Food-induced Anaphylaxis Research Articles

Assessment of parental self-efficacy in managing child food-induced anaphylaxis and using adrenaline autoinjectors.

Anaphylaxis is a life-threatening allergic reaction, associated with mental health burden in patients and caregivers. Intramuscular adrenaline via autoinjector (AAI) is the recommended treatment for the management of anaphylaxis in non-hospital settings; however, AAIs are underused. This study aimed to assess parental self-efficacy in managing child's anaphylaxis and administering AAI to understand how to effectively support families. Seventy-five parents of children with severe food allergy completed a questionnaire to measure parental self-efficacy in managing child food-induced anaphylaxis (PSEMA). We conducted an exploratory factor analysis with 12 items, using principal axis factoring as the extraction method. We used Cronbach's alpha to assess the internal consistency of the factors. We used the Anderson-Rubin approach to estimate the factors' scores and provide a kernel density estimate of their distributions. An assessment through linear regression between the total factors' score and total score was performed. A five-factor model was identified. The factors that emerged were conceptually related to "F1. Manage Injection," "F2. Manage AAI Device," "F3. Manage Anaphylaxis," "F4. Manage Emergency," and "F5. Manage Emotions." The questionnaire demonstrated high internal consistency, with a Cronbach's alpha of 0.91 (95% CI: 0.87-0.94) The variation in the total score explained 90% of the variation in the factor score. The PSEMA questionnaire promises to be an easy and effective tool for measuring parents' self-efficacy in managing anaphylaxis and AAI, allowing clinicians to identify gaps in education and provide effective training.

11 Is emergency department transfer always required following anaphylaxis and epinephrine use?

Abstract Background Patients known for anaphylaxis are advised to always carry 2 epinephrine auto-injectors (EAI) with them. With epinephrine being the first-line treatment for anaphylaxis, current guidelines recommend prompt EAI administration, followed by observation in the emergency department (ED) for 4 hours. Data supporting transfer to the ED in all cases after epinephrine are sparse. Recent North American allergy guidelines no longer suggest that ED presentation after EAI use is required for all cases of anaphylaxis. Objectives We aimed to describe the need for additional ED treatment in children known for food-triggered anaphylaxis who received at least 1 EAI pre-hospital. Design/Methods Data on children under 18 years with food-induced anaphylaxis who received at least one dose of pre-hospital epinephrine was collected from the Cross-Canada Anaphylaxis REgistry (C-CARE) from seven hospitals. A standardized questionnaire obtained information on symptoms, allergens, comorbidities, and pre-hospital and in-hospital management. Multivariable logistic regression was performed to identify factors associated with ED management, among children who received 1, 2 or 3 or more doses of epinephrine pre-hospital. Results From 2011 to 2023, 1054 children with known food-triggered anaphylaxis and who used one or more EAIs pre-hospital were enrolled in C-CARE. The mean age at reaction was 8.2 (standard deviation [SD] 5.3) years, 648 (60.8%) were male and 82 (7.8%) of reactions were severe (defined as loss of bowel control, cyanosis, respiratory arrest, hypotension and/or circulatory collapse, dysrhythmia, severe bradycardia and/or cardiac arrest, confusion, and loss of consciousness). Primary triggers included peanuts (n=280; 26.6%) followed by tree nuts (n=173; 16.4%). 193 patients (18.3%) had known asthma and 201 received additional dose(s) of epinephrine in the ED, the majority of whom (177, 88.1%) received one dose. Only 2.9% of patients required admission. Among all patients, reactions to egg were less likely to require additional epinephrine (aOR 0.90; 95% CI 0.83, 0.99), and more likely with severe reactions (aOR 1.24; 95% CI 1.14-1.35). Among patients who received only one EAI pre-hospital, severe reactions (adjusted odds ratio [aOR] 1.19; 95% confidence interval [CI] 1.08-1.31) and reactions to tree nuts (aOR 1.12; 95% CI 1.04-1.20) were associated with increased odds of an additional dose of epinephrine in hospital. Conclusion One-fifth of anaphylaxis cases that used EAI require an additional dose of epinephrine in ED. Children with severe reactions and reactions to tree nuts are more likely to require additional doses; these cases should be considered for ED transfer and treatment following pre-hospital EAI use.

