Limitations of reliance on specific IgE for epidemiologic surveillance of food allergy

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 09/2012; 130(5). DOI: 10.1016/j.jaci.2012.07.020
Source: PubMed
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    ABSTRACT: This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin disease that were reported in the Journal in 2010. Key epidemiologic observations include an apparent increase in peanut allergy, with more than 1% of children affected, and increasing evidence that early food allergen exposure, rather than avoidance, might improve allergy outcomes. Advances in food allergy diagnosis include improved insights into prognosis and estimation of severity through component-resolved diagnostics and characterization of IgE binding to specific epitopes. Regarding treatment, oral and epicutaneous immunotherapy show promise. Studies of drug allergies show insights into pathophysiology, and studies on insect hypersensitivity reveal improved diagnostic methods. Genetic and functional studies have revealed the important role of epidermal differentiation products in the pathogenesis of atopic dermatitis. Cross-talk between the atopic immune response with the innate immune response have also been found to predispose to infection in patients with atopic dermatitis. New therapeutic approaches to control chronic urticaria have also been identified during the past year.
    The Journal of allergy and clinical immunology 02/2011; 127(2):326-35. DOI:10.1016/j.jaci.2010.11.024 · 11.48 Impact Factor
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    ABSTRACT: This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2011. Food allergy appears to be increasing in prevalence and carries a strong economic burden. Risk factors can include dietary ones, such as deficiency of vitamin D and timing of complementary foods, and genetic factors, such as filaggrin loss-of-function mutations. Novel mechanisms underlying food allergy include the role of invariant natural killer T cells and influences of dietary components, such as isoflavones. Among numerous preclinical and clinical treatment studies, promising observations include the efficacy of sublingual and oral immunotherapy, a Chinese herbal remedy showing promising in vitro results, the potential immunotherapeutic effects of having children ingest foods with baked-in milk if they tolerate it, and the use of anti-IgE with or without concomitant immunotherapy. Studies of allergic skin diseases, anaphylaxis, and hypersensitivity to drugs and insect venom are elucidating cellular mechanisms, improved diagnostics, and potential targets for future treatment. The role of skin barrier abnormalities, as well as the modulatory effects of the innate and adaptive immune responses, are major areas of investigation.
    The Journal of allergy and clinical immunology 12/2012; 129(1):76-85. DOI:10.1016/j.jaci.2011.11.016 · 11.48 Impact Factor
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    ABSTRACT: Food allergy (FA) is a worldwide problem, with increasing prevalence in many countries, and it poses a clearly increasing health problem in Korea. In Korea, as a part of International Study of Asthma and Allergy in Childhood (ISAAC), a series of nation-wide population studies for prevalence of allergic disease in children were carried out, with the Korean version of ISAAC in 1995, 2000, and 2010. From the survey, the twelve-month prevalence of FA showed no significant differences from 1995 to 2000 in both age groups (6-12 years-old, 6.5% in 1995 and 5.7% in 2000; 12-15 year-olds, 7.4% in 1995 and 8.6% in 2000). The mean lifetime prevalence of FA which had ever been diagnosed by medical doctor was 4.7% in 6-12 year-olds and 5.1% in 12-15 year-olds respectively in 2000. In Korean children, the major causes of FA are almost same as in other countries, although the order prevalence may vary, a prime example of which being that peanut and tree nut allergies are not prevalent, as in western countries. Both pediatric emergency department (ED) visits and deaths relating to food induced anaphylaxis have also increased in western countries. From a study which based on data from the Korean Health Insurance Review and Assessment Service (KHIRA) from 2001 to 2007, the incidence of anaphylaxis under the age of 19 was 0.7-1 per 100,000 person-year, and foods (24.9%) were the most commonly identified cause of childhood anaphylaxis. In another epidemiologic study, involving 78889 patients aged 0-18 years who visited the EDs of 9 hospitals during June 2008 to Mar 2009, the incidence of food related anaphylaxis was 4.56 per 10,000 pediatric ED visits. From these studies, common causes of food related anaphylaxis were seafood, buckwheat, cow's milk, fruits, peanut and tree nuts. Although systematic epidemiologic studies have not reported on the matter, recently, plant foods related allergy has increased in Korean children. Among 804 children with moderate to severe atopic dermatitis, we reveals that the peanut sensitization rate in Korea reaches 18%, and that, when sensitized to peanut, patients showed a significant tendency to have co-sensitization with house dust mites, egg white, wheat, and soybean. The higher specific IgE to peanut was related to the likelihood of the patient developing severe systemic reactions. In another study, based on the data analysis of 69 patients under 4 years of age who had suspected peanut and tree nut allergy, 22 (31.9%) were sensitized to walnut (>0.35 kU/L, 0.45-27.4 kU/L) and 6 (8.7%) experienced anaphylaxis due to a small amount of walnut exposure. Furthermore, in this review, clinical and immunological studies on plant food allergies, such as buckwheat allergy, rice allergy, barley allergy, and kiwi fruit allergy, in Korean children are discussed.
    01/2013; 3(1):15-22. DOI:10.5415/apallergy.2013.3.1.15
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