History Of Food Allergy Research Articles

Risk stratification of systemic reactions to subcutaneous immunotherapy: A retrospective study.

Background: Subcutaneous allergen immunotherapy (SCIT) is a very effective treatment modality; however, it can be associated with both local and systemic reactions (SR). Identifying patient factors that predict SR remains paramount. Objective: Our aim was to identify the rate of SRs to SCIT as well as identify patient risk factors associated with the development of SRs. Methods: We conducted an institutional review board approved 10-year retrospective chart review of 459 patients who received SCIT in our clinic. The patients were placed into cohorts according to age, which included pediatric (5-18 years), adult (19-64 years), and senior (>65 years) patients. Results: An SR (N = 177) was identified in 24.8% of the patients (n = 114). The incidence of SR per injection was 0.2% (177 SRs of 74,183 total injections). SRs were identified as class 1 (n = 152), class 2 (n = 21), class 3 (n = 2), and class 4 (n = 2) according to the 2010 World Allergy Organization's SR grading system. There were no observed differences in the number of SRs with respect to age group. Female patients were more likely to have an SR (p = 0.02) overall as well as more than one reaction (p = 0.002). Other risk factors included the following: a patient-reported history of food allergy (p = 0.05), drug allergy (p = 0.005), or positive skin test result to cat and/or dog (p = 0.01). In addition, patients who were receiving SCIT to cat and/or dog (p = 0.004) or to dust mite (p = 0.03) were more likely to have an SR. Conclusion: In our patient population, the majority of SRs to SCIT occurred in female patients, patients with a history of drug or food allergies, and those who were receiving pet or dust-mite SCIT.

RECURRENT APHTHOUS STOMATITIS RELATED TO PSYCHOLOGICAL STRESS, FOOD ALLERGY AND GERD

Background: Recurrent Aphthous Stomatitis (RAS) is inflammation in oral mucosa characterized by recurrent single or multiple ulcers that usually affected in non keratinized mucosa. Etiology RAS is unknown but psychological stress, allergy, and gastrointestinal disease can be predisposing factors Case Management: A 23rd years old complained recurrent oral ulcer with free ulcer period for 3-5 days. The patient had a history of food allergy, GERD and psychological stress. Intraoral examination showed recurrent multiple ulcers in variation site of the mouth. DASS 42 screening showed high stress and high anxiety. Skin Prick Test showed positive allergy to kapok, beef, chicken, cow milk, white egg, duck egg, shrimp, cob fish, milkfish, chocolate, and peanut. Ulcers treated with nonsteroid antiinflammation Aloe Vera gel and stress management by reading assignment method.Discussion: Psychological stress altered the immune system so oral mucosa prone to inflammation, and make the history of GERD getting worse. Stress causes cortisol secretion that changes the imbalance of proinflammatory and antiinflammatory cytokines. Oral mucosa becomes more susceptible to hypersensitivity. In addition, stress decreased oral and esophageal mucosa resistance to GERDConclusion: RAS triggered by psychological stress, allergy, and GERD. Treatment of RAS is by elimination predisposing factors to prevent recurrence.

Dietary risk factors for childhood asthma in a semi-urban area of South India: A cross-sectional study

Background: Although inhaled allergens are more likely to trigger asthma than food allergens, global trends of asthma prevalence emphasize the role of changing dietary habits in modulating the inflammatory mediators involved in the pathogenesis of asthma. Objective: The objective of the study was to identify the dietary risk factors associated with childhood asthma in a semi-urban region of South India. Materials and Methods: This was a cross-sectional study done at a medical college hospital in South India from October 2016 to January 2017. After obtaining the Ethical Committee approval, children aged 3–15 years attending the pediatric outpatient department were enrolled in the study. Parents were interviewed with a precoded Food Frequency Questionnaire. Details regarding common dietary practices followed at home, frequency of consumption of specific food groups and history of food allergy were obtained. Chi-square tests and logistic regression analysis were used to analyze the data. Results: Among 500 subjects, 293 (58.6%) children had physician-diagnosed asthma. Duration of breastfeeding was <1 year (OR 2.01, 95% CI 1.35–2.99); frequent intake of fast food (OR 2.70, 95% CI 1.61–4.52), usage of coloring agents and taste enhancers in cooking (OR 3.93, 95% CI 1.53–10.06), and history of allergy to specific foods (OR 2.21, 95% CI 1.42–3.45) were found to be independent risk factors for childhood asthma. The absence of fish in the diet was significantly associated with increased risk of asthma (OR 1.50, 1.04–2.15) and non-vegetarians were at lesser risk (OR 0.43, 0.24–0.76) of developing asthma. Conclusion: Prolonged duration of breastfeeding (>1 year), restriction of fast food, and avoidance of food additives decrease the risk of asthma in children. Non-vegetarian diet with the inclusion of fish offers a protective effect against asthma. Early identification and appropriate management of coexisting food allergies in children with asthma are necessary.