Anaphylaxis in a country where Asia and Europe meet: Evaluation according to World Allergy Organization (WAO) and European Academy of Allergy and Clinical Immunology (EAACI) diagnostic criteria

BackgroundAnaphylaxis is an acute-onset, life-threatening clinical emergency involving more than one system. The World Allergy Organization (WAO) published anaphylaxis guidelines in 2020. The European Academy of Allergy and Clinical Immunology (EAACI) published anaphylaxis guidelines in 2021 and reviewed the diagnosis of anaphylaxis, risk factors, comorbid diseases, treatment management, and prevention studies.In this study, clinical features, demographic characteristics, risk factors, treatment management, and evaluations according to EAACI and WAO diagnostic criteria were analysed in patients diagnosed with anaphylaxis. In this way, it was aimed to provide a perspective on the diagnosis, etiology, and treatment management in patients with anaphylaxis and to open a window for new studies. MethodsWe retrospectively analysed the data recording system of patients who were evaluated with a history of systemic allergic reaction in the Allergy and Immunology outpatient clinic of our tertiary referral hospital in a ninety-month period between January 2016 and June 2023. The total number of patients admitted to our Allergy and Immunology Clinic between January 2016 and June 2023 was 14,9425. Among these patients, 1032 patients were evaluated in the outpatient clinic according to the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) coding system and diagnosed as T78.2 Anaphylaxis by Allergy and Immunology Specialist. Each patient file was re-evaluated by the authors of the study and 689 eligible patients were included. ResultsIncluded in the study were 689 patients. The mean age of the patients was 46.2 ± 14.2 (35–57) years. 64.4% (n = 444) of the patients were female. Venom, drugs, and food were the 3 leading causes of anaphylaxis. In our study, younger age was determined as a statistically significant risk factor for food-induced anaphylaxis, female gender for drug-induced anaphylaxis and male gender for venom-induced anaphylaxis. (p < 0.001) If the cause of anaphylaxis can be identified, such as venom, drug or food, the frequency of anaphylaxis decreases statistically significantly compared to idiopathic anaphylaxis. (p < 0.001) The rate of acute hypotension, bronchospasm, or laryngeal involvement without skin involvement according to WAO and the rate of WAO severity classification grade 5 were significantly higher in patients who developed anaphylaxis due to venom compared to other patients (p < 0.001). The rate of Grade 3 in the EAACI classification was significantly higher in patients who developed anaphylaxis due to venom compared to other cases (p < 0.001). ConclusionOur study was conducted in a city such as Istanbul, which connects both Asian and European continents. Moreover, it is important because it was conducted in a centre with the highest number of Allergy and Immunology outpatients per year in our country. It is important because it gives the prevalence of anaphylaxis and emphasises the risk factors for each allergen separately.

To the ER? Can Patients Treat Their Anaphylaxis at Home?

To discuss if all patients who use self-injectable epinephrine outside the hospital setting require immediate emergency care. Prior to 2023, anaphylaxis management guidance universally recommended that patients who use self-injectable epinephrine outside of the hospital or clinic setting immediately activate emergency medical services and seek further care. Additional food-induced anaphylaxis management recommendations specified that all patients always carry 2 auto-injector devices and give a second dose of epinephrine if there was not immediate response within 5min of injection. Patients presenting for emergency care after epinephrine are often observed for up to 4-6h afterwards, even when completely asymptomatic. These management steps have lacked evidence for improving outcomes, and universal implementation of these approaches is not cost-effective as guidance for food allergic patients. Epinephrine pharmacokinetics and pharmacodynamics suggest that peak physiologic response is more likely to occur closer to 15min than before 5min, that few patients require a second dose of epinephrine as most stabilize within 15min of use, that 60min of observation after a patient stabilizes after epinephrine use may be adequate as patients infrequently have further sequelae, and that not everyone needs to carry 2 epinephrine auto-injectors on their person at all times. The most recent anaphylaxis practice parameter promotes a contextualized approach to these management questions, outlining the option for watchful waiting to gauge response to epinephrine before seeking emergency care, which has been proven as a more cost-effective management strategy. The recent updated anaphylaxis care guidelines support the evolution of anaphylaxis care, in that universal, immediate activation of emergency services is not required for using self-injectable epinephrine outside the hospital setting.

