Article

Prevalence of seafood allergy in the United States determined by a random telephone survey

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Abstract

Seafood allergy is potentially severe, but the prevalence of this group of food allergies in the US population has not been determined. To estimate the prevalence of seafood (fish, shellfish) allergy in the United States. We performed a nationwide, cross-sectional, random telephone survey by using a standardized questionnaire. Criteria were established in advance to define seafood allergy by report of convincing symptoms and physician evaluation. A total of 5529 households completed the survey (67.3% participation rate), representing a census of 14,948 individuals. Fish or shellfish allergy defined by established criteria was reported in 5.9% (95% CI, 5.3%-6.6%) of households and among individuals as follows: 2.3% (95% CI, 2%-2.5%) for any seafood allergy, 2% for shellfish, 0.4% for fish, and 0.2% for both types. Seafood allergy was more common in adults compared with children (2.8% vs 0.6%; P <.001) and in women compared with men (3.6% vs 2%; P <.001). Recurrent reactions were reported by 58%, dyspnea or throat tightness was reported by more than 50%, and 16% were treated with epinephrine. Despite this level of acuity, only 8.6% were prescribed self-injectable epinephrine. The rate of reactions to multiple fish among those with any fish allergy was 67%; for Crustacea the rate was 38%, and for mollusks the rate was 49%; only 14% with crustacean allergy reported a mollusk allergy. Physician-diagnosed and/or convincing seafood allergy is reported by 2.3% of the general population, or approximately 6.6 million Americans. Affected individuals typically report recurrent and sometimes severe reactions, indicating that seafood allergy represents a significant health concern.

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... In contrast, the allergy was rare in children age 17 and younger. Only one child under the age of 5 was reported to be allergic, giving a prevalence in this young age group of 0.1%, which rose to 0.7% in the age group of 6-to 17-year-old children (Sicherer et al., 2004a). Data reflecting both food allergies and intolerances in Europe, Iceland, New Zealand, Australia, and the United States was obtained from the European Community Respiratory Health Survey. ...
... The onset is usually in young adulthood. There are no data on how common it is to develop tolerance after a period of avoidance, but in a recent survey, 4% reported outgrowing the allergy (Sicherer et al., 2004a). It appears to be a long-lasting allergy. ...
... Tropomyosin is a pan-allergen among invertebrate species; thus, the risk of cross-reactivity to other crustaceans is very high, at about 75% in small challenge studies (Waring et al., 1985). In a recent population survey, 38% of those with crustacean allergy reported having reactions to more than one type (i.e., crab, lobster, and shrimp) (Sicherer et al., 2004a). Interestingly, some rare shrimp-allergic patients may clinically react to only one species of shrimp; sera demonstrated a lack of cross-reactivity between brown and white shrimp when investigated in vitro and by skin testing (Morgan et al., 1989). ...
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Cover design molecule: Model of the major peanut allergen, Ara h 1, produced with the MPACK suite. (C. H. Schein and coworkers, 2006.) Address editorial correspondence to ASM
... Population-based surveys suggest that shellfish allergy is more common than fish allergy. 78,150,151 The major allergen in fish (parvalbumins) is distinct from those in shellfish (tropomyosin), and so crossreactivity between fish and shellfish should not be significant. In one US prevalence study, approximately 10% of those with either fish or shellfish allergy reported allergy to both categories, representing co-allergy. ...
... In one US prevalence study, approximately 10% of those with either fish or shellfish allergy reported allergy to both categories, representing co-allergy. 151 In an allergy referral population of adults with seafood allergy (n ¼ 159), 6% reported allergies to both categories. 152 In a retrospective review of 167 children referred with documented clinical history of seafood allergy, at least 21% of those with fish allergy were allergic to crustaceans; however, rates of allergy to egg and peanut were even higher in these children, emphasizing co-allergy and not cross-reactivity. ...
... In a US national survey conducted in 2002, among 58 people reporting fish allergy, 33% reported reacting to 1 type, 36% to multiple types, and the rest were unsure. 151 In a Japanese survey of 95 people reporting fish allergy, 48% responded that eating any fish caused allergy, whereas 32% reported that some types of fish caused allergy with ingestion, and other types of fish did not. 161 In an adult allergy referral population in Texas, 33% of 21 adults with fish allergy reported allergic reactions to multiple fish. ...
Article
Foods can induce adverse reactions by a variety of mechanisms. An understanding of the characteristic signs and symptoms and the related mechanisms of adverse food reactions allows the clinician to efficiently diagnose and treat patients. Adverse reactions to foods can be classified based on whether there is a nonimmunologic or immunologic basis for symptoms. Food intolerance, or a nonimmunologic reaction, includes a range of responses to foods that result primarily from an individual’s intrinsic inability to metabolize a component of the food, e.g. , lactose sugar in dairy products. Other nonimmunologic adverse reactions may be attributed to food toxins or pharmacologic properties pharmacologic properties of foods themselves. Immunologic adverse reactions, in contrast, involve immune responses to food and are termed food allergy. Food allergy may further be categorized based on the underlying immunopathophysiology as immunoglobulin E (IgE) mediated, non‐IgE mediated, or cell mediated. Some chronic allergic responses involve a combination of immune mechanisms. This review provides a general classification system for adverse food reactions and describes specific conditions.
... A strong and clinically relevant crossreactivity seems to exist between parvalbumins of different fish species. Major and relevant minor fish allergenic molecules are recorede in Table 1 (Griesmeier et al., 2010;Kuehn et al., 2013;Radauer et al., 2008;Sicherer et al., 2004;Worm et al., 2015). Shellfish (shrimps), along with fish are commonly termed as seafood, but these two groups are very distinct in evolutionary terms and contain different molecular repertoires of food allergens. ...
... Subsequently, arginine kinase (Yu et al., 2003), myosin light chain (Ayuso et al., 2008), and sarcoplasmic calcium-binding protein (Fernandes et al., 2015) were identified as minor crustacean allergens. Previous sensitization rates were mainly based on skin or IgE testing to whole shellfish extracts (Abramovitch et al., 2013;Osborne et al., 2011;Pascal et al., 2015;Rona et al., 2007;Sicherer et al., 2004;Vidal et al., 2015). Allergenic molecules present in crustacean species are shown in Table 2. Registered allergen names are stated in accordance with WHO/IUIS Allergen Nomenclature (Matricardi et al., 2016). ...
... Progress in laboratory diagnostics of IgE-mediated allergy is the use of componentresolved diagnosis (CRD) or molecular diagnosis of allergies. The CRD approach has been developed when highly purified or recombinant allergen molecules have become (Griesmeier et al., 2010;Kuehn et al., 2013;Matricardi et al., 2016;Radauer et al., 2008;Sicherer et al., 2004;Worm et al., 2015). Molecular components in ISAC Multiplex testing are shown extra bold*. ...
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.
... Population-based surveys suggest that shellfish allergy is more common than fish allergy. 78,150,151 The major allergen in fish (parvalbumins) is distinct from those in shellfish (tropomyosin), and so crossreactivity between fish and shellfish should not be significant. In one US prevalence study, approximately 10% of those with either fish or shellfish allergy reported allergy to both categories, representing co-allergy. ...
... In one US prevalence study, approximately 10% of those with either fish or shellfish allergy reported allergy to both categories, representing co-allergy. 151 In an allergy referral population of adults with seafood allergy (n ¼ 159), 6% reported allergies to both categories. 152 In a retrospective review of 167 children referred with documented clinical history of seafood allergy, at least 21% of those with fish allergy were allergic to crustaceans; however, rates of allergy to egg and peanut were even higher in these children, emphasizing co-allergy and not cross-reactivity. ...
... In a US national survey conducted in 2002, among 58 people reporting fish allergy, 33% reported reacting to 1 type, 36% to multiple types, and the rest were unsure. 151 In a Japanese survey of 95 people reporting fish allergy, 48% responded that eating any fish caused allergy, whereas 32% reported that some types of fish caused allergy with ingestion, and other types of fish did not. 161 In an adult allergy referral population in Texas, 33% of 21 adults with fish allergy reported allergic reactions to multiple fish. ...
Article
The diagnosis and management of food allergy is complicated by an abundance of homologous, cross-reactive proteins in edible foods and aeroallergens. This results in patients having allergic sensitization (positive tests) to many biologically related foods. However, many are sensitized to foods without exhibiting clinical reactivity. Although molecular diagnostics have improved our ability to identify clinically relevant cross-reactivity, the optimal approach to patients requires an understanding of the epidemiology of clinically relevant cross-reactivity, as well as the food-specific (degree of homology, protein stability, abundance) and patient-specific factors (immune response, augmentation factors) that determine clinical relevance. Examples of food families with high rates of cross-reactivity include mammalian milks, eggs, fish, and shellfish. Low rates are noted for grains (wheat, barley, rye), and rates of cross-reactivity are variable for most other foods. This review discusses clinically relevant cross-reactivity related to the aforementioned food groups as well as seeds, legumes (including peanut, soy, chickpea, lentil, and others), tree nuts, meats, fruits and vegetables (including the lipid transfer protein syndrome), and latex. The complicating factor of addressing co-allergy, for example, the risks of allergy to both peanut and tree nuts among atopic patients, is also discussed. Considerations for an approach to individual patient care are highlighted.
... Population-based surveys suggest that shellfish allergy is more common than fish allergy. 78,150,151 The major allergen in fish (parvalbumins) is distinct from those in shellfish (tropomyosin), and so crossreactivity between fish and shellfish should not be significant. In one US prevalence study, approximately 10% of those with either fish or shellfish allergy reported allergy to both categories, representing co-allergy. ...
... In one US prevalence study, approximately 10% of those with either fish or shellfish allergy reported allergy to both categories, representing co-allergy. 151 In an allergy referral population of adults with seafood allergy (n ¼ 159), 6% reported allergies to both categories. 152 In a retrospective review of 167 children referred with documented clinical history of seafood allergy, at least 21% of those with fish allergy were allergic to crustaceans; however, rates of allergy to egg and peanut were even higher in these children, emphasizing co-allergy and not cross-reactivity. ...
... In a US national survey conducted in 2002, among 58 people reporting fish allergy, 33% reported reacting to 1 type, 36% to multiple types, and the rest were unsure. 151 In a Japanese survey of 95 people reporting fish allergy, 48% responded that eating any fish caused allergy, whereas 32% reported that some types of fish caused allergy with ingestion, and other types of fish did not. 161 In an adult allergy referral population in Texas, 33% of 21 adults with fish allergy reported allergic reactions to multiple fish. ...
... 2,45 Cross-reactivity is shown to be more common among shellfish allergies (75%) 46-49 than among fish allergies (29%-67%). 45,46,[49][50][51][52][53] Therefore, it is essential to obtain a thorough history regarding complaints and symptoms with all other types of seafood that might serve as a clue to understand clinical cross-reactivity between and among fish and/or shellfish species (see Figure 2). ...
... 54 Previous studies show low risk of severe allergic reaction during SPT or PPT. [52][53][54] There are few case studies reporting anaphylaxis during these tests that mostly presented with testing 4 or more fish allergens simultaneously. [55][56][57][58][59][60][61] Young age, 55,56,60 active eczema, 56,60 previous history of anaphylaxis, 55 and PPT with fresh foods 55,56,62 were risk factors for developing a generalized reaction or anaphylaxis during the test and should be considered while performing skin testing in daily practice. ...
Article
Full-text available
Seafood plays an important role in human nutrition and health. A good patient workup and sensitive diagnostic analysis of IgE antibody reactivity can distinguish between a true seafood allergy and other adverse reactions generated by toxins or parasites contaminating ingested seafood. The 2 most important seafood groupings include the fish and shellfish. Shellfish, in the context of seafood consumption, constitutes a diverse group of species subdivided into crustaceans and mollusks. The prevalence of shellfish allergy seems to be higher than that of fish allergy, with an estimate of up to 3% in the adult population and fin fish allergy prevalence of approximately 1%. Clinical evaluation of the seafood-allergic patient involves obtaining a detailed history and obtaining in vivo and/or in vitro testing with careful interpretation of results with consideration of cross-reactivity features of the major allergens. Oral food challenge is useful not only for the diagnosis but also for avoiding unnecessary dietary restrictions. In this review, we highlight some of the recent reports to provide solid clinical and laboratory tools for the differentiation of fish allergy from shellfish allergy, enabling best treatment and management of these patients.
... Food allergy is defined as an abnormal or exaggerated immune response to food proteins. It has been reported that 4-6% of the world's child population has food allergy (1). Responsible foods differ according to culture and population. ...
... Responsible foods differ according to culture and population. While the most common food causing allergies in the United States pediatric population are cow's milk, eggs, peanuts, soy, wheat, fish and shellfish, peanuts, fish and shellfish are more common in adults (1). In a study conducted in the Black Sea region of Turkey, beef (31.8%), cow's milk (18.1%), cocoa (18.1%), eggs (13.6%), and kiwi (13.6%) were found to be among the most common food allergens (2). ...
... Both molluscan and crustacean shellfish are well-known causes of IgE-mediated, immediate hypersensitivity allergic reactions [1,2]. Crustacean shellfish allergies are perhaps the most prevalent food allergy globally with estimates from self-report surveys in the US as high as 2% [3][4][5][6]. When clinical confirmation is sought, the prevalence rate drops to less than half of these estimates [7]. ...
... The prevalence of molluscan shellfish allergy has not been thoroughly assessed. Self-report surveys in the US indicated that the prevalence of molluscan shellfish allergy is between 0.4% and 0.5% [5,6]. A questionnaire-based survey of 2716 school children in France estimated that the prevalence of molluscan shellfish allergy was 0.15% [8]. ...
