hen's eggs, wheat, peanuts, tree nuts, soy, sesame, and seafood allergies. The potential factors affecting the natural course of food allergy include symptom severity on ingestion, age at diagnosis, allergic comorbidities, skin prick test reaction size or serum food-specific immunoglobulin (Ig) E levels, changes in sensitization degree, IgE epitope specificity, ratio of food-specific IgE to IgG4, food-specific IgA levels, component-resolved diagnostic profile, diet, gut microbiome, and interventions such as immunotherapy. Since food allergy places a significant burden on patients and their caregivers in daily life, clinicians should be able to provide relevant knowledge on the natural course of food allergy, appropriately evaluate its resolution, and offer therapeutic options whenever possible.

Prognosis of food-induced anaphylaxis in children: A single-center real-life study.

Background: Food allergies are known to resolve over time, but there is little information on the natural history of food-induced anaphylaxis (FIA). Objective: This study aimed to evaluate the natural history of FIA in children and determine the factors that affect prognosis. Methods: Children with FIA who were followed up for at least 3 years, between 2010 and 2020, were included. Patients' families were contacted by telephone to question their child's tolerance status and invite them for reevaluation if uncertain. The patients were grouped as tolerant or persistent according to parent reports or reevaluation results. Logistic regression analysis was performed to determine the factors that affected persistence. Results: The study included 185 patients (62.2% boys) with 243 anaphylactic reactions to various foods. Fifty-eight patients (31%) gained tolerance within a 3-year follow-up period. Tolerance rates were higher in patients with FIA to milk (40%) and egg (43.9%) compared with to tree nuts (18.8%), legumes (5.6%), and/or seafood (11.1%) (p < 0.001). In a multivariate analysis, risk factors for persistent FIA were multiple food anaphylaxis (odds ratio [OR] 3.755 [95% confidence interval {CI}, 1.134-12.431]; p = 0.030), total IgE > 100 kU/L (OR 5.786 [95% CI, 2.065-16.207]; p = 0.001), and skin-prick test wheal size > 10 mm (OR 4.569 [95% CI, 1.395-14.964]; p = 0 .012) at presentation. Conclusion: Approximately a third of the patients with FIA developed tolerance within 3 years. Clinicians should remember that children with food allergies, even anaphylaxis, may develop tolerance over time. Regular follow up and reevaluation of tolerance status are necessary to avoid unnecessary elimination.

Food-Induced Anaphylaxis among Children Weighing

Introduction: Food-induced anaphylaxis among infants shows an increasing prevalence; however, the prescription of epinephrine auto-injectors (EAIs) for children weighing <15 kg is associated with issues of the needle length and the epinephrine dose. Several studies have shown age-related differences in food-induced anaphylaxis, although little is known about the weight-related differences in food-induced anaphylaxis. This study aimed to reveal the incidence, clinical characteristics, and management of food-induced anaphylaxis in children weighing <15 kg. Methods: This chart review included children who visited the pediatric emergency department (ED) of the National Center for Child Health and Development (Tokyo, Japan) from January 2014 to December 2016 and were diagnosed with food-induced anaphylaxis. The severity of anaphylaxis was evaluated using the Sampson Grading Scale. Results: Of 89,232 ED visits, 444 visits included patients with food-induced anaphylaxis, after excluding cases of food-induced anaphylaxis related to oral desensitization therapy. The incidence was 4.98 per 1,000 visits. More than half of the children (n = 247/444, 55.6%) weighed <15 kg. The proportion of grade 3 and higher severity anaphylactic symptoms was 74.5% (184/247) in children weighing <15 kg and 79.2% (156/197) in children weighing 15 kg or more. The recurrence rate of food-induced anaphylaxis was 22.3% (55/247) in children weighing <15 kg and 48.7% (96/197) in children weighing 15 kg or more. Among the children weighing <15 kg, the proportion of those with recurrent food-induced anaphylaxis was 4 times higher in children weighing 10–15 kg than in those weighing <10 kg (32.2% [47/146] vs. 7.9% [8/101]). The proportion of patients who were prescribed EAIs before each visit was 25.5% (14/55) in children weighing <15 kg with a history of food-induced anaphylaxis. Conclusion: Food-induced anaphylaxis among children weighing <15 kg occurred as frequently and was as severe as that among children weighing 15 kg or more. However, the proportion of patients prescribed EAIs was very low in children weighing <15 kg with food-induced anaphylaxis. The potential need for EAIs is suggested among children weighing <15 kg, especially among children weighing 10 kg or more but <15 kg.