Management of anaphylaxis after pre-hospital epinephrine use in children with food-induced anaphylaxis

BackgroundPrevious guidelines recommend prompt epinephrine administration, followed by observation in the emergency department (ED). The need for transfer in all cases of anaphylaxis has recently been challenged. ObjectiveTo evaluate the need for additional ED treatment among children with anaphylaxis who received prehospital epinephrine. MethodsBetween 2011 and 2023, data were collected on symptoms, triggers, comorbidities, and prehospital and in-hospital management from children (<18 years) with food-induced anaphylaxis who received at least 1 dose of prehospital epinephrine presenting at 7 pediatric EDs. Multivariable logistic regression assessed factors associated with the use of 2 or more prehospital epinephrine autoinjectors (EAIs), epinephrine use in the ED, and hospital admission. ResultsOf the 1127 children (mean 8.1 ± 5.3 years; 60.6% male sex) with food-induced anaphylaxis who used at least 1 EAI prehospital, the most common trigger was peanuts (25.3%). There were 209 (18.5%) children who received additional epinephrine in the ED, most of whom (88.0%) received 1 dose. A total of 30 (2.7%) patients were admitted to hospital. Among all patients, severe reactions (cardiovascular instability/cyanosis/loss of consciousness) (adjusted odds ratio [aOR] 1.22; 95% CI 1.12-1.33) and reactions to tree nuts (aOR 1.09; 95% CI 1.03-1.16) were associated with increased odds of in-hospital epinephrine use. Prehospital inhaled β-agonists (aOR 1.08; 95% CI 1.01-1.16) use and severe reactions (aOR 1.13; 95% CI 1.05-1.22) were associated with the use of 2 or more EAI prehospital. ConclusionA minority of anaphylaxis cases that used prehospital EAIs required additional treatment, supporting that shared decision making about transfer to ED works for most patients.

Characteristics of childhood anaphylaxis in different age groups.

Anaphylaxis is a severe systemic hypersensitivity reaction that usually has a rapid onset and can be fatal. Presentations of childhood anaphylaxis vary widely in accordance with the triggers and the patient's age, geographical region and dietary and lifestyle habits. The medical records of 177 paediatric patients diagnosed with anaphylaxis between January 2021 and January 2024, whose disease progression was monitored at a single tertiary care centre, were reviewed retrospectively. The study included 177 patients diagnosed with anaphylaxis (107 males and 70 females with a median age of 48 months). The most common allergen responsible was food (53.7%). Egg allergy was the most common source of anaphylaxis, afflicting 35 patients (19.3%), while beta-lactam provoked the most common drug allergy, affecting 24 patients (13.6%). The most common organ involved was the skin (92.7%). When the patients were analysed by age group, there were more males in the infancy, preschool and school age groups, while there were more females in the adolescent group (p = 0.44). Food-induced anaphylaxis became less common with increasing age, whereas the rate of drug-induced anaphylaxis increased (p = 0.01 and p = 0.01, respectively). Cardiovascular system findings were observed more frequently in adolescents compared to other age groups (p = 0.003). Most cases stemming from a food allergy were mild, whereas most drug-induced cases were moderate or severe (p < 0.05). When severity was analysed by age group, mild cases in infants were more common than moderate to severe cases. The aetiological and clinical manifestations of childhood anaphylaxis vary among different age groups.

Using NHS Data to Monitor Trends in the Occurrence of Severe, Food-Induced Allergic Reactions Work Package 1

