Food Triggers Research Articles

P0457 Food avoidance, eating disorders and disability in Inflammatory Bowel Disease: a cross-sectional analysis of risk factors

Abstract Background Patients with inflammatory bowel disease (IBD) often adjust their diet to manage symptoms and avoid perceived food triggers. However, these habits can increase the risk of eating disorders (ED) and avoidant/restrictive food intake disorder (ARFID), which may potentially contribute to disability. This study aimed to estimate the prevalence of ARFID and ED in patients with IBD. Additionally, we investigated disability and risk factors associated with ARFID. Methods This cross-sectional study was conducted at two academic tertiary centers in Italy. Patients diagnosed with IBD during paediatric age ,between 2014 and October 2024, were consecutively recruited. ARFID was assessed using the Nine-Item ARFID Screen (NIAS), where a score>23 indicated ARFID risk. ED was evaluated using the Eating Attitudes Test (EAT-26), with a score≥20 suggesting the risk of ED. Malnutrition risk was measured with the Patient-Generated Subjective Global Assessment (PG-SGA) with a score>2 indicating the need for nutritional intervention. Disability was assessed using a modified version of IBD-Disk (mIBD -Disk), including a total of 11 questions with the additional question specifically addressing dietary habits1. Results A total of 144 patients 50.7% with Crohn’s disease (CD) were recruited (median age at time of inclusion: 24 years (21–28), 54.2% female) [Table.1]. One-third had clinically active disease, and the median BMI was 21.8(20.1–24.2). ARFID risk was identified in 24 participants (16.7%), with food-related fears being the most prevalent domain (13.2%). The median EAT-26 score was 5(3–12), with ED observed in 17 patients (11.8%). Malnutrition (PG-SGA score ≥6) was observed in 22.9% of participants. NIAS scores correlated with PG-SGA scores (p< 0.001, ρ=0.56). Patients at risk of ARFID were more likely to require nutritional interventions than those without ARFID risk (79.2%,19/24 vs. 38.3%, 46/120,p< 0.001). Univariate and multivariate analysis identified that moderate-to-severe disability (OR:4.03; 95%CI:1.23–13.17;p =0.02), a score >4 on mIBD-Disk question 11 (OR:3.49;95%CI:1.06–11.47;p =0.04), and the need for nutritional interventions (OR:3.09; 95% CI: 0.99–9.70; p=0.05) were independently associated with ARFID risk. Receiver Operating Characteristic (ROC) curve analysis showed that the mIBD-Disk had 81% diagnostic accuracy (95%CI:0.73–0.90) for predicting ARFID. Conclusion Patients diagnosed with IBD in paediatric age have an increased risk for ARFID and ED. Incorporating the mIBD-Disk into clinical practice could facilitate early screening and timely referral for nutritional and psychological interventions for individuals at risk of eating behaviors and malnutrition

Severity trend of recurrence in pediatric Food Protein-Induced Enterocolitis Syndrome (FPIES).

Reintroduction of offending food in pediatric patients affected by Food Protein-Induced Enterocolitis Syndrome (FPIES) is carried out in hospitals with Oral Food Challenge (OFC), which leads to long waiting time and increases the societal burden of medical cost and human resources. The aim of the study is to assess severity trend of acute FPIES adverse reactions over time in the same patient for possible outpatient or home reintroduction of offending food. All children (<18 years-old) with a diagnosis of acute FPIES referred to 2 Italian pediatric allergy clinics were retrospectively enrolled. To determine if home or outpatient clinic reintroduction of trigger food was possible, a risk of severe reactions <5% was arbitrarily considered acceptable. Of the 202 patients enrolled, 23 (11,4%) presented increasing severity from mild-moderate to severe episode. None of the variables analyzed in these patients (sex, age at onset and interval between first and severe episode) had a statistically significant influence on the risk of more severe reactions. Of all patients initially presented mild or moderate episodes, 15.2% and 13.9% later manifested severe episodes over time, respectively. Of patients with cow's milk FPIES started with a mild episode, 5.5% later experienced a severe episode. Performing OFC for acute FPIES is not safe enough at home, because the probability of severe adverse reaction is >5%. However, it could be considered to perform OFC in outpatient clinic in patients with cow's milk FPIES started with a mild episode and if a rapid transfer plan to emergency department is available.

