Life-threatening Food Allergies Research Articles

Experiences of parents of teenagers with life-threatening food allergies: a qualitative systematic review protocol.

The objective of this review is to synthesize the experiences of parents of teenagers with life-threatening food allergies. Life-threatening food allergies are increasing globally, with a significant effect on families, particularly parents. The teenage years are a time of increasing autonomy for young people; however, for parents living with and caring for a teenager with a life-threatening food allergy, this responsibility can have a considerable impact. This review will include qualitative studies on the experiences of parents of teenagers with life-threatening food allergies, including, but not limited to, caregiving, parenting, and psychosocial experiences; any day-to-day activities, happenings, thoughts, or feelings related to parenting a teenager with life-threatening food allergies; and the handing over of responsibility for the allergy to the teenager. The review will include studies on participants in the community and in health care settings such as inpatient hospitalizations, outpatient visits, school and sports events, family dinners, restaurants, and travel. Participants from all cultural backgrounds, socio-economic backgrounds, and countries will be included. The review will follow the JBI methodology for systematic reviews of qualitative evidence. The search for published studies will include CINAHL, MEDLINE, and PsycINFO (EBSCOhost); Embase (Ovid); LILACS, IBSS, and Sociological Abstracts (ProQuest). The search for unpublished studies will include ProQuest Dissertations and Theses, Open Access Theses and Dissertations (OATD), Bielefeld Academic Search Engine (BASE), Google, and Google Scholar. Databases will be searched from inception until the present. JBI tools and guidelines will be used to conduct critical appraisal, data extraction, data synthesis, and assessment of confidence in the findings. PROSPERO CRD42024503698.

Living with life-threatening food allergies – evaluation of an online pilot program for caregivers

Living with life-threatening food allergies – evaluation of an online pilot program for caregivers

A review on food allergy: pathogenesis, diagnosis methods and treatment approaches

An exaggerated immune reaction to a food that takes place in a vulnerable host is referred to as a food allergy. The two main types of food-induced allergy diseases are those caused by Immunoglobulin E (IgE) antibodies and those caused by non-IgE-mediated mechanisms. These reactions are frequently brought on by food allergens such as egg, seafood, fruits, milk, soy, peanut, etc. In India, roughly 26.5% of the population has been impacted by food-induced allergy diseases. Age, sex, heredity, and geographic location of the patient, as well as vitamin D deficiency and other allergic reactions, are risk factors that might result in life-threatening food allergies. Skin prick test, oral food challenge, component resolved diagnostic testing are the most widely used diagnostic tests for food allergy. Pharmacotherapy of food induced allergic reactions include epinephrine therapy and use of antihistamine drugs. However, the main stay of treatment is avoidance of responsible food and food desensitization. Some home remedies can also be used in order to control allergic reactions caused by food allergens. All these remedies directly or indirectly improve the health of immune system to prevent food induced allergic reactions. The objective of this study was to throw a light on the pathogenesis, diagnostic methods and possible treatment options for food allergy.

Причинно-значимые аллергены и спектр сенсибилизации детей, перенесших пищевую анафилаксию

Aim: to assess the spectrum of sensitization and reveal causative allergens in Ekaterinburg children with the clinical history of food-induced anaphylaxis (FIA) for reducing the number of life-threatening food allergy (FA) episodes in these children. Patients and Methods: the study included 60 children — 36 (60.0%) boys and 24 (40.0%) girls aged from 4 months to 16 years who lived in Yekaterinburg. All children had (FIA) episodes in their clinical histories. The children underwent physical examination, and their allergy- focused clinical history was taken. Also, the ISAC-112 ImmunoCAP assay, a multiplex test with allergen components, was used. Results: the sensitization was assessed, and the causative allergens were identified in 100% of cases. In 31 children (51.67%) FIA was initiated by milk proteins (Bos d4, Bos d5, Bos d8); in 10 (16.67%) – chicken egg (Gal d2, Gal d1); in 10 (16.67%) – walnut (Jug r1, Jug r2, Jug r3); in 9 (15.00%) – fish (Gad c1); in 7 (11.67%) – kiwi (Act d1); in 7 (11.67%) – peanut (Ara h1, Ara h2, Ara h3, Ara h6); and in 20 (33%) – by different nuts (Ber e1, Ana o2, Cora 9, Cora 8). Elevated specific immunoglobulin E (sIgE) levels for birch tree allergens (Bet v1) were found in 39 (65.00%) patients, cat allergens (Fel d1, Fel d2, Fel d4) – in 41 (68.33%), dog allergens (Can f1, Can f2, Can f3, Can f5) – in 24 (40.0%), timothy allergens (Phl p1, Phl p4, Phl p5) – in 10 (16.6%), artemisia allergens (Art v1) – in 8 (13.3%), and house dust mites in 2 (3.33%). Respiratory symptoms in sensitized children with FIA developed in 4 of 5 cases. Conclusion: to reduce the number of life-threatening FA episodes in children with FIA it is necessary to reveal and assess the entire spectrum of sensitization, identify the causative allergens and triggers of potential anaphylactic reaction for the further development of an elimination diet and individualized patient management plan. KEYWORDS: food allergy, food-induced anaphylaxis, children, allergens, sensitization. FOR CITATION: Lepeshkova T.S. Causative allergens and sensitization spectrum in children with the history of food-induced anaphylaxis. Russian Medical Inquiry. 2023;7(2):75–80 (in Russ.). DOI: 10.32364/2587-6821-2023-7-2-75-80.

