Article

Involvement of hidden allergens in food allergic reactions

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Abstract

Hidden allergens in foods can induce allergic reactions. Currently it is not possible to estimate the exact prevalence of these reactions but they are clearly a growing problem. The purpose of this study was to provide an overview of the role of hidden allergens (their importance, the types of food involved, and the severity of reactions) in allergic reactions in our geographical area. A retrospective study was carried out in an adult population. Over a five year period, a total of 530 food reactions were reviewed. One hundred nineteen reactions (22.4%) were considered to be due to hidden allergens. Thirty-two percent of these were anaphylactic reactions. The most common hidden allergen was the Anisakis simplex larvae present in fish and shellfish. Fish allergens hidden in other foods caused reactions in 35% of fish-allergic patients. Twenty-two per cent of allergic reactions caused by eggs were due to egg allergens hidden in foods. All but one of the reactions caused by hidden legume allergens occurred in soy-allergic patients. Reactions caused by hidden fruits and hidden nuts were very uncommon. Hidden allergens were the cause of a quarter of all food allergic reactions, mainly as a result of contamination and carelessness on the part of the patient. A simplex was the hidden allergen most frequently involved. Fruits and nuts were not frequent hidden allergens in our area. Reactions due to other uncommon foods such as soy, mustard, flavourings, and honey were multiple and usually went unnoticed. Only if the sources of hidden allergens are determined will it be possible to avoid such substances and thus guarantee the safety of the allergic patient.

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... Fortunately, most cases are non-life-threatening hives. However, it is noteworthy that most patients (65%) required treatment in the emergency room and some patients were even admitted to Intensive Care Units [14][15][16][17][18][19]. Nowadays, skin prick tests are a common practice, allowing results in 15-20 min when testing for Anisakis simplex hypersensitivity. ...
... Most patients do not associate allergic symptoms with eating fish because they have previously tolerated fish for decades, often between episodes. Moreover, this parasite has been considered, in recent years, as a hidden allergen [18]. The acute allergic reaction is usually triggered between 15 and 30 min, up to 2-6 h after consuming fish. ...
... The reported percentages of cutaneous, respiratory and hypotension/syncope manifestations are very comparable to other series of anaphylaxis (100%, 39% and 23%, respectively). It is important to highlight that skin symptoms are the most frequent (almost 100% of patients), and digestive symptoms are also observed (74%) [15][16][17][18][19]. ...
Article
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The first case of human infection by a species of the Anisakidae family was reported more than 60 years ago. Over the last 20 years, Anisakis has become a highly studied parasite, not only for its parasitism, but also for its role as an inducer of allergic reactions. Several studies have indicated that the pathological changes occurring within the gastrointestinal tract during infection with Anisakis simplex are the combined result of the direct action of the larvae invading the tissue and the complex interaction between the host’s immune system and the parasite. Although the most commonly described pathologies are digestive, urticaria/angioedema and anaphylaxis, occupational asthma and arthritis have been seldom described. This paper is a narrative of the immune-mediated reaction induced by this parasite over the course of the last two decades.
... Several factors leading to food allergic reactions in restaurants have been identified, including exposure to undeclared or hidden allergens (Knoblaugh et al., 2007). One retrospective study indicated that of 530 food allergic cases reviewed over a period of five years, approximately 23% (n = 119) were caused by an allergen that was hidden in a food item (Anibarro et al., 2007). For example, allergic reactions to egg were triggered by hidden egg proteins found in ice cream and pastries, while hidden sources of nuts were common in desserts, including cookies, pastries, and cakes. ...
... Providing allergen-free meals to customers with food allergies is challenging as there are nine million adults and six million children with food allergies in the United States (FARE, 2015a). Many allergic reactions to food occur in commercial restaurants due to crosscontact, hidden food allergens, and restaurant staff's lack of food allergy knowledge and ability to handle special requests (Anibarro et al., 2007;Knoblaugh et al., 2007;Kwon and Lee, 2012). This study investigated the food allergy knowledge level of restaurant employees. ...
... Soy-based products, such as soy sauce and tamari, are commonly used as seasonings in many cuisines, but customers may not be aware that they exist in the food items being ordered (Kwon and Lee, 2012). An analysis of 530 food allergies cases over a five-year period revealed that a total of 119 allergic reactions were due to hidden allergens, particularly fish and shellfish and soy allergens in the form of boiled ham and sausages (Anibarro et al., 2007). Contrasting with Common et al.'s (2013) study, which showed that most participants were not able identify tree nuts as allergens and that small amounts of allergens could cause allergic reactions, about 90% of the participants in this study correctly answered these questions. ...
Chapter
In a national study of craft beer owners, managers and employees, this chapter identifies five components that motivate entrepreneurial activity in craft beer production: tax reduction and indirect benefits; a need for approval; personal development; welfare and community considerations; and a need for independence. Since entrepreneurial engagement remains the backbone of economic development and a common policy objective of local governments, understanding small- and medium-sized business motivations can support the growth of the craft beverage sector. These results parallel prior general business research into the drivers of start-up companies.
... Although food allergen labelling laws could be a great contribute to make food choices easier, they still do not regulate other issues such as the potential presence of hidden allergens due to cross-contact (48). A substance is a hidden allergen when it is unrecognized or not declared on the product ingredient label (49). The labelling that concerns the potential presence of unintentional ingredients, for example due to cross-contact in processing lines, is generally described as precautionary allergen labelling (PAL), for example "may contain", and it is applied voluntarily by the food industry (11,43,48,50,51). ...
... Cross-contact is a serious concern for people with food allergies, given that it is one of the main sources of undeclared or hidden allergens (51,74). Anibarro et al. have reported that hidden allergens accounted for 21% of all food allergic reactions (49). Additionally, in a restaurant, cross-contact is more likely to lead to high-dose exposures than at home, which may cause more severe reactions (51). ...
... Additionally, in a restaurant, cross-contact is more likely to lead to high-dose exposures than at home, which may cause more severe reactions (51). Regarding this issue, staff must be instructed about food preparation and service techniques to avoid cross contact (49). For instance, they should not use the same utensils to prepare, cook, plate and distribute of different meals. ...
Article
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Food allergies are a growing problem and currently the primary treatment of food allergy is avoidance of culprit foods. However, given the lack of information and education and also the ubiquitous nature of allergens, accidental exposures to food allergens are not uncommon. The fear of potential fatal reactions and the need of a proper avoidance leads in most of the cases to the limitation of leisure and social activities. This review aims to be a practical approach on education and accidental exposure prevention regarding activities like shopping, eating out, and travelling. The recommendations are focused especially on proper reading of food labels and the management of the disease, namely in restaurants and airplanes, concerning cross-contact and communication with other stakeholders. The implementation of effective tools is essential to manage food allergy outside home, avoid serious allergic reactions and minimize the disease's impact on individuals' quality of life.
... Meals consumed away from home, such as in restaurants, are particularly challenging for individuals with food allergy due to hard-toidentify or recognize allergens in foods or ingredients, commonly referred to as hidden allergens (Kwon & Lee, 2012;Weiss & Munoz-Furlong, 2008). Ingestion of a hidden allergen in restaurants most commonly occurs because of the inaccurate communication of information by staff regarding the ingredients of a dish to a customer (Anibarro, Seoane, & Mugica, 2007;Weiss & Munoz-Furlong, 2008) but the factors may vary depending on cuisine served, service type (i.e sit down vs quick serve), worker demographics (i.e. ethnicity, language spoken). ...
... ethnicity, language spoken). Nearly a quarter (22.4%) of food allergy reactions in restaurants are caused by the consumption of hidden allergens; 32% of those reactions were found to be severe, life-threatening reactions (Anibarro et al., 2007;Vierk, Koehler, Fein, & Street, 2007). Thus, the careful reading of ingredient labels is recommended for anyone involved in the purchasing, preparing, or serving of food to allergic customers to reduce accidental exposure to allergens (Dupuis et al., 2016;Sheth et al., 2010;Food & Drug Administration [FDA], 2018;Weiss & Munoz-Furlong, 2008). ...
Article
This study aimed to create a food allergy reference resource to identify food allergens in commonly used Chinese restaurant packaged foods to create an initial reference database. Ninety-nine commonly used packaged foods in Chinese restaurants were identified, and their ingredient labels collected for analysis for major allergens, adherence to Food Allergen Labeling and Consumer Protection Act labeling regulations, and use of voluntary allergen advisories. Analyzed data was used in the creation of a food allergen reference resource of packaged Chinese restaurant ingredients to extend the knowledge of allergens commonly found in Chinese restaurants. Wheat (71.7%) and soy (53.5%) were the commonly found allergens on ingredient labels. The manner in which allergens were listed varied among ingredient labels. Food allergen labeling legislation that provides standard guidelines on allergen labeling for easy identification of food allergens and providing food allergy training to foodservice workers about reading ingredient labels could help restaurants, especially Chinese restaurants to better serve customers with food allergies.
... Hence, soy preparations used in food production can be a source of a "hidden allergen." Anibarro et al. [7] analyzed 530 cases of allergic reaction and noted that 22.5% (119 persons) were caused by "hidden allergens." They also observed that, in the case of people allergic to soy, the symptoms caused by the presence of additives were even more frequent-in as many as 39% of respondents, most often after consuming boiled ham, sausages, cheese puffs, precooked dishes, desserts, and gravy [7]. ...
... Anibarro et al. [7] analyzed 530 cases of allergic reaction and noted that 22.5% (119 persons) were caused by "hidden allergens." They also observed that, in the case of people allergic to soy, the symptoms caused by the presence of additives were even more frequent-in as many as 39% of respondents, most often after consuming boiled ham, sausages, cheese puffs, precooked dishes, desserts, and gravy [7]. ...
