History Of Food Allergy Research Articles

Food allergy and atopic dermatitis: Prediction, progression, and prevention.

The rising burden of allergic diseases in childhood requires a compelling need to identify individuals at risk for atopy very early in life or even predict the onset of food allergy and atopic dermatitis since pregnancy. The development and clinical phenotypes of atopic diseases in childhood depend on a complex interaction between genetic and environmental factors, such as allergen exposure, air pollution, and infections. Preventive strategies may include avoidance measures, diet supplements, and early complementary food introduction. Overall, the management of allergic diseases has been improving to date toward a patient's tailored approach. This review will cover the current understanding of risk factors, prediction, and management of food allergy and atopic dermatitis in childhood and discuss how these may contribute to the modification of the natural history of food allergy and atopic dermatitis.

Pollen-food allergy syndrome is a common allergic comorbidity in adults with eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is associated with atopic diseases including asthma, allergic rhinitis, and atopic dermatitis; however, limited data exist on the correlation between pollen-food allergy syndrome (PFAS) and EoE. We analyzed 346 adults with EoE treated at a single center between 2002 and 2016. Demographic and EoE-specific data including clinical features and measures of EoE disease severity and treatments were collected. The presence of other atopic diseases, family history, prevalence of peripheral eosinophilia and elevated IgE, and details of PFAS triggers were collected. Twenty six percent of the 346 subjects in our cohort had both EoE and PFAS (EoE-PFAS). Compared to subjects with EoE alone, subjects with EoE-PFAS had an increased frequency of allergic rhinitis (86.7% vs. 64.2%, P<0.001) and family history of allergies (71.1% vs. 53.3%, P=0.003), and comprised a higher proportion of EoE diagnoses made in the spring (Χ2<0.001). 43.3% of subjects with concurrent EoE and PFAS opted for treatment with elimination diet, and these measures failed to induce remission in 46.2% of cases. In most cases, elimination diet failed despite strict avoidance of PFAS trigger foods in addition to common EoE triggers including dairy, wheat, and eggs. EoE-PFAS was also associated with higher serum IgE at the time of EoE diagnosis (460.6 vs. 289.9, P<0.019). Allergic rhinitis and a family history of food allergy were independently associated with having EoE-PFAS. The most common triggers of PFAS in adults with EoE are apples (21.1%), carrots (15.5%), and peaches (15.5%). Along with asthma, allergic rhinitis and atopic dermatitis, PFAS is a common allergic comorbidity that is highly associated with EoE. Further studies aimed at understanding mechanistic similarities and differences of PFAS and EoE may shed light on the pathogenesis of these closely related food allergy syndromes.

What is new in managing patients with food allergy? Almost everything.

This review aims to describe current concepts in managing patients with food allergy. There have been many recent advances in the management of patients with IgE-mediated reactions to food, including diagnosis, prevention, management, and ongoing research in the field. Food allergy is increasing in prevalence and may be life threatening. This review aims to highlight changes in recommended practice when diagnosing and managing patients with food allergy. Early introduction of highly allergenic foods, particularly peanut, has been shown to decrease the risk for development of food allergy in patients who are at elevated risk. Avoidance of foods without a clinical history of food allergy may increase the risk of subsequent allergy. Epinephrine remains the first line therapy for anaphylaxis, and patients and families need to be instructed on indications and technique for use. Promising research is ongoing in areas of immunotherapy to food allergens. Food allergy is a potentially life-threatening condition that may persist throughout adulthood. Practitioners should be aware of changes to recommendations for the diagnosis, prevention, and management of patients with food allergy.

Eosinophilic Gastroenteritis: More Common Than we Think and Perhaps Ominous in Women