Characteristics and Laboratory Findings of Food-Induced Anaphylaxis in Children: Study in an Asian Developing Country

Introduction: Food allergy is the major cause of pediatric anaphylaxis. Characteristics and triggers may be different in different geographical regions. Studies focusing on food-induced anaphylaxis (FIA) in Asian developing countries are limited. Our study aimed to study characteristics of FIA in a tertiary care center in an Asian developing country. Methods: Retrospective review of pediatric anaphylaxis admission and outpatient visit at a tertiary care hospital in Bangkok, Thailand during 2008–2018 was performed. Data regarding clinical presentation, place reaction occurred, time of onset, investigations (serum tryptase, specific immunoglobulin E, and skin test), treatment, and follow-up periods were collected. Results: One hundred seventy-four anaphylaxis admission records of which 61 episodes of FIA were retrieved. Data from outpatients visit consisted of 17 patients. Most patients were male (76.7%). The median age was 7.1 years (interquartile range 1.9–12.4). The major causes of FIA were shrimp/shellfish (37%), wheat (15.1%), and cow’s milk (11%). Food causing anaphylaxis varied according to age-group: infants had anaphylactic reactions to egg, wheat, and cow’s milk, preschools to wheat and peanut, and older children to shrimp/shellfish. Cutaneous manifestations occurred in all patients, followed by lower respiratory tract symptoms (83.6%) and gastrointestinal symptoms (50.8%). There was no biphasic anaphylaxis reported. Elevated serum tryptase was found in only 4 patients (7%). Conclusion: Recognizing characteristics of pediatric FIA is crucial. The common causes of FIA in our study in Asian children were egg in infants, wheat and peanut in preschool children, and shrimp/shellfish in school-age children and adolescents. Skin manifestation presented in all patients with FIA.

Food-induced anaphylaxis in children up to 3-years-old— preliminary study

The aim of the study was to determine the frequency of food-induced anaphylaxis, analyze the symptoms, and the trigger factors in the group of the youngest children. The additional aim of the study is to estimate the frequency of anaphylaxis episodes in the population of children in the Kuyavian-Pomeranian Voivodeship. Retrospective analysis of medical records of 29 children aged 0-3 years that presented symptoms of food-induced anaphylaxis. Medical charts were reviewed using a collection of documents with the clinical data. The frequency of anaphylaxis was determined to be 0.3% of all hospitalized children aged 0-3 years and 1.9% of children suspected of food allergy. The mean age of an anaphylactic reaction was 12 ± 9 months. The most common symptom was mild-moderate urticaria. The respiratory symptoms were significantly more prevalent in toddlers than in infants (p = 0.148). Cardiac symptoms occurred only in the infant group, that is, in two (11%) infants. As a possible cause of the symptoms, in 18 (62%) cases, parents most often indicated the consumption of milk or milk-rice porridge. Anaphylaxis as the first manifestation of food-allergy was significantly more prevalent in infants than in older children (p = 0.0002). The incidence of anaphylactic reactions rated at 0.3% of all children hospitalized at this age. The most common symptoms of anaphylactic reaction were skin lesions. The primary cause of allergic reactions was cow's milk after first exposure at home. Anaphylaxis has different patterns of symptoms depending on the age of the child.