Article
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The special properties of soy preparations make them common additives for food production and can be dangerous for sensitive individuals. Our aim was to check consumers’ awareness of potential risks of soy preparations added to numerous food products, depending on respondents’ education, and to evaluate immunoreactive properties of chosen soy preparations. A personal questionnaire was used. Respondents (n = 251) were aged 23–28 years old, lived in Poland, and were graduates or students in their last year of food technology, medicine, and university of technology. The slot blot and Western blotting methods were used to mark immunoreactivity of soy preparations. It was shown that most respondents often or usually read labels of food products they buy. The surveyed indicated protein is the allergenic component in soy. Almost half of them were of the opinion that hydrolysis removes the allergenic properties of soy. Most of the medical students surveyed thought that people allergic to soy may consume products that contain soy preparations. The analytical results indicated that soy preparation contained protein fractions that were immunoreactive with sera of allergenic patients. It was proven that preparations, even hydrolysates, contain immunoreactive proteins that may be the source of hidden allergens, even though they are not recognized as dangerous by well-educated respondents.
... Mustard has also been found in sauces and pizza as hidden allergen [38]. Allergic reactions due to the ingestion of uncommon foods including mustard are usually overlooked as they are very difficult to identify and diagnose [119]. A major problem is how to avoid hidden allergens in the commercial or packaged foods, as reactions occur after ingesting the foods accidently or unknowingly that are responsible for the allergic symptoms. ...
... A major problem is how to avoid hidden allergens in the commercial or packaged foods, as reactions occur after ingesting the foods accidently or unknowingly that are responsible for the allergic symptoms. The presence of hidden allergens in foods is not always intentional; their presence is due to many reasons like misleading labels, contamination of foods with allergenic ingredients, carelessness, and listing of ingredients using uncommon term [119]. ...
Article
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Mustard is widely used in a variety of foods/food products to enhance the flavor and nutritional value that subsequently raise the risk of hypersensitivity reactions. Mustard allergy has been reported for many years and is increasing gradually especially in the areas where its consumption is comparatively higher, and it may be considered among the most important food allergies. A number of relevant clinical studies focused on mustard-induced allergic manifestations are summarized in the current review. In addition, the knowledge regarding the immunological as well as biochemical characteristics of mustard allergens that have been known till date and their cross-reactivity with other food allergens have also been discussed here. Notably, mustard may also be present as a hidden allergen in foods; therefore, it is important to recognize food products that may contain mustard as it may pose potential risk for the allergic individuals. Additionally, the better understanding of the underlying mechanism in mustard allergy is a prerequisite for the development of specific therapeutic procedures. Conclusively, mustard sensitivity should be routinely tested in patients with idiopathic anaphylaxis for the safety of the allergic patients.
... Therefore, the concept of idiopathic anaphylaxis has been introduced. This phenomenon may result from the presence of hidden allergens in food, which may be present as a consequence of cross--contamination during production and may not have been included on the label [37,38,39]. Another crucial aspect is the presence of cofactors. ...
Article
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Anaphylaxis is a life-threatening condition characterized by a rapid onset, requiring immediate intervention. It occurs through immunologic or non-immunologic mechanisms and can be triggered by various factors such as foods, medications or insect venoms. The spectrum of symptoms is broad, with skin, respiratory, and gastrointestinal symptoms being most commonly observed. Diagnosis relies on clinical criteria, with the primary treatment involving the intramuscular administration of adrenaline. Prevention involves avoiding triggers and if avoidance is not possible, desensitization should be considered. Deaths from anaphylactic shock are rare and often result from delayed or improper medical assistance and the absence of witnesses to summon help. It is estimated that around 1% of anaphylactic shock cases result in death. Deaths from intentional attempts to induce anaphylactic reactions through suicide are rare. Postmortem diagnosis presents a challenge due to the lack of specific changes, therefore it is essential to thoroughly assess the circumstances of death, medical history and exclude other potential causes. Identifying factors that may trigger an anaphylactic reaction, such as ingested foods or contact with allergens is crucial. A rapid and accurate diagnosis is key to avoid errors resulting from post-mortem processes. Histopathological examinations and the measurement of biochemical markers, such as tryptase and IgE levels, may be helpful in determining the cause of death.
... Allergies and allergy disorders are becoming more commonplace worldwide and are no longer "a rare fact" in Africa as previously believed. A systematic review based on data from 11 In 4 1999, a study realized on suspected allergy cases in Côte d'Ivoire showed that 56.4%, 30.7%, 23.5%, 8.5%, 2.8%, and 1.4% were, respectively, sensitized to mites, cockroaches, molds, pets' dander's (dog and cat), foods (rice, peanut, and soy) and latex allergens 5 . In addition, 52% of cases were polysensitized More than a decade later, studies done in Ghana and Cameroun confirmed the hierarchy of allergens in the sub-Saharan context, with mites (51%), cockroaches (59%), pets' dander's (15%), and foods related allergies (8%) as the main allergens, High sensitization of Africans to mites .and ...
Article
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Background: The immune system plays a crucial role in maintaining health and protecting the human body against microbial invasions. Objective: The purpose of the present study was to assess the prevalence of hypersensitivities reaction in allergic patient attending selected diagnostic centers. Methodology: This cross-sectional was performed at selected hospitals. The study was carried out from 01 st August 2023 to 30 th November 2023 at the Immunology department of Nova Diagnostic and Research Institute, Somalia. There 300 samples were included in this study. Questionnaire and investigation (Sample Testing) was used as the main instrument for collecting patient socio-demographic profile and laboratory test were done at Nova diagnostic center. Results: A total 300 participants were enrolled in this study. Among the 300 the predominant the prevalence of respondents was high which was 273(91%) cases and most of the participants were Banana allergic which was 215 (71.7%) cases. Maximum cases were from age group of 2-20 years (48%) and followed by 21-39 years (22%), 40-58 years (17.67%) and >58 years (12.33%). There was a statistically significant correlation between allergic status and education (P=0.003), but not between allergic status and age group (P=00.219) or gender (P=0.456). Conclusion: The study revealed a significant correlation between allergic status and education, indicating that the majority of participants were allergic to bananas.
... A patient can be exposed to a rare or hidden food allergen. As a result, many cases of so-called idiopathic anaphylaxis are potentially due to unidentified allergens as reported in a retrospective study by Añíbarro et al., that showed that 22.4% of food allergic reactions in individuals over 14 years of age were due to hidden allergens [4]. ...
Article
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In food allergy management, the avoidance of the allergen that caused the reaction plays a fundamental role. Nevertheless, that can be thwarted in case of accidental exposure to a rare or hidden allergen, causing the adoption of a monotonous diet and a consequent reduction in the quality of life of the patient and their family. The identification of a rare and hidden allergen is an important diagnostic challenge, taking into account that a significant proportion of all food reactions is in reality due to them. The aim of the present review is to provide the pediatric allergist an overview of the possible sources of rare and hidden food allergens, taking into consideration the routes of exposure to these potential allergens with the main examples published in the scientific literature and the distinction between types of direct or cross-contamination. The identification of the allergen responsible for the reaction and the provision of a dietary advice customized for the specific individual’s dietary habits is essential to improve quality of life of the familiar nucleus and to reduce the risk of further allergic reactions.
... Cases of Anisakis allergy are increasingly being reported worldwide, with up to 22% of the population in some countries being sensitized (i.e., Anisakis-specific IgE seropositivity) (Rahmati et al., 2020). Also, it was stated that the most frequent cause of an anaphylactic episode due to a hidden allergen, is fish or shellfish infected with A. simplex (Anibarro et al., 2007). ...
Article
Background and aim The nematodes Anisakis simplex and Pseudoterranova decipiens, are zoonotic parasites infecting many marine fish and pose a substantial human health risk. Besides being causative agents for gastrointestinal disease after ingestion of a live larva, and an allergic reaction after consuming/handling infected fish, there is proof-of-principle for hidden allergic concerns. Several anisakid allergens are highly resistant, and in this way may be transmitted to meat by use of fishmeal as a feed component for livestock. To consolidate this hypothesis of transmissibility, a controlled chicken feeding trial using Anisakidae-contaminated feed was conducted. Methods Anisakid larvae were collected from codfish and freeze-dried according to fishmeal manufacturing conditions. This larvaemeal was then administered to chickens, and after three weeks of exposure, blood and muscle samples were subjected to a targeted proteomic analysis aiming at detecting anisakid peptides. Results and discussion Results demonstrated that peptides from at least six A. simplex allergens were transferred from the feed to the chicken meat and blood. If future experiments confirm a remaining allergenic potency of these peptides in humans, it would significantly change the importance of these zoonotic nematodes from originally a purely fishborne food risk to potentially a wider risk from several food sources.
... Taking into account the wide distribution and growing consumption of these products, it should be considered an allergen [15]. Some authors describe that hidden allergens account for almost a quarter (21%) of all food allergy reactions [16]. Nowadays, P. ovata seeds or psyllium are not considered a declared food allergen, like sesame seeds, nuts, egg, soybean or others despite the hidden risks shown in this study [17]. ...
... Moreover, they are also one of the most common causes of food allergy in populations where fish consumption is high. In the last few years, the incidents of hypersensitivity reaction to PVs have been noticed with increasing frequency (Anibarro et al., 2007;Ma et al., 2008;Griesmeier et al., 2009). The direct contact or intake of fish can cause mild to severe life threatening health problems in sensitized individuals, which may include dermatitis, asthma, diarrhea, acute urticaria, angioedema, and sometimes anaphylactic shock and/or death. ...
Article
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Parvalbumins are the calcium binding low molecular weight proteins of acidic nature with remarkable heat-stability and enzymatic degradation. They are responsible for more than 95% fish-food related allergies. In muscle, they form a major part of muscle sarcoplasmic proteins and thought to be involved in muscle relaxation. Direct contact or ingestion of fish by sensitized individuals can cause mild to severe health problems. The present study was extended to in silico sequence analyses, 3D structure prediction, functional and evolutionary characterization of two Parvalbumins namely Parvalbumin-2 of Zebra fish, Danio rerio (Length 109aa) and Parvalbumin-beta of Common carp, Cyprinus carpio (Length 108 aa). The evolutionary analyses were performed using Maximum Likelihood and Maximum parsimony methods. The structures were predicted through comparative modelling. Two suitable templates for comparative modelling (PDB IDs: 5CVP and 1B8R respectively) have been selected on the basis of BLASTp and FASTA results. The target-template alignment, model building, loop modeling and evaluation have been performed through MODELLER 9.10. After fruitful verification, the models were deposited to Protein Model Database (PMDB). The models have been assigned PMDB IDs PM0074993 and PM0074994. The data mining and sequence analyses of the proteins were performed by CLC protein workbench 4.0. Functional characterizations of the proteins were performed using ProFunc server. The study reveled that parvalbumin has an Isoelectric point of 4.25. Both the proteins contain 2 EF-hand domains. The investigation generated new information on the importance of the parvalbumin that will help the researchers from several angles.