Establishment of DAS-ELISA and lateral flow immunochromatography for the detection of peanut allergen Ara h 3 after heat-moisture treatment.

Peanuts are highly nutritious but pose a significant risk of triggering food allergies. While heat treatment can reduce the allergenicity of many foods, it may also alter their structure, potentially impacting detection results. This study employed double antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) and lateral flow immunochromatography (LFIA) to evaluate the allergen Ara h 3 following heat-moisture treatment. DAS-ELISA achieved a detection limit of 39.06ng/mL, with inter-plate and intra-plate coefficients of variation below 3.05% and 6.79%, respectively, and recovery rates ranging from 78.48% to 90.93%. LFIA, with a detection limit of 1.6μg/mL, demonstrated high sensitivity, stability, and no cross-reactivity with other proteins. Both methods were effective in detecting peanut-processed products, with heat-moisture treatment significantly reducing Ara h 3 antigenicity, making them valuable tools for assessing desensitization in food production.

The role of diet in migraine control: deconstructing myths

Introduction: Migraine can be controlled through effective drug treatments, both during headache attacks, as a preventative measure, but also through non-drug treatments, including diet therapy. This treatment consists of eliminating food triggers and adding improvement factors. Objective: To address the role of diet in controlling migraine, through the elimination of food triggers and the addition of improvement factors, in addition to demystifying some mistaken behaviors. Method: This study was an integrative and retrospective review of articles on the relationship between food and migraine. Results: Three relationships were found between diet and migraine attacks: 1) food may be a triggering factor; 2) food may be a mitigating factor; or 3) food may be an aggravating factor. There is no specific diet therapy for migraine, but diets that are based on the pathophysiological mechanisms of migraine. Conclusions: Food can be a trigger or a factor in improving migraine attacks and diet therapy for controlling migraine consists of removing food triggers and replacing them with a healthy diet.

Food Protein-Induced Allergic Proctocolitis: Real-World Experience from an Italian Cohort.

Background/Objectives: Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-mediated food allergy, usually presenting as bloody stools in breastfed, well-appearing, and regularly growing infants. The aim of our study was to describe the clinical features of Italian infants affected by FPIAP and their management and natural history in a real-life setting. Methods: A retrospective, observational study was performed at two tertiary pediatric hospitals (Florence and Trieste), including FPIAP-diagnosed infants between 2012 and 2022. Results: Most of the 100 enrolled patients were breastfed (68.0%), and the majority of those who underwent diagnostic tests (n = 51) showed normal hemoglobin and total IgE levels. A maternal elimination diet was performed in 69.0%, mostly for milk only, but 40.6% underwent multiple elimination diets. The remission rate was high both in breastfed infants (76.8%) and in those who received extensively hydrolyzed formula (81.8%). Nine subjects were left on a free diet, but six were lost at follow-up. The median time of complete remission was 30 days (IQR 14-60). Culprit food reintroduction was tolerated at a median age of 8 months (IQR 6-11), in ladder modality (for hen's egg and cow's milk) in 61.7%. Nine patients relapsed (14.3%) upon reintroduction with no associated variables identified at the regression analysis. The relapse rate was slightly higher when trigger food reintroduction was attempted > 12 months (16.7%) versus <12 months (13.0%). Conclusions: In our population, FPIAP had, as expected, a benign evolution. The early reintroduction of the suspect food in a gradual manner for cow's milk and hen's egg leads to good tolerance within the first year in most patients, avoiding unnecessary elimination diets.