Article
Full-text available
Seafood is a frequent cause of allergic reactions to food globally. The presence of undeclared trace amounts of clam can cause allergic reactions in sensitive individuals. Limited tools are available to test food products for the presence of traces of clam. We report on the development of a sandwich ELISA that can detect and quantify clam protein in food. Antisera against a mix of two commercially important clam species, Atlantic Surf (Spisula solidissima) and ocean quahog (Arctica islandica), were raised in rabbit and sheep. A sandwich ELISA was constructed with this antisera, and sensitivity and specificity were evaluated. Also, model food products spiked with clam protein were analyzed to assess the performance of the ELISA. Comparison was made with a commercially available ELISA for crustacea. The lower limit of quantification of the sandwich ELISA is 2.5 ppm clam protein in food samples, allowing the detection of low amounts of clam that may trigger a reaction in clam allergic patients. The sandwich ELISA was highly specific with cross-reactivity only noted for other molluscan shellfish (mussel and scallop). Clam protein in tomato juice and potato cream soup was detected well with recoveries ranging from 65 to 74% and from 74 to 113%, respectively. However when potato cream soup was retorted, the recover fell to 20%, imposing the risk of underestimating the clam content of a food product. A commercially available crustacean ELISA test was not suitable to detect clam protein. The sandwich ELISA described here is suitable for detection and quantification of clam protein in food products. Care should be taken with food products that have been retorted as the results may be underestimated.
... Food allergens are defined as specific components of food or ingredients within food (typically proteins or chemical haptens) that can be recognized by allergen-specific immune cells to elicit specific immunologic reactions, resulting in characteristic symptoms (26). Cutaneous reaction to food is a common presentation of food allergy, including IgE-mediated (urticaria, angioedema, flushing, and pruritus), cell-mediated (contact dermatitis and dermatitis herpetiformis), and mixed IgE-and cell-mediated (atopic dermatitis) reactions (26). ...
... Food allergens are defined as specific components of food or ingredients within food (typically proteins or chemical haptens) that can be recognized by allergen-specific immune cells to elicit specific immunologic reactions, resulting in characteristic symptoms (26). Cutaneous reaction to food is a common presentation of food allergy, including IgE-mediated (urticaria, angioedema, flushing, and pruritus), cell-mediated (contact dermatitis and dermatitis herpetiformis), and mixed IgE-and cell-mediated (atopic dermatitis) reactions (26). In this survey, half of the patients with urticaria have certain food items that need to be avoided; however, only 16.4% of them consider this approach as effective. ...
Article
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Background The clinical features of urticaria have not been fully illustrated. Objectives To demonstrate clinical features of urticaria in different areas of southern and northern China. Methods In this hospital-based multicenter study, outpatients with urticaria filled in a questionnaire during the initial visit and follow-up (once per week, lasting for a month). Results Overall, 1,715 outpatients with urticaria with a mean age of 37.86 ± 16.08 years (range = 0.5–87 years) were recruited. The median disease duration was 1.94 ± 4.31 years (range = 0–58 years). More itching was observed in the northern areas higher than that in the southern areas (99.5 vs 94.1%, P < 0.001). The incidence of pain, arthralgia, and family history in southern areas was higher than that in northern areas (5.1 vs 1.1%, 9.6 vs 0, 10.6% vs 3.2%, P < 0.001). The leading subtypes of specified urticaria were chronic spontaneous urticaria (81.4%) and symptomatic dermographism (35.9%). The incidence of symptomatic dermographism and cold urticaria in the southern areas was lower than that in the northern areas (31.8 vs. 50.3%, 4 vs. 8.5%, P < 0.001). Allergic diseases were the most common concomitant disorders of urticaria. More than half of the patients had to avoid certain food, such as fish-prawn-crab (30.7%) and alcohol (20%). Ebastine (41.1%) was the most commonly prescribed drug. The disease duration negatively correlated with the severity of itching and number of wheals (>50/24H) (Spearman’s rank correlation test, p < 0.001). Conclusion This study provides a profile of clinical characteristics of urticaria in China and filled the gap in the field of regional comparative studies on urticaria.
... More than one-third of children today show an allergic reaction to fish species (37). A retrospective study among 2999 children with food allergies in a clinic in Australia showed a 5.6% prevalence of fish allergy (38). ...
... Another study conducted in Singapore confirmed that 13% of 227 children with food sensitivities had a significant sensitivity to fish. Interestingly, it was observed for the first time in Asian societies that fish consumption started very early, at about 7 months (37). Although heat is thought to increase the allergenicity of some fish allergens, commercial heating procedures used in producing canned fish appear to have a different effect on fish proteins (38). ...
Article
Food allergy, which is defined as an inverse immune response to food proteins, appears to increase gradually in children as a result of studies. It affects 6% of children and 3-4% of adults. The role of breast milk in preventing the development of allergies in children is controversial. Allergic reactions caused by food in children cause many symptoms and disorders affecting the gastrointestinal tract, respiratory tract and skin. These symptoms occur by immunoglobulin (Ig)E-mediated or non-IgE-mediated mechanisms. The cornerstone of food allergy treatment is removing foods from the diet by strict elimination method. Along with the genetic tendency, environmental factors can eliminate oral tolerance and cause food allergy. Disease results are affected by the immune system and trigger allergen properties. Foods that cause food allergies are a few, mainly milk, eggs, peanuts, nuts, fish and shellfish. In this review, the level of knowledge about the pathogenesis of the immunological response about most allergens, which are special substances in the protein structure found in foods, has been discussed with studies conducted. Thus, this study will shed light on identifying new immunotherapeutic approaches to allergens.
... Although the 1997 survey did not assess race, 25 the 2002 survey of approximately 15,000 Americans found that rates of probable FA to seafood were dramatically higher among black children and adults relative to their white counterparts (3.7% vs 1.9%, respectively), yet the relative frequency of physician-diagnosed shellfish allergy among these probable cases was almost identical (40% vs 38%, respectively). 26,27 This suggested that the observed differences in prevalence may not entirely be attributable to systematic racial differences in health care access-a well-known phenomenon in other chronic conditions, such as asthma. 29 Updated prevalence estimates from more recent random-digit dial telephone surveys have identified similar disparities and are suggestive of a growing burden of FAs among black Americans. ...
... A 2014 analysis of previously published FA prevalence data sets, 31 which presented stratified prevalence estimates, including the aforementioned national surveys conducted by Sicherer [25][26][27][28] and Gupta 30 , calculated that overall FA prevalence among the general US population had increased by 1.2 percentage points during the prior 2 decades, and by 2.1 percentage points each decade among black Americans. 31 More recent data from national population-based surveys have reported that current FA prevalence is now higher among black Americans compared with white Americans. ...
Article
Immunoglobulin E-mediated food allergy is an increasingly prevalent public health concern globally. In North America, particularly in the United States, racial and ethnic differences in food allergy prevalence and rates of sensitization have become apparent. Black and Hispanic children in the United States have been estimated to have the highest rates of food allergy. Beyond rates of prevalence, food allergy outcomes, such as health care utilization, psychosocial outcomes, and economic burden, also vary considerably by race and ethnicity. It is important to consider socioeconomic status in conjunction with race and ethnicity in studying differences in food allergy outcomes.
... Shellfish allergy is common, being reported in 2.8% of adults and 0.6% of children (Sicherer et al., 2004). Shrimp is the most common shellfish allergy followed by crab and lobster. ...
... Shrimp is the most common shellfish allergy followed by crab and lobster. Although symptoms are usually limited to cutaneous manifestations (e.g., urticaria, angioedema, flushing), anaphylaxis is reported in 20 to 40% of reactions (Sicherer et al., 2004). Shrimp allergy represents an IgE-mediated reaction to the shrimp protein tropomyosin. ...
Article
Chitin is an abundantly available polysaccharide and is the primary structural component of crustacean shells. Nanochitin can be made by extracting chitin from crustacean shell waste (CSW) by depolymerization and demineralization, then using various top-down and bottom-up approaches such as acid hydrolysis, ultrasonication, grinding, microwave irradiation, and electrospinning. Nanochitin finds wide application in the food industry due to its unique characteristics, including its small size, solubility, low density, high surface area, superior chemical reactivity, low toxicity, biodegradability, biocompatibility, antioxidant activity, antimicrobial properties, and excellent mechanical performance. In this paper, the recent advances in preparation methods of nanochitin from CSW are reviewed. Food applications such as nanochitin's ability to stabilize Pickering emulsions, as a reinforcing agent in food films, improving saltiness perception of food, inhibition of starch retrogradation, and lipid digestion are also discussed. This review will contribute to a deeper understanding of nanochitin's potential as a functional food ingredient.
... Shellfish allergy is a common food allergy, especially in the Asia-Pacific region [1][2][3]. Allergic reactions to shellfish include gastrointestinal manifestations such as nausea, emesis, diarrhea, and abdominal cramping, as well as respiratory distress and life-threatening anaphylaxis [4,5]. Shellfish allergies tend to occur in childhood and persist throughout life [2], and are therefore most common in adults [6]. ...
... The mechanism leading to the onset of food allergies was thought to partly involve immature digestive function, as food allergies are more common in infancy [5]. However, recent research has demonstrated the importance of epicutaneous antigen exposure in the mechanism of sensitization [8]. ...
Article
Full-text available
Background: Shellfish allergy is one of the most common food allergies. Recent studies have shown that sensitization to allergens via the skin is involved in the development of food allergies. In this study, a mouse model of shrimp allergy was generated by epicutaneous sensitization and used to identify skin conditions associated with susceptibility to sensitization. Methods: Four-week-old female BALB/c mice were sensitized by repeated application of 0.1 mg of tropomyosin to tape-stripped skin on days 0, 7, and 15, followed by a challenge on days 28 and 35. Results: Epicutaneously sensitized mice exhibited higher serum levels of tropomyosin-specific IgE on day 15 than control mice. After the oral challenge, model mice had higher anaphylaxis scores and lower rectal temperature. After three tape-strip treatments for sensitization, the skin was analyzed by Raman microscopy. The sensitized mice exhibited lower relative intensities of Raman bands at 399, 915, and 1073 cm−1 than control mice, which could be helpful noninvasive markers in screening for potential sensitization via the skin. Conclusions: An epicutaneous sensitization shellfish allergy model was generated. This model will be useful in studies to elucidate the pathogenesis of skin sensitization. Raman microscopy may also be valuable for capturing subtle skin changes leading to sensitization.
... Allergies to certain foods that start in childhood can persist into adulthood, and new allergies can occur at any stage of life (5). For example, 40 to 60% of fish or shellfish allergies begin in adulthood (6). Peanut allergy affects nearly 5 million adults in the United States, and about one in six individuals with peanut allergy experience their first episode in adulthood (7). ...
Article
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Food allergy is a growing concern due to its increasing world-wide incidence. Strict avoidance of allergens is a passive treatment strategy. Since the mechanisms responsible for the occurrence and development of food allergy have not yet been fully elucidated, effective individualized treatment options are lacking. In this review, we summarize the pathways through which food antigens enter the intestine and review the proposed mechanisms describing how the intestine acquires and tolerates food antigens. When oral tolerance is not established, food allergy occurs. In addition, we also discuss the contribution of commensal bacteria of the gut in shaping tolerance to food antigens in the intestinal tract. Finally, we propose that elucidating the mechanisms of intestinal uptake and tolerance of food antigens will provide additional clues for potential treatment options for food allergy.
... Due to the high sequence homologies among crustacean tropomyosins (82 -100%) and among mollusk homologs (65 -99%) [50,53,67], commonly observed cross-reactions can be explained in shellfish allergic patients [17,29,54,76,100]. The cross-reactivity rate of shellfish tropomyosins (75%) is significantly higher than the cross-reactivity rate of fish parvalbumins (50%) [10,67,75,89]. ...
Article
Fish, crustaceans, and mollusks are among the most potent allergenic foods of animal origin and are thus important triggers of work-related immediate-food allergies. In Germany, work-related seafood allergies are of great importance in the fishing and processing industries as well as in the areas of food preparation, food control, and food sales. There is no causal therapy of seafood allergy, only the strict and lifelong avoidance of allergens remains. The following recommendations serve to assess the impact of a seafood allergy with regard to the work opportunities ended by it for the assessment of the reduction of earning capacity (MdE (German for Minderung der Erwerbsfähigkeit)) in the context of the occupational disease number 5101 of the Annex to the German regulation for occupational diseases. As a special feature of work-related seafood allergy with regard to insurance law aspects, it must be taken into account that there is a potential risk of systemic reaction with subsequent multi-organ involvement. For the estimation of MdE in the general labor market, the impact of a seafood allergy can therefore be assessed, depending on its clinical severity, as generally "mild" to "severe" in justified individual cases.
... Recent data also indicates that White adults have lower rates of food allergy relative to their Black, Hispanic, Asian, and multi-racial counterparts and prevalence rates appear similar among adults in the highest-and lowest-income strata [1••]. These epidemiological findings of racial differences are mostly consistent with previous literature [52], such as the random digit dial telephone survey research by Sicherer et al. that demonstrated Black respondents reported higher rates of seafood allergy than other racial/ethnic groups [53]. Similar differences were reported by Luccioli et al. in 2008 whose analysis of data from the 2005-2007 Infant Feeding Practices Study II concluded there were more Black children with reported, probable food allergy than White or Hispanic children (12.5% vs 5.6% vs 5.1%, respectively) [54]. ...
Article
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Purpose of review: In recent decades, food allergy has become an increasing concern for families, clinicians, and policymakers. This review aims to summarize what is currently known about the epidemiology and population-level burden of IgE-mediated food allergy, including its effects on quality of life. Recent findings: Prevalence surveys, healthcare utilization data, and findings from longitudinal cohort studies across the globe indicate that food allergy imposes a growing societal burden. Worryingly, recent data indicate that food allergies may be more prevalent among adult populations than previously acknowledged, with many reported cases of adult-onset allergies. While it remains unclear how much of the current population-level burden of disease results from true, IgE-mediated allergy, as much epidemiological data does not incorporate clinical confirmation of disease prevalence-it is clear that affected individuals suffer impairments in their quality of life and incur substantial economic costs-beyond the physical health burden imposed by anaphylaxis.
... The immunobalance of T-helper1/T-helper2 (Th1/Th2) plays a critical role in controlling autoimmune disorders (Sicherer et al. 2004;Taylor and Hefle 2005). One theory of immunoregulation is based on homeostasis between Th1 and Th2 activities (Kidd 2003). ...