... Hidden allergens have been a matter of debate in the etiology of IA [47][48][49]. However, to the authors' experience, these are not common causes of IA, but they should be considered in patients, in particular, when an anaphylactic episode was suspected after recent meal by evaluating the ingredients [50•]. ...
Article
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Purpose of review: The aim of this systematic review is to present the proposed theories of pathogenesis for idiopathic anaphylaxis (IA), to discuss its classification, its diagnostic approach, and management. Recent findings: IA represents a major diagnostic challenge and is diagnosed when excluding the possible identifiable triggers of anaphylaxis. The current research, however, revealed that certain conditions including mastocytosis, mast cell activation syndromes, and hereditary alpha tryptasemia can masquerade and overlap with its symptomatology. Also, newly identified galactose-alpha-1,3-galactose mammalian red meat allergy has recently been recognized as underlying cause of anaphylaxis in some cases that were previously considered as IA. IA comprises a heterogenous group of conditions where, in some cases, inherently dysfunctional mast cells play a role in pathogenesis. The standard trigger avoidance strategies are ineffective, and episodes are unpredictable. Therefore, prompt recognition and treatment as well as prophylaxis are critical. The patients should always carry an epinephrine autoinjector.
... Hidden fish allergens in food represent another sizable threat to fish-allergic patients. In a study by Anibarro et al., 35% of fish allergic patients reacted to fish proteins hidden in other foods [177]. In addition not all allergens from different fish species are detected by commercial tests [125]. ...
Article
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Fish allergy constitutes a severe problem worldwide. Its prevalence has been calculated as high as 7% in paediatric populations, and in many cases, it persists into adulthood with life-threatening signs and symptoms. The following review focuses on the epidemiology of Immunoglobulin E (IgE)-mediated fish allergy, its pathogenesis, clinical manifestations, and a thorough approach to diagnosis and management in the paediatric population. The traditional approach for managing fish allergy is avoidance and rescue medication for accidental exposures. Food avoidance poses many obstacles and is not easily maintained. In the specific case of fish, food is also not the only source of allergens; aerosolisation of fish proteins when cooking is a common source of highly allergenic parvalbumin, and elimination diets cannot prevent these contacts. Novel management approaches based on immunomodulation are a promising strategy for the future of these patients.
... According to our results, in patients with confirmed fish/shrimp allergy, the mean level of specific IgE to molecular components was higher in comparison to patients with the positive results to molecular components, but without clinical reactions to these food allergens. While probably extremely rare, there are examples of patients reacting to fish allergens that are hidden in foods (Anıbarro et al., 2007); the lowest provoking dose of fish is in the low milligram range Helbling et al., 1999;Poulsen et al., 2001;Untersmayr et al., 2005;Untersmayr et al., 2007). ...
Article
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The aim of this study is the evaluation of the occurrence of fish/shrimp allergy in atopic dermatitis patients. The occurrence of fish/shrimp allergy was confirmed in the challenge test or according to the history; the sensitisation to molecular components with ISAC Multiplex testing was analysed. Altogether 100 atopic dermatitis patients were examined. The food allergy to fish was confirmed in 13 patients (13%), while shrimp allergy occurred in 6 patients (6%).In patients with allergy to fish, the significantly higher occurrence of sensitisation to Asp f 1, Asp f 6, Alt a 6, Der f 1, Der f 2, Der p 1, Der p 2, Lep d 2 and Blo t 5 was confirmed. In patients with food allergy to shrimps, the significantly higher occurence of sensitisation to Asp f 6, Alt a 6, Cla h 8, Bla g 1 and Bla g 5 was confirmed also.
... It is recommended that the third-stage A. simplex larvae be considered as a possible causative food allergen in adults presenting with urticaria, angioedema or anaphylaxis following raw fish consumption (Choi et al. 2009) and in cases of allergy which occurs in conjunction with close contact to fish or fish bi-products. In Spain, a woman suffering from allergic asthma after handling fish returned a positive skin prick test to A. simplex (Pulido-Marrero et al. 2000) and a man with bilateral conjunctivitis was positive to A. simplex in a conjunctival provocation test (Anibarro et al. 2007). In both cases, the patients were negative for allergy to common fish species. ...
Article
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The infective stage of Anisakidae nematodes responsible for allergic reactions in humans is found in a variety of edible fish and cephalopods. The identification of geographical regions that are high risk for infected seafood may help prevent allergic reactions in humans. Despite an abundance of published literature which has identified anisakid larvae in an array of edible seafood as well as scattered reports of human allergic anisakiasis, the relationship between the two has not been fully explored. Therefore, a systematic spatio-temporal study was conducted to determine the prevalence of Anisakis spp. in fish from January 2000 to August 2020 firstly to explore the relationship between fish infection and cases of allergic anisakiasis and secondly to use fish infection data to map potential allergic anisakiasis ‘hot spots’. A systematic literature search for original English text articles was conducted through search engines, Web of Science, Scopus, PubMed, Science Direct and Google Scholar. Out of 3228 articles which describe anisakid infection in fish, 264 were used for data extraction. Of 904 articles describing allergic anisakiasis, 37 were used for data extraction. A qualitative summary of the extracted data was performed using equal interval method (ArcMap software) in order to compare the global distribution of Anisakis-infected fish. Of the 152-identified fish hosts, five families were most commonly infected with Anisakis spp. These included Lophiidae (86.9%), Trichiuridae (77.05%), Zeidae (70.9%), Merlucciidae (67.8%) and Gadidae (56.8%). The hot spot areas for allergic anisakiasis were North and northeast of Atlantic Ocean, southwest of USA, west of Mexico, south of Chile, east of Argentina, Norway, UK and west of Iceland (confidence 99%). The highest rate of allergic anisakiasis was in Portugal and Norway with the prevalence rate of 18.45–22.50%. Allergologists should consider allergic anisakiasis as a public health issue particularly in high-risk countries where high prevalences in fish have been demonstrated.
... 8 Studies suggest A. simplex (s.l.) is a major hidden producer of allergic incidents associated with food. 9 Although Anisakis larvae mostly infect visceral organs, they can also penetrate the musculature and accumulate in edible parts of fish. The presence of these nematode larvae in fish flesh is important not only from the health point of view but also because of its economic implications, since it decreases fish quality and provokes consumer rejection. ...
Article
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BACKGROUND Seafood parasitation by Anisakis (Anisakidae) larvae has been reported in most of the oceans and seas worldwide. The presence of these nematodes in commonly consumed fish represents a potential hazard for consumers as they can provoke gastrointestinal symptoms and allergic reactions. In the present work, the capacity of a SYBR Green qPCR protocol to quantify Anisakis larvae in commercial fish was evaluated using experimentally spiked samples with different numbers (0–50) of A. simplex third‐stage larvae (L3). To verify the agreement of the obtained results, 25 naturally infected fish specimens of Atlantic blue whiting underwent a parallel visual inspection. RESULTS The logarithmic behavior of the Cq data obtained from the experimentally spiked samples allowed the development of a descriptive mathematical model that correlates the Cq value with the number of Anisakis larvae (R² = 0.9908, CV = 2.37%). In the commercial blue whiting specimens there was a high correlation between the results of the molecular technique and the visual inspection (R² = 0.9912); the Bland–Altman analysis showed that 94% of the differences were within the limits of agreement (−4.98 and 6.68), indicating the reliability of the descriptive mathematical model based on the SYBR Green qPCR technique. CONCLUSION The descriptive function presented based on the SYBR Green qPCR assay is promising as a sensitive and accurate tool for measuring the Anisakis larval load in commercial fish, with a potential application not only in the food industry but also in prevention programs for public health. © 2020 Society of Chemical Industry
... The list of Anisakis allergens seems incomplete as new isoforms [18] and new potential allergens [19][20][21][22][23] are still being identified. A. simplex allergens are considered to be the most common hidden allergens in marine fish products [24]. These allergens may cause hypersensitivity reactions in sensitized humans in the form of urticaria, angioedema, asthma, rhinitis, conjunctivitis, gingivostomatitis, contact dermatitis, and even severe anaphylaxis [25,26]. ...
Article
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Anisakis simplex third-stage larvae are the main source of hidden allergens in marine fish products. Some Anisakis allergens are thermostable and, even highly processed, could cause hypersensitivity reactions. However, Anisakis proteome has not been studied under autoclaving conditions of 121 °C for 60 min, which is an important process in the food industry. The aim of the study was the identification and characterization of allergens, potential allergens, and other proteins of heat-treated A. simplex larvae. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to identify 470 proteins, including allergens-Ani s 1, Ani s 2, Ani s 3, Ani s 4, Ani s 5-and 13 potential allergens that were mainly homologs of Anisakis spp., Ascaris spp., and Acari allergens. Ani s 2, Ani s 3, Ani s 5, and three possible allergens were found among the top 25 most abundant proteins. The computational analysis allowed us to detect allergen epitopes, assign protein families, and domains as well as to annotate the localization of proteins. The predicted 3D models of proteins revealed similarities between potential allergens and homologous allergens. Despite the partial degradation of heated A. simplex antigens, their immunoreactivity with anti-A. simplex IgG antibodies was confirmed using a Western blot. In conclusion, identified epitopes of allergenic peptides highlighted that the occurrence of Anisakis proteins in thermally processed fish products could be a potential allergic hazard. Further studies are necessary to confirm the IgE immunoreactivity and thermostability of identified proteins.
... Foods 2020, 9, 423 2 of 19 soybeans may remain indiscernible or hidden due to mislabeling or the cross contact of allergen-free food products with allergenic foods, e.g., during the food manufacturing process [7]. As part of the Allergen Bureau of Australia & New Zealand, the VITAL (Voluntary Incidental Trace Allergen Labeling) expert panel established reference doses for allergenic foods on the basis of individual clinical threshold data. ...