Evidence-Based Approaches to Food Allergy Diagnosis

The prevalence of food allergy has increased in the past decades. However, most studies are based on self-reported clinical history of food allergy rather than food challenge-confirmed ones; these may overestimate the prevalence of food allergy. Food allergy has been identified as one of the most common causes of anaphylaxis, especially among children. Like other studies, the study by Rosero et al., published in this issue, identified that food is the most common trigger for anaphylaxis among pediatric patients admitted to a tertiary hospital.1 The incidence of food-induced anaphylaxis in children worldwide is varied, with a range of 1 to 77 per 100,000 person‐years.2 Moreover, almost half of all patients with food allergies experienced anaphylaxis in any previous reaction (46%, 2556/5587), based on the Food Allergy Research &amp; Education (FARE) Patient Registry.3 The most common food triggers causing anaphylaxis in adults are crustaceans and eggs, cow’s milk, nuts, wheat, and shellfish among children.4,5 A detailed allergy-focused clinical history is the first step in the diagnostic work-up among patients suspected to have food allergies. The allergy-focused history will serve as a guide to the allergy tests that will be done. Skin prick tests (SPT) to allergen extracts and fresh food, serum-specific IgE (sIgE) to allergen extracts and individual allergen components, and basophil activation test (BAT) are recommended tests to support the diagnosis of IgE-mediated allergy.6 These tests have high to moderate sensitivity (negative result rules out FA) and specificity (positive result rules in FA) to a variety of food.7 BAT is suggested to support the diagnosis of food allergy among those with an equivocal diagnosis of IgE-mediated allergy to peanut and sesame. The gold standard for diagnosing food allergy is the oral food challenge (OFC). However, the OFC is resource-intensive and may pose severe allergic reactions. In the EAACI guidelines on diagnosing IgE-mediated FA, OFC is the recommended reference diagnostic procedure to confirm or exclude FA.6 Based on the same guidelines, the double-blind placebo-controlled food challenge is suggested if an open OFC outcome is indeterminate and in research studies. There are tests available in laboratories that lack evidence of diagnostic validity and do not show a correlation with food allergy. Patients will seek physicians' opinions regarding these tests or will come to the clinic with the results of these tests marketed as food allergy or food intolerance tests. Society guidelines and practice parameters do not recommend unvalidated tests to diagnose food allergy.6,8-10 These tests, such as IgG or IgG4 antibody level, hair analysis, electrodermal testing, antigen leukocyte antibody test, mediator release test, and kinesiology.11 The Philippine Society of Allergy, Asthma, and Immunology does not recommend food-specific IgG testing to identify or predict adverse reactions to food.9 The production of food-specific IgG or IgG4 is a normal immunologic response linked to the development of tolerance, not food allergy or intolerance. Identifying the food trigger through an allergy-focused clinical history and validated diagnostic tests is essential to prevent future adverse reactions, eliminate unnecessary food elimination, prevent nutritional deficiencies, and improve quality of life.

Pollen–Food Allergy Syndrome: Allergens, Clinical Insights, Diagnostic and Therapeutic Challenges

Pollen–food allergy syndrome (PFAS), also known as oral allergy syndrome, is a common condition affecting individuals sensitized to pollens such as birch, ragweed, and grass. This syndrome arises from immunological cross-reactivity between pollen allergens and structurally similar proteins found in various fruits, vegetables, and nuts. Although typically presenting with mild oral and pharyngeal symptoms, PFAS can occasionally result in severe allergic reactions, underscoring its clinical significance. This review explores the pathophysiology of PFAS, highlighting the molecular mechanisms underlying cross-reactivity and examining the main protein families involved, including those contributing to variations in symptom severity. Current diagnostic approaches, including skin prick testing, specific immunoglobulin E measurements, and component-resolved diagnostics, are discussed. Emerging diagnostic tools and biomarkers with potential to enhance accuracy are also examined. Therapeutic strategies for PFAS primarily focus on symptom management and avoidance of trigger foods. However, novel approaches such as allergen immunotherapy and biologics targeting key immune pathways are gaining traction as potential interventions for more severe or refractory cases. By addressing the diagnostic and therapeutic challenges of PFAS, this paper aims to provide clinicians and researchers with a comprehensive understanding of this condition, fostering improved patient care and the development of innovative treatment strategies.

