Oral Provocation Research Articles

Are pediatricians aware of the mysterious FPIES? Current diagnostic and treatment options. Case report

The prevalence of food allergies continues to grow steadily, and due to certain difficulties in diagnosing allergies not associated with immunoglobulin E, some conditions are little known. Such diagnosis-challenging diseases include food protein-induced enterocolitis syndrome (FPIES), a relatively low-prevalence disease most commonly occurring in early childhood but, in some cases, affecting adults as well. The pathogenesis of FPIES has not been reliably studied. FPIES is associated with elevated serum tryptase and release of pro-inflammatory cytokines, including interleukin-17. A characteristic symptom of FPIES is uncontrollable vomiting, which is probably triggered by the serotonin secreted by enterochromaffin cells, which activates the vagus nerve and the vomiting reflex, determining a good response of vomiting relief with ondansetron, a serotonin receptor antagonist. Changes in gut microbiota composition were also reported in FPIES. FPIES can lead to severe complications such as hypovolemic shock due to the rapid progression of symptoms and rapid dehydration, which often requires hospitalization of patients with acute FPIES. The provoking factors usually include products from the "big nine" allergens: cow's milk, eggs, gluten, soy, nuts, peanuts, fish, seafood, and sesame. FPIES can be acute or chronic; the manifestations slightly differ depending on the disease form. Laboratory diagnosis is difficult due to the lack of reliable biomarkers, and the diagnosis is established clinically and confirmed with an oral provocation test. The key treatment for FPIES is to eliminate the trigger protein from the diet, and depending on the severity of the disease, some patients may be allowed to consume a heat-treated allergen. The prognosis of FPIES is favorable: tolerance to the trigger product in most cases is developed within two years. Further studies are required to clarify the pathogenesis, prevalence, and treatment methods, with prospective follow-up of patients with a history of FPIES and the analysis of concurrent and subsequent diseases, including allergic conditions. The article presents two clinical cases of children diagnosed with FPIES.

Protocol for a systematic review and meta-analysis of interventions aimed at delabeling low-risk penicillin allergies with consideration for sex and gender

BackgroundApproximately, 10% of people report a penicillin allergy; however, more than 90% can safely undergo delabeling after a detailed history, oral challenge, or other investigations such as penicillin skin testing (PST). Although PST is the gold standard, the results can be heterogeneous, and awaiting specialist assessment may take an inordinate amount of time. Therefore, oral provocation challenge has become acceptable for individuals with low-risk penicillin allergy histories. There also appears to be an association with increased prevalence of adverse drug reaction reporting in female individuals, which may translate to penicillin allergy prevalence; however, the evidence has not been assessed through a sex and gender lens. This systematic review will identify and synthesize the findings from studies that report measures of effectiveness and safety of interventions aimed at delabeling penicillin allergies in low-risk individuals. Information related to sex and gender will be extracted, where available, to understand potential differences in allergy reporting and patient outcomes.MethodsThe Cochrane Handbook for Systematic Reviews of Interventions and the Centre for Review and Dissemination’s Guidance for Undertaking Reviews in Health Care will be used as frameworks for conducting this systematic review. The literature search will be conducted by a medical librarian (B. M. M.) and will consist of a search strategy to identify and retrieve published studies that meet our inclusion criteria. Studies that require penicillin skin testing (PST) as a step prior to other interventions will be excluded. Integrated knowledge translation involving co-design was carried out for this systematic review protocol creation. Data extraction will be conducted at four levels: (1) study level, (2) patient level, (3) intervention level, and (4) outcome level. A narrative descriptive synthesis of results and risk of bias of all included studies will be provided, and, if relevant, a meta-analysis will be performed.DiscussionThe dissemination of findings from this knowledge synthesis to various stakeholders is intended to inform on options for evidence-based interventions to aid in delabeling penicillin allergies in individuals with a low risk of experiencing a hypersensitivity reaction. Detailed reporting on the characteristics of delabeling interventions as well as the effectiveness of similar interventions will benefit policy makers considering the implementation of a penicillin allergy delabeling protocol. Additionally, findings from this systematic review will report on the current evidence regarding the role of sex and gender in both the prevalence and outcomes associated with the presence of penicillin allergies.Systematic review registrationPROSPERO CRD42022336457.