The usefulness of molecular diagnosis in the assessment of the aetiology, clinical phenotypes and risk of food-induced anaphylaxis in children

Aim: Food-induced anaphylaxis is most common in the paediatric population and has an unpredictable course. The aim of this paper was to perform a demographic and clinical assessment of food-induced anaphylaxis in children using molecular diagnosis. Materials and methods: The study included 541 children aged 0–18 years who developed 893 sudden reactions to food. Levels of IgEs against 112 allergen molecules were measured in each child. We analysed demographic and clinical data in two age groups. The aetiology of anaphylaxis was determined at the level of source allergens and at the level of allergen molecules. We also determined the risk factors for severe clinical course of reactions. Results: A total of 631 food-induced anaphylactic reactions developed by 421 children were included in the analysis. The group of children aged 0–6 years was mostly composed of boys (p = 0.0023) and children with atopic dermatitis (p = 0.0001). Also, cutaneous and mucosal symptoms were more common (p &lt; 0.0001), and milk casein, Bos d 8, was the most common cause of anaphylaxis in this group (p &lt; 0.0001). In the group of 7–18-year-olds, anaphylaxis was more common in children with no asthma or atopic dermatitis (p = 0.0001); hazelnuts (p = 0.0005) and, in terms of allergen molecules, walnut 2S albumin, Jug r 1 (p = 0.0011), were a more common cause of reaction; as well as exercise-induced anaphylaxis (p &lt; 0.0001) and cardiovascular symptoms (p = 0.0247) were more common. In the study population, more severe anaphylaxis was more common in children without asthma or atopic dermatitis (p = 0.0428) and in the case of anaphylaxis induced by cashew nut 2S albumin, Ana o 3 (p &lt; 0.0001) and wheat allergen, Tri a 14 (p = 0.0143). Conclusions: Molecular diagnostics allows for a detailed assessment of the aetiology and the risk of severe food-induced anaphylaxis.

Food-induced anaphylaxis in children up to 3-years-old preliminary study.

The aim of this study was to determine the frequency of food-induced anaphylaxis, analyze the symptoms, and triggering factors in a group of youngest children. Also, the study aims to estimate the frequency of anaphylaxis episodes in children in the Kuyavian-Pomeranian Voivodeship region. Retrospective analysis of medical records of 29 children aged 0-3 years that presented symptoms of food-induced anaphylaxis. Medical charts were reviewed using a collection of documents with the clinical data. The frequency of anaphylaxis was determined to be 0.3% of all hospitalized children aged 0-3 years and 1.9% of children suspected of food allergy. The mean age of an anaphylactic reaction was 12±9 months. The most common symptom was mild-moderate urticaria. The respiratory symptoms were significantly more prevalent in toddlers than in infants (p = 0.148). Cardiac symptoms occurred only in the infant group, i.e., in two (11%) infants. As a possible cause of the symptoms, in 18 (62%) cases, parents most often indicated the consumption of milk or milk-rice porridge. Anaphylaxis as the first manifestation of food-allergy was significantly more prevalent in infants than in older children (p = 0.0002). The incidence of anaphylactic reactions rated at 0.3% of all children hospitalized at this age. The most common symptoms of anaphylactic reaction were skin lesions. The primary cause of allergic reactions was cow's milk after the first exposure at home. Anaphylaxis has different patterns of symptoms depending on the age of the child.