Food as migraine trigger

Migraine is a neurological disorder that is characterized by severe headaches and temporary motor and sensory disturbances. Migraine triggers are internal or external factors that can increase the likelihood of a migraine attack. Some individuals with migraine associate their attacks with the consumption of certain types of food, but no have been conducted in Iceland. The aim of the study was to estimate the proportion of individuals with migraine in Iceland who associate their symptoms with consuming certain types of food. An electronic questionnaire was submitted to two groups (≥18 years old), members of the Icelandic Facebook group 'Migreni' (n=395 and to patients being treated by a neurologist (n=108), with the question if they thought certain foods could trigger migraine attacks. A total of 503 opened the survey (19.6% in the Facebook group and 65% managed by a neurologist). Response options were never/rarely, sometimes, often, or always. Other questions included types of migraine, medication use and background. Out of 466 participants, 354 individuals (76%) claimed that food often or always triggered their migraine. The proportion was higher in the Facebook group than in the neurologist group (78% vs. 66%, p=0.007). Red wine and skipping meals (hunger) were the most common food-related triggers, reported as triggers often or always by >50%. Other common food triggers included white wine, liquorice, and smoked meat; they were reported as triggers by 20-50% of participants. Food seems to be a common migraine trigger, and the main food-related triggers were similar to those reported in other studies. However, previous studies have not shown liquorice as a common food trigger for migraines, and smoked meat was found to be a more common trigger than seen in other studies.

Medicinal Herbs for the Treatment of Peptic Ulcers

: Peptic ulcers are common gastrointestinal disorders characterized by the erosion of the stomach lining, duodenum, or esophagus. Conventional treatments, such as proton pump inhibitors and antibiotics for Helicobacter pylori eradication, have been the mainstay of therapy. However, the emergence of drug resistance and potential side effects have led to the exploration of alternative and complementary approaches, including medicinal herbs. This comprehensive review examines the potential use of medicinal herbs in the management of peptic ulcers. Ten herbal remedies, including Liquorice, Slippery Elm, Marshmallow Root, Aloe Vera, Chamomile, Ginger, Turmeric, Meadowsweet, Fenugreek, and Cabbage, are analyzed for their therapeutic properties and scientific research findings. These herbs have demonstrated anti-inflammatory, antimicrobial, and mucoprotective effects that may support ulcer healing and symptom relief. Herbal formulations, such as teas, capsules, tablets, and extracts, offer convenient delivery methods for patients seeking herbal remedies. However, safety considerations and potential herb-drug interactions must be carefully monitored. Integrating herbal remedies with conventional treatments presents a comprehensive approach to peptic ulcer management. By combining these therapies, patients may experience enhanced therapeutic outcomes and improved quality of life. Dietary recommendations also play a crucial role, with the inclusion of soothing and beneficial foods, while avoiding trigger foods that may exacerbate symptoms. As the evidence base grows, collaborative efforts between traditional herbal medicine practitioners and mainstream medical professionals are vital to ensure safe and effective integration.

Play With Morphing Food: Supporting Children-Food Interaction With an Interactive Cooking Toolkit

To support children’s food interaction and enhance their understanding of food through morphing food technology, we develop a design exploration through the Research through Design (RtD) methodology. Our exploration integrates four stages: (1) defining design objectives through empathy with stakeholders, (2) investigating morphing food materials to understand their deformation mechanisms, (3) designing and iteratively developing tools based on user feedback, and (4) conducting a workshop-based evaluation. Our design outcome is a toolkit, comprising a morphing food library, trigger tools, and instructional interfaces. The workshop showed that through interaction with morphing food, children learned not only scientific principles but also developed culinary skills, as well as the diversity of food forms and functions. We discussed the detailed findings, insights, and implications for future design.

Dietary Intake and Quality in Irritable Bowel Syndrome: A Comparative Study With Controls and the Association With Symptom Severity.

Patients with irritable bowel syndrome (IBS) often attribute the onset or worsening of gastrointestinal symptoms to intake of food. Hence, to alleviate symptoms, patients with IBS may avoid triggering foods, potentially impacting their dietary intake and diet quality. This study aimed to compare the habitual diet intake and quality of patients with IBS with controls and to explore the association between dietary habits and symptoms in patients with IBS. Patients with IBS were included in 4 clinical studies reporting habitual dietary intakes at baseline. Age- and sex-matched controls representing the general population were derived from the Swedish population-based Riksmaten study. Dietary intakes were assessed using 4-day food diaries. Diet quality was measured using the diet quality index-Swedish national dietary guidelines (DQI-SNR), and diet diversity was scored based on the variety of food groups consumed. The study included 646 patients with IBS and 646 controls (38 ± 14 years, 77% female). Both groups adhered to Nordic nutrition recommendations for macronutrients, except patients consumed fewer carbohydrates. Patients reported eating less carbohydrates, coffee, and dairy products and more fats, lactose-free dairy products, and nuts and seeds compared with controls. Fewer patients had a good diet quality according to the DQI-SNR. In patients, symptom severity and gastrointestinal-specific anxiety were associated with reduced energy and carbohydrate intake, lower diet diversity, and worse diet quality. Poor diet quality was associated with younger age, more severe IBS symptoms, anxiety, and depression. Patients with IBS exhibit different dietary patterns compared with controls, with poorer dietary habits linked to more severe symptoms. Understanding food-symptom associations may enhance the optimization and personalization of dietary management for patients with IBS.