People with food allergies may experience food allergic reactions due to accidental exposure. These reactions are commonly categorised as non-severe, fatal food anaphylaxis and near-fatal food anaphylaxis. Non-severe allergic reactions to food are more common with an incidence of up to 1,000 times greater than fatal food-related anaphylaxis. However, obtaining accurate data relating to the circumstances under which these reactions occurred is challenging under the current diagnosis coding system used in the National Health Service (NHS). This project addressed two key questions: 1. What are the trends in the occurrence of food hypersensitivity (FHS) reactions and their consequences in terms of healthcare encounters (both to hospital and primary care)? 2. What are the circumstances surrounding severe, life-threatening reactions to food? Approach The researchers used existing NHS datasets (relating to Hospital Admissions, Accident &amp; Emergency visits, Critical Care admissions and Primary care visits) to evaluate healthcare encounters due to food hypersensitivity over the study period. Patient pathways through the healthcare system were also assessed by linking these different datasets. Key Results • Food-induced anaphylaxis represented 29.4% of reported anaphylaxis. admissions, and increased significantly from 1.23 to 4.02 admissions per 100,000 population per annum over the study period. • However, despite an annual increase of 5.7% in hospitalisation for food-induced anaphylaxis between 1998 and 2018, the case fatality rate (proportion of hospital admissions associated with a fatal outcome) more than halved, from 0.7% in 1998 to less than 0.3% in 2018. • 152 deaths were identified during the study period where the cause was very likely to have been food-induced anaphylaxis. • At least 86 (46%) fatalities were triggered by peanut or tree nuts. • Cows’ milk was reported to be the most common cause of fatal anaphylaxis in children aged under 16 years. • Using data from England for the period 2008-2018, the prevalence of food allergy ranged from 4% in preschool-aged children (under 5 years), 1-2% in school-aged children and young people (5 to 20 years) and 0.9% in adults. Although the same methods were used throughout the study period, the statistics presented may be prone to limitations such as miscoding and incomplete datasets. • Prescription of adrenaline auto-injector devices (AAI) are an important risk management intervention in people at risk of food-induced anaphylaxis. However, there is significant under-prescribing of AAI. Data showed that 40% of individuals with prior food-induced anaphylaxis were not prescribed AAI and at least 59% did not have AAI on repeat prescription. • Most healthcare visits for food allergy occurred in general practice. Less than 3% of individuals with a diagnosis of food allergy attended Accident and Emergency during the study period, 2008-2018. Therefore, using hospital data in isolation to analyse patterns of health service utilisation with respect to FHS may not provide a comprehensive overview.

Hospitalizations for Food-Induced Anaphylaxis Between 2016 and 2021: Population-Based Epidemiologic Study.

Food-induced anaphylaxis (FIA) is a major public health problem resulting in serious clinical complications, emergency department visits, hospitalization, and death. This study aims to assess the epidemiology and the trends in hospitalizations because of FIA in Spain between 2016 and 2021. An observational descriptive study was conducted using data from the Spanish National Hospital discharge database. Information was coded based on the International Classification of Diseases, Tenth Revision. The study population was analyzed by gender and age group and according to food triggers, clinical characteristics, admission to the intensive care unit, severity, and in-hospital mortality. The annual incidence of hospitalizations because of FIA per 100,000 person-years was estimated and analyzed using Poisson regression models. Multivariable logistic regression models were constructed to identify which variables were associated with severe FIA. A total of 2161 hospital admissions for FIA were recorded in Spain from 2016 to 2021. The overall incidence rate was 0.77 cases per 100,000 person-years. The highest incidence was found in those aged <15 years (3.68), with lower figures among those aged 15 to 59 years (0.25) and ≥60 years (0.29). Poisson regression showed a significant increase in incidence from 2016 to 2021 only among children (3.78 per 100,000 person-years vs 5.02 per 100,000 person-years; P=.04). The most frequent food triggers were "milk and dairy products" (419/2161, 19.39% of cases) and "peanuts or tree nuts and seeds" (409/2161, 18.93%). Of the 2161 patients, 256 (11.85%) were hospitalized because FIA required admission to the intensive care unit, and 11 (0.51%) patients died in the hospital. Among children, the most severe cases of FIA appeared in patients aged 0 to 4 years (40/99, 40%). Among adults, 69.4% (111/160) of cases occurred in those aged 15 to 59 years. Multivariable logistic regression showed the variables associated with severe FIA to be age 15 to 59 years (odds ratio 5.1, 95% CI 3.11-8.36), age ≥60 years (odds ratio 3.87, 95% CI 1.99-7.53), and asthma (odds ratio 1.71,95% CI 1.12-2.58). In Spain, the incidence of hospitalization because of FIA increased slightly, although the only significant increase (P=.04) was among children. Even if in-hospital mortality remains low and stable, the proportion of severe cases is high and has not improved from 2016 to 2021, with older age and asthma being risk factors for severity. Surveillance must be improved, and preventive strategies must be implemented to reduce the burden of FIA.