Article
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The soybean (Glycine max) has been recognized as a frequent elicitor of food allergy worldwide. A lack of causative immunotherapy of soybean allergy makes soybean avoidance essential. Therefore, sensitive and specific methods for soybean detection are needed to allow for soybean verification in foods. Loop-mediated isothermal amplification (LAMP) represents a rapid and simple DNA-based detection method principally suitable for field-like applications or on-site analytical screening for allergens during the manufacturing of foods. This work describes the systematic development and selection of suitable LAMP primers based on soybean multicopy genes. The chemistry applied allows for a versatile detection of amplified DNA, using either gel electrophoresis, fluorescence recording, or a simple Lateral Flow Dipstick (LFD). LAMP based on the ORF160b gene was highly specific for the soybean and may allow for a detection level equivalent to approximately 10 mg soy per kg food. Various soybean cultivars were detectable at a comparable level of sensitivity. LAMP combined with LFD-like detection facilitates a simple, highly specific and sensitive detection of the soybean without the need for expensive analytical equipment. In contrast to the majority of antibody-based methods for soybean detection, all identified primer sequences and optimized protocols are disclosed and broadly available to the community.
... Examples of errors include failure to disclose or communicate the allergy, 13 cross-contact, inconsistent or incomplete food labeling, and hidden or undeclared allergens in specialty menus or mixed dishes. 9,11,14,15 Although an error could occur in any type of restaurant, Asian restaurants have been cited as high risk in several studies, 11,16,17 as well as Italian restaurants, 16 seafood restaurants, 18 and bakeries and ice cream shops. 11 Chain or franchise restaurants may be more likely to provide consistent food allergy training to managers and staff than independently owned restaurants. ...
Article
Individuals with food allergy are at risk for accidental exposures, potentially resulting in allergic reactions that may cause significant morbidity and mortality. Dining out, including restaurants or take-out, account for a large proportion of severe reactions. Errors due to gaps in knowledge or miscommunication can easily occur on behalf of food-allergic individuals or restaurant staff, resulting in accidental exposures and allergic reactions. Improved legislation, training of restaurant staff, and practitioner-guided education are recommended to reinforce patient safety and prevent severe allergic reactions. This Work Group Report provides guidance with specific practices that practitioners may recommend, and that patients and restaurant staff may employ, for prevention and treatment of food-allergic reactions in restaurants.
... In the allergic cases from this region, the consumption of cooked hake (Merluccius merluccius) predominates, closely followed by cooked or raw anchovies (Engraulis encrasicholus) [7]. It is becoming apparent that AS is the most important hidden food allergen in the adult population suffering acute urticaria and anaphylaxis of the Basque Country in northern Spain, and this recognition has now spread to other regions in Spain [7][8][9][10]. It is also the etiological factor which is most commonly associated with urticaria for any specific food allergy in the adult population and comprises as much as 10% of the anaphylaxis previously diagnosed as idiopathic [7][8][9]. ...
... The next step is to rule out a "hidden" food allergen. The most common cause is unintentional contamination in the processing steps, but there are many ways for allergens to be hidden in food (75). One of the first record of hidden allergen in food allergy was reported in 1928 by Balyeat who described asthma symptoms in two peanut-allergic children after they had drunk milk from a cow fed on peanut plants (76). ...
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Background and aim of the work: The possibility of an allergic reaction or an intolerance to additives is frequently suspected by parents, especially for chronic illness with frequent exacerbations such as atopic dermatitis or chronic urticaria. For more than 50 years, potential adverse reactions to additives have been suggested, but to date data are conflicting. The purpose of this article is to provide the clinicians with general information about additives and adverse reactions to them and to suggest a practical approach to children suspected to have reactions to food additives. Methods: We performed an extensive research on all English-language Medline articles, case reports and reviews published online until December 2018. Used search terms were: food additives, food dye, adverse reactions, food allergy, food hypersensitivity, intolerance, drugs, children. Results: There are only few case reports of adverse reactions in childhood with a clear involvement of additives. In this review article we reported the associations between additives and adverse reactions described in literature, in order to inform the pediatrician about the potential clinical manifestations. Conclusions: Prior to suspect an adverse reaction to additives, it is important to rule out other possible causes: the diagnostic process is complicated and rarely conclusive. The gold standard is the double-blind placebo controlled oral challenge after an exclusion diet.
... Allergy to Anisakis spp. has been reported to be relatively common in some areas of Spain (Audicana & Kennedy, 2008;Fernández de Corres, Del Pozo, & Aizpuru, 2001;López Sáez et al., 1999;Puente et al., 2008), being the most important hidden food allergen in those members of the adult population who are suffering acute urticaria and anaphylaxis (Table 3 at Supplementary materials) (Añíbarro, Seoane, & Múgica, 2007;Audicana & Kennedy, 2008;Del Pozo et al., 1997). Studies carried out in Spain also showed that subclinical sensitization in blood donors and healthy populations ranged from 0.4% to 22% (Table 3 at Supplementary materials) (Fernández de Corres et al., 2001;Puente et al., 2008;Valiñas et al., 2001). ...
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Background: Nematodes of the genus Anisakis parasitize many commercial fish species and are responsible for a fish-borne zoonosis (anisakiasis) and allergic reactions. Anisakis can also cause consumer distrust in fishery products and economic losses to the fish industry. Scope and approach: We review current socioeconomic, legislative, risk management and human health problems caused by the occurrence of Anisakis in fishery products and discuss possible strategies to mitigate them. Key findings and conclusions: Visual inspection (and candling) of fishery products as required by EU legislation is not efficient for parasite detection. Consequently, visible (and non-visible) Anisakis reach the market and may be detected (and eaten) by consumers. Marine fish appears to be the only industrial food product that is at high risk of containing parasites when placed on the market. Anisakiasis and allergy to Anisakis are hidden, underestimated emerging zoonoses worldwide. There is a need to better understand the impact of these zoonoses on individual health and particularly exposed human populations, and to assess the risk posed by Anisakis allergens in fishery products. Quantitative risk assessment (QRA) is identified as an appropriate methodology as it estimates the risk from fishing ground to human disease. Improvements in parasite control legislation and procedures (e.g. establishment of research-based and standardized parasite detection methodologies, appropriate sampling strategies, development of non-destructive methods for detection and removal of nematodes from fish products), suitable for use by seafood businesses, are recommended to improve protection of consumers and to protect the industry by minimizing Anisakis-associated economic losses. QRA may help to provide the scientific basis for improved food safety legislation and strategies to reduce the risk of anisakiasis/allergy in humans.
... Identification of the trigger is essential to prevent further re-exposure [1]. Published evidence frequently mentions accidental exposures: accidental ingestion, contamination, the presence of occult allergens and labelling errors [2, [7][8][9][10]. Intentional contact with the allergen as a form of achieving self-harm is rarely reported. ...
... Introduction During the last decades, progress in the food industry and globalization have markedly increased the exposure to new allergenic sources that not always are adequately pointed out [1]. Coupled with changes in eating habits, including widespread consumption of raw, marinated or smoked fish, a quota of food allergies of unknown origin in the general population may be due to sensitization to Anisakis spp., representing a public health issue of growing importance [2,3]. ...
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Anisakis simplex spp. sensitization rates have increased worldwide, with a significant impact on health-care systems. To date, no clear-cut diagnostic criteria and laboratory algorithm have been established, so anisakiasis still represents an under-reported health problem whose clinical manifestations, when present, mimic the much more common allergic and digestive disorders. Aim of the study was to systematically review the available literature on the prevalence of sensitization against Anisakis in the general population and in specific population groups, taking into account the impact of the different available diagnostic techniques on the epidemiological data. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant papers reporting Anisakis sensitization epidemiological data were found covering a period ranging from 1996 to February 2017. Overall, 41 studies comprising 31,701 participants from eleven countries were included in the qualitative synthesis. General asymptomatic population resulted sensitized to Anisakis in 0.4 to 27.4% of cases detected by means of indirect ELISA or ImmunoCAP specific IgE detection, and between 6.6% and 19.6% of the samples by Skin prick test (SPT). Occupationally exposed workers (fishermen, fishmongers and workers of fish-processing industries) documented specific IgE between 11.7% and 50% of cases, whereas SPT positivity ranged between 8% and 46.4%. Symptomatic allergic patients to any kind of allergen were found to be positive to Anisakis specific IgE detection between 0.0% (in children with mastocytosis) to 81.3% (among adults with shellfish allergy). Results highlighted that hypersensitivity prevalence estimates varied widely according to geographical area, characteristics of the population studied, diagnostic criteria and laboratory assays. Further studies are needed to overcome the documented misdiagnosis by improving the diagnostic approach and, consequently, providing more affordable estimates in order to address public health interventions on populations at high risk of exposure to Anisakis and to tailor health services related to specific groups.
... 9,10 In the present situation accidental allergic reactions to food occur frequently among allergic patients, including severe and fatal reactions. [11][12][13][14][15] The comparability between studies is limited because of different time frames and study populations. 11 In those studies, eating outside the home and prepackaged foods are both mentioned frequently as main causes together with patient factors, such as ignoring or missing the (precautionary allergen) label or not informing restaurant staff. ...
Article
Background: Accidental allergic reactions to food are frequent, can be severe and even fatal. Objective: To analyze the culprit food products and levels of unexpected allergens in accidental reactions. Methods: A prospective cohort study was conducted in adults (n=157) with a physician-confirmed diagnosed food allergy. During a 1-year follow up, 73 patients reported accidental allergic reactions and the culprit food products. Food samples received (51) were analyzed for a wide range of suspected non-ingredient allergens and the risk was quantified. Results: A very diverse range of food products was responsible for the unexpected allergic reactions. Thirty-seven percent (19/51) of products analyzed had 1 to 4 culprit allergens identified that were not supposed to be present according to the ingredient declaration. Concentrations varied from 1 to 5000 mg protein of the allergenic food per kg food product, and were highest for peanut, milk and sesame. Milk proteins posed the highest estimated risk for objective allergic reactions. The intake of culprit allergens by patients varied considerably. For these cases in which culprit allergens were detected, the intake of at least one allergen exceeded the reference dose or a culprit allergen with a yet unknown reference dose was present. Both patient neglect of PAL statements and omission of using a PAL statement by food manufacturers seem to contribute to accidental reactions. Conclusion: A wide range of food products are causing accidental reactions in food allergic patients. Eight different allergens not declared on the ingredient lists were detected in the culprit food products, all representatives of the allergens regulated in the EU.