Article
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Probiotics have been considered as an economical and safe alternative for the treatment of a large number of chronic diseases and improvement of human health. They are known to modulate the host immunity and protect from several infectious and non-infectious diseases. The colonization, killing of pathogens and induction of host cells are few of the important probiotic attributes which affect several functions of the host. In addition, prebiotics and non-digestible food substances selectively promote the growth of probiotics and human health through nutrient enrichment, and modulation of gut microbiota and immune system. This review highlights the role of probiotics and prebiotics alone and in combination (synbiotics) in the modulation of immune system, treatment of infections, management of inflammatory bowel disease and cancer therapy. Key points • Probiotics and their derivatives against several human diseases. • Prebiotics feed probiotics and induce several functions in the host. • Discovery of novel and biosafe products needs attention for human health.
... In recent years, there has been a high demand for the production of seafood worldwide since it is an important component of the human diet and represents an abundant source of nutrients. However, hypersensitivity due to consumption and inhalation of or contact with shellfish, as crustaceans, can result in angioedema, urticaria, and even anaphylactic reactions where IgE antibodies mediate immune responses (Munera et al., 2012;Sicherer et al., 2004). Several reports have identified shellfish immunoreactive proteins as tropomyosin, myosin, troponin C, hemocyanin, and triosephosphate isomerase, among others (Daul et al., 1994;Rahman et al., 2011;Shiomi et al., 2008). ...
Article
In recent years there has been an increase in the prevalence of allergic reactions to contact with/or consumption of crustaceans by immune responses mediated by IgE antibodies. Arginine kinase (AK) is considered one of the main allergens present in marine invertebrates. Currently, the allergenic potential of the brown crab (Callinectes bellicosus), which is a crustacean of great economic importance, has not been studied. Therefore, the aim of this work was to identify C. bellicosus AK as an allergen and to predict IgE-binding epitopes through immunobioinformatic analysis. AK was purified by precipitation with ammonium sulfate and ion- exchange chromatography. AK allergenicity was evaluated by IgE reactivity against sera from crustacean-allergic and non-allergic patients in both native and denaturing conditions. Additionally, a homology model was built based on the deduced amino acid sequence. A single band (~40 kDa) was found in SDS-PAGE, which was identified as an AK by mass spectrometry. AK showed immunoreactivity against crab-allergenic sera in both native and denaturing conditions with 70% and 80% positive reactions, respectively. Additionally, a 1073 bp ORF was obtained which codes for a deduced sequence of 357 amino acids corresponding to AK with > 90% identity with other AKs. Structural homology model of AK showed two main domains with conserved / folding of phospho-guanidine kinases. BediPred and Discotope were used for epitope prediction analysis, which suggests eight possible linear epitopes and seven conformational epitopes, respectively; and shows to be similar to other crustaceans AKs. C. bellicosus AK was identified as an allergenic protein by IgE reactivity and immunobioinformatic analysis indicates that both linear and conformational epitopes could be located in the surface of C. bellicosus AK structure.
... Although these allergies are not very common in adults, they can occur at any age. In the case of this type of food allergy situation, it is important to consult an allergist who can determine what tests need to be done after diagnosis, decide whether it is an allergy, and advise patients on how to manage exposure and symptoms [29]. Allergies to shellfish occur when the immune system opposes the proteins found in these animals. ...
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Depending on the world population, the importance of water resources and the consumption of aquatic organisms as a food source are increasing day by day. The presence of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are involved in critically important biochemical and physiological processes in the body, emphasizes the importance of seafood consumption. Shellfish are low in calories but rich in protein and omega-3 fatty acids. They also contain high amounts of many micronutrients, including iron, zinc, magnesium and B12. Consuming shellfish regularly can boost immunity, aid weight loss, and support brain and heart health. However, shellfish is one of the common food allergens, and some species may contain contaminants and heavy metals. Aquatic products poisoning occurs with the consumption of unhealthy seafood or fish containing toxins. Symptoms cause severe and fatal poisoning in consumers, depending on the presence and concentration of the toxin. To prevent food poisoning, information on the growing conditions of the species should be provided and regularly inspected for toxins (heavy metal poisoning and allergic reactions).
... Shellfish allergy had late onset at a median age of 25 years old in Canadians (29), whereas shellfish allergy started much earlier in the Asian population. While shellfish allergy affected 0.1% of children aged 0-5 years in the United states (30), IgE sensitization to shellfish was as high as 10.6% among Singaporean children younger than 3 years of age (31). It was noteworthy that shellfish was the most frequent cause of food allergy in several studies that involved school-age or pre-school Asian children (9,12,(18)(19)(20)(21)(22), which was probably attributed to the early introduction of shellfish in the Asian diet. ...
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Asian countries have unique ways of food processing and dietary habits that may explain the observed differences in the prevalence, natural history, epidemiology and sensitization pattern of food allergic diseases when compared to western countries. Per capita consumption of seafood, including fish and shellfish, is well above the global average for many Asian countries because of their coastal geographical location and rich seafood supply. The wide availability and high abundance of seafood in Asian countries have shaped a diverse way of processing and eating this major food group. Such unique features have significant impact on the sensitization profile and allergenicity of Asians to fish and shellfish. For example, fish and shellfish are eaten raw in some countries that may promote sensitization to heat-labile allergens not otherwise seen in other regions. Fermented fish sauce is commonly used as a condiment in some countries which may promote fish sensitization. Shrimp head and shrimp roe are regarded as delicacies in some countries, but their allergen profiles are yet to be characterized. Freshwater fish and shellfish are a common food source in many Asian countries but the allergenicity of many such species remains unknown. In this review, we discuss factors that may contribute to differences in molecular profile and sensitization pattern for fish and shellfish that are observed in Asian populations and revisit the current status of seafood allergy in this part of the world. Acknowledging the similarities and differences of seafood allergy patterns between Asian and western populations can help us refine a better strategy for diagnosing and managing seafood allergy.
... Allergy to seafood was much less widespread in children than in adults (0.5% vs 2.5%). 4 In 2014, the frequency of food intolerance in the adult population of Mexico was examined using the survey method. The frequency of shrimp hypersensitivity was estimated at 4%. 5 The aforementioned studies employed a variety of diagnostic methods. ...
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Shrimp tropomyosin has a similar structure to house dust mite (HDM) tropomyosin. In this research, 232 adult patients with symptoms of persistent allergic rhinitis were randomly selected. In the group, 59% were sensitized to Dermatophagoides pteronyssinus and 57.8% to Dermatophagoides farinae. In total, 128 (55.2%) patients were sensitized to both HDM species and 143 (61.6%) to at least one. Slightly over a quarter (25.4%) of patients were sensitized to shrimp. Of the 35 shrimp-sensitized patients, the sensitization to Der p 10 and Pen a 1 was found in 11 cases (31.4%). There was a strong correlation between IgE Pen a 1 and IgE Der p 10 concentrations. The results indicate that there are other allergens responsible for a high incidence of shrimp sensitization in HDM-sensitized patients. A high convergence of Der p 10 and Pen a 1 levels may indicate that the determination of just one of the above is reasonable.
... The exact prevalence rates depend on the method of diagnosis, geographic areas and consumption habits. Based on a large-scale telephone survey, the prevalence of self-reported shellfish allergy was 2.0% among 14,949 Americans ( Figure 1) [11]. The percentage was higher in adults (2.5%) than in children (0.5%). ...
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Shellfish allergy caused by undesirable immunological responses upon ingestion of crustaceans and mollusks is a common cause of food allergy, especially in the Asia-Pacific region. While the prevalence of shellfish allergy is increasing, the mainstay of clinical diagnosis for these patients includes extract-based skin prick test and specific IgE measurement while clinical management consists of food avoidance and as-needed use of adrenaline autoinjector should they develop severe allergic reactions. Such a standard of care is unsatisfactory to both patients and healthcare practitioners. There is a pressing need to introduce more specific diagnostic methods, as well as effective and safe therapies for patients with shellfish allergy. Knowledge gained on the identifications and defining the immuno-molecular features of different shellfish allergens over the past two decades have gradually translated into the design of new diagnostic and treatment options for shellfish allergy. In this review, we will discuss the epidemiology, the molecular identification of shellfish allergens, recent progress in various diagnostic methods, as well as current development in immunotherapeutic approaches including the use of unmodified allergens, hypoallergens, immunoregulatory peptides and DNA vaccines for the prevention and treatment of shellfish allergy. The prospect of a “cure “for shellfish allergy is within reach.
... 7 With over 75 million imaging studies conducted annually worldwide, approximately 5.9% of people having seafood allergies, and physicians routinely basing treatment decisions on these food allergies, this perception of an iodine cross-sensitivity likely influences millions of treatment decisions each year. 9,10 Iodine is an essential human nutrient that is obtained naturally from foods. 11,12 Iodine is converted to iodide in the digestive process and then concentrates in the thyroid gland (75% of total body stores) for ongoing synthesis of thyroxine and triiodothyroxine. ...
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Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The current evidence regarding iodine-containing compounds and iodine allergy cross-reactivity is reviewed. Summary Iodine is an essential human nutrient found in the thyroid gland. It is used in the synthesis of the thyroid hormones thyroxine and triiodothyroxine. Patients who report having adverse reactions to iodine-containing substances are often labelled as having an “iodine allergy,” which can result in delays in care or patients being denied essential ICM or other iodine-containing drugs. A literature review was conducted to evaluate the evidence regarding iodine allergy and iodine-containing drugs. Of 435 articles considered potentially appropriate for full review (plus 12 additional articles included on the basis of references from the eligible articles), 113 could not be obtained. After exclusion of 353 articles that did not meet all inclusion criteria, the remaining 81 articles were included in the review. The results of the literature review indicated that iodine has not been shown to be the allergen responsible for allergic reactions to iodinated contrast media, amiodarone, povidone-iodine, and other iodine-containing compounds. Conclusion There is a lack of evidence to support cross-reactivity between iodine-containing compounds in so called iodine-allergic individuals.
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Seafood is promoted as an important part of a healthy diet. But is it? The science shows that animal seafood consumption is associated with poorer health-outcomes, including diabetes, heart disease and cancer. Seafood from the Chesapeake Bay is also a source of dietary toxins including heavy metals and organic pollutants, as well as cholesterol. Seafood is praised as an excellent source of protein, yet this nutrient is a false idol of nutrition, as most Americans eat twice the quantity they need in their diets. Consumption of animal protein is associated with several adverse health outcomes including cancer and kidney disease. Seafood is rich in omega-3 fatty acids that are promoted as preventative of coronary artery disease, yet findings from extensive studies don’t support the efficacy of taking fish oil supplements. Seafood satiates eaters while providing no dietary fiber, a nutrient critical for health and most often missing in the Standard American Diet. The health benefits of choosing whole plant based foods that are widely available in the Chesapeake Bay region as an alternative to seafood consumption is discussed.
Article
Shrimp is a common seafood with high nutritional value and delicious flavor. However, many individuals are allergic to shrimp, but no therapies have been provided until now. The aim of this study was to evaluate the impacts of the high-intensity ultrasound processing (0, 5, 10, 15, 20 min, at room temperature) on the physiochemical and allergenic properties of shrimp samples. The results indicated allergenicity decreased with increasing treatment time, and the best hypoallergenic effect showed at 20 min with a 76% reduction of tropomyosin. At 20 min, the total soluble protein content decreased by 28.26%, while the in vitro digestibility, peptide content, total antioxidant capacity strengthened by 7.53%, 0.81%, and 71.29%, respectively. β-Sheets and α-helices increased with processing time, accompanied by the reduction of turns and unordered conformations determining by Fourier-transform infrared spectroscopy. More fragments, strips, and holes were observed after 20 min, which indicated the physical essence of ultrasound treatment in improving the extraction of bioactive molecules. Industrial relevance The high-intensity ultrasound as a novel non-thermal processing technique exhibits great potential in reducing the allergenicity of food products. In comparison to thermal processing techniques, it consumes less energy and has a higher mass transfer rate without altering the fundamental properties of foods. Shrimp allergens can be efficiently modified or even eliminated after the optimal condition of ultrasound treatment. The sensory and nutritional properties of shrimp can be retained to meet the marketing requirements for consumers. Therefore, the manufacture of hypoallergenic shrimps with high quality will be one of the most popular products in the future. The findings in this study provide a better understanding of ultrasound application in both lowering allergenicity and retaining the nutritional characteristics of shrimp.
Article
Scope Shellfish allergy is an important cause of food allergy, and tropomyosin (TM) is the major allergen within shellfish. Probiotics are safe bacteria that benefit host health and nutrition and have been proposed as a novel approach for treating immunological diseases including food allergies. Methods and results The probiotic strain Lactobacillus casei Zhang (LcZ) isolated from koumiss was investigated for its capacity to modulate food allergy induced by TM in BALB/c mice. Oral administration of LcZ attenuated allergy symptoms and intestinal epithelial damage. Furthermore, flow cytometry, RT‐qPCR, and ELISA demonstrated that LcZ administration altered the development and function of dendritic cells (DCs), T cells and B cells, finally resulting in the change of TM‐specific antibody isotypes into a tolerogenic pattern. Moreover, an in vitro spleen cell culture model revealed that LcZ directly modulated regulatory tolerogenic DC and T cell development, dependent on the activation of the NF‐κB signaling pathway. Conclusion This work indicated the ability of LcZ to alleviate TM‐induced food allergy and demonstrated the involvement of the tolerogenic immune cells and NF‐κB signaling pathway, indicating LcZ to be a potential immunomodulator and immunotherapy assistor. This article is protected by copyright. All rights reserved
Article
Insect-based foods are starting to enter the EU market, raising concerns about their safety. Allergic consumers might be exposed to even a greater risk, since insects have proven to trigger allergic symptoms, particularly in patients sensitised to crustaceans. Current legislation does not enforce producers to include insects in the list of allergenic ingredients. Food allergenicity risk assessment (FARA) is still at its infancy, and the debate on the need to define allergen thresholds is open. In this paper, we aimed at applying the concepts of stochastic quantitative FARA to describe present and future scenarios of exposure to foods containing Tenebrio molitor, the yellow mealworm. According to our risk characterisation, mealworm-based food products represent a major risk for individuals allergic to crustaceans to develop symptoms after the consumption of a dose lower than a serving size. Moreover, other allergic consumers might be at risk. A correct labelling of insect containing foods would help safeguarding the health of EU allergic consumers. Quantitatively assessing the risk of allergenicity provides a clear description of the problem, facilitating the decisional process of the risk manager, supporting the implementation of effective allergen management procedures and limiting the phenomenon of uninformative precautionary labelling.