Cow's milk allergy treatment. An expert consensus

The treatment of cow's milk protein allergy is based on the complete elimination of cow's milk protein from the diet. To achieve remission of symptoms and future tolerance, exclusion must be total. In formula fed infants the extensively hydrolysed formula is the most appropriate option in mild or moderate forms, while those based on amino acids are reserved for the most severe cases. The treatment time, the acquisition of tolerance and the moment for the oral provocation test will vary according to the clinical picture, the immunological mechanism involved and the age of the patient. The aim of this consensus has been to reflect the updated knowledge together with the experience of neonatologists, pediatricians, experts in allergy, nutrition and gastroenterology.

Modern Approaches to the Diagnosis o Food Allergy in Children: Oral Food Challenges (Review)

The diagnosis of food allergies significantly impacts the lives of patients and their families, restricting diets and social activities. A misdiagnosis can lead to severe allergic reactions, making accurate diagnosis crucial. Immunoglobulin E (IgE)-mediated food allergies are diagnosed using skin tests or serum-specific IgE levels. However, for most allergens, the only reliable method for confirming the diagnosis remains the oral food challenge (OFC). Objective — elucidation of the importance of oral provocation tests in the diagnosis of food allergy and their relevance for the future treatment of food allergy. Materials and methods. A search for information on OFC was conducted in scientometric databases such as Web of Science, Scopus, Google Scholar, ScienceDirect and PubMed using the following keywords: «food allergy», «oral food challenge», «children». After reviewing the publications, professional sources that met the query criteria and were published between 2017 and 2024 were selected for the review. Results and discussion. OFCs help determine allergen sensitivity and reaction severity, which is useful for further management. They also have therapeutic value, reducing anxiety related to food allergies and improving quality of life. Psychological aspects play an important role in food allergies, as the fear of severe reactions often exceeds actual risks.One limitation of OFCs is the need for substantial resources and specialized knowledge, available only in specialized medical centers. This leads to long waiting lists and delays in food introduction, increasing the risk of developing allergies. Additionally, OFCs are often conducted in controlled environments, which may not reflect real-world accidental exposures.OFC results can include false positives, false negatives, and inconclusive outcomes. They are also time-consuming and may affect school or work attendance for patients and caregivers. It is essential to standar­dize doses for each food according to portion sizes and patient age. Conclusions. The frequency of food allergies is currently increasing in Ukraine, highlighting the need for allergists to master the technique and implement oral food challenges in general allergy practice to establish food allergies in children.

Clinical characteristics and risk factors for antituberculosis drug-induced hypersensitivity.

The aim of this study was to explore the clinical characteristics and risk factors for hypersensitivity reactions induced by antituberculosis drugs. A retrospective analysis was conducted on the medical records of patients with active tuberculosis (TB) treated in the TB ward at West China Hospital, Sichuan University, from November 2010 to April 2020. Out of 7106 patients with active tuberculosis, 205 experienced hypersensitivity reactions to antituberculosis drugs; the incidence of hypersensitivity was 2.9%. The predominant clinical manifestation was a rash, observed in 57.1% (117/205) of these cases. Additionally, 19.0% (39/205) of patients presented with concurrent liver injury. The laboratory parameters white blood cell count, total lymphocyte count, monocyte count, eosinophil count, basophil count, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were significantly elevated in patients with hypersensitivity compared to those without. In 38 patients who tested positive for oral antituberculosis drug provocation, 14 (36.8%) were allergic to more than two antituberculosis drugs. Significant risk factors included being female (odds ratio [OR] = 1.387, 95% confidence intervals [CI]: 1.016-1.894), under 65 years of age (OR = 1.826, 95% CI: 1.145-2.913), existing liver disease (OR = 2.464, 95% CI: 1.822-3.333) and a history of allergic diseases (OR = 6.633, 95% CI: 2.681-16.406) and were significantly correlated with hypersensitivity to antituberculosis drugs. Hypersensitivity reactions to antituberculosis drugs primarily affect the skin, with significant associations observed with liver injury. Females, individuals younger than 65 years, those with pre-existing liver disease and patients with a history of allergic diseases are at elevated risk for hypersensitivity.