... previous study, the evidence of an altered intestinal permeability which correlates with severity of clinical symptoms was reported in gastrointestinal cases of anisakiasis [4]. Anisakis s. infestation can cause allergic reactions with symptoms, such as conjunctivitis, acute and chronic urticaria, angioedema, rhinitis, asthma and anaphylactic shock [5][6][7][8][9][10]. The clinical manifestations are accompanied by increased serum specific IgE levels, while the diagnosis can be made by skin prick test (SPT) using Anisakis s. allergens [2]. ...
Article
Background: Allergy to Anisakis simplex (s.) is spreading due to the increased consumption of raw, smoked or marinated fish. In humans, Anisakis s. can directly attack the gastrointestinal mucosa, provoking a parasitosis known as anisakiasis, or giving rise to the formation of IgE and, finally, inducing IgE-mediated reactions like urticaria, angioedema and anaphylactic shock. During recent years, a dietary approach to Anisakis s. infestation has also been addressed. Methods: A total of 620 patients with urticaria, angioedema, or both and a history of anaphylaxis following consumption of raw, smoked or marinated fish were recruited, evaluated for specific IgE levels to Anisakis s. and subjected to skin prick test. Following 18 month fish-free diet, patients were re-evaluated at 6, 12 and 18 months, respectively. Results: After 6-month fish-free diet, we recorded an improvement of symptoms and a remarkable reduction of specific IgE levels. The extension of the diet over 6 months in some cases resulted in a further reduction of specific IgE levels. Conclusion: Data obtained confirm the importance of a fish-free diet in patients with severe symptoms since a new antigenic exposure coincides with a relapse of symptoms and increased IgE levels. This last point should be kept in mind and carefully evaluated in patients at risk for anaphylaxis or angioedema.
... In a 2007 retrospective study of 530 food reactions in adults in Spain, approximately 22.4% (119 cases) were attributed to hidden allergens, of which 32% were anaphylactic [20]. The majority of episodes were due to A. simplex (discussed above) but more importantly, all but two of the remaining cases were due to the unsuspected presence of common food allergens such as nuts and fish. ...
Article
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Purpose of review: This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings. Recent findings: Multiple new and elusive causes of anaphylaxis have been described over the past 35 years. Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.
... The two most frequent food allergens that induce severe and potentially lethal anaphylaxis are milk and egg, while the third differs between countries (18) being peanuts in the USA and Switzerland, wheat in Germany and Japan, tree nuts in Spain, and sesame in Israel (16). Foods and meals containing hidden allergens at restaurants are a serious source of risk for patients with food allergies (19). The prevalence of food-induced anaphylaxis seems to vary with the population selected and the region where they are recruited. ...
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Prevalence of food-induced anaphylaxis increases progressively and occurs in an unpredictable manner, seriously affecting the quality of life of patients. Intrinsic factors including age, physiological, and genetic features of the patient as well as extrinsic factors such as the intake of drugs and exposure to environmental agents modulate this disorder. It has been proven that diseases, such as mastocytosis, defects in HLA, or filaggrin genes, increase the risk of severe allergic episodes. Certain allergen families such as storage proteins, lipid transfer proteins, or parvalbumins have also been linked to anaphylaxis. Environmental factors such as inhaled allergens or sensitization through the skin can exacerbate or trigger acute anaphylaxis. Moreover, the effect of dietary habits such as the early introduction of certain foods in the diet, and the advantage of the breastfeeding remain as yet unresolved. Interaction of allergens with the intestinal cell barrier together with a set of effector cells represents the primary pathways of food-induced anaphylaxis. After an antigen cross-links the IgEs on the membrane of effector cells, a complex intracellular signaling cascade is initiated, which leads cells to release preformed mediators stored in their granules that are responsible for the acute symptoms of anaphylaxis. Afterward, they can also rapidly synthesize lipid compounds such as prostaglandins or leukotrienes. Cytokines or chemokines are also released, leading to the recruitment and activation of immune cells in the inflammatory microenvironment. Multiple factors that affect food-induced anaphylaxis are discussed in this review, paying special attention to dietary habits and environmental and genetic conditions.
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This book is an updated reference source on food safety best practices. The chapters discuss analytical approaches to measuring food contaminants, quality control and risk assessment of food storage, food irradiation, etc. The contributors discuss how quality control and management help to establish sustainable and secure food systems globally. The book covers topics such as techniques to measure food contaminants, toxins, heavy metals and pesticide content in food. FEATURES ◾ Examines the role of food safety approaches in global food supply chains ◾ Describes various detection techniques for food contaminants and toxins ◾ Discusses the application of nanotechnology and other innovations in food safety and risk assessment ◾ Reviews the international regulations for management of food hazards ◾ Includes the hazard analysis critical control points (HACCP) principles This book is an essential resource to help students, researchers, and industry professionals understand and address day-today problems regarding food contamination and safety and their impact on human health.
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Dietary patterns are changing severely, especially the consumption of highly processed foods with lots of spices is increasing, carrying an increased risk of immediate hypersensitivity (type I), in sensitised individuals, due to the possible presence of allergens, especially the hidden ones. Paprika is a fruit of the Capsicum genus, which belongs to the Solanaceae family and is commonly consumed fresh or as a spice. Despite recorded cases of anaphylaxis, its allergenicity has yet to be clearly investigated. In this study, we research to identify proteins that could trigger a severe allergic reaction in patients with an equivocal clinical picture. Two types of protein extracts extracted from 3 different paprika spices were immunoblotted with sera from patients with severe allergic symptoms, presumably to paprika. Proteins from the IgE reactive bands obtained were subjected to LC–MS/MS identification and then in silico analysis to assess their possible sensitising capacity and proinflammatory potential using online tools. The spices were shown to contain a number of incompletely investigated highly immunoreactive allergenic proteins, including proteins of foreign origin (contaminants), the presence of which can stimulate inflammatory mechanisms and cross-reactivity with other food allergens, which can threaten life and health and should be investigated in detail.
Article
Small scale dairy producers, who are often also the sellers of dairy products, are the ones responsible for ensuring food safety conditions all throughout the food distribution chain. Food contamination may appear in any part of the food chain including sale, due to cross-contamination that can occur caused by wide varieties of food offered at open markets, improper food handling, contaminated equipment, and poor personal hygiene. An observational study was conducted to determine the hygienic conditions of artisan dairy products' selling places at open markets. In addition, dairy products' sellers were interviewed to obtain complementary data regarding hygiene conditions at the households, as well as during transportation and sale at the open market. The research included 293 selling places and 279 dairy products’ sellers from 43 open markets located in different parts of the Republic of Serbia. Based on a total hygiene assessment score (HAS) calculated for each selling place, acceptable, marginal acceptable and unacceptable group of selling places were identified. A two-step cluster analysis was performed to identify a group of potentially more risky selling places, and resulted in two identified clusters. The differences between hygiene conditions among clusters were mainly influenced by their position at the open market. The establishment and maintenance of a cold chain needs to be improved as one of the most important prerequisites of food safety, especially for those selling places located at an open place. The obtained results suggest the need for additional training and raising awareness of small dairy producers regarding the importance of hygiene during production, distribution and sale of dairy products.
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Zoonotic foodborne parasites often represent complex, multi host life cycles with parasite stages in the hosts, but also in the environment. This manuscript aims to provide an overview of important zoonotic foodborne parasites, with a focus on the different food chains in which parasite stages may occur. We have chosen some examples of meat-borne parasites occurring in livestock (Taenia spp., Trichinella spp. and Toxoplasma gondii), as well as Fasciola spp., an example of a zoonotic parasite of livestock, but transmitted to humans via contaminated vegetables or water, covering the ‘farm to fork’ food chain; and meat-borne parasites occurring in wildlife (Trichinella spp., Toxoplasma gondii), covering the ‘forest to fork’ food chain. Moreover, fish-borne parasites (Clonorchis spp., Opisthorchis spp. and Anisakidae) covering the ‘pond/ocean/freshwater to fork’ food chain are reviewed. The increased popularity of consumption of raw and ready-to-eat meat, fish and vegetables may pose a risk for consumers, since most post-harvest processing measures do not always guarantee the complete removal of parasite stages or their effective inactivation. We also highlight the impact of increasing contact between wildlife, livestock and humans on food safety. Risk based approaches, and diagnostics and control/prevention tackled from an integrated, multipathogen and multidisciplinary point of view should be considered as well.
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In Australia and New Zealand (NZ), snapper Chrysophrys auratus is known for delicate mild flavoured flesh and is a favoured species to serve raw as sashimi or in sushi. The diet of snapper includes a variety of intermediate hosts of larval nematodes, and as a result, snapper has potential to become highly infected with zoonotic/non-zoonotic nematodes. The aims of this study were to survey nematodes in snapper from Australia and New Zealand waters and to identify nematode species using combined morphological and molecular methods. The zoonotic potential of nematodes identified in this study are discussed. A total of 112 snapper were purchased from the Sydney fish market, New South Wales, Australia. Fish were dissected and only the visceral content and digestive tract were examined for nematode infection. Parasites were initially identified by the microscopic method as four different types belonging to the families Anisakidae (Anisakis types I & III, and Terranova type II) and Cucullanidae (Dichelyne spp.). All Anisakidae nematodes were at infective stages. Species-level identification was actualised through sequencing of the internal transcribed spacer (ITS–1, 5.8S, ITS–2) regions. The Anisakis types I & III were confirmed as Anisakis pegreffii and A. brevispiculata, respectively of which A. pegreffii is considered globally as a zoonotic nematode. The specific identification of Terranova type II and Dichelyne spp. was not possible as no comparable sequence data were available in GenBank. The phylogenetic tree clustered Anisakis types I & III with A. pegreffii and A. brevispiculata, respectively; Terranova type II sequences as a separate clade with previously identified larval and adult Terranova and Pseudoterranova species. Based on phylogenetic analyses the present Cucullanid specimens were assigned herein as Dichelyne cf. pleuronectidis, and an unknown species Dichelyne sp. 1. This study represents the first host record globally for zoonotic Anisakid nematodes in this popularly consumed table fish and a new region record for D. cf. pleuronectidis and Dichelyne sp. 1. Further investigation is required, using more comprehensive parasite detection and recovery methods, to assess the health risk these nematodes may pose to human and fish health in Australia/NZ.