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Food allergy is a hot topic, considering the rise in incidence the allergic disease exhibits in children. Nevertheless, the recent medical literature does not cover the natural history and evolution particularities of this disease. The first atopic diseases are food allergies and atopic dermatitis, followed by astma and allergic rhinitis. The most frequent food allergies are cow’s milk protein, egg, wheat, soy, peanut and fish. The severity of symptoms on the onset of cow’s milk protein allergy is predictive for a negative impact on length of the disease. Egg allergy is a predictive factor for astma. Peanut and fish allergies may be persistent into adulthood. Food allergy is polimorphic, the diagnosis takes time and the course of the disease is different for different allergens and clinical forms.
Article
Epidemiological studies have been pivotal in advancing understanding of the etiology of food allergy and in guiding the development of evidence-based guidelines for food allergy prevention and clinical management. In recent years, as research into the population-level distribution and determinants of food allergy has accumulated, data indicate that substantial differences in food allergy outcomes and management exist across racial/ethnic and other socioeconomic strata. This clinical commentary aims to provide a review of existing epidemiological studies and shed valuable light on the disparate burden of food allergy. Emerging methods to quantify environmental exposure and food allergy outcomes are detailed, as are specific areas in which future research is warranted. We also highlight the role that epidemiology plays in advancing health equity and provide a framework as to how it can effectively inform health policy at all phases of the policy cycle—from initial population health assessment to the evaluation and refinement of specific health policies (ie, national guidelines to promote earlier introduction of peanut-containing foods for allergy prevention).
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Food allergies are increasing in prevalence, have a highly variable clinical presentation, and can result in life-threatening reactions. In order for clinicians to accurately diagnose and manage food allergies, they must have a clear understanding of the symptoms and underlying pathophysiology. Food allergies by definition are immune-mediated responses that occur reproducibly on food ingestion, which differentiates them from non-immunologic adverse food reactions like lactose intolerance or food poisoning. Food allergies can be IgE mediated, non-IgE/cell mediated, or mixed IgE and non-IgE mediated with varying clinical presentations depending on the underlying immune mechanisms. IgE-mediated food allergies produce symptoms that affect the cutaneous (hives, pruritus, angioedema), gastrointestinal (abdominal pain, vomiting, diarrhea), respiratory (rhinorrhea, dyspnea, wheezing), and cardiovascular (hypotension, syncope) systems. IgE-mediated food allergies can progress to anaphylaxis, which is a severe and potentially fatal systemic reaction that requires timely recognition and treatment. Non-IgE- or cell-mediated reactions are typically delayed or chronic, and include food protein-induced allergic proctocolitis (FPIAP), food protein-induced enterocolitis syndrome (FPIES), celiac disease, and food-induced pulmonary hemosiderosis (Heiner syndrome). Mixed IgE- and non-IgE-mediated reactions occur in eosinophilic esophagitis or eosinophilic gastroenteritis, which present with symptoms of dysphagia, vomiting, reflux, and abdominal pain related to eosinophilic infiltrates in the GI tract. This chapter describes the clinical manifestations of food allergies with an emphasis on anaphylaxis and the pathophysiology behind these reactions.
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Food allergy is a serious, potentially life-threatening health condition that can substantially impact quality of life, incur large economic costs, and has been increasing in prevalence worldwide. Estimated pediatric prevalence rates vary drastically by country and range from <1% to over 10%. In the United States, food allergy affects nearly 8% of children, comparable to other countries such as the United Kingdom and Australia. Among children with food allergy in the United States, approximately 40% are reported to have experienced a severe reaction with a similar proportion reporting emergency department visits for food allergy treatment in their lifetime. Additionally, it is suggested that racial differences in food allergy outcomes may exist. Black and Asian children have been reported to be more likely to develop a food allergy. Therefore, this chapter summarizes current literature on pediatric food allergy prevalence and trends as well as observes racial differences in food allergy.
Article
Substantial numbers of children and adults report having immunoglobulin E-mediated food allergies. However, generating accurate food allergy prevalence data is difficult. Self-reported data can overestimate prevalence when compared with prevalence estimates established by more rigorous methods. As of 2004, in the United States, the Food Allergen Labeling and Consumer Protection Act mandated that the label should declare the source of the food if the product contains that food or a protein-containing ingredient from that food (not all proteins in a major food allergen cause allergic reactions) in the manner described by the law. The 8 major food allergens are milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans, commonly referred to as the "Big 8." These 8 allergens are thought to account for 90% of the food allergy reactions. Recently published large surveys of Americans and Canadian adults and children provide considerable insight into the prevalence of allergy for the major allergens. These data indicate that there is a large variation in prevalence among the Big 8. The prevalence of soy beans allergy is lower than the prevalence reported for each of the other 7 major allergens, which has been used to argue that soy could be removed from the Big 8 without risking harm to the public. However, the momentum appears to be in favor of expanding the Big 8. The US Food and Drug Administration is evaluating classification of sesame seed as a major allergen; it is already classified as a major allergen in Canada, Australia, and Europe. Europe classifies 14 foods as major allergens. There may be some advantage to standardizing major allergen lists globally, although it may be equally important to acknowledge differences in priority allergens based on cultural and dietary preferences. It is incumbent upon health professionals to help their patients and clients identify foods to which they are allergic and aid in planning diets that are nutritionally adequate despite elimination of these foods.
Article
Background Shrimp, belonging to the class Malacostraca and specifically to the order Decapod, is a common species in crustaceans with abundant nutrients, such as protein, amino acids, minerals, unsaturated fatty acids, vitamins, astaxanthin, and antioxidants. However, shrimp is considered as one of the “big eight” allergenic foods, which leads to a series of allergic reactions from mild to life-threatening in shrimp-allergic individuals. Tropomyosin is identified as shrimp's major allergen. Food processing techniques induce the structural changes in allergens to further affect shrimp allergenicity. Compared to conventional treatments (e.g. heating, steaming), novel processing treatments show superior effects in reducing shrimp allergenicity and retaining the nutritional value and sensory quality. Scope and approach This review discusses the epidemiology worldwide of shrimp allergy and the properties of shrimp's main allergens. It summarizes the latest findings of novel processing methods to lower the allergenicity of shrimps, including microwave, ultrasound, pulsed light, cold plasma, fermentation, enzymatic hydrolysis, high pressure, and a combination of several processing methods. Besides, current strategies and future therapies for patients are also discussed to better manage shrimp allergy. Key findings and conclusions Shrimp allergy is a critical health issue with globally increasing prevalence. In the food industry, non-thermal processing techniques can modify allergen structures and meanwhile maintain shrimp physiochemical properties better than thermal techniques. Ultrasound processing is the most commonly discussed technique that effectively reduces shrimp allergenicity. Compared to when the novel processing technique was applied alone, a combination of several processing techniques applied sequentially can reduce shrimp allergenicity more efficiently and effectively. To date, studies focusing on the application of novel processing techniques to reduce/modify shrimp allergens are still scarce, and improved processing efficiency is also required in further research.
Chapter
Atopic dermatitis, asthma, allergic rhinitis, and food allergies are complex and multifactorial and may be caused by a variety of different mechanisms, which result in multiple heterogeneous clinical presentations. Allergic diseases likely coexist in a multimorbidity framework in which no single condition holds priority over any of the co-occurring conditions. Their prevalence rates vary throughout the world and are the highest in the English-speaking nations and in the developed countries. There has been a two- to threefold increase in asthma prevalence in the latter part of the 20th century. The increase is asthma may have flattened off, and in some age groups asthma rates may be decreasing in the areas of high prevalence. However, in many parts of the world, the prevalence of allergic diseases continues to increase, and the global differences may be getting smaller. The time frame in which allergies have increased is too short for the change to be attributable to genetic factors alone, and the answer likely lies in the influences of environmental exposures and associated lifestyle, both of which have undergone rapid and profound changes. Numerous environmental changes have occurred in parallel, including changes in early life microbial exposures, family size and childcare arrangements, diet and exercise, housing design, and exposure to outdoor and indoor air pollutants. The increase in the prevalence is likely a consequence of environmental factors increasing the risk in genetically susceptible individuals through gene–environment interactions. Thus, when identifying environmental protective and susceptibility factors that are amenable to intervention, genetic predisposition of the individual needs to be considered to enable the development of genotype-specific strategies for prevention. Some of the challenges facing epidemiology in the 21st century are how best to utilize a vast amount of available data and how to integrate different scales of data and different levels of directness of the measurement of variables of interest to inform the design of personalized prevention strategies and targeted treatments.
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Fraud occurs frequently in the fishery and aquatic product markets. Therefore, the authentication of fishery and aquatic products has become a crucial issue. Recently, elemental and stable isotope analyses have become popular for aquatic food authentication. In this review, relevant literature was collected to highlight the current progress in the authentication of fishery and aquatic products using multi‐element and stable isotope analyses combined with chemometrics. Both technologies provide valuable insight regarding geographic origin, culture method, and species identification of fishery and aquatic products. Their classification rate varied from 60% to 100% in most studies. The formation of both elemental and stable isotope profiles of fishery and aquatic products is complex and affected by many factors, including diet, biological differences, and culture environment. The classification rate of these methods may be increased by combining multiple technologies, selecting the correct elements and stable isotopes for specific purposes, selecting and verifying proper discrimination methods, and increasing sample sizes. This review provides valuable information to build reliable and stable tracing methods for fishery and aquatic products.
Article
Background The IgE- and IgG4-binding patterns of the major fish allergen parvalbumins are not clearly understood. IgE antibody-binding to parvalbumin from Asian seabass, Lat c 1.01, is implicated in up to 90 % of allergic reactions, although the region of IgE or IgG4 epitopes are unknown. In the present study, we characterized the specific IgE- and IgG4-binding regions of Lat c 1.01 using serum from pediatric and adult patients with clinically-confirmed fish allergy. Methods A comparative investigation of patient IgE- and IgG4-binding to recombinant Lat c 1.01 was performed by immunoblotting and indirect ELISA using serum from 15 children and eight adults with clinically confirmed IgE-mediated reactions to fish. The IgE- and IgG4-binding regions of Lat c 1.01 were determined by inhibition ELISA using seven overlapping peptides spanning the entire 102 amino acid sequence. Elucidated IgE-binding regions were modelled and compared to known antibody-binding regions of parvalbumins from five other fish species. Results Ninety five percent (22/23) patients demonstrated IgE-binding to rLat c 1.01, while fewer patients (10/15 children and 7/8 adults) demonstrated robust IgG4 binding when determined by immunoblots. IgE-binding for both cohorts was significantly higher compared to IgG4-binding by ELISA. All patients in this study presented individual IgE and IgG4 epitope-recognition profiles. In addition to these patient-specific antibody binding sites, general IgE epitopes were also identified at the C- and N-terminal regions of this major fish allergen. Conclusions and Clinical relevance Our findings demonstrate two specific IgE epitopes on parvalbumin from Asian seabass, while IgG4 binding is much lower and patient specific. This study highlights the importance of advancement in epitope analysis regardless of the age group for diagnostics and immunotherapies for fish allergy.
Article
A fluorescence detection method based on quantum dot-aptamer-graphene oxide probes (QD-Apt-GO) was developed to detect β-lactoglobulin (β-LG) in foods. When β-LG was present in the samples, it specifically bound to the aptamer, inhibiting the binding of probes to graphene oxide (GO), and the fluorescence of the probes could be detected. When β-LG was not present, the probes could bind to GO through π-π stacking, and the fluorescence was consequently quenched. The detection range of the optimized assay for β-LG detection was 0.36-500 mg L-1. The limit of detection (LOD) for β-LG was 96.91 μg L-1. The method was also validated for food sample detection. In the spike and recovery experiments of Neocate amino acid infant formula, infant millet cookies, and infant rice porridge, the recoveries were in the range of 83.33-114.53%, which met the required range of the addition recoveries. At the same time, the results were consistent with those of commercial ELISA kits. Three types of random food products purchased from a local market were analyzed for β-LG via the developed assay and using a commercial ELISA kit. The results showed good accuracy and consistency between the proposed method and the commercial ELISA kit.
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.
Article
Shellfish allergy is more prevalent in South‐East Asia (~5%1) than in Western populations (e.g. United States ~2‐3%.2). Typically commencing in late childhood, it is the leading cause of anaphylaxis in adolescents and adults in Asia. Cross‐sectional studies have demonstrated a high correlation between shellfish and house dust mite (HDM) sensitization in warm, humid climates and urban environments where HDM are ubiquitous. The major shellfish allergen, tropomyosin, shares ~80% structural homology with HDM tropomyosin, and primary sensitization to dust mite tropomyosin has been hypothesized to induce cross‐sensitization to shellfish.
Article
The COVID‐19 pandemic raised acute awareness regarding inequities and inequalities and poor clinical outcomes amongst ethnic minority groups. Studies carried out in North America, the UK and Australia have shown a relatively high burden of asthma and allergies amongst ethnic minority groups. The precise reasons underpinning the high disease burden are not well understood but it is likely that this involves complex gene‐environmental interaction, behavioural and cultural elements. Poor clinical outcomes have been related to multiple factors including access to healthcare, engagement with healthcare professionals and concordance with advice which are affected by deprivation, literacy, cultural norms and health beliefs. It is unclear at present if allergic conditions are intrinsically more severe amongst patients from ethnic minority groups. Most evidence shaping our understanding of disease pathogenesis and clinical management is biased towards data generated from white population resident in High Income Countries. In conjunction with standards of care, it is prudent that a multi‐pronged approach towards provision of composite, culturally‐tailored, supportive interventions targeting demographic variables at the individual level is needed, but this requires further research and validation. In this narrative review, we provide an overview of epidemiology, sensitisation patterns, poor clinical outcomes and possible factors underpinning these observations as well as highlight priority areas for research.