Rash decisions: Unmasking a risk phenotype in adults with persistent delayed penicillin allergy sensitized during historic infection with Epstein-Barr virus

BackgroundPenicillin-associated exanthems in the setting of infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) are often viewed as a transient event, and not a true allergy. Recent evidence challenges this and suggest a notable subset of patients retain penicillin hypersensitivity. ObjectiveWe investigated the occurrence and predictors of persistent adulthood hypersensitivity in those with a penicillin-associated rash occurring in the setting of EBV infection. MethodRetrospective analysis of patients referred for penicillin allergy testing to an Australian tertiary hospital captured from 2015 to 2023 was carried out. ResultsOf 2,066 patients, 23 (1%) had a penicillin-associated rash during an historic EBV infection; 16 (70%) female, median 18 years (interquartile range [IQR] 16-20) at index reaction, median 38 years (IQR 33.5-57) when allergy tested. Skin-prick and delayed-intradermal testing (D-IDT) to a penicillin panel were performed and oral provocation challenge in those testing negative. Persistent sensitisation was shown in 6/23 (26%); 4/6 (67%) positive D-IDT, 3/6 (50%) positive oral challenge. Notably, 5/6 (83%) had a severe maculopapular exanthem (sMPE) with facial swelling, including 2/6 (33%) with probable drug reaction with eosinophilia and systemic symptoms (DRESS) during the index reaction, compared with 0/17 (0%) in patients tolerating penicillin on re-exposure. ConclusionThis study highlights the requirement of allergy testing in adult patients reporting a penicillin-associated sMPE in the setting of EBV, even if occurring during childhood or adolescence.

Comparing Skin and Serum Testing to Direct Challenge Outcomes in Children With β-Lactam Allergies

BackgroundThere is a scarcity of prospective studies investigating the relative roles of skin prick and intradermal testing, serum-specific Immunoglobulin E, and extended oral challenges in diagnosing children with reported beta-lactam allergies. ObjectiveTo determine the sensitivity and specificity of skin testing and serum-specific Immunoglobulin E in children with beta-lactam allergies, with immediate and non-immediate historic reactions. MethodsFour hundred children with parent-reported beta-lactam allergies were recruited into an open-label prospective study. Detailed allergy histories were collected. Those with medically observed and documented histories of anaphylaxis, requiring epinephrine, or SCARs were excluded. In total, 380 children underwent all testing modalities and a direct provocation test. Each child was followed up for a minimum of three years. ResultsTrue allergy in children was uncommon, 8·3% reacted to the direct provocation challenge or the 5-day extended oral provocation challenge. Children reporting cephalosporin allergy or a reaction within one year were more likely to react to direct provocation testing. The sensitivity, specificity, and positive predictive value of skin testing was 12·5%, 98·8% and 20·0% for direct challenge outcomes, 4·76%, 99·0% and 25·0% for extended challenge outcomes, and 6·9%, 99·0% and 40·0% for both challenges combined. Follow-up investigations revealed that 5·7% of children had a mild repeat reaction and 2·7% continued to avoid the culprit despite successful delabeling. The relabeling rate for children readmitted to hospital was 15% with the relabeing being unfounded. ConclusionGenuine beta-lactam allergies were rare, with over 90% of children effectively delabeled. Skin and serum-specific Immunoglobulin E testing did not aid the diagnosis of beta-lactam antibiotic allergy in children, regardless of medical history. Extended oral challenges proved valuable in confirming allergies and boosted parental confidence.

Tolerance of peanuts and tree nuts in Spanish children with exclusive sensitization to lipid transfer proteins.

Allergy to peanuts and tree nuts is a common cause of food allergy in Spain, with lipid transfer proteins (LTP) being the most frequently recognized panallergen. LTP sensitization often leads to multiple food group sensitivities, resulting in overly restrictive diets that hinder patient's quality of life. This study aimed to assess the tolerance of peanuts and tree nuts (hazelnuts and walnuts) in children sensitized to LTP, potentially mitigating the need for such diets. This prospective study enrolled individuals diagnosed with allergy to peanuts, hazelnuts, or walnuts. Data were collected from medical records, including demographics and clinical history. Allergological assessment comprised skin prick tests using commercial extracts and the nuts in question, alongside measurements of total and specific IgE to nuts and their primary molecular components. Participants showing positive LTP sensitization without sensitization to seed storage proteins underwent open oral nut challenges. A total of 75 individuals labeled as allergic to peanuts, 44 to hazelnuts, and 51 to walnuts were included. All of them underwent an open oral provocation test with the incriminated nut, showing a high tolerance rate. Peanut was tolerated by 98.6% of patients, 97.72% tolerated hazelnut, and 84.3% tolerated walnut. The findings suggest that the majority of patients allergic to peanuts, hazelnuts, or walnuts, due to LTP sensitization and lacking IgE reactivity to seed storage proteins, can tolerate these nuts. This supports the need for personalized nut tolerance assessments to avoid unnecessary dietary restrictions.