Age- and Elicitor-Dependent Characterization of Hymenoptera Venom-Induced Anaphylaxis in Children and Adolescents

BackgroundHymenoptera venom is one of the most frequent causes of anaphylaxis. Studies from adults indicate the clinical profiles and risk factors of Hymenoptera venom induced anaphylaxis (VIA). Much less is known about pediatric VIA. ObjectiveTo better understand elicitor and age related factors determining pediatric VIA by analyzing data from the anaphylaxis registry. MethodsWe selected pediatric VIA, pediatric food induced anaphylaxis (FIA) and adult VIA cohorts from the anaphylaxis registry and performed a comparative data analysis regarding elicitors, symptoms and management. Results725 pediatric VIA, 3,149 pediatric FIA and 5,534 adult VIA were identified. In pediatric VIA, boys were more frequently affected, atopy was not increased and the onset of the reaction after exposure was fast (≤ 30 min; 91%) when compared to pediatric FIA. Symptoms in pediatric VIA were age dependent, and although respiratory symptoms occurred besides skin symptoms most frequent in both, pediatric VIA and FIA, cardiovascular symptoms were more frequently reported in pediatric VIA than pediatric FIA.The analysis of pediatric versus adult VIA reveled clear differences of the frequency of involved organ systems (skin: 93/78%, respiratory: 77/64%, and cardiovascular: 61/85%). Among both, the pediatric and adult VIA, the rates of adrenaline application by a professional were low (29/31%) but the hospitalization rates were higher in children than in adults (61%/42%). Venom immunotherapy (VIT) was initiated frequently regardless of age (78% each). ConclusionPediatric VIA is more frequent in boys, symptoms are age dependent and often hospitalization is required. Adrenaline should be applied according the current guidelines. VIT is an important treatment option in pediatric VIA and should be considered in severely affected children.

Low serum adrenic acid levels in infants and subsequent food-induced anaphylaxis

BackgroundThe dietary fat hypothesis links increases in allergic diseases to reduced consumption of n-3 polyunsaturated fatty acids (PUFAs) from fish, e.g., eicosapentaenoic acid (EPA), and increased intake of n-6 PUFAs from vegetable oils, e.g., arachidonic acid (AA). ObjectiveBuilding upon the 'fat hypothesis', we aimed to investigate the association between 24 types of serum fatty acid levels in infants and the risk of subsequent food-induced anaphylaxis (FIA) by 2 years of age as the primary outcome. MethodsThis study was conducted as a prespecified supplemental analysis within the ABC randomized clinical trial. We measured levels of 24 fatty acids in residual serum samples collected from 268 infants at 5-6 months of age using gas chromatography-mass spectrometry. ResultsAmong the 258 infants, 58 exhibited immediate-type food allergies, while 200 showed no food allergy (NFA). Of the 58 infants, 12 were diagnosed with FIA, while the remaining 46 had non-anaphylactic food allergy (NAFA). Unexpectedly, among the 24 fatty acids, only adrenic acid (AdA), also known as docosatetraenoic acid, which is one of the n-6 PUFAs, showed significantly lower levels in infants with FIA (median [IQR] (wt.%): 0.16 [0.14-0.17]), compared to those with NFA (0.19 [0.17-0.21]) (P=.0007). In contrast, AdA levels in infants with NAFA were 0.19 [0.16-0.21] (wt.%), which did not differ significantly from infants with NFA (P=.69). ConclusionThis study generated a hypothesis suggesting that infants with low serum AdA levels might be at greater risk of subsequent FIA. This unexpected result warrants further investigation.

Emergency Management of Food-induced Anaphylaxis and Severe Reactions in Young Infants.

Emergency Management of Food-induced Anaphylaxis and Severe Reactions in Young Infants.

Regular consumption following early introduction of allergenic foods and aggressive treatment of eczema are necessary for preventing the development of food allergy in children.