Propofol use in children with allergies to egg, peanut, soybean or other legumes.

Propofol is the most commonly administered intravenous agent for anaesthesia in children. However, there are concerns that the emulsified preparation may not be safe in children with an allergy to egg, peanut, soybean or other legumes. We conducted a retrospective study of children with immunologically confirmed egg, peanut, soybean or legume allergy and who underwent general anaesthesia at Princess Margaret Hospital for Children between 2005 and 2015. We extracted details regarding allergy diagnosis, each anaesthetic administered and any adverse events or signs of an allergic reaction in the peri-operative period. A convenience sample of patients without any known food allergies was identified from our prospective anaesthesia research database and acted as a control group. We identified 304 food-allergic children and 649 procedures where propofol was administered. Of these, 201 (66%) had an egg allergy, 226 (74%) had a peanut allergy, 28 (9%) had a soybean allergy and 12 (4%) had a legume allergy. These were compared with 892 allergy-free patients who were exposed to propofol. In 10 (3%) allergy patients and 124 (14%) allergy-free patients, criteria for a possible allergic reaction were met. In nine of the food-allergic children and in all the controls valid non-allergic explanations for the clinical symptoms were found. One likely mild allergic reaction was experienced by a child with a previous history of intralipid allergy. We conclude that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.

Anaphylaxis admissions in pediatric intensive care units: Follow-up and risk of recurrence.

Data about the risk of anaphylaxis recurrence in children are lacking. We assessed anaphylaxis recurrence and medical follow-up in a cohort of children previously hospitalized in a French pediatric intensive care unit (PICU) for anaphylaxis. We conducted a telephone survey of 166 children (≤18years) hospitalized from 2003 to 2013. In all, 106 (64%) completed the survey (boys, 59%; mean age [SD]: 15.3years [5.5]). The main index triggers were drugs (45%) and foods (37%). The mean duration follow-up was of 7.7years (SD: 2.4). Thirty-eight (36%) children experienced 399 new allergic reactions during a follow-up period of 282 patient-years (incidence rate: 1.4/100patients/y; 95% CI: 0.64-2.04). Twelve children experienced 19 anaphylaxis reactions including five requiring PICU admission (anaphylaxis recurrence rate: 0.20/100patients/y; 95% CI non-calculable). Food was the trigger for 79% of recurrent reactions and drugs for 8%. The food trigger was previously known in 83%, the same as the index trigger in 69%. Overall, 1.5% of the recurrent reactions were treated with adrenaline injection and 8% an emergency hospital admission. Patients with recurrence had more likely a history of food allergy (P<10-4 ), asthma (P<0.005), atopic dermatitis (P<0.05) than those without. 31% of the 50 children with food allergy did not see an allergist, 23% had no adrenaline auto-injector, and 26% lacked a school individual healthcare plan. Following a PICU admission for anaphylaxis, recurrence is high in children with food allergy compared with drug allergy. Allergic comorbidities increase the risk. Medical follow-up has to be improved for these at-risk children.

Issue Highlights

Issue Highlights

Children with avoidant/restrictive food intake disorder and anorexia nervosa in a tertiary care pediatric eating disorder program: A comparative study.

The purpose of this study was to examine the medical and psychological characteristics of children under the age of 13 years with avoidant restrictive food intake disorder (ARFID) and anorexia nervosa (AN) from a Canadian tertiary care pediatric eating disorders program. Participants included 106 children assessed between 2013 and 2017 using the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5). Data were collected through clinical interviews, psychometric questionnaires, and chart review. Information collected included medical variables (e.g., weight, heart rate, need for inpatient admission, and duration of illness from symptom onset); medical comorbidities (e.g., history of food allergies, infection, and abdominal pain preceding the eating disorder); and psychological variables (e.g., psychiatric comorbidity, self-reported depression and anxiety, and eating disorder related behaviors and cognitions). Children with ARFID had a longer length of illness, while those with AN had lower heart rates and were more likely to be admitted as inpatients. Children with ARFID had a history of abdominal pain and infections preceding their diagnoses and were more likely to be diagnosed with a comorbid anxiety disorder. Children with AN had a higher drive for thinness, lower self-esteem, and scored higher on depression. This is the first study to look at DSM-5 diagnosis at assessment and include psychometric and interview data with younger children with AN and ARFID. Understanding the medical and psychological profiles of children with AN and ARFID can result in a more timely and accurate diagnosis of eating disorders in younger children.