Introduction: Eosinophilic gastroenteritis is thought to be a rare condition, and the largest series has included only 51 patients over > 20 years from the Mayo Clinic, a tertiary referral center. We present a series of 50 patients with eosinophilic gastroenteritis from the private practice of 1 community based gastroenterologist over 17 years. We focus this report primarily on the 18 women in our series and their natural history' as women are thought to be more susceptible to autoimmunity and less susceptible to allergy. Methods: Eosinophilic gastroenteritis was defined on the basis of more than 30 eosinophils/hpf in biopsies of stomach or duodenum. Patients with eosinophilic colitis were not included. Charts were reviewed for clinical and demographic characteristics and natural history. Results: Demographic and clinical characteristics of the 18 women are provided in table 1. Only 1 of the 18 women demonstrated helicobacter pylori on gastric biopsies. 3 women had co existing eosinophilic esophagitis and 2 of these women also had increased eosinophils in the stomach and duodenum and clear history of food allergies and allergic rhinitis. The other woman with co existing Eosinophilic Esophagitis had breast cancer and had prior radiation to the breast. 5 women had increased eosinophils in duodenum and 2 of these had peripheral polyneuropathy. 13 women had eosinophilic gastritis only. Using the date of diagnosis of eosinophilic gastritis as the baseline, 1 woman developed acute myelogenous leukemia 2 years after diagnosis, 1 woman died of sphlanchnic thrombosis due to anti phospholipid antibody syndrome 1 years after diagnosis, 1 woman developed SLE and total alopecia 4 years after diagnosis, and 1 woman (who had daughter and 2 granddaughters with crohn's ileo colitis) developed pancreatic cancer 4 years after diagnosis. 1 other woman died of 2 weeks after diagnosis of uncertain cause. Only 4 women required treatment with a brief tapering course of steroids and in each case only once. Conclusion: Eosinophilic gastroenteritis is uncommon but not rare and seems to be inversely related to H Pylori. EosGE seems to rarely require steroid therapy. Eosinophilic gastritis but not enteritis in women may be a harbinger of future malignancy or autoimmune diseases.Figure: Endoscopic Eosinophilic Gastroenteritis.Table: Table. Eosinophilic Gastroenteritis DemographicsTable: Table. Patient Characteristics

Food allergen extracts to diagnose food-induced allergic diseases: How they are made

ObjectiveTo review the manufacturing procedures of food allergen extracts and applicable regulatory requirements from government agencies, potential approaches to standardization, and clinical application of these products. The effects of thermal processing on allergenicity of common food allergens are also considered. Data SourcesA broad literature review was conducted on the natural history of food allergy, the manufacture of allergen extracts, and the allergenicity of heated food. Regulations, guidance documents, and pharmacopoeias related to food allergen extracts from the United States and Europe were also reviewed. Study SelectionsAuthoritative and peer-reviewed research articles relevant to the topic were chosen for review. Selected regulations and guidance documents are current and relevant to food allergen extracts. ResultsPreparation of a food allergen extract may require careful selection and identification of source materials, grinding, defatting, extraction, clarification, sterilization, and product testing. Although extractions for all products licensed in the United States are performed using raw source materials, many foods are not consumed in their raw form. Heating foods may change their allergenicity, and doing so before extraction may change their allergenicity and the composition of the final product. ConclusionThe manufacture of food allergen extracts requires many considerations to achieve the maximal quality of the final product. Allergen extracts for a select number of foods may be inconsistent between manufacturers or unreliable in a clinical setting, indicating a potential area for future improvement.

Tu1126 - Pollen-Food Allergy Syndrome is a Common Allergic Comorbidity in Adults with Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is associated with atopic diseases including asthma, allergic rhinitis, and atopic dermatitis; however, limited data exist on the correlation between pollen-food allergy syndrome (PFAS) and EoE. We analyzed 346 adults with EoE treated at a single center between 2002 and 2016. Demographic and EoE-specific data including clinical features and measures of EoE disease severity and treatments were collected. The presence of other atopic diseases, family history, prevalence of peripheral eosinophilia and elevated IgE, and details of PFAS triggers were collected. Twenty six percent of the 346 subjects in our cohort had both EoE and PFAS (EoE-PFAS). Compared to subjects with EoE alone, subjects with EoE-PFAS had an increased frequency of allergic rhinitis (86.7% vs. 64.2%, P < 0.001) and family history of allergies (71.1% vs. 53.3%, P = 0.003), and comprised a higher proportion of EoE diagnoses made in the spring (Χ2 < 0.001). 43.3% of subjects with concurrent EoE and PFAS opted for treatment with elimination diet, and these measures failed to induce remission in 46.2% of cases. In most cases, elimination diet failed despite strict avoidance of PFAS trigger foods in addition to common EoE triggers including dairy, wheat, and eggs. EoE-PFAS was also associated with higher serum IgE at the time of EoE diagnosis (460.6 vs. 289.9, P < 0.019). Allergic rhinitis and a family history of food allergy were independently associated with having EoE-PFAS. The most common triggers of PFAS in adults with EoE are apples (21.1%), carrots (15.5%), and peaches (15.5%). Along with asthma, allergic rhinitis and atopic dermatitis, PFAS is a common allergic comorbidity that is highly associated with EoE. Further studies aimed at understanding mechanistic similarities and differences of PFAS and EoE may shed light on the pathogenesis of these closely related food allergy syndromes.