Over the past two decades, food allergy prevention strategies have shifted from 'delayed introduction' to 'no delayed introduction' to 'early introduction' of allergenic foods. This article reviews important research in this field published in the early 2020s to support future strategies for food allergy prevention. Recent randomized controlled trials (RCTs), systematic reviews, meta-analyses, and real-world studies have reported that early allergenic food introduction, especially peanut and egg, are effective for preventing food allergies. However, there are also reports that food-induced anaphylaxis admission rates in infants are increasing. Early allergenic food introduction by itself is not sufficient to prevent the development of food allergies. Recent RCTs (SPADE study and COMEET study) have demonstrated that continued regular cow's milk consumption after early introduction is important for preventing the onset of cow's milk allergy. Furthermore, an RCT (PACI study) reported that early and aggressive anti-inflammatory topical therapy for eczema can contribute to the prevention of egg allergy by suppressing percutaneous sensitization. Food allergies may be prevented through a combination of early food introduction, regular consumption, and active eczema treatment. Further research is needed to develop well tolerated, effective, and practical strategies to prevent food allergies.

Loading-Dose Dupilumab May Function as a Prophylactic Agent for Food-Induced Anaphylaxis: A Case and Review of the Literature

Recent advances in targeted therapy using monoclonal antibodies have revolutionized care in many fields, and dupilumab for the treatment of moderate-severe atopic dermatitis is no exception. While on a trial of loading dose dupilumab, a 25-year-old white male with a past medical history significant for anaphylaxis after ingesting peanuts and tree nuts did not experience anaphylaxis after accidentally consuming almonds. Similarly to anti-IgE, the large-scale inhibition of IL-4 and IL-13 signaling to various immune cells involved with type II hypersensitivity reactions using loading dose dupilumab may have played a role in preventing anaphylaxis in this patient. The role of loading dose dupilumab as a potential prophylactic agent against food-induced anaphylaxis could be explored cautiously as a novel way to reduce both morbidity and mortality in patients with these allergies.

Clinical characteristics and management of pediatric egg-induced anaphylaxis: A cross-sectional study

BackgroundEgg is the third most common food allergy in children; however, data on pediatric egg-induced anaphylaxis are sparse. ObjectiveTo describe the clinical characteristics, management, and outcomes of pediatric egg-induced anaphylaxis. MethodsChildren presenting with anaphylaxis were recruited from 13 emergency departments as part of the Cross-Canada Anaphylaxis Registry, from which data on anaphylaxis triggered by egg were extracted. Multivariate logistic regression was used to determine factors associated with prehospital epinephrine autoinjector (EAI) use and to compare anaphylaxis triggered by egg with other triggers of food-induced anaphylaxis (FIA). ResultsWe recruited 302 children with egg-induced anaphylaxis. The mean age was 2.6 years (SD = 3.6), and 55.3% were male. Only 39.4% had previously been diagnosed with an egg allergy. Prehospital EAI use was 32.1%, but this was not significantly lower than in other triggers of FIA (P = .26). Only 1.4% of patients required hospital admission. Relative to other triggers of FIA, patients with egg-induced anaphylaxis were significantly younger (P < .001) and exhibited more vomiting (P = .0053) and less throat tightness (P = .0015) and angioedema (P < .001). ConclusionTo the best of our knowledge, this is the largest published cohort of pediatric egg-induced anaphylaxis. In this cohort, prehospital EAI use was very low. In addition, we identified certain symptoms that distinguish egg-induced from other triggers of FIA. Taken together, high suspicion is crucial in identifying egg-induced anaphylaxis, given the younger patient demographic and frequent lack of FIA history.