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Soybean (Glycine max) allergy can be life threatening. A lack of causative immunotherapy of soybean allergy makes soybean avoidance indispensable. Detection methods are essential to verify allergen labeling and unintentional allergen cross contact during food manufacture. Here, we aimed at evaluating our previously described primers for loop-mediated isothermal amplification (LAMP) of multicopy gene ORF160b, combined with a lateral flow dipstick (LFD)-like detection, for their performance of soybean detection in complex food matrices. The results were compared with those obtained using quantitative real-time Polymerase Chain Reaction (qPCR) as the current standard of DNA-based allergen detection, and antibody-based commercial lateral flow device (LFD) as the current reference of protein-based rapid allergen detection. LAMP-LFD allowed unequivocal and reproducible detection of 10 mg/kg soybean incurred in three representative matrices (boiled sausage, chocolate, instant tomato soup), while clear visibility of positive test lines of two commercial LFD tests was between 10 and 10 2 mg/kg and depending on the matrix. Sensitivity of soybean detection in incurred food matrices, commercial retail samples, as well as various processed soybean products was comparable between LAMP-LFD and qPCR. The DNA-based LAMP-LFD proved to be a simple and low-technology soybean detection tool, showing sensitivity and specificity that is comparable or superior to the investigated commercial protein-based LFD.
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For the increasing number of consumers with food allergies in the United States, dining out may pose serious health threats. Both restaurateurs and consumers need to be vigilant to prevent food allergy reactions in restaurants, but empirical studies that explored knowledge, attitudes, and behaviors of consumers with food allergies are limited. Therefore, this research aimed to examine food allergy knowledge, attitudes and behaviors of customers with food allergies or parents or guardians with children with food allergies by conducting focus groups and a cross-sectional survey. Customers with food allergies (n = 63) and parents or guardians of children with food allergies (n = 257), who were members of a food allergy social networking website, participated in the survey. Due to the nature of the website, in which members share their dining experience and recommendations, only 2.8% of participants indicated that they have never eaten at a restaurant. The average knowledge score of participants was 24.7 out of 30 (82.3%), and they well recognized typical causes of food allergy reactions in restaurants (i.e., hidden allergens, cross-contacts, and restaurant employees’ lack of knowledge, care, and communication about food allergies). Customers with food allergies took a variety of actions to prevent food allergy reactions before or during their visits to restaurants. Depending on the types of food allergens and previous dining experiences, respondents voiced diverse concerns about different types of restaurants. Restaurateurs may benefit from recognizing and addressing these concerns to improve their service for customers with food allergies.
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Parasite infections modulate immunologic responses, and the loss of parasite infections in the last two to three decades might explain the increased prevalence of allergic diseases in developed countries. However, parasites can enhance allergic responses. Parasites contain or release allergen-like molecules that induce the specific immunoglobulin, IgE, and trigger type-2 immune responses. Some parasites and their proteins, such as Anisakis and Echinococcus granulosus allergens, act as typical allergens. A number of IgE-binding proteins of various helminthic parasites are cross-reactive to other environmental allergens, which cause allergic symptoms or hamper accurate diagnosis of allergic diseases. The cross-reactivity is based on the fact that parasite proteins are structurally homologous to common environmental allergens. In addition, IgE-binding proteins of parasites might be useful for developing vaccines to prevent host re-infection. This review discusses the functions of the IgE-biding proteins of parasites.
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Idiopathic anaphylaxis (IA) or spontaneous anaphylaxis is a diagnosis of exclusion when no cause can be identified. The exact incidence and prevalence of IA is not known. The clinical manifestations of IA are similar to other known causes of anaphylaxis. A typical attack is usually acute in onset and can worsen over minutes to a few hours. The pathophysiology of IA has not yet been fully elucidated, although an IgE‐mediated pathway by hitherto unidentified trigger/s might be the main underlying mechanism. Elevated concentrations of urinary histamine and its metabolite, methylimidazole acetic acid, plasma histamine, and serum tryptase have been reported, consistent with mast cell activation. There is some evidence that corticosteroids reduce the frequency and severity of episodes of IA, consistent with a steroid‐responsive condition. Important differential diagnoses of IA include galactose alpha‐1,3 galactose (a carbohydrate contained in red meat) allergy, pigeon tick bite (Argax reflexus), pine processionary caterpillar allergy, wheat‐dependent exercise‐induced anaphylaxis, Anisakis simplex allergy and mast cell disorders. Other differential diagnoses include ‘allergy‐mimics’ such as asthma masquerading as anaphylaxis, undifferentiated somatoform disorder, panic attacks, globus hystericus, vocal cord dysfunction, scombroid poisoning, vasoactive amine intolerance, carcinoid syndrome and phaeochromocytoma. Acute treatment of IA is the same as for other forms of anaphylaxis. Long term management is individualised and dictated by frequency and severity of symptoms and involves treatment with H1 and H2 receptor blockers, leukotriene receptor antagonist and consideration for prolonged reducing courses of oral corticosteroids. Patients should possess an epinephrine autoinjector with an anaphylaxis self‐management plan. There are anecdotal reports regarding the use of omalizumab. For reasons that remain unclear, the prognosis of IA is generally favourable with appropriate treatment and patient education. If remission cannot be achieved, the diagnosis should be reconsidered. This article is protected by copyright. All rights reserved.
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Food allergies are becoming more prevalent and affect up to 1–2% of adults and 5–8% of children in the UK. This study investigated the food allergen knowledge, attitude towards food allergens and food allergy management practices among food allergic and intolerant consumers and/or their family members and carers. Questionnaires were distributed at three major Free From events in the UK in 2017 and 2018. Structural Equation Modelling (SEM) was used as a confirmatory technique to determine the model's validity. Cereals containing gluten, milk and eggs were the most common triggers reported by the consumers. Other trigger foods such as chocolate, garlic, maize, onions, red and white meat, spices, and fruits such as apples and cherries were also reported. Consumers demonstrated very good understanding on the severity of allergic reactions, prevention method and hidden egg ingredients. Overall, consumers were relatively good in the knowledge section. The participants were motivated in their personal allergen avoidance towards food allergens especially in checking food labels, preference for more free from product choices and handwashing. Consumers did not rely on dietary apps or social media to find out about allergen-free food products. Both knowledge and attitude did not translate into food allergy management practices. Significant correlation between knowledge and attitude was identified suggesting that as knowledge decreases, so will their attitude scores. This study suggests that targeted and systematic food allergy management topics and peer support could be used to improve consumers’ knowledge and attitude to positively impact food allergen handling practices.
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There is an increasing number of food allergic reactions occurring in food services including takeaways. This study investigated the food allergy knowledge, attitude and practices of staff in takeaways. Although more than half of the takeaways’ staff (n=28) demonstrated good food allergy knowledge, there still exists some misunderstanding among the respondents. There were confusion about lactose intolerance and milk allergy, a third of the takeaways’ staff were uncertain that hands could transfer allergens. Almost half of the respondents were not aware of the danger of offering water to dilute a food allergen to stop the reaction Experienced staff and managers / owners reported more positive attitude and higher frequency of good food allergen management practices. Respondents also strongly agreed that customers should inform staff if they have food allergies. However, takeaways’ staff would enquire customers if they need allergen information when taking orders over the telephone. Clear communication between front service staff, customers and kitchen crew are important and should be established and meals verified with cooks to ensure safe meals are prepared. Managers or owners should also strongly encourage their staff to participate in food allergy training. Food Standards Agency has set up a free food allergy online training that would be a valuable addition to food businesses.
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Purpose of review: With the development of innovative technologies, new agents are continually introduced to the workplace. Some of these agents can act as hidden allergens whenever they are not declared in the product labels or whenever their health hazards are unknown. This review article focuses on the identification and description of unusual and/or hidden allergens recently incriminated in occupational diseases. Recent findings: Occupational exposure is an important global health issue that can induce respiratory and cutaneous disorders, as well as life-threatening anaphylaxis. Apart from the classic forms of occupational exposure, reports have emerged from nonconventional or newly identified allergens or additives. These compounds are substances added to another in order to alter or improve the general quality or to counteract undesirable properties, and some of them may behave as potent and frequently hidden allergens. These highly uncommon and/or hidden allergens belong to several categories: foods, spices, cosmetics, insects, enzymes, chemicals, drugs, preservatives, and coloring agents, among others. Summary: A high level of suspicion and awareness about the potential hidden allergens is necessary to ascertain the allergens implicated. It is of utmost importance to identify the specific eliciting agents of the occupational diseases in order to avoid strictly further exposure to them.
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Abstract: Food allergies are one of the major problems of public health in developed countries. Many food allergies are increasing in prevalence, such as the allergy to peanuts (Arachis hypogaea). Vicilin Ara h are seed reserve proteins from peanuts that are known to be the cause of the allergic reaction to this leguminous. Although cases related to peanut allergies are almost scarce in Europe, they are of great concern in the USA, affecting mostly children. The epidemiologic information for this allergy is still outdated, even when acknowledging this health problem. The existing diagnostic methods prove to be ineffective, as they are still underdeveloped. The only method amongst them that can diagnose accurately a peanut allergy is the double-blind placebo-controlled oral food challenge, which is unpractical in clinical routine. Concerning these difficulties, a research and a survey to 371 people were conducted to understand the actual epidemiologic situation in 2016. We also present some methods that are being investigated in various areas (industry, immunotherapy, schools, etc.) that aim to provide a better quality of life to those patients.