Microbiota alterations are related to migraine food triggers and inflammatory markers in chronic migraine patients with medication overuse headache

ObjectiveChronic migraine (CM) patients with medication overuse headache (MOH) were recently shown to be associated with leaky gut and inflammation. We aimed to investigate gut microbiota profiles of CM patients with MOH, and their correlations with inflammatory serum parameters, migraine food triggers, and comorbid anxiety and depression.Materials and methodsThe study included women participants (32 CM patients with NSAID overuse headache, and 16 healthy non-headache sufferers). Migraine duration, monthly migraine headache days, presence of irritable bowel syndrome symptoms, and HADS-D and HADS-A scores were recorded. Serum samples were collected to measure circulating LPS, HMGB1, HIF-1α, and IL-6. The gut microbiota profiles of the patients were evaluated using fecal samples.ResultsSerum LPS, HMGB1, HIF-1α, and IL-6 levels were significantly higher in the CM + MOH group compared to the healthy controls. HADS-A and HADS-D scores were considerably higher in the CM + MOH group compared to the healthy controls. In the microbiota analysis, alpha and beta diversities were similar between the two groups. The class Clostridia, the order Eubacteriales, and the genus Ruminococcus were less abundant in the CM + NSAID overuse headache group compared to the control group. At the genus level Desulfovibrio, Gemmiger, and Dialister and at the species level, Clostridium fessum, Blautia luti, Dorea longicatena, Eubacterium coprostanoligenes, and Gemmiger formicilis were more abundant in the CM + NSAID overuse headache group compared to the control group. Desulfovibrio, Gemmiger, Dialister, Ethanoligenens harbinense, Eubacterium coprostanoligenes, Dorea longicatena, and Thermoclostridium stercorarium showed positive correlations and Clostridia bacteria showed negative correlations with migraine food triggers. Positive correlations were found between LPS and Hapalosiphonaceae, HMGB1 and Melghirimyces, HIF1-α and Rouxeilla and Blautia luti, IL-6 and Melghirimyces and Ruminococcus.ConclusionIn CM patients with MOH, we have revealed the presence of dysbiosis towards an inflammatory state, and positive correlations were shown between altered gut microbiota and inflammatory serum parameters and migraine food triggers.

Relationship between food triggers and sensory hypersensitivity in patients with migraine.

The recognition of food as the trigger of attacks occurs in approximately 25% of individuals with migraine. However, differentiating migraine food triggers and prodrome symptoms is still a challenge. To understand the association of clinical characteristics of migraine with food triggers and to identify predictors of food triggers. Patients with migraine diagnosed according to the criteria of the third edition of the International Classification of Headache Disorders (ICHD-3) were evaluated for the presence or absence of food triggers. In total, 502 patients with migraine were investigated, and they were divided into two groups: those with food triggers (58.4%) and those without food triggers (41.6%). The main food triggers were alcohol (44%), chocolate (42%), cheese (27.7%), excess carbohydrates (27.7%), coffee (21.8%), cold cuts (16%), and citrus fruits (11.9%). Aura and excessive use of analgesics were more frequent among patients with food triggers (p = 0.022). Photophobia and osmophobia were associated with the presence of a food trigger (p < 0.001). There was a greater impact of migraine in the presence of food triggers (p = 0.002). Through binary logistic regression, we identified clinical predictors of food triggers, such as photophobia and osmophobia. The presence of a food trigger was significantly associated with photophobia and osmophobia. Osmophobia might be another mechanism by which patients perceive foods as triggers for their migraine attacks.