Prognostic accuracy of clinical signs and diagnostic tests in cow's milk allergy in newborns

The aim of the study was to explore the correlation between clinical signs and confirmatory tests for cow's milk allergy (CMA) in the neonatal period and their relation to family history and the occurrence of food allergies in the postneonatal period. The medical documentation of 361 newborns with suspected CMA and exclusion of other comorbidities was analyzed. The correlations between clinical signs and methods to confirm CMA [elevated levels of total immunoglobulin E (IgE) and/or specific IgE for cow's milk, improvement after the introduction of a cow's milk-free diet and positive challenge procedure] were studied. In 90 children, the data were additionally analyzed in relation to outcome (at the age of 1-11years), evaluated by questionnaires, which inquired about signs and symptoms of food allergy, methods of CMA confirmation, and the presence of other food allergies. There was a positive correlation between exanthema and confirmed CMA in the neonatal period (R=0.184; p=<0.001; n=361), and hematochezia and confirmed CMA in the neonatal (R=0.203; p<0.001; n=361) and postneonatal period (R=0.215; p=0.042; n=90). Additional food allergies in the postneonatal period were positively correlated with neonatal CMA (R=0.275; p=0.009; n=90). No correlation was found between a positive family history of food allergies and CMA in the neonatal (R=-0.66; p=0.398; n=165) and postneonatal periods (R=0.00; p=1.000; n=116). Neonatal exanthema and hematochezia were the predominant clinical signs in neonates with CMA. Allergies to other food allergens appeared more frequently in children with CMA in the neonatal period. Neonatal CMA did not occur more frequently in families with food allergies.

Perioperative considerations for the food-allergic pediatric patient.

Patients with a history of food allergy and food intolerance are common in the pediatric population and are encountered frequently in the perioperative setting by pediatric anesthesiologists. Perioperatively, food allergy can present on a spectrum ranging from minor acute urticaria to more severe hypovolemia and anaphylactic shock. Allergy to foods including fruits, fish, egg, soy, and peanut are most concerning for their potential to cross-react with perioperative medications. There is little in the anesthesia literature that focuses on the perioperative management of children with food allergies. This educational review will provide a brief overview of classic immunoglobulin E (IgE)-mediated food allergies, less common non-IgE food allergies, and present perioperative considerations for these patients. An audio summary of this topic is included as Supplementary Audio S1.

Effect of atopic dermatitis on the natural course of food allergy in infants and young children

Purpose: There have been studies showing that food allergy plays a role in the pathogenesis of atopic dermatitis. However, there have been few studies about the effect of atopic dermatitis on remission of food allergy. Thus, this study aimed to evaluate the dif-ference in remission according to the presence of atopic dermatitis in infants and young children with milk or egg allergy. Methods: A retrospective study was performed on 109 infants and young children with IgE-mediated food allergy in a tertiary hos-pital. They divided into food allergy with atopic dermatitis (FA with AD) and without atopic dermatitis (FA without AD). Results: In the milk allergy group, initial milk-specific IgE levels were 21.16±27.98 kUA/L and 11.36±22.88 kUA/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of milk allergy at 36 months of age were 64.9% and 90.0%, respectively, in FA with AD and FA without AD. In the egg allergy groups, initial egg-specific IgE levels were 34.48±36.72 kUA/L and 15.66±28.60 kUA/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of egg allergy at 36 months of age were 61.2% and 90.0% in children with FA with AD and FA without AD. Conclusion: Atopic dermatitis may play an important role in the natural history of food allergy in infants. Different strategies are needed for the management of food allergy in young children with atopic dermatitis. (Allergy Asthma Respir Dis 2017;5:256-261)

Matthew Smith. Another Person’s Poison: A History of Food Allergy. (Arts and Traditions of the Table: Perspectives on Culinary History.) xii + 290 pp., bibl., index. New York: Columbia University Press, 2015. $29.95 (cloth).