Article
Background Fish allergy is not uncommon -especially in countries with high fish consumption-, can frequently be severe and may affect dietetic and lifestyle choices. Nevertheless, data on its clinical course and natural history are scarce. Objective To describe the natural history of IgE-mediated fish allergy and the potential differential reactivity to various fish species and identify prognostic markers in children with confirmed disease. Methods Clinical history, specific-IgE and skin prick tests (SPTs) to various fish were recorded in 126 children with confirmed IgE-mediated fish allergy. IgE reactivity was also evaluated by immunoblotting. Eligible participants proceeded to a series of food challenges to tuna, swordfish and codfish. In total, 234 challenges were performed. Results Fifty-eight children (9.7±3.9 years) were included in the analysis. Age at first reaction was 0.5-5 years (median: 1.3). Thirteen children (22%) tolerated all fish tested -including cod- 1-14 years (mean 8.2±4.2 years) following their first reported reaction. Complete fish tolerance increased with age, ranging from 3.4% in preschool children to over 45% in adolescents (95% CI: 26.3%-79.7%). Most children were able to tolerate swordfish (94%) and tuna (95%). Pre-challenge sIgE to cod >4.87 kUA/L was the best positive predictive marker for fish allergy persistence (94%), followed by SPT to sardine >6.5 mm (92%). Conclusion A considerable proportion of fish-allergic children develop tolerance around adolescence. Most fish-allergic children can consume tuna and swordfish, which, thus, provide safe alternatives for a balanced diet.
Article
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Fish allergy is a life-long food allergy whose prevalence is affected by many demographic factors. Currently, there is no cure for fish allergy, which can only be managed by strict avoidance of fish in the diet. According to the WHO/IUIS Allergen Nomenclature Sub-Committee, 12 fish proteins are recognized as allergens. Different processing (thermal and non-thermal) techniques are applied to fish and fishery products to reduce microorganisms, extend shelf life, and alter organoleptic/nutritional properties. In this concise review, the development of a consistent terminology for studying food protein immunogenicity, antigenicity, and allergenicity is proposed. It also summarizes that food processing may lead to a decrease, no change, or even increase in fish antigenicity and allergenicity due to the change of protein solubility, protein denaturation, and the modification of linear or conformational epitopes. Recent studies investigated the effect of processing on fish antigenicity/allergenicity and were mainly conducted on commonly consumed fish species and major fish allergens using in vitro methods. Future research areas such as novel fish species/allergens and ex vivo/in vivo evaluation methods would convey a comprehensive view of the relationship between processing and fish allergy.
Article
With turbot being increasingly consumed, turbot parvalbumin (TPV) allergy has become a pressing problem requiring immediate resolution. Glycosylation treatment not only resulted in cross-link formation but also caused changes in the simulated gastric fluid and simulated intestinal fluid digestion stability of TPV. In addition, KU812 experimentation revealed lower levels of β-hexosaminidase, histamine, tryptase, interleukin 4 (IL-4)/IL-13 in glycated protein-treated mice compared with native PV–treated ones. Glycated TPV exhibited a weaker allergic reaction compared with native TPV. Systemic anaphylaxis resulted in mild anaphylactic responses and reduced temperature, along with significantly increased levels of immunoglobulin E and histamine. Furthermore, glycosylation treatment reduced the release of cellular mediators and cytokines (IL-4/IL-13). Glycation to T-PV decreased allergic responses by downregulating Th2 cytokines, regulated the Th1/Th2 balance and effectively reduce the allergenicity and sensitisation ability of T-PV.
Article
This review summarizes (1) the U.S. status quo for aquatic food animal production and marketing; (2) major food safety and quality issues/concerns for aquatic food animals in the United States, including fish misbranding, finfish/shellfish allergies, pathogens, toxins and harmful residues, microplastics, and genetically engineered salmon; and (3) various U.S. regulations, guidances, and detection methods for the surveillance of fishery products. Overall, fish misbranding is the biggest challenge in the United States due to the relatively low inspection rate. In addition, due to the regulatory differences among countries, illegal animal drugs and/or pesticide residues might also be identified in imported aquatic food animals. Future regulatory and research directions could focus on further strengthening international cooperation, enhancing aquatic food animal inspection, and developing reliable, sensitive, and highly efficient detection methods.
Article
The increasing number of people with seafood allergy has caused a series of problems for practitioners and consumers in the seafood industry year by year. Thereby, development of efficient, convenient and low-cost allergen detection methods is urgently needed. This review introduces three important existing seafood allergen detection methods associated with DNA-based, protein-based and aptamer-based. Their principles and biological characteristics are firstly presented. The core of these three methods are DNA amplification techniques, specific binding of antigens and antibodies, and specific binding of aptamers and ligands, respectively. Among them, DNA-based detection method is an indirect analysis, which takes the gene of allergen as the detection object and is characterized by good stability and high sensitivity. Protein-based and aptamer-based, methods employ indirect analysis for allergen detection. The difference is that the latter uses an easily synthesized and highly efficient aptamer as the detection probe, showing great promising potentials. The advantages and disadvantages of the three mentioned detection methods are also discussed. In the future, as more efficient and reliable detection methods for seafood allergens come into practice, the possibility of seafood allergy patients eating seafood products by mistake will be greatly reduced, which will ensure the food safety and the health of allergy patients.
Article
Scylla paramamosain frequently elicits IgE-mediated type-I hypersensitivity reactions. Molecular candidates for crab allergen-specific immunotherapy have not been studied previously. In this study, reduced and alkylated (red/alk) derivatives with destroyed conformational epitopes and mutant derivatives (mtALLERGEN) with deleted heat/digestion-stable linear epitopes were produced of tropomyosin and myosin light chain. Structural changes and the allergenicity of derivatives was analyzed. Compared with wild-type allergens, red/alk derivatives had dramatically altered protein structures, whereas mtALLERGEN showed slightly structural effects. Enzyme linked immunosorbent assay revealed the heterogeneous epitope-recognition patterns with derivatives among 29 crab-sensitised patients, of whom 13% and 62% recognised conformational and linear epitopes, respectively, whereas 25% recognised both epitope types to the same extent. Furthermore, mtALLERGEN could not bind to IgE or induce basophil activation in some patients. These results imply that hypo-allergenic derivatives of crab myofibril allergens that specifically lacked linear epitopes may serve as viable candidates for immunotherapy.
Article
Adverse reactions after food intake are commonly reported and a cause of concern and anxiety that can lead to a very strict diet. The severity of the reaction can vary depending on type of food and mechanism and it is not always easy to disentangle between different hypersensitivity diagnoses, which sometimes can exist simultaneously. After a carefully taken medical history, hypersensitivity to food can often be ruled out or suspected. The most common type of allergic reaction is IgE-mediated food allergy (prevalence 5–10 %). Symptoms vary from mild itching, stomach pain and rash to severe anaphylaxis. The definition of IgE-mediated food allergy is allergic symptoms combined with specific IgE-antibodies and therefore only IgE-antibodies to suspected allergens should be analyzed. Nowadays, methods of molecular allergology can help with the diagnostic process. The most common allergens are milk and egg in infants, peanut and tree nuts in children and fish and shellfish in adults. In young children milk/egg allergy have a good chance to remit, making it important to follow up and reintroduce the food when possible. Other diseases triggered by food are non-IgE-mediated food allergy e.g. eosinophilic esophagitis, celiac disease, food protein-induced enterocolitis syndrome, hypersensitivity to milk and biogenic amines. Some of the food hypersensitivities dominate in childhood, others are more common in adults. Interesting studies are ongoing regarding the possibility to treat food hypersensitivity, such as oral immunotherapy (OIT). The purpose of this review was to provide an overview of the most common types of food hypersensitivity reactions. This article is protected by copyright. All rights reserved Abstract
Article
Résumé Entre 2002 et 2020, 172 anaphylaxies alimentaires observées chez le sénior ont été rapportées au RAV. On observe un sex-ratio H/F de 0,85 et une moyenne d’âge de 67,3 ans (60–93). Les allergènes les plus fréquents sont d’origine végétale : en premier, les légumineuses (20 cas), puis les céréales (16 cas) et les fruits à coque (15 cas), principalement la noisette. Les protéines PR-10 sont en cause dans au moins 11,7 % des anaphylaxies. À l’instar du soja, les anaphylaxies attribuées à Cor a 1 sont surtout rapportées par des allergologues exerçant en Belgique et dans le nord-est de la France. Les anaphylaxies liées aux viandes rouges et abats sont les plus fréquentes (24 cas soit 13,9 %), toujours associées à un syndrome alphaGal quand il est recherché, 16 sont attribuées aux crustacés, 8 aux mollusques et aux poissons respectivement et 6 cas à Anisakis. Cette série confirme la rareté de l’allergie au lait de vache et à l’œuf chez le sénior. Le RAV a colligé 4 anaphylaxies de grade I, 77 de grade II, 84 de grade III et 5 de grade IV dont un décès. La gravité est significativement liée à des antécédents de cardiopathie ou HTA. Quarante pour cent des sujets avaient déjà présenté une allergie dans le passé avec l’aliment suspecté et seulement 55 % disposaient d’un stylo d’adrénaline et 33 % d’un plan d’action. Cette grande série souligne l’intérêt d’un bilan allergologique détaillé chez le sujet âgé. Leur prise en charge doit non seulement comporter un protocole de soins d’urgence avec auto-injecteur d’adrénaline, mais aussi une éducation thérapeutique et diététique pour le patient et son entourage. Elle devrait être formalisée par un PAI, à l’instar de l’enfant scolarisé, compte tenu du risque de récidive, des comorbidités et perte d’autonomie pour certains.
Article
Food processing can change the structure and immunoreactivity of purified allergen, while food processing affected the immunoreactivity of the processed and purified allergen is still poorly understood. In this study, tropomyosin (TM) was purified from Scylla paramamosain after different treatment. Basophil activation test was employed to detect the allergenicity of allergens. Protein structure was detected by mass spectrum, circular dichroism spectroscopy and surface hydrophobicity. The critical amino acids were identified by Dot blot. Heating affects the biochemical characteristics of TM, obviously. The allergenicity of TM was decreased in high temperature-pressure processed crab, due to alterations in protein structure (e.g. denaturation). Seven critical amino acids were identified, including R21, E103, E104, E115, A116, E122 and E156, which related to maintain the IgE-binding activity of TM. This research of thermal processing helps to accurately reduce or eliminate the immunoreactivity of crab by food processing.
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BACKGROUND—Recent years have seen increased levels of production and consumption of seafood, leading to more frequent reporting of allergic reactions in occupational and domestic settings. This review focuses on occupational allergy in the fishing and seafood processing industry. REVIEW—Workers involved in either manual or automated processing of crabs, prawns, mussels, fish, and fishmeal production are commonly exposed to various constituents of seafood. Aerosolisation of seafood and cooking fluid during processing are potential occupational situations that could result in sensitisation through inhalation. There is great variability of aerosol exposure within and among various jobs with reported allergen concentrations ranging from 0.001 to 5.061(µg/m3). Occupational dermal exposure occurs as a result of unprotected handling of seafood and its byproducts. Occupational allergies have been reported in workers exposed to arthropods (crustaceans), molluscs, pisces (bony fish) and other agents derived from seafood. The prevalence of occupational asthma ranges from 7% to 36%, and for occupational protein contact dermatitis, from 3% to 11%. These health outcomes are mainly due to high molecular weight proteins in seafood causing an IgE mediated response. Cross reactivity between various species within a major seafood grouping also occurs. Limited evidence from dose-response relations indicate that development of symptoms is related to duration or intensity of exposure. The evidence for atopy as a risk factor for occupational sensitisation and asthma is supportive, whereas evidence for cigarette smoking is limited. Disruption of the intact skin barrier seems to be an important added risk factor for occupational protein contact dermatitis. CONCLUSION—The range of allergic disease associated with occupational exposure to crab is well characterised, whereas for other seafood agents the evidence is somewhat limited. There is a need for further epidemiological studies to better characterise this risk. More detailed characterisation of specific protein antigens in aerosols and associated establishment of dose-response relations for acute and chronic exposure to seafood; the respective roles of skin contact and inhalational exposure in allergic sensitisation and cross reactivity; and the contribution of host associated factors in the development of occupational seafood allergies are important areas for future research. Keywords: occupational seafood allergy; occupational asthma; protein contact dermatitis
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To determine rates of other atopic manifestations in people with peanut allergy and the prevalence of such allergy in their families. A survey of people with self reported peanut allergy and people referred by their general practitioner for suspected peanut allergy; survey and skin testing of 50 children with reported peanut allergy and their available first degree relatives. 622 adults and children with reported, suspected, or known peanut allergy. Prevalence of peanut allergy and other allergies in the families of people with peanut allergy. 622 valid completed questionnaires were returned out of the 833 questionnaires dispatched (74.7%). All forms of atopy were both more common in successive generations (P < 0.0001) and more common in maternal than paternal relatives (P < 0.0001). Peanut allergy was reported by 0.1% (3/2409) of grandparents, 0.6% (7/1213) of aunts and uncles, 1.6% (19/1218) of parents, and 6.9% (42/610) of siblings. Consumption of peanuts while pregnant or breast feeding was more common among mothers of probands aged < or = 5 years than mothers of probands aged > 5 years (P < 0.001). Age of onset correlated inversely with year of birth (r = -0.6, P < 0.001). Skin prick testing of 50 children with reported peanut allergy and their families: 7 probands (14%) had a negative result for peanut. Peanut allergy was refuted by food challenge in all those tested (5/7). No parent and 13% (5/39) of siblings had a positive result on skin prick testing for peanut. Two of these siblings had negative challenge with peanuts. The prevalence of peanut allergy in siblings is therefore 3/39 (7%). Peanut allergy is more common in siblings of people with peanut allergy than in the parents or the general population. Its apparently increasing prevalence may reflect a general increase of atopy, which is inherited more commonly from the mother. Peanut allergy is presenting earlier in life, possibly reflecting increased consumption of peanut by pregnant and nursing mothers.