THE ROLE OF LIFESTYLE-RELATED TREATMENTS FOR IRRITABLE BOWEL SYNDROME

Introduction: The role of diet and lifestyle in Irritable Bowel Syndrome (IBS) mainly involves alleviating symptoms and improving the quality of life for patients. Diet plays a significant role through the identification and avoidance of trigger foods, the introduction of an appropriate amount of fiber, and adherence to specific guidelines. Lifestyle, including regular physical activity, stress reduction techniques, and healthy sleep habits, also contributes to the reduction of bowel discomfort. Aim of the study: The aim of this study is to examine the relationship between diet and lifestyle, and the occurrence and course of Irritable Bowel Syndrome. Material and Methods of Research: A literature review focused on keywords related to the topic was performed using databases such as PubMed and Google Scholar, as well as textbooks and articles on websites. Results: Irritable Bowel Syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract, primarily characterized by abdominal pain and changes in bowel habits. Dietary modifications, such as a lowFODMAP diet, and lifestyle factors, including physical activity levels, stress management, and meal regularity, significantly influence the course of the disease. There are gender differences in symptomatology and psychosocial impact as well as gender-specific responses to pharmaceutical treatments. Ongoing research is needed to better understand the mechanisms underlying IBS and to optimize therapeutic strategies. Conclusion: The effectiveness of IBS therapy requires a comprehensive approach that includes dietary modifications, increased daily physical activity, learning to manage emotions, and regular collaboration with a doctor. Understanding and implementing these elements are crucial for effectively alleviating symptoms and improving the functioning of patients with Irritable Bowel Syndrome.

Using NHS Data to Monitor Trends in the Occurrence of Severe, Food-Induced Allergic Reactions Work Package 2

People with food allergies may experience food allergic reactions due to accidental exposure. These reactions are commonly categorised as non-severe, fatal food anaphylaxis and near-fatal food anaphylaxis. Non-severe allergic reactions to food are more common with an incidence of up to 1,000 times greater than fatal food-related anaphylaxis. However, obtaining accurate data relating to the circumstances under which these reactions occurred is challenging under the current diagnosis coding system used in the National Health Service (NHS). This project addressed two key questions: 1. What are the trends in the occurrence of food hypersensitivity (FHS) reactions and their consequences in terms of healthcare encounters (both to hospital and primary care)? 2. What are the circumstances surrounding severe, life-threatening reactions to food? Approach • A UK arm of NORA was established using the same online platform as the existing European Registry. • Participation of healthcare professionals and/or patients to enter relevant information was co-ordinated by BSACI in conjunction with the Paediatric Emergency Research in the United Kingdom Ireland (PERUKI) network. • Different versions of the questionnaire were developed to increase response rates: (1) a comprehensive form mapped to existing NORA data fields for completion by Healthcare Professionals in the non-acute setting; (2) a shorter form with key data fields to increase data reporting in more pressured, acute healthcare settings; and (3) a form for completion by patients or their parent/guardian. Key Results The launch of the UK anaphylaxis registry faced delays and was impacted by significant pressures on NHS services due to the COVID-19 pandemic. This led to a lower than anticipated uptake of the Registry by clinics and Accident &amp; Emergency departments. As a result, only a minority of accidental reactions (less than 5%) were captured in the registry, almost all in children and young people under age 18 years. Some indicative results of this analysis are the following: • 213 cases reported to be due to a food trigger and of these, 208 occurred in children/young people aged 18 years or under. • Common food triggers were peanut, tree nuts (especially cashew), cow’s milk/dairy and hen’s egg. • 47% of reactions occurred after consumption of prepacked food products and in at least 59% of these cases, the allergen was declared as an actual ingredient. Further work would be needed to understand how to optimise reporting of data, for example by reducing the time burden for completion by clinicians and patients.

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

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

Smoking Behaviors, Dietary Patterns, and Dyspepsia among Indonesian Adults in 2022