Previous articleNext article No AccessMatthew Smith. Another Person’s Poison: A History of Food Allergy. (Arts and Traditions of the Table: Perspectives on Culinary History.) xii + 290 pp., bibl., index. New York: Columbia University Press, 2015. $29.95 (cloth).Rachel A. AnkenyRachel A. Ankeny Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Isis Volume 107, Number 4December 2016 Publication of the History of Science Society Article DOIhttps://doi.org/10.1086/689795 Views: 36Total views on this site Citations: 1Citations are reported from Crossref © 2016 by The History of Science Society. All rights reserved.PDF download Crossref reports the following articles citing this article: Current Bibliography of the History of Science and Its Cultural Influences, 2016, Isis 107, no.S1S1 (Jun 2017): i–240.https://doi.org/10.1086/692972

A new framework for the documentation and interpretation of oral food challenges in population-based and clinical research.

BackgroundThe conduct of oral food challenges as the preferred diagnostic standard for food allergy (FA) was harmonized over the last years. However, documentation and interpretation of challenge results, particularly in research settings, are not sufficiently standardized to allow valid comparisons between studies. Our aim was to develop a diagnostic toolbox to capture and report clinical observations in double‐blind placebo‐controlled food challenges (DBPCFC).MethodsA group of experienced allergists, paediatricians, dieticians, epidemiologists and data managers developed generic case report forms and standard operating procedures for DBPCFCs and piloted them in three clinical centres. The follow‐up of the EuroPrevall/iFAAM birth cohort and other iFAAM work packages applied these methods.RecommendationsA set of newly developed questionnaire or interview items capture the history of FA. Together with sensitization status, this forms the basis for the decision to perform a DBPCFC, following a standardized decision algorithm. A generic form including details about severity and timing captures signs and symptoms observed during or after the procedures. In contrast to the commonly used dichotomous outcome FA vs no FA, the allergy status is interpreted in multiple categories to reflect the complexity of clinical decision‐making.ConclusionThe proposed toolbox sets a standard for improved documentation and harmonized interpretation of DBPCFCs. By a detailed documentation and common terminology for communicating outcomes, these tools hope to reduce the influence of subjective judgment of supervising physicians. All forms are publicly available for further evolution and free use in clinical and research settings.

Prevalence of sensitization to food allergens and challenge proven food allergy in patients visiting allergy centers in Rawalpindi and Islamabad, Pakistan.

In this study, we estimated the prevalence of food allergy in the adult allergic patients of Rawalpindi and Islamabad , Pakistan, based on self-report, skin prick test (SPT) and oral food challenge test (OFC). SPT was used for the estimation of sensitization to wheat, egg, milk, beef, chicken, mutton, fish, corn, lentils, rice, soya, peanut and banana. Among 689 patients, 39.19 % showed sensitivity to one or more foods, where, sensitization to wheat (156; 22.6 %) was highest, followed by egg (148; 21.48 %) and milk (138; 20.03 %). Sensitization to various proteins ranged between 15.53–15.97 %, while lentils, corn, rice, soya and peanut sensitization was 15.4, 16, 12.5, 12 and 11.5 % respectively. Only 7.1 % patients were SPT positive for banana allergen. SPT was performed in patients with self-reported food allergy (341/689) and also with no self-reported history of food allergy (348/689). SPT results were positive in 69.8 % of the self-report group, whereas, in the patients with no self-reported food allergy 9.2 % were found sensitized to one or more tested food allergens. 101 patients were recruited for OFC, 61 % of these were confirmed of food allergy. The prevalence of food allergy in the study population was 9 %. Food specific OFC results show that wheat allergy is affecting 1.6 % (95 % CI 0.9–2.84 %) of the total allergy patients, followed by egg allergy 1.31 % (95 % CI 0.70–2.47 %). Furthermore, corn allergy, rice allergy and peanut allergy were 1.02, 0.87 and 0.73 %, respectively. In conclusion, wheat allergy is the most prevalent, followed by egg, chicken, beef and fish allergy, respectively.

Retrospective review of factors associated with severe hospitalised community-acquired influenza in a tertiary paediatric hospital in South Australia.