Ethambutol induced subacute cutaneous lupus erythematosus in an elderly female with co-morbidities

Papulosquamous lesions in an elderly female with multiple co-morbidities often pose diagnostic challenge. We present an interesting case of anti-tubercular treatment (ATT) induced sub-acute cutaneous lupus erythematosus. The patient presented with papulosquamous lesions in generalised distribution, which showed interface dermatitis on histopathology. The serology for anti-nuclear antibodies, anti-Ro and anti-La was positive. The rash resolved spontaneously after stopping all the suspected drugs. Oral provocation was performed with first line anti-tubercular drugs and ethambutol was found to be the culprit drug, which was later confirmed by reappearance of skin rash by inadvertent ingestion of one dose of ethambutol by the patient.

Basophil Activation Test Is Inferior to Provocation Test in Diagnosing Aspirin Hypersensitivity

Introduction: Diagnostic of aspirin (ASA) hypersensitivity is largely based on provocation tests. However, they have significant limitations including influence of medications, necessity of hospitalization, and safety issues. Basophil activation test (BAT) seems to be a promising in vitro alternative. It has already proven to be a useful tool for diagnosing IgE-mediated allergy to certain food and airborne allergens as well as insects venoms. The aim of the study was to assess performance of BAT in diagnosing aspirin hypersensitivity in comparison with current golden standard (oral provocation test, OPT). Methods: The study group comprised 148 adult patients with suspicion of aspirin hypersensitivity, including 51 (36%) with chronic urticaria, 73 (51%) with asthma, and 55 (39%) with chronic sinusitis. The control group was 10 healthy adult patients who used NSAIDs during preceding year with good tolerance. BAT with ASA was conducted in all the participants. Additionally, in the study group, OPT was performed with cumulative dose of 1,000 mg of ASA. Results: Out of 148 study group participants, 114 underwent BAT and ASA provocation with conclusive results acquired in both tests. In this group, the threshold for positive BAT was 4.9%. Sensitivity and specificity of BAT were found to be 55.9% and 75%, respectively, with a positive predictive value of 77% and a negative predictive value of 54%. The highest sensitivity (78%) was found in subgroup patients with chronic urticaria, while specificity was highest in the subgroup with chronic respiratory diseases (87%). Conclusion: Despite significant advantages of BAT such as safety, no influence of drugs, and objectivity, its performance makes it inferior to current standard in ASA hypersensitivity.

Alternative Drug Safety in Children with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in the pediatric age group as pain relievers, antipyretics and anti-inflammatory drugs. Since NSAIDs are used in many medical conditions, there is a need for alternative NSAIDs to be used safely in people with hypersensitivity reactions. Selective and partially selective COX-2 inhibitors and weak COX-1 inhibitors are generally used as safe alternative drugs. The aim of this study was to evaluate safe NSAIDs determined by oral provocation tests (OPTs) according to phenotypes in children with NSAID hypersensitivity reactions. Methods: The results of the oral provocation test performed with alternative NSAIDs (paracetamol, meloxicam, nimesulide, celecoxib) in patients followed up with the diagnosis of NSAID hypersensitivity reaction in the Pediatric Immunology and Allergy Department between January 2015 and February 2023 were evaluated retrospectively. Results: During the study period, 91 patients underwent OPTs with 109 alternative drugs 48 (52.7%) of whom were girls, with a median age of 15 years. 91 patients had a history of reactions to 117 drugs. As an alternative NSAID; OPT was performed with paracetamol in 58 patients, meloxicam in 44 patients, nimesulide in 5 patients, and celecoxib in 2 patients. Since 15 patients used paracetamol safely at home, no tests were performed with paracetamol. Reactions were observed in 3 of the 73 patients (4.1%) who underwent OPT with paracetamol and in 2 of the 44 (4.5%) who underwent OPT with meloxicam. Reactions to nimesulide were also observed in the latter 2 patients (2/5, 40%), but they appeared to tolerate celecoxib. No reaction was observed in the 2 patients who were tested with celecoxib. Conclusion: Paracetamol, meloxicam, and nimesulide can be used as safe alternative drugs in most children with NSAID hypersensitivity. Selective COX-2 inhibitors should be tried as an alternative in patients who cannot tolerate them.