The effect of roasting on peanut allergens’ digestibility, allergenicity, and structure

Peanut allergy is among the most widespread and life-threatening food allergies. Roasting was conducted to improve the sensorial quality of peanut and to change the structure and allergenicity of allergens. The potential allergenicity of digested defatted peanut powder did not significantly differ between raw and roasted peanuts. The raw/roasted peanut proteins were digested by trypsin and then analyzed with isobaric tags for relative and absolute quantitation (iTRAQ) to discover the changes in peptide quantity. Among the 44 detected peptides, the abundance of 29 peptides significantly increased by up to 36.78 times after roasting. Among those 29 peptides, seventeen peptides overlapped with linear IgE-binding epitopes, which were either destroyed or exposed after roasting. Combined with the spatial structure model, the iTRAQ result indicated the breaking of disulfide bonds and depolymerization of proteins during roasting. Roasting changed the conformational structure of protein, which increased allergen digestibility but did not guarantee a decrease in the potential allergenicity of peanut.

Genome-wide association study reveals an association between the HLA-DPB1∗02:01:02 allele and wheat-dependent exercise-induced anaphylaxis

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a life-threatening food allergy triggered by wheat in combination with the second factor such as exercise. The identification of potential genetic risk factors for this allergy might help high-risk individuals before consuming wheat-containing food. We aimed to identify genetic variants associated with WDEIA. A genome-wide association study was conducted in a discovery set of 77 individuals with WDEIA and 924 control subjects via three genetic models. The associations were confirmed in a replication set of 91 affected individuals and 435 control individuals. Summary statistics from the combined set were analyzed by meta-analysis with a random-effect model. In the discovery set, a locus on chromosome 6, rs9277630, was associated with WDEIA in the dominant model (OR = 3.95 [95% CI, 2.31-6.73], p = 7.87× 10-8). The HLA-DPB1∗02:01:02 allele displayed the most significant association with WDEIA (OR = 4.51 [95% CI, 2.66-7.63], p = 2.28× 10-9), as determined via HLA imputation following targeted sequencing. The association of the allele with WDEIA was confirmed in replication samples (OR = 3.82 [95% CI, 2.33-6.26], p = 3.03× 10-8). A meta-analysis performed in the combined set revealed that the HLA-DPB1∗02:01:02 allele was significantly associated with an increased risk of WDEIA (OR = 4.13 [95% CI, 2.89-5.93], p = 1.06× 10-14). Individuals carrying the HLA-DPB1∗02:01:02 allele have a significantly increased risk of WDEIA. Further validation of these findings in independent multiethnic cohorts is needed.

Exercise-food challenge test in patients with wheat-dependent exercise-induced anaphylaxis.

Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a severe and potentially life-threatening food allergy. Diagnosis of WDEIA is challenging because reactions are not always reproducible. This study aimed to evaluate the positivity rate of exercise-food challenge test at our allergy unit in order to confirm the diagnosis, and to investigate the effect on the episode of reactions after the test. This retrospective evaluation included patients aged 5-60 years who presented at the pediatric and adult allergy units of Siriraj Hospital during 2014-2018 with a convincing history of WDEIA and who underwent a 4-day exercise-food challenge test. Demographic data, challenge test result, and episodes of the reaction before and after the challenge test were obtained. Fourteen of the 17 patients that were enrolled were included in the analysis. The 3 excluded patients were found to have IgE-mediated wheat allergy. Median age and time to diagnosis was 18.3 years (range: 10.5-43.4) and 1.8 years (range: 0.3-6.2). History of recurrent acute urticaria before the onset of anaphylaxis was reported in 5 patients (35.7%). Exercise-food challenge test was positive in 10 patients (71.4%). Median mean number of exacerbations per year before and after the confirmation test was 2 (range: 1-10) and 1 (range: 0-3), respectively. For WDEIA, time to diagnosis was delayed, and one-third of patients had recurrent acute urticaria proceeding anaphylaxis onset. Our exercise-food challenge test could be utilized safely in both children and adult and able to elicit symptoms in two-third of patients.