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Abstract: Food allergies are one of the major problems of public health in developed countries. Many food allergies are increasing in prevalence, such as the allergy to peanuts (Arachis hypogaea). Vicilin Ara h are seed reserve proteins from peanuts that are known to be the cause of the allergic reaction to this leguminous. Although cases related to peanut allergies are almost scarce in Europe, they are of great concern in the USA, affecting mostly children. The epidemiologic information for this allergy is still outdated, even when acknowledging this health problem. The existing diagnostic methods prove to be ineffective, as they are still underdeveloped. The only method amongst them that can diagnose accurately a peanut allergy is the double-blind placebo-controlled oral food challenge, which is unpractical in clinical routine. Concerning these difficulties, a research and a survey to 371 people were conducted to understand the actual epidemiologic situation in 2016. We also present some methods that are being investigated in various areas (industry, immunotherapy, schools, etc.) that aim to provide a better quality of life to those patients.
Article
Abstract: Food allergies are one of the major problems of public health in developed countries. Many food allergies are increasing in prevalence, such as the allergy to peanuts (Arachis hypogaea). Vicilin Ara h are seed reserve proteins from peanuts that are known to be the cause of the allergic reaction to this leguminous. Although cases related to peanut allergies are almost scarce in Europe, they are of great concern in the USA, affecting mostly children. The epidemiologic information for this allergy is still outdated, even when acknowledging this health problem. The existing diagnostic methods prove to be ineffective, as they are still underdeveloped. The only method amongst them that can diagnose accurately a peanut allergy is the double-blind placebo-controlled oral food challenge, which is unpractical in clinical routine. Concerning these difficulties, a research and a survey to 371 people were conducted to understand the actual epidemiologic situation in 2016. We also present some methods that are being investigated in various areas (industry, immunotherapy, schools, etc.) that aim to provide a better quality of life to those patients
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Food allergies are one of the major problems in public health in developed countries. Many food allergies are increasing in prevalence, such as the allergy to peanuts. Ara h are seed reserve proteins from peanut that are known to be the causes of the allergic reaction of this leguminouse. The vicilin Ara h1 is one of this seed proteins that is one of the causes of the allergic reaction. . Although cases related with peanut allergies are almost scarce in Europe, they are of great concern in the USA, affecting mostly children. The epidemiologic information of this allergy is still outdated, even acknowledging this health problem. The existing diagnostic methods prove to be ineffective, as they are still underdeveloped, and the only method amongst them that can diagnose accurately a peanut allergy is the double-blind placebo-controlled oral food challenge, which is unpractical in clinical routine. Concerning these difficulties, a research was conducted to understand the actual epidemiologic situation in 2016. As a result some methods that are being investigated in various areas (industry, immunotherapy, schools, etc.) are presented, aiming to provide a better quality of life to those patients.
Article
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This report has been prepared by an EAACI task force representing the five EAACI Sections and the EAACI Executive Committee composed of specialists that reflect the broad opinion on allergy expressed by various clinical and basic specialties dealing with allergy. The aim of this report is to propose a revised nomenclature for allergic and related reactions that can be used independently of target organ or patient age group. The nomenclature is based on the present knowledge of the mechanisms which initiate and mediate allergic reactions. However, the intention has not been to revise the nomenclature of nonallergic hypersensitivity.
Article
Full-text available
This report has been prepared by an EAACI task force representing the five EAACI Sections and the EAACI Executive Committee composed of specialists that reflect the broad opinion on allergy expressed by various clinical and basic specialties dealing with allergy. The aim of this report is to propose a revised nomenclature for allergic and related reactions that can be used independently of target organ or patient age group. The nomenclature is based on the present knowledge of the mechanisms which initiate and mediate allergic reactions. However, the intention has not been to revise the nomenclature of nonallergic hypersensitivity.
Article
Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients). Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days. Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.
Article
Milk-allergic persons often rely on kosher labeling to select dairy-free foods. A 2-year-old boy experienced multiple generalized reactions after ingestion of milk or milk products; his serum contained elevated levels of milk-specific IgE antibodies, and his milk skin test was strongly positive. An identical reaction occurred after ingestion of "pareve"-labeled raspberry sorbet. Using an inhibition immunoassay with pooled sera from two milk-sensitive persons as the source of IgE antibodies, we found the milk allergen level in sorbet provided by the family to be 11% of the level found in non-fat dry milk. The milk allergen level in three independently purchased containers of sorbet ranged from 2% to undetectable. The presence of milk in three of four of the sorbets was confirmed by immunoblotting studies, by quantitation of milk proteins by polyacrylamide gel electrophoresis, and by quantitation of lactose by gas chromatography. Subsequently, it was discovered that milk was incorporated into the sorbet when equipment used to package ice cream had been used to package the sorbet. Although kosher labeling may provide assurance to milk-sensitive persons that a particular food does or does not contain milk, such labeling is no guarantee that this is indeed the case.
Article
Food allergy occurs in up to 8 percent of children,1 but anaphylaxis occurs in only a few. There are no reliable data on the incidence, prevalence, or mortality rates for food-induced anaphylaxis in either children or adults. Fatalities receive transient attention in the local press, particularly when a child is involved, but few case series of food-induced anaphylaxis have been described in medical journals.2 , 3 The descriptive study by Sampson and colleagues4 in this issue of the Journal attempts to characterize food-induced anaphylaxis in children and adolescents. Six fatal and 7 near-fatal cases were identified in a 14-month period; 12 of . . .
Article
To establish a useful laboratory protocol to investigate possible cases of fatal anaphylaxis, we measured mast-cell-derived tryptase levels and allergen-specific immunoglobulin E (IgE) antibody levels in sera obtained prior to or within 24 h after death from 19 anaphylaxis victims. Elevated serum tryptase levels (range = 12 ng/mL to 150 micrograms/mL) were found in nine of nine Hymenoptera sting fatalities, six of eight food-induced fatalities, and two of two reactions to diagnostic therapeutic agents. Tryptase levels were normal (less than 10 ng/mL) in 57 sequential sera obtained postmortem from six control patients. Tryptase could not be measured in pleural or pericardial fluids for technical reasons. Serum IgE antibodies were elevated in five of the nine Hymenoptera sting fatalities and in eight of the eight fatal food reactions; assays were unavailable for the two diagnostic/therapeutic agents. If elevated, the victim's serum IgE antibodies to food could be used to identify allergens in uneaten portions of foods consumed shortly before the anaphylactic event. IgE antibodies were moderately stable during storage in a variety of anticoagulants at room temperature for up to 11 weeks. Elevated mast-cell-derived tryptase levels in postmortem sera reflect antemortem mast cell activation and may be used as a marker for fatal anaphylaxis. If assays are available for IgE antibodies to relevant allergens, such assays provide evidence for antemortem sensitization; these assays may be modified to identify allergens in foods consumed by victims of food-induced anaphylaxis.
Article
ADVERSE reactions to cow's milk have been estimated to occur in 0.1 to 7.5 percent of children.1 , 2 A variety of manifestations have been reported, including urticaria, angioedema, atopic dermatitis, rhinitis, wheezing, anaphylactic reactions, various gastrointestinal syndromes, and failure to thrive.3 , 4 Some patients may be extremely sensitive to milk; the ingestion of as little as one drop has been reported to cause generalized reactions.5 In children, repeated exposures to small quantities of food allergens may lead to recurrence of symptoms and delay the resolution of food allergy.2 , 6 , 7 The management of sensitivity to cow's milk is based on the complete elimination of . . .
Article
Between 1973 and 1985, 114 children, aged 2 to 14 years, underwent double-blind, placebo-controlled, food challenge (DBPCFC) to peanut. Thirty-two of 46 children with symptoms produced by DBPCFC to peanut were included in this longitudinal evaluation. Contact was made with the 32 subjects 2 to 14 years after their positive DBPCFC to peanut. All 32 subjects had exhibited a positive puncture skin test to peanut at the time of the original evaluation. Sixteen subjects had experienced symptoms caused by accidental peanut ingestion in the year before contact. Eight subjects had reacted to accidental ingestion in more than 1 year but less than 5 years before contact. Eight subjects had completely avoided peanut since the original evaluation and positive DBPCFC. No subjects could be demonstrated to have "outgrown" their peanut reactivity. All subjects tested continued to have skin reactivity to a puncture skin test with peanut extract. It appears uncommon for peanut-sensitive patients to lose their clinical reactivity, even after many years have elapsed. In addition, data were collected concerning reactions to other legumes and other (nonlegume) nuts. Only two patients with DBPCFC to peanut reacted on DBPCFC to soy or pea (one each). None of the subjects with a positive DBPCFC to peanut reacted to nonlegume nuts.
Article
Ten fatalities and one survivor of attempts to smuggle cocaine within the body were investigated. Most cases have occurred since 1979. All but one of the victims were male. Victims found dead at home or in hotel rooms had little or no drug paraphernalia at the scene, although abundant laxatives and enema apparatus were often evident. Some died aboard aircraft, and witnesses described agitated behavior followed by grand-mal type seizures, respiratory collapse, and death. Seven victims presented to hospital emergency rooms. The symptoms include mydriasis, seizures, acute toxic psychosis, and coma in various combinations. One individual, realizing his plight, sought emergency room help by claiming he attempted suicide by using cocaine. All victims had recently returned to the United States on flights from South America. Balloons, condoms, or plastic bags filled with 3 to 6 g of cocaine each were swallowed and found in the gastrointestinal tract of eight victims. One of these had ingested more than 147 packets totaling 460 g. Two victims inserted packets of cocaine into their rectums, and one woman was found with nearly 170 g of cocaine in her vagina. The packets, being semipermeable membranes, do not have to break open to cause death from acute cocaine toxicity. Characteristic autopsy and radiologic findings, circumstances of death, and toxicologic data are presented. The "body packer syndrome" should be considered in any international traveler who dies suddenly, has seizures, or presents with any signs consistent with cocaine toxicity.