The Role of Medical History and Allergic Tests in the Analysis of Antibiotic Allergy in the Pediatric Population

The Role of Medical History and Allergic Tests in the Analysis of Antibiotic Allergy in the Pediatric Population

Differences in the Course, Diagnosis, and Treatment of Food Allergies Depending on Age-Comparison of Children and Adults.

Food allergy (FA) has become a common global public health issue, with a growing prevalence in the modern world and a significant impact on the lives of patients, their families, and caregivers. It affects every area of life and is associated with elevated costs. Food allergy is an adverse immune reaction that occurs in response to a given food. The symptoms vary from mild to severe and can lead to anaphylaxis. This is why it is important to focus on the factors influencing the occurrence of food allergies, specific diagnostic methods, effective therapies, and especially prevention. Recently, many guidelines have emphasized the impact of introducing specific foods into a child's diet at an early age in order to prevent food allergies. Childhood allergies vary with age. In infants, the most common allergy is to cow's milk. Later in life, peanut allergy is more frequently diagnosed. Numerous common childhood allergies can be outgrown by adulthood. Adults can also develop new IgE-mediated FA. The gold standard for diagnosis is the oral provocation test. Skin prick tests, specific IgE measurements, and component-resolved diagnostic techniques are helpful in the diagnosis. Multiple different approaches are being tried as possible treatments, such as immunotherapy or monoclonal antibodies. This article focuses on the prevention and quality of life of allergic patients. This article aims to systematize the latest knowledge and highlight the differences between food allergies in pediatric and adult populations.

Improving inpatient paediatric de-labelling of allergies to beta-lactams: a quality improvement study

ObjectiveTo evaluate the implementation of an antimicrobial stewardship programme-led inpatient beta-lactam allergy de-labelling programme using a direct oral provocation test (OPT).DesignOne-year quality improvement study using a before–after design.SettingFree-standing tertiary care...

L’allergie alimentaire aux lentilles : une entité méconnue chez l’enfant

Introduction: Food allergies affect about 6-8 % of children. Legumes are the most common ingredients in the Mediterranean diet. They occupy the fifth place among the foods responsible for allergic reactions that can be severe and cause anaphylaxis. Lentils are most involved in IgE-mediated food allergies in children. However, little information is available on lentil allergens.Objectives: The aim of this study is to describe the clinical and biological picture of food allergy to lentils in order to raise awareness of this emerging allergen among pediatricians.Patients and Methods: We report 4 cases of food allergy to lentils in children aged 3 to 6 years, 2 of whom were male. Clinical symptoms occurred within 2 hours of ingestion or inhalation of lens vapor. Three patients consulted for localized or generalized urticarial reactions, including one with angioedema of the face. One patient had consulted on several occasions for unexplained discomfort after meals. A personal or family atopic background was found in 3 patients. Two of these patients had other associated food allergies: to fish (2 cases), peanut (1 case), egg (2 cases) and shrimp (1 case). One of our patients was found to be underweight (-2 SD). Prick tests to the native allergen were very positive in two children and confirmed the diagnosis. They were doubtful in one case and were not performed in a child with a very severe clinical picture. The specific IgE assay was very positive in one case. The evolution was favorable in all cases. The management consisted of a strict avoidance of raw or cooked lentils as well as other foods in the context of a cross-food allergy.Conclusion: Allergy to lenses is rare in our context. Its diagnosis is based on a suggestive anamnesis, followed in case of doubt by an oral provocation test. It is essentially due to the major allergen vicilin Len c 1. It may be associated with hypersensitivity to other legumes belonging to the same family, notably peas. In the majority of cases, the disease evolves favorably and tolerance is acquired.

Preparation and Immunochemical Characterization of a Water-Soluble Gluten Peptide Fraction for Improving the Diagnosis of Celiac Disease.