Bifidobacterium breve M-16V alters the gut microbiota to alleviate OVA-induced food allergy through IL-33/ST2 signal pathway.

There has been a marked increase in life-threatening food allergy (FA). One hypothesis is that changes in bacterial communities may be key to FA. To better understand how gut microbiota regulates FA in humans, we established a mouse model with FA induced by ovalbumin. We found that the mice with FA had abnormal bacterial composition, accompanied by increased immunoglobulin G, immunoglobulin E, and interleukin-4/interferon-γ, and there existed a certain coherence between them. Interestingly, Bifidobacterium breve M-16V may alter the gut microbiota to alleviate the allergy symptoms by IL-33/ST2 signaling. Our results indicate that gut microbiota is essential for regulating FA to dietary antigens and demonstrate that intervention in bacterial community regulation may be therapeutically related to FA.

Food Allergy Management at School.

Approximately 8% of schoolchildren in the United States experience potentially life-threatening food allergies. They must diligently avoid allergenic foods and have prompt access to epinephrine to treat anaphylaxis. These prevention strategies must be sustained without interruption, posing a range of challenges at school. We conducted semi-structured interviews with 178 participants about their experiences managing food allergies outside the home. Interviews were transcribed and analyzed using an iterative approach in NVivo 10. Participants reported highly varied school experiences across the ecological model. They described the need to be proactive and self-sufficient to manage food allergies. Whereas food allergy-related social exclusion was common, participants also described positive peer interactions, including intensive peer engagement and support. They perceived that formal school policies were limited in scope and inconsistently implemented. Prevention-oriented policies were more common in lower grades than in higher grades. Poorly defined and implemented policies disrupted students' social and educational experiences at school, families' relationships with school staff, and, ultimately, the safety and wellbeing of students with allergies. Given the high prevalence of food allergies among children, these findings demonstrate the need for multiple layers of support to facilitate safe, socially inclusive food allergy management at schools.

Estimated risk reduction to packaged food reactions by epicutaneous immunotherapy (EPIT) for peanut allergy

BackgroundPeanut allergy is a generally persistent, sometimes life-threatening food allergy. With no treatments demonstrating the ability to cure a food allergy, the focus of drugs in development has been on providing a level of protection against accidental exposure reactions. However, no study has estimated the relative risk reduction of a food-allergic population receiving a specific immunotherapeutic treatment for their allergies. ObjectiveTo estimate the relative risk reduction when consuming peanut-contaminated packaged food products in a double-blind, placebo-controlled Phase 3 study population of children treated with epicutaneous immunotherapy (EPIT) for 12 months with either a patch containing 250 μg peanut protein (250-μg patch) or a placebo patch. MethodsThe probability of an allergic reaction due to the unintended presence of peanut protein in packaged food products was modeled per study group and food category combination using Monte Carlo simulations. Risks per eating occasion of a contaminated packaged food product and the number of individuals per study population predicted to react on a yearly basis were investigated. ResultsThe population treated with the 250-μg patch demonstrated a significantly increased dose-response distribution after 12 months of treatment, which resulted in a relative risk reduction of 73.2% to 78.4% when consuming peanut-contaminated packaged food products. In contrast, no statistically significant change was observed for the placebo group at the 12-month point. ConclusionOur study estimates a substantial relative risk reduction for allergic reactions among peanut-allergic children after 12 months of EPIT with the 250-μg patch, supporting the potential real-world clinical relevance of this investigational immunotherapy and its possible role as a future therapy for peanut-allergic children. ClinicalTrials.gov Identifier: NCT02636699

Detection of serum and salivary IgE and IgG1 immunoglobulins specific for diagnosis of food allergy