Food-induced anaphylaxis in children – state of art

Food-induced anaphylaxis is the most frequent type of anaphylaxis and the most common cause of fatal acute hypersensitivity reactions in children. It typically occurs after accidental food exposure, after inhalation of food allergen, cutaneous contact and controlled oral food challenge. There is no consensus on a universal clinical definition of anaphylaxis or a uniform symptoms severity score. Recent advances in molecular allergology allow, in many cases, the detailed identification of the allergenic molecule responsible for anaphylaxis. Along with the development of precision medicine, new phenotypes and endotypes of anaphylaxis are being defined. The anaphylaxis course is entirely unpredictable, and even initially mild symptoms may herald a potentially fatal reaction. At the same time, a significant proportion of immediate food hypersensitivity episodes are mild and known as systemic allergic reactions. The occurrence and severity of clinical course of food-induced anaphylaxis are influenced by factors related directly to the child, coexisting diseases, the type and the nature of the allergen, or the presence of cofactors. The unpredictable course of anaphylaxis justifies immediate treatment based on rapid intramuscular administration of adrenaline, regardless of severity. Delayed adrenaline administration is associated with higher incidence of severe course and death. Appropriate and prompt treatment of anaphylaxis is even more critical during the COVID-19 pandemic due to difficult access to medical facilities, hence current treatment plans for food-induced anaphylaxis emphasise the need to administer adrenaline immediately after the onset of the first, even mild, but rapidly progressive symptoms and recommend that the patient have at least two adrenaline autoinjectors.

Food allergy and food-induced anaphylaxis in children: an increasing critical public health issue.

Food allergy and food-induced anaphylaxis in children: an increasing critical public health issue.

A 10-year review found increasing incidence trends of emergency egg allergy reactions and food-induced anaphylaxis in children.

International reports have suggested that food allergies and food-induced anaphylaxis have increased in children. We investigated the incidence of emergency food reactions over a 10-year period. This study retrospectively reviewed the medical records of children presenting to Umeå University hospital, Sweden, with an emergency food reaction from January 1, 2006 to December 31, 2015. Cases were identified using discharge codes for allergies and anaphylaxis. Anaphylaxis cases were included if they fulfilled the international criteria. We found emergency food allergy reactions in 519 children (58% boys) from 2006-2015 at a median age of 1.3years. One-third were hospitalised (32%) including 71/99 cases of anaphylaxis. Milk and eggs were the most commonly identified triggers. Emergency reactions to eggs increased during the study period with a Spearman rank correlation coefficient of 0.770 (p<0.01) and the figures for anaphylaxis were 0.745 (p=0.013). The incidence of food-induced anaphylaxis increased and was 30 per 100000 person-years for the study period. Most of the emergency reactions, treated by secondary care paediatricians and emergency physicians, were to milk and eggs. Allergic reactions to eggs increased from 2006 to 2015, as did food-related anaphylaxis.

National trends in emergency department visits and hospitalizations for food-induced anaphylaxis in US children.

Food is the leading cause of anaphylaxis in children seen in emergency departments in the United States, yet data on emergency department visits and hospitalizations related to food-induced anaphylaxis are limited. The objective of our study was to examine national time trends of pediatric food-induced anaphylaxis-related emergency department visits and hospitalizations. We conducted an observational study using a national administrative claims database from 2005 through 2014. Participants were younger than 18years with an emergency department visit or hospitalization for food-induced anaphylaxis. Outcome measures of our study included time trends of pediatric food-induced anaphylaxis-related emergency department visits and hospitalizations, including observations (in an emergency department or a hospital unit), inpatient admissions, and intensive care unit admissions. During the study period, participants had 7310 food-induced anaphylaxis-related emergency department visits. Emergency department visits for food-induced anaphylaxis increased by 214% (P<.001); the highest rates were in infants and toddlers (age 0-2years). Rates of emergency department visits significantly increased in all age-groups, with the highest increase in adolescents (age 13-17years: 413%; P<.001). Peanuts accounted for the highest rates (5.85 per 100000 in 2014) followed by tree nuts/seeds (4.62 per 100000 in 2014). The greatest increase in rates of emergency department visits for food-induced anaphylaxis occurred with tree nuts/seeds (373.0% increase during the study period). The incidence of food-induced anaphylaxis has significantly increased over time in children of all ages. Food-induced anaphylaxis in children is an important national public health concern.

Paediatric food-induced anaphylaxis hospital presentations in New Zealand.