A Retrospective Study On High Risk Factors For The Development of Peanut Allergy

The Learning Early about Peanut Allergy (LEAP) trial demonstrated that early introduction of peanut products in high risk infants decreases the risk of peanut allergy by 5 years of age. High risk patients were defined as infants with severe eczema, and or egg allergy. In our study, we aimed to identify other high risk factors associated with the development of peanut allergy and thereby additional patient populations who may benefit from early introduction of peanut products. A retrospective chart review was performed on 103 patients ages 0-3 years old with either positive (≥3mm) skin test to peanuts or serum peanut immunoglobulin E (IgE) level greater than or equal to 1.0 kU/L. Clinical data from this subset of patients was analyzed for additional risk factors (i.e. other food allergies, family history of food allergy, parental asthma, etc.) that could lead to the development of peanut allergy using logistic regression analysis. Parental asthma was found to be significantly associated with an increased risk of peanut allergy in the child (p=0.0359, OR 2.743). Other concurrent food allergy to soy was also associated with a propensity for peanut allergy (p-value 0.0150, OR 6.344). Patients with food allergy to soy or parental asthma should be further investigated as potential identifiers of patients at high risk of developing a peanut allergy.

Dietary supplements: a great menace of our time or golden remedy? A cross-sectional study amongschool-aged children.

IntroductionDietary supplements (DS) are commonly used as a remedy for various health issues as they are widely advertised and available.AimThis study aimed to evaluate the prevalence of DS use among school-aged children in Warsaw, the capital city of Poland. Additionally, we evaluated the parents’ motivations for DS administration, the frequency of the use of specific compounds and the influence of child’s history of allergy on DS use.Material and methodsChildren aged 6–7 years who attended the first grade of primary schools in Warsaw were included into the study. Forty-two out of 170 primary schools in Warsaw were randomly selected of which 38 agreed to participate. The research tool was a self-administered questionnaire.ResultsHalf of the studied children received DS in the previous 6 months. Fatty acids were the most commonly administered DS (49.8%). The most common reason for administering DS was prevention of diseases (69.1%). The total household income correlated positively with the DS use. History of food allergy was one of the factors which increased the risk of DS use, whereas diagnosis of asthma did not correlate with a higher frequency of DS use.ConclusionsThis study shows the need to educate patients about medical indications for DS use and expected benefits in the specific indications.

The Consortium for Food Allergy Research (CoFAR): The first generation

The Consortium for Food Allergy Research (CoFAR) was established by the National Institute of Allergy and Infectious Diseases in 2005 as a collaborative research program bringing together centers focused on the study of food allergy. CoFAR was charged with developing studies to better understand the pathogenesis and natural history of food allergy, as well as potential approaches to the treatment of food allergy. In its first iteration an observational study of infants with milk and egg allergy was established, and studies of oral immunotherapy for egg allergy and sublingual immunotherapy for peanut allergy were initiated, as was a phase 1 study of a recombinant peanut protein vaccine. CoFAR was renewed in 2010 for an additional 5-year period during which the initial observational study was continued, a study of eosinophilic esophagitis was initiated, and new therapeutic trials were established to study epicutaneous immunotherapy for peanut allergy and to compare the safety and efficacy of egg oral immunotherapy to the ingestion of baked egg for the treatment of egg allergy. The results of these efforts will be reviewed in this rostrum, with a brief look to the future of CoFAR.