Given the growing incidence and prevalence of life-threatening food allergies, health concerns have raised new perspectives for in vivo and in vitro diagnostic methodologies, pointing to saliva as a promising material, already used to diagnose other pathologies. Based on the above considerations, this study aimed to verify the possible use of saliva for the detection of IgE and IgG1 in the diagnosis of food allergy. This was a randomized, cross-sectional clinical study with a quantitative approach, developed at a hospital referral center in allergy in the state of Ceará, from January to July 2015. The sample consisted of 36 children of both sexes, aged between 1 and 60 months, with a diagnosis of cow's milk protein allergy (CMPA) by the RAST test. Children hospitalized or under immunosuppressive drugs were excluded from the study. Serum and saliva samples of the participants were collected and subsequently subjected to the indirect immunoenzymatic assay (ELISA) for the detection of specific serum and salivary immunoglobulins for food: corn, papaya, cow's milk, egg white, wheat, soybeans, peanuts, nuts, kiwi, cacao, fish, shrimp, bananas and tomatoes. For comparison of serum and saliva results, the T-test of independent samples and Mann-Whitney were adopted, for samples with normal and non-normal distribution respectively. A confidence interval of 95% was adopted for significant results. It was observed that 100% (n = 36) of the participants presented cow's milk allergy through the indirect ELISA, detecting IgE or IgG1 in serum and saliva. When serum IgE and IgG1 concentrations were compared, there was no statistical difference (p > 0.05) in 12 of the 14 foods evaluated. The same amount (n = 12) of non-significant differences (p > 0.05) was observed in the comparison of the 14 foods under IgE and IgG1 contractions in saliva. In the verification of the average values of IgE present in the serum and saliva of the foods, only cow's milk, fish and papaya showed statistically significant differences (p < 0.05). Of the total food evaluated, only the average levels of IgG1 present in serum and saliva showed a significant value (p < 0.05) in banana and tomato. These findings indicate that the detection of IgE and IgG1 in saliva proves to be as efficient as in the serum. The use of the salivary technique for use in the diagnosis of food allergy is suggested.

Healthy infants harbor intestinal bacteria that protect against food allergy.

There has been a striking generational increase in life-threatening food allergies in Westernized societies1,2 One hypothesis to explain this rising prevalence is that 21st century lifestyle practices, including misuse of antibiotics, dietary changes, and higher rates of Caesarean birth and formula feeding have altered intestinal bacterial communities; early life alterations may be particularly detrimental.3,4 To better understand how commensal bacteria regulate food allergy in humans we colonized germ free (GF) mice with feces from healthy or cow’s milk allergic (CMA) infants 5. We show here that GF mice colonized with bacteria from healthy, but not CMA, infants were protected against anaphylactic responses to a cow’s milk allergen. Differences in bacterial composition separated the healthy and CMA populations in both the human donors and the colonized mice. Healthy and CMA colonized mice also exhibited unique transciptome signatures in the ileal epithelium. Correlation of ileal bacteria with genes upregulated in the ileum of healthy or CMA colonized mice identified a Clostridial species, Anaerostipes caccae, that protected against an allergic response to food. Our findings demonstrate that intestinal bacteria are critical for regulating allergic responses to dietary antigens and suggest that interventions that modulate bacterial communities may be therapeutically relevant for food allergy.

Development of a measure to assess factors associated with college students’ Willingness and Readiness to Act in a Food Allergic Emergency (WilRAFAE): A pilot

The rise of food allergies and anaphylaxis in the US population is an emerging public health concern. Individuals living with life-threatening food allergies may require assistance during an anaphy...

A qualitative study exploring parents\u2019 experiences with epinephrine use for their child\u2019s anaphylactic reaction

BackgroundChildren with life threatening food allergies live with the constant threat of a fatal reaction, and caregivers must always be prepared to treat with an epinephrine auto-injector (EAI). This interpretive phenomenological study explored parents’ perceptions and lived experiences with prescribed EAI use for their child.MethodsThe purposive sample included ten parents of five children under 12 years of age, diagnosed with a food allergy and prescribed with an EAI who recently experienced anaphylaxis. Data sources included digitally-recorded semi-structured interviews and a reflexive journal.ResultsEight main themes emerged: perception of anaphylaxis, life challenges, isolation, anxiety, hesitation, guilt, influence of health care professionals, and lessons learned. Parents uniformly described multiple life challenges and feelings of isolation, anxiety and hesitation during a reaction that lead to subsequent guilt.ConclusionsHandling reactions correctly provided parents with confidence to treat subsequent reactions. Witnessing the effects of an EAI and receiving positive feedback from health care providers further strengthened their confidence to quickly and competently intervene in future reactions.