Globally, rates of paediatric food-induced anaphylaxis (FIA) are increasing. Little data is available regarding the epidemiology of FIA among New Zealand (NZ) children. This study investigated the incidence of paediatric (0-14 years) FIA hospital presentations in NZ over a 10-year period. Ministry of Health public hospital discharge data from 2006 to 2015 were analysed using FIA-related International Classification of Diseases codes (T78.0 - anaphylactic shock due to adverse food reaction and T78.2 - anaphylactic shock unspecified and free text qualifier) to identify acute hospital presentations. The overall annualised FIA hospital presentation rate was 16.2 per 100 000 children. Subgroup analysis indicated a significantly higher rate in males (19.1/100 000) than in females (13.1/100 000), and among children aged less than 2 years of age (50.5/100 000) compared with older children. Rates among Asian and Pacific children were higher than Māori and NZ European children. In 67.7% of cases, a single specific allergen was suggested by the information provided; among these cases, nuts (48%), specifically peanuts (26%), were the most commonly reported allergen, followed by cow's milk (21%). Time trend analysis showed a 2.8-fold increase in the overall annualised rate for the 10-year period. These findings are consistent with other international studies indicating increasing rates of FIA in children. These data will provide information for a review of NZ paediatric allergy services to ensure current international standards with regard to the equitable delivery of timely, appropriate and accessible care are being met. Reasons for differences by gender, age and ethnicity require further investigation.

Lethal Food-Induced Anaphylaxis in Children

Despite careful contributions, food allergic children have a significant risk of anaphylactic episodes.

アナフィラキシーを呈した小児即時型食物アレルギーの年齢と原因食物に関する検討

目的 : アナフィラキシーを呈した即時型食物アレルギーの小児例について, 年齢・原因食物別の内訳と臨床像を把握する.方法 : 2008年1月～2013年12月までの6年間に, 当院救急外来を受診した15歳以下のアナフィラキシーを呈した即時型食物アレルギー49例について, 診療録より後方視的に検討した.結果 : 原因食物の内訳は, 魚卵 (9例) , 鶏卵 (8例) , ソバ (8例) が三大原因であった. このうち, 0歳は鶏卵58% (7/12) , 1～6歳は魚卵31% (5/16) , 7歳以上はソバ38% (8/21) がそれぞれ最多であった. アドレナリン筋肉内投与が実施されたのが12例で, 内訳はソバ4例, 鶏卵3例で, 魚卵は1例のみであった.結論 : アナフィラキシーを呈した即時型食物アレルギーの小児例の原因食物は, 年代によって傾向が異なり, 年齢を考慮した啓蒙が必要と考えられた. 他の報告と比較して魚卵の頻度が高く, 地域の食習慣による影響が示唆された.

Multiple Epinephrine Doses in Food-Induced Anaphylaxis in Children

Multiple Epinephrine Doses in Food-Induced Anaphylaxis in Children

Risk factors for severe pediatric food anaphylaxis in Italy

Little is known about the cause of food-induced anaphylaxis in children or about the factors that might affect its clinical severity. The aim of this study was to investigate the cause of food-induced anaphylaxis in children in Italy and to identify factors that could influence the appearance of symptoms and the severity of anaphylaxis. One hundred and sixty-three children with anaphylaxis consecutively attending 29 outpatient allergy clinics throughout Italy were enrolled in this prospective study. Information about past anaphylaxis episodes was collected with a standardized questionnaire. Food sensitization was evaluated by skin-prick test. A clinical history of asthma increased the risk of wheezing [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1-4.5] and respiratory arrest (OR 6.9; 95% CI 1.4-34.2). A clinical history of chronic/relapsing gastrointestinal symptoms increased the risk of vomiting (OR 2.1; 95% CI 0.9-4.3), hypotension (OR 7.9; 95% CI 1.9-32.0), and bradycardia/cardiac arrest (OR 9.2; 95% CI 0.9-91.3). The severity of present and previous episodes was similar only in patients with mild or moderate anaphylaxis. Peanut and egg were the most frequent causes of severe anaphylaxis. A clinical history of asthma and chronic/relapsing gastrointestinal symptoms (probably linked to food allergy) may predict the development of respiratory and gastrointestinal symptoms and the severity of anaphylaxis.