The clinical burden of food allergies: Insights from the Food Allergy Research & Education (FARE) Patient Registry

BackgroundFood allergies are serious and potentially life-threatening, and often place a large burden on patients and their caregivers, including impacts on quality of life. ObjectiveTo assess the real-world patient burden of food allergies, using self-reported data available from the Food Allergy Research & Education (FARE) Patient Registry (NCT04653324). MethodsThe FARE Patient Registry is voluntary and captures real-world experiences of adults and pediatric patients in the United States, and their caregivers, through a series of surveys assessing patient health and experiences with food allergies. Self-reported data were descriptively analyzed. ResultsThe FARE study cohort included 5587 patients with food allergies; 82% had multiple food allergies and 62% were aged <18 years. About half of the patients were first diagnosed by an allergist/immunologist (53%), most commonly with a skin prick test (71%) or a serum immunoglobulin E test (62%). This analysis found that food allergies (most commonly peanut [66%], tree nuts [61%], egg [43%], and milk [37%]) impart a large clinical burden on patients, many of whom experience food-related allergic reactions and comorbidities. Many patients experienced >1 food-related allergic reaction per year (42%), with 46% experiencing food-induced anaphylaxis. Half of all food-related allergic reactions occurred at home. Accidental exposures to food allergens were experienced by 77% of patients. The most common allergic comorbidities reported by patients with food allergies were atopic dermatitis (48%), asthma (46%), and allergic rhinitis (39%). The clinical burden of food allergies were found to be greater in patients with multiple food allergies, and different for adults versus pediatric patients. ConclusionThis is the first study to assess patient experience and disease burden information from patients contributing to the FARE Patient Registry, thus providing a unique insight into the lives of patients in the United States with food allergies. These insights may assist clinicians and other public health stakeholders in the management of patients with food allergies.

The sensitivity of food allergy skin testing soon after food-induced anaphylaxis

The sensitivity of food allergy skin testing soon after food-induced anaphylaxis

Infant Whole-Cell Versus Acellular Pertussis Vaccination in 1997 to 1999 and Risk of Childhood Hospitalization for Food-Induced Anaphylaxis: Linked Administrative Databases Cohort Study

Evidence suggests that children who had received an initial priming dose of whole-cell pertussis (wP) vaccine, rather than acellular pertussis (aP) vaccine, had a lower risk of developing IgE-mediated food allergy, the most common cause of anaphylaxis-related hospital presentations ofchildhood. To assess the association between wP versus aP vaccination in infancy and subsequent hospital presentations for anaphylaxis. This study was preregistered under PMID 34874968. Perinatal records for a cohort of New South Wales-born children (1997-1999) receiving their first dose of pertussis-containing vaccine before age 4 months were probabilistically linked to hospital and immunization records. We used adjusted Cox models to estimate hazard ratios (aHRs) and 95% CIs for anaphylaxis-coded hospitalizations. There were 218,093 New South Wales-born children who received a first dose of wP or aP before age 4 months. Among these children, 86 experienced at least one hospitalization for food-induced anaphylaxis at age 5-15 years (range of events per patient, one to three). The person-time of follow-up was 1,476,969 years, and 665,519 years for children vaccinated with wP as a first dose (wP-1 children) and aP as a first dose (aP-1 children), respectively. The incidence rates for first hospitalization for food anaphylaxis were 3.5 (95% CI, 2.6-4.6) and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among wP-1 children and aP-1 children, respectively (aHR for wP vs aP= 0.47; 95% CI, 0.26-0.83). For first admission for venom anaphylaxis, the incidence rate was 4.9 (95% CI, 3.9-6.2) per 100,000 child-years among wP-1 children and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among aP-1 children (aHR for wP vs aP= 0.92; 95% CI, 0.53-1.60), and for all-cause anaphylaxis, the incidence rate was 10.6 (95% CI, 9.0-12.4) per 100,000 child-years among wP-1 children and 12.8 (95% CI, 10.2-15.8) per 100,000 child-years among aP-1 children (aHR for wP vs aP= 0.92; 95% CI, 0.53-1.60). Vaccination with wP in infancy was associated with a lower risk of hospitalizations for food-induced anaphylaxis (and therefore severe IgE-mediated food allergy) occurring in childhood.

A case-control study for comorbidity and laboratory factors associated with food-induced anaphylaxis.