Development of a novel mouse model to study tick-borne onset of red meat allergy

Abstract Bites from Amblyomma americanum, also known as the lone star tick, cause a life-threatening food allergy that induces IgE-mediated allergic reactions in affected individuals after eating dietary ‘red’ meat such as beef, pork, and lamb. Currently, there is no treatment to prevent or cure red meat allergy. Thus, establishing how lone star ticks cause red meat allergy is important for protecting individuals against this allergy. Our lab has successfully developed a novel mouse model of hypersensitivity to tick exposure to better understand how bites from the lone star tick sensitize the host to produce and maintain allergic IgE. Using this model, we identified increased T follicular helper cell and germinal center B cell responses and elevated serum titers of tick-specific IgE and IgG1 in mice exposed to lone star ticks subcutaneously. Furthermore, these mice generate a hypersensitivity response after oral challenge with red meat, as measured by basophil activation. Finally, we found that both the formation of inflammatory skin lesions at the site of tick exposure and the production of IgE were dependent on CD4+ helper T cells. These findings suggest that contained within the tick are factors that markedly influence priming of CD4+ T cells leading to the production of allergic IgE. Based on these data, we propose that manipulation of the factors within lone star ticks that drive CD4+ helper T cell activity could be used locally in the skin at the tick bite site to prevent the onset of meat allergy and systemically to stop an allergic reaction from progressing to a state of severe hypersensitivity.

Counseling Adults With Food Allergies After an Anaphylactic Reaction: An Application of Emotion-Focused Therapy

Little information is known about how counselors may work with adult clients regarding psychosocial sequelae of food allergies. The current article aims to provide counselors with a deeper understanding of life-threatening food allergies, ways in which adults may attempt to manage food allergies in adulthood, and emotional reactions that may occur after experiencing anaphylaxis. This article discusses ways that counselors can utilize emotion-focused therapy (EFT) interventions to help adult food-allergic clients process emotional reactions after experiencing anaphylaxis due to an ingested food allergen. Both in-session and at-home EFT strategies are discussed. EFT for trauma is discussed as a potential direction for future counseling research. Medical family therapy is discussed as a potential direction for counseling practice so that counselors may have a framework for working with other health-care professionals to help address food-allergic adult clients' psychosocial needs.

Can We Use a Genogram to Identify Potential Life Threatening Food Allergies in a Child?

Can We Use a Genogram to Identify Potential Life Threatening Food Allergies in a Child?

Oral Immunotherapy, Sublingual Immunotherapy, or Epicutaneous Immunotherapy: Which Is the Right Solution?

The current standard of care treatment for food allergy relies on avoidance. However, as outlined in this review, over the past decade, the literature has grown significantly showing promising results for interventional therapies for IgE-mediated food allergies utilizing oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT). Within the near future, we expect to have multiple FDA-approved products on the market for treatment of life-threatening food allergies and will have options to present to our patients. As we move into this next phase of our practice, we will need to consider meaningful endpoints for our patients (e.g., likelihood of inducing desensitization versus sustained unresponsiveness, the relevance of various threshold changes induced by therapy, effects on quality of life, etc.). This review provides a comprehensive overview of the currently published literature and will prepare the practicing allergist for a thoughtful discussion with their patients and colleagues on the most recent developments in the field.

A Strategy to Promote Successful Transition to School Nursing.

The purpose of this article is to share the findings of implementing a standardized, blended approach to school nurse orientation. This includes using classroom training, mentor/supervisory support, and skills labs to assure specific competencies that are needed for new nurses to successfully transition into this independent setting. This includes a description of the specialized skills and knowledge that are needed to successfully transition into this nursing specialty. School nurses are caring for more complex students. For example, students who were once homebound requiring tube feedings, ventilator, and tracheostomy care are now attending schools. They are responsible for triaging students with diverse needs which requires critical thinking skills. They case manage students with chronic diseases including: diabetes, asthma, life threatening food allergies and seizures. Lastly, school nurses manage students with risky behaviors related to drug usage, bullying and unprotected sex resulting in pregnancy.

Advances in Food-Induced Anaphylaxis

Anaphylaxis is a potentially life-threatening severe systemic reaction and food allergy is one of its most frequent causes. Diagnosis of food-induced anaphylaxis requires diagnostic criteria for anaphylaxis based on clinical features and a comprehensive history. Adrenaline is a first-line treatment along with support measures. Epinephrine (adrenaline) is the first choice drug in anaphylaxis because it is the only medication that has been proved to reduce hospitalization and death. Long-term treatment based on an accurate identification of the anaphylaxis trigger, a clear education and training of the patients, their family and the community, under the coordination of a trained allergist, is strongly recommended in order to avoid future events.