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Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to exposure to allergens and assessed by skin prick test responses to common allergens. Although it is generally agreed that atopy is an important risk factor for allergic diseases such as asthma, rhinitis, and eczema, the extent to which atopy accounts for these diseases is controversial. We aim to describe the prevalence of sensitization to common allergens and investigate the degree of association of atopy (as defined by positive skin prick test to 1 or more common allergens) to asthma, rhinitis, and eczema in a birth cohort at the age of 4 years. A birth cohort of 1456 children was recruited over a 14-month period (1989-1990). These children have been seen previously at 1 and 2 years of age. At 4 years, 1218 children were reviewed and an interview was administered or postal questionnaire was completed for the presence of allergic diseases (asthma, rhinitis, and eczema). Additionally, in 981 children, skin prick tests with a battery of 12 common allergens were performed. Allergens were house dust mite (Dermatophagoides pteronyssimus), grass pollen mix, cat, dog, Alternaria alternata, Cladosporium herbarum, cow's milk, hen's egg, soya, cod, wheat, and peanut. A mean wheal diameter of at least 3 mm greater than the negative control was taken as positive. This analysis is confined to the 981 (67% of the original population) who also had skin prick tests to the standard battery. chi(2) tests were used to test the univariate association between each allergic disease and positive skin test. Multiple logistic regression analysis was performed to obtain the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the independent effect of sensitization to each allergen on allergic disease, adjusting for the effect of sensitization to other allergens. To ascertain how much of allergic disease is attributable to atopy, we estimated the population-attributable risk. This was calculated with the formula: P(R - 1) where R is the OR for the allergic disease under consideration and P is the proportion of atopy in children with that disease. Children who were skin prick-tested at 4 years were similar in most characteristics to the rest of the population, except that they had a higher prevalence of allergic disease. Allergic disorders (asthma, rhinitis, and eczema) were present in 276 (28.1%) of 981. One hundred ninety-two (19.6%) children were atopic (positive reaction to 1 or more allergens). Sensitization to inhalant allergens was relatively common (19.2%) as compared with food allergens (3.5%). House dust mite (11.9%), grass pollen (7.8%), and cat (5.8%) were the most common positive reactions. A test to the 4 most common allergens (house dust mite, grass pollen, cat, and A alternata) could detect 94% of the atopic children. Sensitization to the 4 most common allergens was strongly associated with the presence of allergic disorders. There was a graded effect with the potent allergens, such as house dust mite, having the greatest impact. For example, 50% of children sensitized to house dust mite had asthma as opposed to 44% sensitized to cat, 42% sensitized to grass pollen, and 32% sensitized to A alternata. Overall, 68.4% of children sensitized to house dust mite had asthma, eczema, and/or rhinitis. The respective figures for grass pollen, cat, and A alternata were 64.9%, 66.7%, and 57.4%. The proportion of children sensitized to cat was not higher in households with cat ownership (households with cats: 5.1% [19/374]; households without cats: 6.2% [36/580]; not significant [NS]). Similarly, no difference was seen in sensitization to dog in households with and without dogs (households with dogs: 1.8% [5/282]; households without dogs: 2.8% [19/673]; NS). Boys were atopic more often than girls at this age (male: 112 of 497 [22.5%] vs female: 80 of 484 [16.5%]; OR: 1.47, 95% CI: 1.07-2.02). Male preponderance was observed with most allergens, but this was statistically significant only for house dust mite (male: 75/497 [15.1%] vs female: 42/484 [8.7%]; OR: 1.87; CI: 1.25-2.79) and grass pollen (male: 51/497 [10.3%] vs female: 26/484 [5.4%]; OR: 2.01; CI: 1.23-3.29). An independent effect of allergen sensitization on asthma was observed only with house dust mite with an OR of 8.07 (CI: 4.60-14.14). The highest independent risk for rhinitis was sensitization to grass pollen (OR: 5.02; CI: 2.21-11.41), and for eczema, sensitization to peanut (OR: 4.65; CI: 1.02-21.34). The majority of children (98/192) were sensitized to >1 allergen. A graded effect was observed with the risk of allergic disease in the child increasing with the number of positive skin prick test reactions. This effect was consistent throughout the spectrum of allergic diseases (asthma, eczema, and rhinitis). (ABSTRACT TRUNCATED)
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IgE-mediated reactions to fish allergens represent one of the most frequent causes of food allergy. We have constructed an expression cDNA library from carp (Cyprinus carpio) muscle in phage lambda gt11 and used serum IgE from a fish allergic patient to isolate 33 cDNA clones that coded for two parvalbumin isoforms (Cyp c 1.01 and Cyp c 1.02) with comparable IgE binding capacities. Both isoforms represented calcium-binding proteins that belonged to the beta-lineage of parvalbumins. The Cyp c 1.01 cDNA was overexpressed in Escherichia coli, and rCyp c 1.01 was purified to homogeneity. Circular dichroism analysis and mass spectroscopy showed that rCyp c 1.01 represented a folded protein with mainly alpha-helical secondary structure and a molecular mass of 11,416 Da, respectively. rCyp c 1.01 reacted with IgE from all fish-allergic patients tested (n = 60), induced specific and dose-dependent basophil histamine release, and contained most of the IgE epitopes (70%) present in natural allergen extracts from cod, tuna, and salmon. Therefore, it may be used to identify patients suffering from IgE-mediated fish allergy. The therapeutic potential of rCyp c 1.01 is indicated by our findings that rabbit Abs raised against rCyp c 1.01 inhibited the binding of IgE (n = 25) in fish-allergic patients to rCyp c 1.01 between 35 and 97% (84% mean inhibition) and that depletion of calcium strongly reduced IgE recognition of rCyp c 1.01. The latter results suggest that it will be possible to develop strategies for immunotherapy for fish allergy that are based on calcium-free hypoallergenic rCyp c 1.01 derivatives.
Article
A method of sample selection for household telephone interviewing via random digit dialing is developed which significantly reduces the cost of such surveys as compared to dialing numbers completely at random. The sampling is carried out through a two-stage design and has the unusual feature that although all units have the same probability of selection, it is not necessary to know the probabilities of selection of the first-stage or the second-stage units. Simple random sampling of possible telephone numbers, within existing telephone exchanges, is inefficient because only about 20 percent of these numbers are actually telephone numbers assigned to households. The method of selection proposed reduces the proportion of unused numbers sharply.
Article
Background Allergy to peanuts and tree nuts (TNs) is the leading cause of fatal and near-fatal food allergic reactions. Peanut allergy appears to be increasing in prevalence.
Article
Background: Allergic reactions to fish are a common cause of food allergy in many areas of the world where fish is a major source of protein. Although different species of fish may be consumed, possible cross-reactivity has received limited investigation. Objective: The aim of this study was to assess potential cross-reactivity to different species of fish species using double-blind, placebo-controlled food challenges (DBPCFC) in fish-allergic adults and to compare skin test and RAST reactivity with the challenge response. Methods: Nine skin prick test and/or RAST-positive adult individuals with histories of an immediate-type reaction following fish ingestion were challenged with different fish species using double-blind, placebo-controlled food challenge. Results: Of a total of 19 double-blind, placebo-controlled fish challenges performed, 14 challenges (74%) resulted in the induction of objective signs that were consistent with an IgE-mediated response. The most common sign observed was emesis (37%); the most prevalent subjective symptoms reported were compatible with the oral allergy syndrome (84%). Three subjects reacted to at least three fish species and one subject reacted to two fish species tested. In regard to the positive challenges, predictive accuracy of skin prick test and RAST was 84% and 78%, respectively. Conclusion: Our results indicate that clinically relevant cross-reactivity among various species of fish may exist. Advising fish-allergic subjects to avoid all fish species should be emphasized until a species can be proven safe to eat by provocative challenge.
Article
Despite the importance of anaphylaxis, little information is available on its clinical features. To evaluate the clinical and allergologic features of anaphylaxis in children referred to the allergology and immunology unit of A. Meyer Children's Hospital (Florence, Italy) from 1994 to 1996. Ninety-five episodes of anaphylaxis occurred in 76 children (50 boys and 26 girls). Sixty-six children (87%) had only one episode of anaphylaxis, while 10 (13%) had two or more episodes. Sixty-two (82%) of the 76 patients had a personal history of atopic symptoms, although 14 (18%) did not. Sixty (79%) of the 76 children studied had at least one positive skin prick test to one or more of the common inhalant and/or food allergens. Children with venom-induced anaphylaxis usually had negative skin tests to the allergens tested. A younger age and eczema were more frequent among children with food-dependent anaphylaxis, whereas an older age together with urticaria-angioedema were common among those with exercise-induced anaphylaxis. The mean latent period (+/-SD) of the anaphylaxis episodes was 15.4 +/- 27.5 minutes. Skin and respiratory manifestations had an earlier onset and were more common than the gastrointestinal and cardiovascular ones. The most frequent clinical manifestation in children with food anaphylaxis was gastrointestinal symptoms, whereas cardiovascular symptoms were rare. The most probable causative agents in the 95 episodes described were foods (57%), drugs (11%), hymenoptera venom (12%), exercise (9%), additives (1%), specific immunotherapy (1%), latex (1%), and vaccines (2%), but in 6 cases (6%) the agent was never determined. Among the foods, seafood and milk were the most frequently involved. As for location, 57% of the anaphylactic events occurred in the home (54/95), 12% outdoors (11/95); 5% in restaurants (5/95); 3% in the doctor's office (3/95); 3% in hospitals (3/95); 3% on football fields (3/95); 2% on the beach (2/95); 1% in the gym (1/95); 1% at school (1/95); and 1% in the operating room (1/95). In the remaining 12% of cases (11/95) the site remained unknown. Sixty-two percent of the patients (59/95) were treated in an emergency room or hospital, while 32% (30/95) were not (this information is lacking in 6% of the cases [6/95]). Patients were treated with corticosteroids in 72% of the cases (68/95), with antihistamines in 20% (19/95), with epinephrine in 18% (17/95), with beta2-agonists in 5% (5/95), and with oxygen in 4% (4/95). In our area, foods, particularly seafood and milk, seem to be the most important etiologic factors triggering anaphylaxis. Food-induced anaphylaxis often occurs in younger children with a severe food allergy, whereas exercise-induced anaphylaxis occurs more often in older children with a history of urticaria-angioedema. The venom-induced variant usually presents itself in nonatopic subjects. Given the fact that most of the children had only one anaphylactic reaction, prevention is almost impossible. Epinephrine, although it is the first-choice treatment of anaphylaxis, often goes unused, even in hospitals and doctors' offices.
Article
Using a 1-stage random-digit dial telephone survey, we estimated the number of pet dogs and cats and cancer case ascertainment in the principal catchment area of an animal tumor registry in Indiana, the Purdue Comparative Oncology Program (PCOP). These findings will assist in the estimation of pet cancer incidence rates for the PCOP. The estimated canine and feline populations for Marion County were 144,039 (95% confidence interval, 121,555 to 166,523) and 94,998 (74,384 to 115,648), respectively. For Tippecanoe County (excluding university housing residences), the estimated canine population was 18,000 (14,445 to 21,555), whereas the estimated feline population was 17,165 (12,569 to 21,761). The estimated cancer case ascertainment was 88.3% (dogs, 92.5%; cats, 83.0%) with no statistically significant difference in the estimated ascertainment by county of residence or by species of pet. The amount that owners report themselves willing to pay for treatment of cancer in dogs or cats, however, differed in counties polled. This method's appropriateness for estimating pet populations in general and the validity of the data gathered were supported by response rate of 88.0% and by concurrence with census data for household characteristics previously documented to be associated with pet dog and cat ownership.
Article
The purpose of this study was to determine whether patients allergic to one fish species can safely eat other fish species. Eleven atopic, food-allergic children and young adults with histories consistent with IgE-mediated fish hypersensitivity were skin prick tested to 10 fish species. Skin prick tests (SPTs) were positive to all 10 fish in eight of the 11 patients, and the remaining three patients had at least two positive fish SPTs. Positive oral challenges occurred to only one fish in seven of the patients, to two fish species in one patient, and to three fish species in two patients. One patient did not react to any of the fish tested. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblot analyses were performed on raw and cooked protein extracts from nine of the 10 fish species used in SPTs. Several protein bands in the raw-fish extracts appeared to denature with cooking and form high molecular weight conglomerates. Immunoblot analyses with sera from documented fish-allergic patients demonstrated specific IgE binding to protein bands from fish to which patients were not clinically allergic, as determined by oral challenge. In ELISA-inhibition assays, the concentration of fish antigen required to achieve 50% inhibition was similar for fish to which the patients were clinically allergic as compared to fish to which they were clinically tolerant. SPT and in vitro evidence of IgE-specific cross-reactivity does not necessarily correlate with symptomatic fish allergy. In addition, these fish-hypersensitive patients were able to consume one or more other fish species without adverse allergic reactions.
Article
IgE-antibody reactivity to oysters and crustacea of sera from six oyster-sensitive, seven oyster- and crustacea-sensitive, and 12 crustacea-sensitive subjects was investigated. All six subjects with a history of only oyster sensitivity had minimal RAST reactivity (ratios 2 to 5) to extracts of raw or boiled oysters. Three of the seven oyster- and crustacea-sensitive subjects and six of the 12 crustacea-sensitive, oyster-tolerant or unexposed subjects had elevated RAST ratios to oyster (14 to 41). Generally, elevated oyster RAST correlated with skin prick test reactivity to oyster but not with total serum IgE levels. The oyster RAST values of the 19 crustacea-sensitive subjects (with or without oyster sensitivity) correlated with crustacea RAST reactivity (crab RAST, most significant; shrimp RAST, least significant). Rabbit antisera to crustacea extracts detected precipitating antigens present in extracts of raw or boiled oysters. Significant inhibition of the oyster RAST was obtained with oyster or crustacea extracts. These studies suggest that in the diagnosis of oyster sensitivity the RAST may not be useful and that oyster and crustacea contain common antigenic structures.