Use of Multiple Doses of Epinephrine in Food-Induced Anaphylaxis in Children

Jarvinen KM, Sicherer SH, Sampson HA, Nowak-Wegrzyn A. J Allergy Clin Immunol . 2008;122(1): 133–138 PURPOSE OF THE STUDY. Data from mixed or adult populations indicate that 16% to 35% of anaphylactic reactions from various causes require >1 dose of epinephrine. This study sought to determine the prevalence and risk factors for administration of repeated doses of epinephrine in food-induced anaphylaxis in children. STUDY POPULATION. Questionnaires ( N = 542) were distributed to parents or caregivers of consecutive patients up to 18 …

Use of multiple doses of epinephrine in food-induced anaphylaxis in children

Food allergy is the most common cause of anaphylaxis outside the hospital setting. We sought to determine the rate, circumstances, and risk factors for repeated doses of epinephrine in the treatment of food-induced anaphylaxis in children. Anonymous questionnaires were distributed to families of children with food allergies during allergy outpatient visits to a food allergy referral center. Demographic information, allergy and reaction history, and details regarding the last 2 anaphylactic reactions requiring epinephrine were collected. A total of 413 questionnaires were analyzed. Seventy-eight children (median, 4.5 years of age; range, 0.5-17.5 years) reported 95 reactions for which epinephrine was administered. Two doses were administered in 12 (13%) and 3 doses in an additional 6 (6%) reactions treated with epinephrine. Peanut, tree nuts, and cow's milk were responsible for >75% of reactions requiring epinephrine. Patients receiving multiple doses of epinephrine more often had asthma (P = .027) than children receiving a single dose. The amount of food ingested or a delay in the initial administration of epinephrine were not risk factors for receiving multiple doses. The second dose of epinephrine was administered by a health care professional in 94% of reactions. In this referral population of children and adolescents with multiple food allergies, 19% of food-induced anaphylactic reactions were treated with more than 1 dose of epinephrine. Prospective studies are necessary to identify risk factors for severe anaphylaxis and to establish rational guidelines for prescribing multiple epinephrine autoinjectors for children with food allergy.

Use Of Epinephrine In Food-induced Anaphylaxis In Children

Use Of Epinephrine In Food-induced Anaphylaxis In Children

Identification of a serine protease inhibitor homologue in Bird's Nest by an integrated proteomics approach.

For centuries, the edible nests of Collocalia spp. ("Bird's Nests") have been used as a Chinese delicacy that had been claimed to be an effective health-giving tonic. However, clinical studies indicated that in Singapore, Bird's Nest is the most common cause of food-induced anaphylaxis in children, which could lead to potentially life-threatening allergenic reactions. The purpose of this study was to characterize the major allergens in Bird's Nest by using the combined technologies of two-dimensional gel electrophoresis (2-DE), immunochemistry, N-terminal protein sequencing, and mass spectrometry. Results from the immunostaining of the Western blots of the Bird's Nest 2-DE separated proteins with the sera from allergic patients indicated the presence of a major allergen of 66 kDa. Initial searches of the matrix assisted laser desorption/ionization--time of flight--mass spectrometry (MALDI-TOF-MS) tryptic peptide masses of the allergen in the SWISS-PROT and NCBI nonredundant databases revealed that this protein was novel. Based on the partial protein sequence information obtained from N-terminal microsequencing and nanoelectrospray-tandem MS, the 66 kDa immunoreactive allergen was found to be homologous to ovoinhibitor, a Kazal-type serine protease inhibitor, which is one of the dominant allergens found in chicken egg white.