Predictive value of the number of adverse reaction episodes for the IgE-mediated food allergy diagnosis

Introduction and objectivesThe reproducibility of the adverse reaction increases the suggestiveness of a history of food allergy. However, the positive predictive value (PPV) of multiple adverse reaction episodes for the diagnosis of IgE-mediated food allergy is not known. This evaluation was the objective of our study. Patients and methodsWe retrospectively studied 180 children with a history of non-anaphylactic adverse reactions after the ingestion of a food. All children had the prick test positive for the offending food and performed the oral food challenge (OFC) within 12 months after the last adverse reaction episode (ARE). We have evaluated whether increasing the number of ARE increased the probability that the OFC would be positive (failed). Results93 patients (52%) presented one ARE, 49 (27%) presented two ARE, 24 (13%) presented three ARE, 14 (8%) patients presented≥four ARE. The OFC was positive in 94/180 (52%). The outcome of the OFC was found to be positively correlated with the number of ARE (OR=1.56; 95% CI=1.16–2.09; p=0.003). A PPV=100% was observed with a number of ARE≥five. ConclusionsThe number of ARE is an important predictor of the diagnosis of food allergy, although less than we would have imagined. The number of ARE could be used to increase the predictability of the diagnostic tests currently in use, to define clinical prediction rules alternative to OFC and easy to use in clinical practice.

Prevalence, Characteristics, and Outcome of Cow's Milk Protein Allergy in Chinese Infants: A Population-Based Survey.

Cow's milk protein allergy (CMPA) is commonly seen in children. There have been no reports of the true prevalence of CMPA in Chinese infants. The aim of this population-based study is to determine the prevalence, clinical characteristics, and outcome of CMPA in Chinese infants. We carried out a prospective survey in 7 participating hospitals throughout southern China. We included infants ≤12 months of age during the survey. For those suspected of CMPA, oral food challenge with cow's milk protein (CMP) was performed. A follow-up telephone interview was conducted at 12 months after the diagnosis to assess the clinical outcome of CMPA. A total of 9910 questionnaire surveys were distributed and 7364 (74.3%) were returned. The eligible survey number of surveys was 6768 (91.9%). A total of 182 infants was confirmed with CMPA, including 13 with anaphylactic reactions, 28 with clinical symptoms and serum immunoglobulin E (sIgE) >3.5 IU/mL, and 141 with positive CMP challenge test. The prevalence of CMPA was 2.69%. Infants with confirmed CMPA had significantly stronger family history of either 1 or both parents with food allergy, higher Cesarean section rate, and lower rate of breastfeeding, compared with those without CMPA. At 12-month telephone follow-up of 176 CMPA infants, 136 infants (77.3%) had become tolerant to CMP. The prevalence of CMPA was 2.69%. CMPA infants had a strong family history of food allergy and atopy. Both Cesarean delivery and formula feeding were risk factors for CMPA. At 12-month follow-up, the majority of CMPA infants had become tolerant to CMP.

Food Allergies

Food allergy represents a rapidly growing public health problem in the United States and other westernized nations. Adverse reactions to foods are categorized as either immunologic or nonimmunologic reactions. This distinction is highly important but often confusing to patients and physicians unfamiliar with allergy, who may simply describe any adverse reaction to a food as an “allergy.” A food allergy is an immune-mediated, adverse reaction to one or more protein allergens in a particular food item involving recognition of that protein by specifically targeted IgE or allergen-specific T cells. This chapter discusses the definition, pathophysiology, epidemiology, testing, management, prognosis, and natural history of food allergy. Clinical manifestations are systematically covered, including cutaneous, respiratory, cardiovascular, and gastrointestinal reactions, as well as eosinophilic esophagitis, food protein–induced enterocolitis syndrome, and oral allergy syndrome. Emerging treatments such as food oral immunotherapy are also reviewed. Tables outline signs and symptoms of immediate hypersensitivity reactions to food, the prevalence of major food allergens in the United States, common patterns of cross-reactivity among foods, clinical criteria for the diagnosis of anaphylaxis, and clinical studies involving treatment for food allergies. Figures illustrate the classification of adverse reactions to food, esophageal histology, visual and radiographic features of eosinophilic esophagitis, and a food allergy action plan. This review contains 4 figures, 8 tables, and 64 references. KeyWords: Food allergy, Hypersensitivity, IgE-mediated allergy, Eosinophilic esophagitis, Anaphylaxis