Article
Two edible shrimp species are widely available in Louisiana, Penaeus setifecus (white shrimp) and Penaeus aztecus (brown shrimp). Some sensitive individuals report only occasional allergic symptoms after shrimp ingestion, suggesting that there may be species-specific allergens. To investigate this possibility, we evaluated shrimp species-specific reactivity in 31 individuals with a history of immediate hypersensitivity reactions after shrimp ingestion with skin prick tests and RASTs with white and brown shrimp extracts. On selected individuals, RAST-inhibition studies were performed with white shrimp and/or brown shrimp-coupled disks, with white and/or brown shrimp extracts as inhibiting allergen. Positive skin tests to both types of extract were observed in 77% (23/30) of the subjects; one individual reacted to brown shrimp extract only. Elevated RASTs to both extracts were observed in 16/31 study participants; one subject reacted only to white shrimp extracts and two subjects to brown shrimp extract alone. Sera from two individuals tested by RAST inhibition recognized qualitatively different allergens in brown and white shrimp extracts, supporting the hypothesis that there are species-specific shrimp allergens. Species specificity is important because it may explain the intermittent symptoms of some study subjects. The percentage of shrimp-sensitive subjects testing positive by skin test and RAST can be increased by use of extracts from more than one species of shrimp.
Article
There is now enough experience with the use of double-blind, placebo-controlled, food challenge (DBPCFC) to recommend its use as an office procedure for most patients complaining of adverse reactions to foods. This manual discusses the practical methods required for the allergist to undertake DBPCFC in the office. Thorough histories supplemented by food allergen skin testing are used to design a DBPCFC that carefully attempts to reproduce the history of food-induced symptoms described by the patient. Precautions that must be taken are delineated before challenge, as is treatment that may be required if a reaction occurs. For those foods to which challenges are positive, longitudinal evaluation with repeated challenge at appropriate intervals help to determine whether or not the problem will resolve over a period of time.
Article
Fatal food-induced anaphylaxis is rarely reported. In 16 months, we identified seven such cases involving five males and two females, aged 11 to 43 years. All victims were atopic with multiple prior anaphylactic episodes after ingestion of the incriminated food (peanut, four; pecan, one; crab, one; fish, one). In six cases the allergenic food was ingested away from home. Factors contributing to the severity of individual reactions included denial of symptoms, concomitant intake of alcohol, reliance on oral antihistamines alone to treat symptoms, and adrenal suppression by chronic glucocorticoid therapy for coexisting asthma. In no case was epinephrine administered immediately after onset of symptoms. Premortem or postmortem serum samples were available from six victims; in each case elevated levels of IgE antibodies to the incriminated food were demonstrated. Food-sensitive individuals must self-administer epinephrine promptly at the first sign of systemic reaction. Emergency care providers should be aware of cricothyrotomy as a life-saving procedure.
Article
Adverse reactions to ingested crustacea are common and may be life-threatening. We studied 14 individuals with histories of such reactions to shrimp by immediate skin tests and RAST with extracts of shrimp, crab, crayfish, and lobster. Nine of these subjects (8/8 atopics and 1/6 nonatopics) had positive immediate skin tests (wheal greater than or equal to 2 mm) and RAST (ratios greater than 3.0) to shrimp. Their skin tests and RAST ratios to the other crustacea were also frequently positive even, in several cases, in the absence of prior exposure. In contrast, only 1/10 volunteers with no history of intolerance to crustacea had a weak positive skin test to raw shrimp. These studies suggest that both skin tests and RAST are useful in the confirmation of hypersensitivity to shrimp in atopic individuals and that cross-reactivity among crustacea may exist.
Article
Food allergy was studied in a total of 866 Finnish children aged 1, 2, 3 and 6 years in the Helsinki region. The diagnosis was based on history as well as on elimination and challenge performed at home concerning fish, citrus fruit and eggs. The prevalence of food allergy was 19% at one year of age, increased to a peak of 27% at three years, and thereafter decreased to 8% at six years of age. The most common allergenic foods were citrus fruit, tomato, eggs, strawberry and fish. A positive history of food allergy could be confirmed by challenge in about half of the cases in the younger age groups and in 100% at six years of age. The data indicate that food allergy is common in Finnish children.
Article
We evaluated the prevalence and characteristics of the principal foods implicated in 355 children diagnosed with IgE-mediated food allergy. Diagnosis was established on the basis of positive clinical history for the offending food, positive specific IgE by skin prick test and RAST, and open food challenge. Our results showed the principal foods involved in allergic reactions are: eggs, fish, and cow's milk. These are followed in frequency by fruits (peaches, hazelnuts and walnuts), legumes (lentils, peanuts and chick peas) and other vegetables (mainly sunflower seeds). The legumes demonstrated the highest degree of clinical cross-reactivity. Most patients with food allergy reacted to one or two foods (86.7%). Only 13.3% of patients reacted to 3 or more foods, mostly to legumes and fruits. We found that food allergy begins most frequently in the first (48.8%) and second (20.4%) years of life. Allergy to proteins of cow's milk, egg, and fish begins predominantly before the second year, demonstrating a clear relationship with the introduction of these foods into the child's diet. Allergy to foods of vegetable origin (fruits, legumes and other vegetables) begins predominantly after the second year.
Article
A presentation of findings from a large population of anaphylaxis cases. Retrospective chart review and follow-up questionnaire provided data on 266 subjects (113 males and 153 females) aged 12 to 75 years (mean age, 38 years) who were referred to a university-affiliated private allergy-immunology practice in Memphis, Tenn, for evaluation and management of anaphylaxis from January 1978 through March 1992. Of 266 subjects, 162 (61%) had three or more anaphylactic episodes, 41 (15%) had two episodes, and 63 (24%) had one episode. Atopy was present in 98 individuals (37%). Physicians thought foods, spices, and food additives caused anaphylaxis in 89 individuals (34%); crustaceans and peanut accounted for about half of these cases. Medications were thought to have caused the anaphylactic episodes in 52 individuals (20%); nonsteroidal anti-inflammatory drugs in about half of these cases. Other probable causes included exercise (n = 19), latex (n = 2), hormonal changes (n = 2), and insect bites (n = 4). A suspected cause could not be determined in 98 individuals (37%). These subjects were diagnosed as having idiopathic anaphylaxis. Of the 266 subjects, 102 responded to a follow-up survey; 68 (67%) of the 102 were thought to have identifiable causes of anaphylaxis (32 of whom [47%] failed to carry epinephrine syringes for self-administration despite instructions to do so). In contrast, of 34 subjects with idiopathic anaphylaxis who responded to the survey, only three (9%) did not carry epinephrine. (1) Atopy is common in subjects who experience anaphylaxis, regardless of its origin; (2) crustaceans and nonsteroidal anti-inflammatory drugs are the most common food and medication groups, respectively, thought to cause anaphylaxis; (3) causative agents can be identified for two thirds of the subjects, and recurrent attacks are the rule; and (4) subjects with idiopathic anaphylaxis are more likely to carry epinephrine for self-administration than those with identifiable causes.
Article
A quality-control retrospective review of medical records was conducted for cases of anaphylaxis encountered at Mayo Clinic Rochester during a 3 1/2-year period. For inclusion in the study, all patients had to manifest general symptoms of mediator release such as generalized pruritus, urticaria, angioedema, and flushing. Of the 179 patients with anaphylaxis (mean age, 36 years), 66% were female, 49% had atopy, and 37% had a previous history of immediate reactions to allergens. Of these study patients, 11 were receiving medications capable of exacerbating anaphylaxis (beta-blockers in 7 of them). Consultation with an allergist was obtained in 142 cases, and a probable diagnosis was made after review of the medical records. Causes of anaphylaxis included foods in 59 patients, idiopathic in 34, Hymenoptera in 25, medications in 23, and exercise in 12; false-positive diagnoses were recorded in 18. Allergy prick tests were done in 104 patients, 71 of whom had positive results; allergen-specific IgE tests were done in 44 patients, 23 of whom had positive results. In 19 patients, only allergen-specific IgE testing was done, and results were positive in 12. Normal test results included C1 esterase inhibitor in 33 patients, metabisulfite challenge in 15, and dye or preservative challenge in 10. Food skin tests were graded on a relative value scale and revealed 15 highly allergic, 24 moderately allergic, and 39 weakly allergic food groups. A standard protocol should be used for assessment of patients with anaphylaxis, and fresh food extracts should be used for prick skin testing. A national incidence study of anaphylaxis is needed. The public and school personnel should be educated about food anaphylaxis, and emergency treatment for anaphylaxis should be readily available for patients.
Article
We did a population study to identify the prevalence of reactions to eight foods commonly perceived to cause sensitivity in the UK. A cross-sectional survey of 7500 households in the Wycombe Health Authority area and the same number of randomly-selected households nationwide was followed up by interviews of positive respondents from the Wycombe Health Authority area. Those who agreed entered a double-blind, placebo-controlled food challenge study to confirm food intolerance. 20.4% of the nationwide sample and 19.9% of the High Wycombe sample complained of food intolerance. Of the 93 subjects who entered the double-blind, placebo-controlled food challenge, 19.4% (95% confidence interval 11.4%-27.4%) had a positive reaction. The estimated prevalence of reactions to the eight foods tested in the population varied from 1.4% to 1.8% according to the definition used. Women perceived food intolerance more frequently and showed a higher rate of positive results to food challenge. There is a discrepancy between perception of food intolerance and the results of the double-blind placebo-controlled food challenges. The consequences of mistaken perception of food intolerance may be considerable in financial, nutritional, and health terms.
Article
Fish allergy is a relatively common and potentially fatal condition. Most fish allergic subjects are allergic to multiple fish species. We encountered a patient clinically allergic only to swordfish. To characterize the in vivo and in vitro IgE antibody responsiveness of this patient solely allergic to swordfish. Prick skin tests, as well as immunoassay and protein immunoblotting for IgE antibody were performed using commercial fish extracts and fresh swordfish. A more typical multiple fish-allergic subject and a subject not allergic to food were also studied for comparison. The multiple fish-allergic subject demonstrated IgE antibody to a 13-kD protein in all fish tested (probably Gad c 1 and its analogues in other fish). The swordfish-allergic subject did not recognize this 13-kD band but did demonstrate IgE directed against a 25-kD band only in swordfish. The negative control showed no IgE binding to either the 13 or 25 kD bands. It is possible to be allergic to a single fish species, such as swordfish, and such monospecific allergy may be due to the presence of species-specific allergens, in this case a 25-kD allergen in swordfish.
Article
To assess the clinical spectrum of anaphylaxis with a view to developing management guidelines and as a foundation for an epidemiological study. Study of the reaction histories and investigations of 172 patients, including children and adults, referred because of anaphylactic reactions. Over 700 reactions occurred in 172 patients from age 5 months to 69 years. There were equal numbers of males and females; when ranked by age at worst reaction, the youngest quartile (0-4 years) was 75% male and the oldest quartile (40+ years) was 74% female. The severity of reactions graded continuously from fatal to mild One hundred and twenty of 172 had two or more reactions; the worst reaction was the first in 33, midsequence in 35 and the most recent in 52. Suspected causes of each patient's worst reaction associated with positive allergy tests include peanuts (42), tree nuts (23), other foods (25, in five associated with exercise), venoms (six bee, 22 wasp), muscle relaxants (seven) and latex (six). Twenty were classified as idiopathic and, in a further 13, investigation of the suspected cause proved negative. There was doubt about the nature of some of the 'reactions' reported even though these had been treated as for anaphylactic reactions. The clinical spectrum of anaphylaxis has been defined for the area served by our unit. Management guidelines and future epidemiological studies will have to address the continuous distribution of severity of reactions, the wide age range and the multiplicity of causes.
Article
To identify the causative agents, presenting signs and symptoms, and course of disease in children diagnosed with anaphylaxis. Design. Five-year retrospective chart review. Urban children's hospital pediatric emergency department, operating suite, and inpatient units. Fifty-five cases of anaphylaxis in 50 patients 1 to 19 years of age. None. The most common inciting agents in this population were latex (27%), food (25%), drugs (16%), and venoms (15%). Thirty-two cases (58%) occurred outside of the hospital, including 3 of 11 severe cases. Nineteen (35%) had histories of prior allergy to the causative agent. Most agent exposures were intravenous (38%), oral (27%), or dermal (20%). The most common systems involved were respiratory (93%), skin (93%), cardiovascular (26%), and neurologic (26%). Features distinguishing the 11 patients requiring intensive care included latex agents (45%), nonenteral route of exposure (91%), and presence of cardiovascular symptoms (45%). Of the 17 patients with known past anaphylaxis, only 5 had epinephrine self-administration devices available, and 3 had used them. (1) Most patients with anaphylaxis present with skin or respiratory symptoms. (2) Severely ill children more commonly have nonenteral and/or latex exposures that occur in the hospital. (3) Most children with anaphylaxis have no stated histories of prior reaction to the causative agent. (4) Those patients who have had past episodes of anaphylaxis infrequently have epinephrine self-administration devices available for use.
Article
Current clinical advice regarding peanut allergy is based on small series of patients. To determine, in a large group of peanut allergic subjects, the patterns of clinical severity, symptom progression and availability and use of rescue medications. Questionnaire study of 622 self-reported allergic subjects. A total of 406 patients (66%) reported symptoms on contact with peanut. Only 121 (19%) had been knowingly exposed to peanut before the first documented reaction, implying a high frequency of occult sensitization. Severe symptoms were more common in adults. Abdominal symptoms were significantly associated with collapse. Fifty per cent reported reactions in the previous year. Only 82 (13%) had been admitted to hospital because of a reaction. Adrenaline was carried in some form by 65% though only 78 subjects (12.5%) had ever received injected adrenaline. Only 18/43 subjects (41%) who collapsed were given adrenaline. Skin-prick test weal size correlated weakly with severity but there were large overlaps between the groups. Peanut-specific IgE peaked in the teenage group, but did not correlate with severity. Peanut allergy is characterized by more severe symptoms than other food allergies and by high rates of symptoms on minimal contact. Skin-prick testing and peanut-specific IgE levels do not predict clinical severity. Avoidance of peanut is difficult. Many people suffering severe relations are inadequately treated. Sufferers need education and training in the use of rescue medication.