Background: The global prevalence of dyspeptic syndrome among adults was estimated to be 1.8–57% in 2014, with an average of 20.8%. In a pilot survey involving 30 respondents, we found 21 acute respiratory infections, 16 dyspeptic syndromes, and 6 hypertension cases. Smoking was observed in 70% of the total respondents. This was the basis for conducting additional research in 2022 to examine the relationship between dyspepsia, smoking behaviors, and dietary patterns among adults in Krajan Hamlet, Malang, Indonesia. Methods: This quantitative study used an analytical observational design with a cross-sectional approach. The sample consisted of 70 adults aged 18–65, selected by random sampling. The collected data were analyzed using the Chi-squared test (p&lt;0.05). Results: The prevalence rate for dyspepsia was 44.3%. Among them, 67.1% were smokers (both frequent and non-frequent), and 32.9% were non-smokers (including former and passive). The active smokers had a smoking duration of &gt;2 years and smoked &gt;10 cigarettes daily. A total of 11.4% of subjects exhibited eating habits of consuming trigger foods that put them at a high risk for dyspepsia. Specifically, 42.0% of subjects had an eating interval of &gt;6 hours, while 87.1% had a meal frequency that led to a high risk of developing dyspepsia. There was a significant relationship between a high-risk diet and dyspeptic syndrome (p=0.037). Conclusion: High-risk diets exhibited a relationship with the prevalence of dyspeptic syndrome. Early detection is crucial in an effort to prevent and reduce the incidence and complications of dyspeptic syndrome. Highlights: This study investigated the relationship between dyspepsia, smoking behaviors, and dietary patterns, which are often overlooked, particularly among those living in rural areas. The findings of this study are anticipated to raise awareness regarding the detrimental impacts of smoking and unhealthy diets on dyspepsia.

Descriptive Profile of Anaphylactic Reaction Patients Hospitalized at RSUP Prof. DR. I.G.N.G Ngoerah Period 2018-2023

Introduction: Anaphylactic reaction is a severe, potentially life-threatening systemic hypersensitivity reaction caused by a specific allergen. This study aimed to evaluate the clinical profile of anaphylactic patients hospitalized in Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar. Method: This was a cross-sectional descriptive study of anaphylactic patients hospitalized in our center from January 2018 to December 2023. Patients diagnosed with anaphylactic reactions were included in this study. All the data (demographic, clinical manifestations, potential trigger) were attained from medical records for descriptive analysis. Result: 292 patients were enrolled in this study; half were women (54,4%), and the median age was 38,50 years (interquartile range 24). The most common potential triggers were drugs (57%), followed by food (18,5%), blood products (14,1), insect bites, and other triggers (4,8%). Almost all patients experience skin and mucosal manifestations (99%). Anaphylactic shock occurs in only 22% of patients. Discussion: Previous studies have found similar results to our findings, and anaphylactic reaction caused by drugs was associated with a more severe reaction. The effect of estrogen hormones on more severe reactions has been reported in female mice, but human research is still limited. Conclusion: Further studies are needed to investigate the correlation between demographic characteristics or specific clinical manifestations with a severe reaction.

The risk of anaphylaxis on holidays.

The goal of this review is to summarize the potential causes of anaphylaxis in the different holiday contexts, providing practical suggestions aimed to mitigate the stress challenged by allergic patients because of unfamiliar situations. A regard was reserved to potential food triggers, particularly uncommon ones and typical of certain destinations, and to arthropods responsible for anaphylaxis. This review highlights the potential risk of anaphylaxis due to the unusual contexts more experienced during holidays (i.e., travels, outdoor activities and eating out). Moreover, it underlines the need for a further allergological education in these cases, in order to prepare allergic patients to avoid and manage undesired situations.

Food-triggered anaphylaxis in adults.

Adult food allergy, either unresolved from childhood, or new-onset in adult-life, is known to be increasingly prevalent. Although much of the reported anaphylaxis in adults is due to drug reactions, foods are becoming an increasingly important trigger, affecting adults of all ages, with a wide variation in food triggers which are often quite different to those reported in children. Peanuts are well known to cause anaphylaxis in some adult populations, but other legumes such as soy may be more relevant in others. Reactions to natto, fermented soybeans, are currently mainly reported in Japan, but changing dietary practices and an increase in plant-based eating mean natto, other forms of soy and other legumes are increasingly linked to anaphylaxis in Western countries. Anaphylaxis to red meat, caused by sensitization to galactose-α-1,3-galactose and first reported in North America, is now a more world-wide concern. Co-factor induced anaphylaxis is increasingly associated with both wheat allergy and lipid transfer protein allergy. More research is urgently needed to characterize adult food allergy, its triggers and symptom severity. Unusual food triggers and potential co-factors should be considered, so that anaphylaxis in adults can be correctly managed, not merely labelled as idiopathic.