BackgroundInfluenza infection can result in severe disease with debilitating complications. Young children have the highest rate of influenza hospitalisations with various factors influencing influenza susceptibility and severity.ObjectivesThis study aimed to determine the disease burden and assess risk factors for severe hospitalised influenza in South Australian children under 5 years of age.MethodsInfluenza admissions to the tertiary paediatric hospital in South Australia from 2008 to 2012 were identified. Data from laboratory‐confirmed influenza cases were collected, including infecting influenza strain, co‐infections, prematurity, pre‐existing medical comorbidities and other potential risk factors. Predictors of high‐level care were assessed using logistic regression.ResultsA total of 267 children with laboratory‐confirmed influenza were hospitalised. Of these, 147 admissions (53%) occurred in children without underlying medical risk factors. Eighteen children (7%) required high‐level care, of which 11 (61%) had no underlying medical risk factors. No deaths were reported. The majority of children were unimmunised against influenza. Co‐infections were identified in 40% of children (n = 107). Influenza B was associated with a requirement for higher care (OR 3.7, CI 1.3–10.9, P = .02) as was a history of food allergies (OR 9.7, CI 1.5–61.4, P = .02) and iron deficiency anaemia (OR 4.8, CI 1.4–16.1, P = .01).ConclusionsInfluenza can be a severe illness, even in children without underlying medical conditions. The identification of Influenza B strain, history of food allergies and iron deficiency anaemia as predictors of severity in hospitalised cases warrants further investigation and may have important implications for preventative strategies to reduce the burden of childhood influenza.

The Prevalence and Natural History of Food Allergy.

Numerous studies have demonstrated that the prevalence of food allergy is increasing. Not only are more children being diagnosed with food allergies, but studies suggest that when people outgrow their food allergies, it is taking longer than was previously thought. Studies in recent years have noted factors that may lead to a lower likelihood of developing a food allergy, including the early introduction of common food allergens, having a sufficient vitamin D level, or having a higher maternal intake of peanut early in pregnancy. Given a recent report that sensitization to common food allergens did not increase from the late 1980s/early 1990s to the mid-2000s, further studies will need to examine if the rise in food allergy prevalence is due to a change in the relationship between sensitization and clinical allergy or changes in the recognition and diagnosis of food allergy.

Allergic rhinoconjunctivitis continued to increase in Swedish children up to 2007, but asthma and eczema levelled off from 1991.

This study investigated whether allergies among schoolchildren increased in Sweden between 1979 and 2007 and whether the geographical differences observed in previous studies remained. We collected questionnaire data on asthma, allergic rhinoconjunctivitis (ARC) and eczema in children aged seven to eight years from Mölndal, Gothenburg, in south-western Sweden and Kiruna in northern Sweden in 1979 (n = 4682), 1991 (n = 2481) and 2007 (n = 1029). The same regions and questions were used in all three studies, and extra questions on food allergy or intolerance were added in 2007. In 1979, 1991 and 2007, the total prevalence of asthma was 2.5%, 5.7% and 7.1%, ARC was 5.5%, 8.1% and 11.1% and eczema was 7.1%, 18.3% and 19.7%, respectively. Asthma prevalence remained higher in Kiruna, but no significant regional differences were seen for ARC and eczema. Almost 20% reported a history of food allergy or intolerance, with a higher prevalence in Kiruna. The allergy risk was reduced if both parents were born outside Sweden. The prevalence of ARC continued to increase between 1991 and 2007, but increases in asthma and eczema started to level off in 1991. Some geographical differences remained, but total allergy rates were similar in Kiruna and Mölndal in 2007.

Association of bronchial asthma and allergic rhinitis with IgE mediated allergy to common food allergens

Background and objective: Prevalence of immunoglobulin (Ig) E-mediated food allergy is primarily reported in patients of all age groups. The present study was aimed to investigate the relative prevalence of food allergy andallergens in patients with bronchial asthma and allergic rhinitis. Methods: Patients of all age groups and both sexes were screened using standard questionnaire and skin prick-test (SPT) with common foods. Specific IgE level was determined by enzyme linked immunosorbent assay (ELISA) and allergy wasestablished. Results: Of 575 patients screened, 120 (21%) gave history of food allergy. Of the history positive patients skin testedall showed a marked positive reaction to food extracts. Egg whole, black gram and lemon elicited marked positive SPT reaction in maximum of 12 (10%) cases each followed by rice, mushroom and corn in 11 cases each (9.1%), milk and cheese 10 cases each (8.3%), paneer and sardine fish 9 cases each (7.5%), maize and tamarind 8 cases each (6.6%), peanut and brinjal 7 cases each (5.8%), garlic and cabbage 4 cases each (3.3%), banana, sago and mutton 3 cases each (2.5%0, pineapple, pork, potato and almond with 2 cases each (1.6%), 1 case of beef, lady finger and drumstick (0.8%). The SPT positive patients showed elevated specific IgE levels (range: 0.8-79 IU/mL) againstrespective food allergens than normal controls (0.73 IU/mL, mean±2SD). The prevalence of food allergy was estimated to be 4.5% (2.6%-6.34%)at 95% confidence interval (95% CI) in test population (n=470). Conclusions: Food allergy is estimated to be 21% in adolescents and adults with asthma, rhinitis or both. Many food allergens were recorded as per the test.