Background: Food-induced anaphylaxis (FIA) is a serious and potentially life-threatening allergic reaction triggered by food allergens. Objective: This case-control study aimed to investigate comorbidities and laboratory factors associated with FIA in the pediatric population of Israel. Methods: Retrospective data from the electronic health records of Leumit Health Care Services were used to identify 711 pediatric patients with FIA and 2560 subjects with food allergy and without anaphylaxis matched for age, gender, and ethnicity. Comorbidities were identified based on medical billing diagnosis codes, and laboratory characteristics were compared between the two groups. Results: The mean ± standard deviation age of patients with FIA was 4.1 ± 4.1 years, and 37.3% were girls. Laboratory analysis revealed increased eosinophil counts (p < 0.001), elevated immunoglobulin E (IgE) (p < 0.001), and IgA levels (p = 0.001) in the FIA group compared with the controls. With regard to comorbidities, the FIA group had higher prevalence rates of allergic diseases, including allergic rhinitis (odds ratio [OR] 1.72; p < 0.001), allergic conjunctivitis (OR 1.84; p = 0.001), asthma (OR 1.36; p < 0.001), angioedema (OR 6.37; p < 0.001), atopic dermatitis (OR 1.77; p < 0.001), and contact dermatitis (OR 1.42; p = 0.001). There was a trend toward significance for chronic spontaneous urticaria (p = 0.051). There was a significant negative association between helminthiases, particularly enterobiasis, and FIA (OR 0.76 [95% confidence interval, 0.59-0.98]; p = 0.029). Conclusion: This study provides valuable epidemiologic evidence on the associations among FIA, comorbidities, and laboratory factors in the pediatric population.

Unraveling determinants of severe anaphylaxis — A cluster analysis from a large national hospitalization database

BackgroundUnderstanding potential risk factors and phenotypes at-risk of anaphylaxis can tailor public health actions to prevent avoidable deaths. Therefore, our aim was to explore patterns of hospital admissions diagnosed with anaphylaxis in France from 2012 to 2021, across different age groups, using the national French hospital database and to evaluate potential determinants to propose phenotypes at-risk, with a particular view to severe cases. MethodsThis is a descriptive study, using data from the French Program for the Medicalization of Information Systems, from 2012 to 2021. We included all patients hospitalized for anaphylaxis using International Classification of Diseases (ICD)-10 codes listed as a primary diagnosis. Potential risk factors were selected according to corresponding ICD codes, available as secondary data of hospitalization. Severe anaphylaxis (SA) was defined based on the need of admissions in intensive care units. To explore the patterns and characteristics, we employed cluster analysis using the clustering large applications algorithm. Charlson comorbidity index (CCI) was used to evaluate comorbidities. ResultsDuring the 9-year study period, 78,453 patients had 86,654 admissions due to anaphylaxis for all-causes. Most of the cases were non-severe anaphylaxis (93.7%), 5.9% were SA, and 0.4% evolved to fatal anaphylaxis (FA). Rate of admissions for SA was 0.08/100,000/year. Seasonal trend of cases of anaphylaxis due to Hymenoptera venoms were shown. Increased severity and risk of death were significantly higher in the elderly. Food-induced anaphylaxis is more frequent in childhood, but SA occurred at adolescence and early adulthood. The CCI was higher in SA and FA. By applying the clustering algorithm CLARA, we identified 3 clusters distributed according to the severity. ConclusionMore than providing a snap shot of potential risk factors for anaphylaxis in France, we were able to suggest phenotypes of anaphylaxis of different severities and to propose actions based on our findings. Although further research is needed in the field, we strongly believe that the data presented may contribute to public health advancements to ensure quality of care of patients suffering from anaphylaxis.

Use of in vitro and in vivo tests in the diagnosis of food-induced anaphylaxis – a case study

Food allergy is a chronic disease that affects both children and adults. Systemic allergic reactions in children are most commonly caused by foods, especially nuts, milk, and eggs. A conventional diagnostic work-up for allergy typically pinpoints the allergen source, while component-resolved diagnostics is an approach that identifies the allergen molecules responsible for causing anaphylaxis. In some cases, determining the causative agent of anaphylaxis requires the use of various diagnostic tests. In the following paper, we want to highlight the importance of a critical approach to allergy tests results and caution in the diagnosis of idiopathic anaphylaxis. Based on a case report of food-induced anaphylaxis, we discuss the diagnostic methods that can be applied following a negative IgE test result for allergens obtained with a multiplex platform.