Article
Masked allergens in processed foods are sometimes responsible for "idiopathic" anaphylaxis because of the lack of full ingredient labeling. Patients, even if they are aware of a specific hypersensitivity, may be unaware of trace amounts of the offending allergen(s) that are present in these products. We report a case of severe anaphylaxis to mustard masked in "chicken dips." A 38-year-old woman had an anaphylactic reaction beginning 20 minutes after eating "chicken dips" in a fast food restaurant. She was treated successfully in an emergency room and then referred to us for evaluation. We performed skin prick tests, IgE antibody, and inhibition assays to identify allergens in foods eaten just prior to the anaphylactic reaction. She had a history of allergy to mustard. Skin prick tests revealed sensitivity to mustard, coriander, and curry powder, which contains mustard. She had 56.3 KU/L mustard-specific serum IgE antibody in a Phadebas CAP RAST assay (Pharmacia, Sweden). The mustard RAST was inhibited with an extract of "chicken dips," confirming the presence of mustard in "chicken dips." This case points out the risk of masked allergens in modern food products and the value of the RAST inhibition assay for the identification of such hidden allergens.
Article
Article
Hidden allergens in processed foods can provoke severe allergic reactions in sensitive individuals. The presence of soy proteins in typical Spanish sausage products (chorizo, salchichón, mortadella, and boiled ham), doughnut and soup stock cubes has not been reported previously. The present article reports two examples of severe allergic reactions due to the ingestion of foods that unexpectedly contained soybean proteins. Allergollogic study included skin prick tests with the implicated foods and their components, serum specific IgE and bronchial and oral provocation tests. Skin test, serum-specific IgE, and bronchial and oral challenge tests (the latter, in one patient) were positive against soy and the above mentioned processed foods in which the presence of soybean flour was confirmed. This report demonstrates the importance of hidden allergens in allergic reactions to foods and the need to scrutinize closely every food component.
Article
Peanut is one of the major food allergens inducing anaphylaxis. It is increasingly consumed and often used as a hidden ingredient, thus making avoidance especially difficult for allergic patients. In Switzerland legislation stipulates that all ingredients of a processed food exceeding 2% of the total mass of the finished food product should be labelled. However, in the case of a mixture of vegetables it can be labelled as "vegetable mix" if it does not exceed 10% of the total weight. Peanut, which is a member of the legume family, can thus form up to 10% of processed foods without being mentioned on the label, thus making avoidance impossible. We report on two patients who presented severe anaphylaxis from peanut hidden in a pizza from a fast food restaurant. We were able to provide evidence for the presence of major peanut antigens in the pizza sauce by immunochemical analysis. These two cases clearly demonstrate the danger of peanut hidden in foods and point up the necessity of a change in legislation.
Article
We describe a case of severe systemic reactions caused from poppy seed ingestion. Poppy seeds were suspected to be responsible for the symptoms on the basis of the clinical history. This suspicion was confirmed by skin testing and the prick-prick test. Moreover, a RAST assay was conducted with an extract of fresh food, confirming the presence of specific IgE to poppy seed. Although poppy seeds are not commonly used, we highlight the possible importance of such rare and often hidden sources of allergens.
Article
Because of a fatal case of soy anaphylaxis occurring in Sweden in 1992, a study was started the following year in which all physicians were asked to report fatal and life-threatening reactions caused by food. The results of the first 3 years of the study are reported here, including results from another ongoing study on deaths from asthma during the same period. In 1993-6, 61 cases of severe reactions to food were reported, five of them fatal. Peanut, soy, and tree nuts seemed to have caused 45 of the 61 reactions, and four of them were fatal. If two cases occurring less than a year before our study started are included, we are aware of two deaths caused by peanuts and four deaths caused by soy. All four youngsters who died from soy anaphylaxis with asthma were severely allergic to peanuts but had no previously known allergy to soy. In most cases, there was a rather symptom-free period for 30-90 min between early mild symptoms and severe and rapidly deteriorating asthma. Soy has probably been underestimated as a cause of food anaphylaxis. Those at risk seem to be young people with asthma and peanut allergy so severe that they notice symptoms after indirect contact.
Article
Cow's milk is one of the first foreign proteins ingested by infants and is one of the most common and potent food allergens. The presence of cow's milk is widespread due also to its unlabelled inclusion as an ingredient, or to errors in cooking, processing and preparation, and in restaurant food. As several foods may contain cow's milk in a hidden form, foods for allergic babies should be prepared at home or with food items with all their ingredients listed on the label. Parents should be provided with appropriate material and instructed how to detect potential sources of hidden cow's milk by judiciously reading food labels to avoid possible untoward reactions. A study on products with potential hidden forms of cow's milk or its proteins is reported herein.
Article
Avoidance of latex allergens is the primary method to prevent adverse reactions. Natural rubber latex is found in many different products in both the health care industry and in modern society, and consequently results in unexpected exposures of sensitized individuals. The use of latex gloves by food handlers provides one potential route for inadvertent exposure to latex allergens. In this study we have used two immunological methods to determine whether latex proteins are transferred to foods following contact with latex gloves. Direct transfer of latex protein to cheese was visualized using a modified immunoblot method. Sliced cheese was touched with a gloved finger. A nitrocellulose membrane was applied to lift the potential fingerprints and a rabbit anti-latex antiserum was used to visualize the transfer of any latex finger-prints. After handling lettuce with gloves, transferred protein was recovered by extracting the lettuce and quantified using an inhibition ELISA for latex proteins. Fingerprints of latex protein were readily detectable on cheese after contact with powdered latex gloves, but not with vinyl gloves. Furthermore, powdered latex glove use resulted in measurable amounts of latex protein on lettuce with an exposure-dependent increase in the latex protein levels. Lettuce alone or lettuce handled with vinyl gloves was negative for latex protein. The use of latex gloves by food handlers is the source of an indirect food additive in the form of latex proteins. It is recommended that food handlers avoid the use of latex gloves to eliminate inadvertent exposure of latex-sensitive individuals.
Article
Fatal anaphylactic reactions to foods are continuing to occur, and better characterization might lead to better prevention. The objective of this report is to document the ongoing deaths and characterize these fatalities. We analyzed 32 fatal cases reported to a national registry, which was established by the American Academy of Allergy, Asthma, and Immunology, with the assistance of the Food Allergy and Anaphylaxis Network, and for which adequate data could be collected. Data were collected from multiple sources including a structured questionnaire, which was used to determine the cause of death and associated factors. The 32 individuals could be divided into 2 groups. Group 1 had sufficient data to identify peanut as the responsible food in 14 (67%) and tree nuts in 7 (33%) of cases. In group 2 subjects, 6 (55%) of the fatalities were probably due to peanut, 3 (27%) to tree nuts, and the other 2 cases were probably due to milk and fish (1 [9%] each). The sexes were equally affected; most victims were adolescents or young adults, and all but 1 subject were known to have food allergy before the fatal event. In those subjects for whom data were available, all but 1 was known to have asthma, and most of these individuals did not have epinephrine available at the time of their fatal reaction. Fatalities due to ingestion of allergenic foods in susceptible individuals remain a major health problem. In this series, peanuts and tree nuts accounted for more than 90% of the fatalities. Improved education of the profession, allergic individuals, and the public will be necessary to stop these tragedies.
Article
Keywords:contamination;detection;food allergy;hazelnut;hidden allergen
Article
To date, there are no population-based epidemiologic studies providing information about the prevalence of food-induced anaphylaxis. However, statistics from the United Kingdom demonstrated an increase of anaphylaxis from 5.6 cases per 100,000 hospital discharges in 1991-92 to 10.2 cases in 1994-95. The increase for the subcategory of food-induced anaphylaxis was above the overall increase in anaphylaxis. In the UK register of fatal anaphylactic reactions, all food-induced fatalities have been accompanied by respiratory problems with respiratory arrest. Atopic individuals with bronchial asthma and prior allergic reactions to the same food are at a particularly high risk. Not only peanuts, seafood and milk can induce severe, potentially lethal, anaphylaxis, but indeed a wide spectrum of foods, according to the different patterns of food sensitivity in different countries. Foods with "hidden" allergens and meals at restaurants are particularly dangerous for patients with food allergies. Similarly, schools, public places and restaurants are the major places of risk. However, the main factor contributing to a fatal outcome is the fact that the victims did not carry their emergency kit with adrenaline (epinephrine) with them. Therefore, we suggest that the pharmaceutical industry should reintroduce an adrenaline inhaler that is more effective, especially in asthmatic reactions.
Article
A voluntary registry of individuals with peanut and/or tree nut allergy was established in 1997 to learn more about these food allergies. The purpose of this study was to elucidate a variety of features of peanut and tree nut allergy among the first 5149 registry participants. The registry was established through use of a structured questionnaire distributed to all members of the Food Allergy and Anaphylaxis Network and to patients by allergists. Parental surrogates completed the forms for children under the age of 18 years. Registrants were primarily children (89% of registrants were younger than 18 years of age; the median age was 5 years), reflecting the membership of the Network. Isolated peanut allergy was reported by 3482 registrants (68%), isolated tree nut allergy by 464 (9%), and allergy to both foods by 1203 (23%). Registrants were more likely to have been born in October, November, or December (odds ratio, 1.2; 95% CI, 1.18-1.23; P <.0001). The median age of reaction to peanut was 14 months, and the median age of reaction to tree nuts was 36 months; these represented the first known exposure for 74% and 68% of registrants, respectively. One half of the reactions involved more than 1 organ system, and more than 75% required treatment, frequently from medical personnel. Registrants with asthma were more likely than those without asthma to have severe reactions (33% vs 21%; P <.0001). In comparison with initial reactions, subsequent reactions due to accidental ingestion were more severe, more common outside the home, and more likely to be treated with epinephrine. Allergic reactions to peanut and tree nut are frequently severe, often occur on the first known exposure, and can become more severe over time.
Article
Undeclared allergens in processed products represent a major health problem for sensitized persons. Peanut flour and gluten are known as potent food allergens. The study was designed to evaluate with enzymeimmunoassay (ELISA) test kits the presence of gluten and peanut in Polish products. Hidden peanut contamination was detected in 4 of 34 (11.8%) processed foods (corn crisps, wafers, cereal bar and halva). 5 of 37 (13.5%) foodstuffs (cornflakes, corn crisps, bouillon cube, vegetable soup for infants, curry powder) contained undeclared gluten. The nutritional management of sensitized persons with food allergy requires new labeling regulations.
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