Food Allergies

Food allergy represents a rapidly growing public health problem in the United States and other westernized nations. Adverse reactions to foods are categorized as either immunologic or nonimmunologic reactions. This distinction is highly important but often confusing to patients and physicians unfamiliar with allergy, who may simply describe any adverse reaction to a food as an “allergy.” A food allergy is an immune-mediated, adverse reaction to one or more protein allergens in a particular food item involving recognition of that protein by specifically targeted IgE or allergen-specific T cells. This chapter discusses the definition, pathophysiology, epidemiology, testing, management, prognosis, and natural history of food allergy. Clinical manifestations are systematically covered, including cutaneous, respiratory, cardiovascular, and gastrointestinal reactions, as well as eosinophilic esophagitis, food protein–induced enterocolitis syndrome, and oral allergy syndrome. Emerging treatments such as food oral immunotherapy are also reviewed. Tables outline signs and symptoms of immediate hypersensitivity reactions to food, the prevalence of major food allergens in the United States, common patterns of cross-reactivity among foods, clinical criteria for the diagnosis of anaphylaxis, and clinical studies involving treatment for food allergies. Figures illustrate the classification of adverse reactions to food, esophageal histology, visual and radiographic features of eosinophilic esophagitis, and a food allergy action plan. This review contains 4 figures, 8 tables, and 64 references. KeyWords: Food allergy, Hypersensitivity, IgE-mediated allergy, Eosinophilic esophagitis, Anaphylaxis

EOSINOPHILIC CYSTITIS AND PARASITIC INFECTION

Introduction Eosinophilic cystitis is a rare condition characterized by eosinophilic inflammation of the bladder with few documented pediatric cases. The mechanism of disease remains unclear, although it has been associated with various disorders such as allergic diseases, malignancy, trauma, and infection. Treatment regimens are non-standardized and have included antihistamines, leukotriene antagonists, antimicrobials, steroids, and anti-inflammatory agents. Case Description A 12-year-old African American male with history of food allergy and allergic rhinitis presented to urology due to persistent hematuria and dysuria. Cystouretheroscopy with biopsy demonstrated evidence of eosinophilic cystitis. He denied use of any medications or history of international travel. CBC revealed a normal AEC of 388 cells/µL; however, he was noted to have eosinophilia to 1670 cells/µL on CBC performed four years prior. He was initially treated with phenazopyridine, oxybutynin, and cetirizine. Montelukast and ibuprofen were added for refractory symptoms. Due to consideration for immunosuppressive steroid therapy, stool O&P, Strongyloides, Trichinella, Toxocara serologies, and GI PCR panel were sent to exclude parasitic infection. Strongyloides IgG and Clostridium difficile toxin were positive. He was treated with ivermectin and metronidazole for latent Strongyloides infection and C. difficile colitis, respectively, and demonstrated interval clinical improvement. Discussion To the authors’ knowledge, this is the first case of eosinophilic cystitis associated with Strongyloides stercoralis infection. A high index of suspicion for parasitic infection in patients with eosinophilic cystitis must be maintained regardless of exposure history or peripheral eosinophil counts as chronic infection may be asymptomatic. Initiation of steroid therapy without confirming negative testing may result in life-threatening, disseminated strongyloidiasis.

THE PREVALENCE OF ECZEMA IN CHILDREN WITH FOOD ALLERGY

Introduction Eczema is the most common atopic condition estimated to affect 13% of US children. Due to the known association between food allergy (FA) and eczema, FA prevention efforts often focus on young children (0-4 years) with eczema. The objective of this study is to further evaluate risk factors for the development of FA in a large population-based sample, specifically in young children. Methods A randomized, cross sectional questionnaire was administered between October 2015 and September 2016, resulting in parent-proxy data for 38,408 children. Weighted proportions and multiple logistic regression models were used to systematically compare participant characteristics and estimate their adjusted effects on allergic disease risk among the US population. Results Among US children with FA, 17.8% report having eczema. In young children eczema is present in 22.9% with peanut allergy, 35.3%with egg allergy, 21.0% with milk allergy, 24.5% with tree nut allergy, and 48.3% with wheat allergy. In those with FA and eczema, 43.8% report developing asthma and 44.8% report developing allergic rhinitis. Of young food allergic children, 40.4% have parental history of eczema, 36.4% have parental history of asthma, 63.1% have parental history of environmental allergy, and 60.9% have parental history of FA. Conclusions While eczema continues to have a strong association with the development of FA, parental history of atopy is another strong predictor. Including children with parental history of atopy may create a better target group for future FA prevention strategies.