Food Allergy: Our Evolving Understanding of Its Pathogenesis, Prevention, and Treatment.

Food allergy is defined as an IgE-mediated hypersensitivity response to ingested food with allergic symptoms ranging from urticaria to life-threatening anaphylaxis. Food allergy is thought to develop because of (1) failed induction of tolerance upon initial exposure to food antigen or (2) breakdown of established tolerance to food antigen. We review current understanding of the pathogenesis, epidemiology, and natural history of food allergy, including the unconventional IgE-mediated food allergy to mammalian meat known as alpha-gal food allergy. We highlight emerging data on food allergy treatment and prevention, emphasizing the growing appeal of manipulating the gut microenvironment using probiotics and helminth products to blunt systemic allergic responses to food.

The Natural History of Food Allergy

On a population level, it is well recognized that some IgE-mediated childhood food allergies, such as milk and egg allergies, are more likely to resolve than others, such as peanut and tree nuts allergies. Unfortunately, some studies suggest that resolution rates may have slowed compared with impressions from past decades. The clinician can apply the knowledge of the epidemiology of these allergies to describe likely patient outcomes, and direct management in a general manner. However, the ability to evaluate and predict the natural course of specific food allergies for individual patients is essential to inform personalized patient care. Data are accumulating to assist in identifying whether a child's allergy has likely resolved, informing the timing of oral food challenges or subsequent testing. Exciting recent studies are increasingly identifying early prognostic markers as well. Emerging food allergy therapies carry risks and costs. Identifying which egg-allergic patient has likely persistent allergy, and which patient with peanut allergy may experience natural resolution, is becoming an important goal to identify the best candidates for these therapies. Although more work needs to be done to identify reliable predictive markers and validate them, there is already much known about the natural course of food allergies that can be applied by the clinician to improve patient care.

Anaphylaxis in an urban Belgian emergency department: epidemiology and aetiology

Objectives: Anaphylaxis is an emergency condition of which reliable epidemiological data are lacking. This study focusses on epidemiology and aetiology of anaphylactic reactions in an urban Belgian emergency department (ED).Methods: Patient data were collected from 04/2009 to 04/2013.During this period, emergency doctors completed a questionnaire for adult patients (>15 years) with anaphylaxis presenting at the ED. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analysed using a Microsoft Excel database.Results: Anaphylaxis accounted for 0.04% of all emergency visits in this 4-year period. In both women and men, dyspnoea and urticaria were noted most frequently. 51.7% of cases were possibly elicited by foods, 46.1% by drugs and 3.4% by hymenoptera stings. Women more often reported allergic diseases in their personal history. 55.7% of patients, who had a history of allergy, reported a suspected food-related allergy, 24.6% a drug-related allergy and 8.2% a hymenoptera venom-related allergy. In 76.5% of patients who reported a history of food allergy, food was the presumed elicitor of anaphylaxis. For patients with history of drug allergy, 88.2% had a presumed drug anaphylaxis at the time of presentation at the ED. 81% of cases presented with grade 4 or 5 anaphylaxis. With increasing age, the severity of anaphylaxis increased. Higher tryptase levels correlated with a higher grade of anaphylaxis.Conclusion: In this Belgian urban population, foods and drugs were by far the most common suspected elicitors of anaphylaxis. Personal history of allergic diseases was present in more than half of the cases.

Ocular symptoms as the initial signs of zinc deficiency

A 2-year-old boy with a history of food allergy presented with severe edema and erythema, excoriations and honey-colored crusting on both lower eyelids, and erythematous rash on his perioral region. An evaluation for micronutrient deficiencies revealed low plasma zinc level. The patient was started on a regimen of zinc supplementation, and at 4weeks' follow-up there was nearly complete resolution of the lesions.