The diagnosis of celiac disease (CD) is complex and requires a multi-step procedure (symptoms, serology, duodenal biopsy, effect of a gluten-free diet, and optional genetic). The aim of the study was to contribute to the improvement of CD diagnosis by preparing a water-soluble gluten peptide fraction (called Solgluten) and by selecting gluten-specific enzyme-linked immunosorbent assays (ELISA) for the detection of gluten immunogenic gluten peptides (GIPs) in urine and blood serum spiked with Solgluten. Food-grade Solgluten was prepared by the extraction of a peptic digest of vital gluten with water, centrifugation, and freeze-drying. The process was relatively easy, repeatable, and cheap. The content of gliadin-derived GIPs was 491 mg/g. Solgluten was used as antigenic material to compare two competitive ELISA kits (R7021 and K3012) and two sandwich ELISA kits (M2114 and R7041) in their quality regarding the quantitation of GIPs in urine and blood serum. The quality parameters were the reactivity, sensitivity, coefficients of variation and determination, and curve shape. The evaluation of the kits showed a number of discrepancies in individual quality parameters measured in urine and serum. Due to the lowest limit of quantitation and the highest coefficient of determination, M2114 may be the first choice, while R7021 appeared to be less suitable because of the high coefficients of variation and unfavorable curve progression. The results set the stage for improving CD diagnosis by supplementing conventional blood tests with oral provocation with Solgluten and subsequent ELISA measurement of GIPs that could support the no-biopsy approach and by better assessing the effect of a gluten-free diet by monitoring adherence to the diet by measuring GIPs in urine and blood.

À propos d’un cas pédiatrique d’allergie au kaki

Food allergy to persimmon (Diospyros kaki) is exceedingly rare. We report a case involving a 3.33-year-old child who experienced an episode of palpebral edema with pruritus and facial erythema following the first ingestion of this fruit. Allergological investigation reveals a biological sensitivity to persimmon, with specific immunoglobulin E levels at 0,79 kU/L, as well as a positive skin prick tests to persimmon fresh extract. An oral provocation test was also conducted, demonstrating no reaction to the ingestion of 1 then 2 grams of persimmon, but a similar reaction to the initial episode when ingesting 5 grams (resulting in a total cumulative dose of 8 grams). Our observation describes the pediatric manifestations of this allergy along with a literature review.

Provocation tests

Oral provocation tests involve the supervised administration of suspected foods in increasing doses to evaluate a patient's allergic condition. Acknowledged as the superior method for diagnosing food allergies, it surpasses results from specific IgE serum or prick tests, which indicate sensitization but not necessarily allergy. The test is indicated in cases of diagnostic uncertainty, assessment of natural or induced tolerance, or cross-reactivity risks. Three types of tests exist: open, single-blind, and double-blind with a placebo. While the latter two reduce anxiety, open tests are more practical for children under three.

Acute generalized exanthematous pustulosis induced by isoniazid and pyrazinamide in a child

An 8-year-old female with cervical lymph node tuberculosis, received rifampicin, isoniazid, pyrazinamide, and ethambutol. Two weeks later, she developed a fever and a generalized erythematous rash covered with pustules. Acute generalized exanthematous pustulosis diagnosis was confirmed by a skin biopsy. Antitubercular therapy was discontinued. Drug causality was found using oral provocation tests and patch tests. Cutaneous adverse drug reactions to first-line antituberculosis drugs are common. However, acute generalized exanthematous pustulosis is rare. It is a severe form of cutaneous drug reaction, primarily associated with beta-lactam antibiotics, and clinically characterized by non-follicular pustules on erythematous skin.

Research progress on pollen food allergy syndrome

Pollen food allergy syndrome (PFAS) is an IgE-mediated allergic reaction that occurs when some pollinosis patients ingest certain plant-derived food that contains cross-reactive allergenic components. PFAS is prevalent in both children and adult pollinosis patients. In most cases, PFAS symptoms are confined to the oropharynx and occur within several minutes after oral contact with food. Therefore, PFAS has been also referred as oral allergy syndrome (OAS). A small proportion of PFAS patients would experience systemic symptoms or anaphylaxis. Currently, the diagnosis of PFAS is mainly based on clinical history and allergic tests [skin prick tests and(or) serum specific IgE tests]. Oral provocation tests are used to verify atypical patients. Component-resolved diagnosis is essential for further precise diagnosis and treatment. Management options for PFAS include lifestyle adjustment, symptomatic medication, and immunotherapy. The efficacy and appropriate population for immunotherapy need further investigation. This article aims to update the knowledge on epidemiology, pathogenesis and clinical management of PFAS, thereby enhancing clinicians' understanding as well as treatment progress of this disease entity.