Oral food challenge failures among foods restricted because of atopic dermatitis

BackgroundRecent studies have suggested that removing foods from the diet to manage atopic dermatitis (AD), based on positive allergy test results, may lead to immediate allergic reactions on reintroduction of that food. ObjectiveTo examine the frequency of oral food challenge (OFC) failures among foods removed from the diet as suspected AD triggers, focusing on the 5 major food allergens in the United States. MethodsOFCs to egg, milk, peanut, soy, and wheat, performed from 2008 to 2014, at a children's hospital's allergy clinics, were reviewed. OFCs were offered based on history and laboratory values. Reasons for food avoidance were classified as food allergy (IgE-mediated reaction occurring within 2 hours); sensitization only (lack of introduction because of positive test results); and removal because of test results during AD evaluation. ResultsThere were 442 OFCs performed, with 89 failures (20.1%). Reasons for OFCs included a history of food allergy (320 of 442 [72.4%]), food sensitization without any introduction (77 of 442 [17.4%]), and AD (45 of 442 [10.2%]). OFC failures among those who had food allergy (70 of 320 [21.9%]), sensitization only (13 of 77 [16.9%]), and suspected AD trigger (6 of 45 [13.3%]) did not significantly differ (P = .63). Wheat was more likely to be avoided than the other 4 foods for AD concerns (P < .001). ConclusionThe frequency of OFC failure among those who removed foods suspected as AD triggers was 13.3%, indicating a loss of tolerance. Restriction of foods to manage AD must be done with caution and close monitoring.

Food-induced anaphylaxis in infants and children

BackgroundRecent recommendations to introduce peanut products to infants for peanut allergy prevention requires a focused assessment of infant anaphylaxis. ObjectiveThis study describes the symptomatology of food-induced anaphylaxis (FIA) in infants (<12 months) compared with older pediatric cohorts. MethodsRetrospective review between June 2015 and June 2017 of children presenting with FIA at a large urban children's hospital emergency department (ED). ResultsA total of 357 cases of FIA were evaluated: 47 in infants (<12 months), 43 in toddlers (12-24 months), 96 in young children (2-6 years), and 171 in school-aged children (>6 years). Infants presented with gastrointestinal (GI) involvement more frequently than any other age group (89% vs 63% [P = .003], 60% [P < .001], and 58% [P < .001]). Additionally, infants and young children presented with skin involvement more frequently than school-aged children (94% and 91% vs 62% [P < .001]). Respiratory symptoms were more common in older cohorts (17% in infants vs 44% in young children [P < .001] and 54% in school-aged children [P < .001]). Egg and cow's milk were more common causes of FIA in infants compared with school-aged children (egg, 38% vs 1% [P < .001]; milk, 17% vs 7% [P = .03]). Only 21% of infants with FIA had eczema, and 36% had a history of food allergy. ConclusionInfants with FIA primarily presented with GI and skin manifestations. Egg was the most common food trigger in infants. Most infants with FIA did not have eczema or a history of food allergy.

Food allergy guidance in the United States military: A work group report from the American Academy of Allergy, Asthma & Immunology's Military Allergy and Immunology Assembly

A diagnosis of food allergy adversely affects one's ability to join or remain in the military. Inadequate knowledge or misconceptions of current military-specific standards regarding food allergy and how these apply to enlistment, induction, and retention in the US military can lead potentially to inaccurate counseling because each military service has specific regulations that affect the evaluation and decision-making process. Recognizing this knowledge gap, the American Academy of Allergy, Asthma & Immunology's Military Allergy and Immunology Assembly established a work group that reviewed and summarized all aspects of military instructions, policies, and regulations regarding IgE-mediated food allergy. Aflowchart was developed outlining each step of the military entry process for an applicant with a history of food allergy. Furthermore, summary tables were made to provide improved "fluency" regarding each service's medical regulations, whereas key considerations were outlined for the allergist who is evaluating a subject who is seeking military entry or retention. Both civilian and military allergists play an essential role in the evaluation, counseling, and management of patients with a food allergy history. Understanding the service-specific language and regulations regarding food allergy will improve the allergist's awareness, counseling, and management of these individuals.

Skin prick test analysis reveals cross-sensitization to tomato profilin and grass pollen in nasobronchialallergic patients with history of tomato food allergy.

The association between grass pollen sensitization and food allergy to tomato is of great interest. We report here, the first such study in Indian population. We investigated 246 allergic rhinitis / asthma patients by diagnostic case history and skin prick test (SPT); grass pollen mix, tomato extract and purified tomato profilin were used for SPT. Tomato profilin was purified by affinity chromatography, and analyzed by HPLC (95% purity) and SDS-PAGE (14 kDa). We observed that 38% of the patients had sensitization to both grass pollen and tomato fruit, of which 92% were sensitized to tomato profilin. Among patients with a history of food allergy to tomato fruit, the association was more pronounced (66%). Tomato profilin appears to be an important cross-sensitizing panallergen in respiratory allergic patients in the Indian subcontinent.