Article
Allergic reactions to fish are a common cause of food allergy. We compared the binding of pediatric and adult fish-allergic patient IgE antibodies to fish proteins. Clinical histories of fish allergy were confirmed by prick skin tests, RAST and if possible, with blinded oral food challenges. The patients included five children with severe allergic reactions to catfish (4/5), cod (1/5), and tuna (1/5) and five adults with severe allergic reactions to catfish (5/5), cod (2/5), snapper (3/5), and tuna (2/5). Extracted proteins from catfish, cod, snapper, and tuna were separated with SDS-PAGE. IgE immunoblots and immunoblot inhibition studies were performed using serum sample from these patients. Multiple fish proteins ranging from 12 to 45 kD from the four fish extracts were identified by SDS-PAGE. A major protein (12.5 kD) was present in all fish extracts except for raw tuna. Immunoblots using individual pediatric and adult serum samples revealed that the major IgE binding was to the 12.5-kD protein from catfish, cod, and snapper. The immunoblot with tuna using serum from a pediatric patient with isolated tuna anaphylaxis revealed an IgE binding protein band at 40 kD. Preincubation of serum samples from two separate fish-allergic patients with 1 mg of cod fish extract completely inhibited IgE binding to the 12.5-kD fish protein in subsequent immunoblots. Pediatric and adult fish-allergic patients have similar in vitro IgE binding to a 12.5-kD protein from fish extracts. This protein is immunochemically similar to Gad c I, the major allergen in cod.
Article
Peanut (PN) and tree nut (TN) allergies are potentially life-threatening, rarely outgrown, and appear to be increasing in prevalence. However, there is relatively little reported about the clinical features of acute reactions to these foods and their potential association. To describe the clinical features of acute reactions during initial and subsequent accidental ingestions of PN and TN among children with a history of at least one acute allergic reaction to these foods. Questionnaire survey, examination, and serologic testing for specific IgE antibody of patients with convincing histories of acute reactions (at least one organ system involved within 60 minutes of ingestion) to PN or TN. A total of 122 patients (63% males; median age, 8 years at time of study) had acute reactions; 68 had reactions only to PN, 20 only to TN, and 34 to both PN and TN. Of those reacting to TN, 34 had reactions to one, 12 to two, and 8 to three or more different TN, the most common being walnut, almond, and pecan. Initial reactions usually occurred at home (median age, 24 months for PN and 62 months for TN) and were considered to result from a first exposure in 72% of cases. Eighty-nine percent of the reactions involved the skin (urticaria, angioedema), 52% the respiratory tract (wheezing, throat tightness, repetitive coughing, dyspnea), and 32% the gastrointestinal tract (vomiting, diarrhea). Two organ systems were affected in 31% of initial reactions, and all three in 21% of reactions. Thirty-eight of 190 first reactions to PN or TN were treated with epinephrine. Accidental ingestions occurred in 55% of PN-allergic children (average of two accidents per patient with an accidental ingestion) and in 30% of TN-allergic children over a median period of 5.5 years. On average, symptoms after accidental exposure were generally similar to those at initial exposure. Accidents occurred commonly in school but also at home and in restaurants. Modes of accidental ingestion included sharing food, hidden ingredients, cross-contamination, and school craft projects using peanut butter. Eighty-three percent of the children were breastfed, with >90% of the mothers ingesting PN and at least one TN during lactation. Among patients reporting no history of exposure (>60% of patients for each TN), IgE antibodies were found to a particular TN in 50% to 82% of patients and to PN in 100% of patients. Acute allergic reactions to PN occur early in life. PN and TN allergic reactions coexist in one third of PN-allergic patients, frequently occur on first known exposure, and may be life-threatening, requiring emergency treatment. Accidental ingestions are common, occur frequently outside of the home, and often require emergency treatment. Consequently, early diagnosis followed by education on avoidance and treatment measures (including self-administered epinephrine) is imperative.
Article
Up to 8% of children less than 3 years of age and approximately 2% of the adult population experience food-induced allergic disorders. A limited number of foods are responsible for the vast majority of food-induced allergic reactions: milk, egg, peanuts, fish, and tree nuts in children and peanuts, tree nuts, fish, and shellfish in adults. Food-induced allergic reactions are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract and may be caused by IgE-mediated and non-IgE-mediated mechanisms. In part 1 of this series, immunopathogenic mechanisms and clinical disorders of food allergy are described.
Article
Despite increasing awareness of peanut allergy, little is known of its prevalence. We report on a two-stage interview survey conducted in Great Britain. A total of 16434 adults (aged 15+ years) reported their own allergies and atopies and named cohabitants with peanut allergy (stage 1). Follow-up interviews were conducted with identified sufferers from peanut allergy (stage 2). At stage 1, peanut allergy was reported in 58 respondents and 205 other household members. When we accounted for cases where peanut allergy was unconfirmed or newly reported at stage 2, the prevalence, based on 124 confirmed sufferers, was estimated as 0.48% (95% confidence interval 0.40%-0.55%). The prevalence in children (0.61%, 0.41%-0.82%) was slightly higher than in adults; age-of-onset was strikingly earlier. Prevalence was strongly associated with other atopies, particularly tree-nut allergy. Cases tended significantly to cluster in households. Half of cases had never consulted a doctor. Exactly 7.4% reported being hospitalized after a reaction. Peanut allergy is reported by 1 in 200 of the population and is commoner in those reporting other atopies. The fact of similar rates in children and adults argues against a recent marked rise in prevalence. The frequency and potential lethality of this disorder emphasize the need for sufferers to demographic factors, other food allergies, atopic conditions, and allergy in family/household members. Our study comprised a screening survey and detailed interviews with sufferers identified. The frequency and potential lethality of this disorder emphasize the need for sufferers to receive correct medical advice on management [corrected].
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
The aim of this study was to report the prevalence, type and reported symptoms associated with food intolerance. A cross-sectional epidemiological study involving 15 countries using standardized methodology. Participants answered a detailed interviewer-administered questionnaire and took part in blood, lung function and skin prick tests to common aeroallergens. Randomly selected adults who took part in the second phase of the European Community Respiratory Health Survey (ECRHS). The subjects were 17280 adults aged 20-44 y. Twelve percent of respondents reported food allergy/intolerance (range 4.6% in Spain to 19.1% in Australia). Atopic females who had wheezed in the past 12 months, ever had asthma or were currently taking oral asthma medications were significantly more likely to report food allergy/intolerance. Participants from Scandinavia or Germany were significantly more likely than those from Spain to report food allergy/intolerance. Respondents who reported breathlessness as a food-related symptom were more likely to have wheezed in the past 12 months, to have asthma, use oral asthma medications, be atopic, have bronchial hyperreactivity, be older and reside in Scandinavia. Self-reported food allergy/intolerance differed significantly across multiple countries. The reasons for these differences were not explored in this study, but are likely to be largely due to cultural differences.
Article
Exposure to indoor allergens is associated with asthma morbidity. Nationally, asthma morbidity disproportionately affects socially disadvantaged populations, but it is unclear whether exposure to indoor allergens follows a similar pattern. We sought to examine the national prevalences and demographic correlates of sensitivity to indoor allergens related to asthma. Analysis of a cross-sectional survey of a representative sample of 4164 United States children aged 6 to 16 years who participated in allergen testing in the Third National Health and Nutrition Examination Survey from 1988 to 1994 was performed. The main outcome measures were sensitivity reactions to cockroach, dust mite, cat, and Alternaria alternata, as measured via skin prick testing. Multivariate models, including sex, age, race-ethnicity, education, poverty, family history, region of country, housing age, crowding, and urban residence, revealed significant racial-ethnic disparities in sensitivity. Compared with white children, African American children had higher odds ratios (ORs) of cockroach or dust mite sensitivity (cockroach OR, 2.5 [95% CI, 1.9-3.2]; dust mite OR, 1.3 [95% CI, 1.0-1.7]), as did Mexican American children (cockroach OR, 1.9 [95% CI, 1.3-2.8]; dust mite OR, 1.6 [95% CI, 1.2-2.2]). African American children also had significantly higher odds of sensitivity to A alternata (OR, 2.1 [95% CI, 1.5-2.8]). African American and Mexican American children are substantially more likely than white children to be sensitized to allergens important in asthma. Differences in indoor allergen sensitivity are consistent with racial differences in asthma morbidity. Along with other data, these findings suggest that racial disparities in housing, community, or both environmental factors play a role in determining national patterns of asthma morbidity.
Article
Crustaceans and mollusks are a frequent cause of allergic reactions. The only major allergen identified in shrimp is the muscle protein tropomyosin; at least 80% of shrimp-allergic subjects react to tropomyosin. Furthermore, tropomyosin is an important allergen in other crustaceans such as lobsters, crabs and mollusks, as well as other arthropods such as house dust mites and cockroaches, and has been implied as the cause of clinical cross-sensitivity among invertebrates. In contrast, vertebrate tropomyosins are considered non-allergenic. The basis of the allergenicity of proteins has not yet been resolved. Thus, tropomyosin molecules provide an excellent opportunity to study the relationship between protein structure and allergenicity. The aim of the current study was to identify the IgE-binding regions of Pen a 1 and compare these regions with homologous sequences in other allergenic and non-allergenic tropomyosins. Forty-six overlapping peptides (length: 15 amino acids; offset: 6 amino acids) spanning the entire Pen a 1 molecule were synthesized and tested for IgE antibody reactivity with sera from 18 shrimp-allergic subjects to identify the IgE-binding regions of shrimp tropomyosin. Based on the frequency and intensity of the IgE reactivities, five major IgE-binding regions were identified. All five major IgE-binding regions were 15-38 amino acids long. The major IgE-binding regions identified were: region 1: Pen a 1 (43-57); region 2: Pen a 1 (85-105); region 3: Pen a 1 (133-148); region 4: Pen a 1 (187-202), and region 5: Pen a 1 (247-284). In addition, 22 peptides were categorized as minor IgE-binding regions, and 12 peptides did not bind any IgE antibodies. No substantial differences in amino acid group composition in the five IgE-binding regions compared to the whole molecule were detected. Sequence identities and similarities of the Pen a 1 IgE-binding regions with homologous regions of allergenic arthropod tropomyosins were as high as 100%, whereas identities and similarities with homologous vertebrate sequences ranged from 36 to 76% and 53 to 85%, respectively. Five major IgE-binding regions of the allergenic shrimp tropomyosin, Pen a 1, were identified which are positioned at regular intervals of approximately 42 amino acids (7 heptads), suggesting a relationship with the repetitive coiled-coil structure of the tropomyosin molecule. The high degree of similarity between Pen a 1 IgE-binding regions and homologous sequences in invertebrate tropomyosins and the lower percentage of similarity with homologous regions of vertebrate tropomyosins supports a structural basis for cross-reactivity of allergenic tropomyosins.
Article
Little is known about longitudinal trends in the prevalence of allergen skin sensitization in the general population. We sought to measure the change in prevalence of allergen skin sensitization over a 9-year period in a cohort of adults and hence to determine whether cross-sectional differences in prevalence between age groups are due to an aging or cohort effect. In 1991 and 2000, we measured skin sensitization, defined as a wheal diameter of 3 mm or larger than that elicited by a saline control, to Dermatophagoides pteronyssinus, cat fur, mixed grass, Aspergillus fumigatus, and Cladosporium herbarum in a cohort of 1339 adults from Nottingham aged between 18 and 71 years in 1991. Subjects were divided into six 9-year successive birth cohorts, and the effects of birth cohort and the within-subject change from 1991 to 2000 were analyzed in a generalized estimating equation logit model. The unadjusted prevalence of sensitization to any allergen was 30.5% in 1991 and 31.8% in 2000. In cross-sectional analyses the prevalence of sensitization decreased with increasing age at both surveys (risk ratio, 2.15; 95% confidence interval [CI], 1.45-3.17 for 18- to 26-year-old patients relative to 63- to 70-year-old patients in the 1991 survey). In longitudinal analysis there was no within-subject change in sensitization from 1991 to 2000 (adjusted odds ratio, 1.07; 95% CI, 0.97-1.19), but there was a significant cohort effect (adjusted odds ratio per successive 9 year cohort, 1.27; 95% CI, 1.18-1.37). The cross-sectional decrease in allergen sensitization with age in the general population arises predominantly from a secular increase in sensitization prevalence with successive birth cohorts and not to a loss of sensitization within subjects over time. As a result of this cohort effect, the prevalence of allergic sensitization has increased in this general adult population sample.
Article
Scombrotoxic or histamine fish poisoning is a common condition normally associated with consuming spoiled tuna, mackerel, bonito, or skipjack. Typical symptoms like flushing, urticaria, and palpitations mimic those of allergy so histamine fish poisoning can easily be misdiagnosed. Diagnosis is often clinical and the mainstay of treatment is antihistamines.
Article
Allergy to peanut is common. However, it is not known whether the prevalence of sensitization and clinical allergy to peanut is increasing. We sought to determine any change in the prevalence of peanut sensitization and reactivity in early childhood in 2 sequential cohorts in the same geographic area 6 years apart. Of 2878 children born between September 1, 1994, and August 31, 1996, living on the Isle of Wight, 1273 completed questionnaires, and 1246 had skin prick tests at the age of 3 to 4 years. Those with positive skin prick test responses to peanut were subjected to oral peanut challenges, unless there was a history of immediate systemic reaction. These data were compared with information on sensitization and clinical allergy to peanut available from a previous cohort born in 1989 in the same geographic area. There was a 2-fold increase in reported peanut allergy (0.5 % [6/1218] to 1.0 % [13/1273]), but the difference was nonsignificant (P =.2). Peanut sensitization increased 3-fold, with 41 (3.3 %) of 1246 children sensitized in 1994 to 1996 compared with 11 (1.1 %) of 981 sensitized 6 years ago (P =.001). Of 41 sensitized children in the current study, 10 reported a convincing clinical reaction to peanut, and 8 had positive oral challenge results, giving an overall estimate of peanut allergy of 1.5% (18/1246). Sensitization to peanut had increased between 1989 and 1994 to 1996. There was a strong but statistically nonsignificant trend for increase in reported peanut allergy.