Food-triggered anaphylaxis in adults.

Purpose Of Review: Adult food allergy, either unresolved from childhood, or new-onset in adult-life, is known to be increasingly prevalent. Although much of the reported anaphylaxis in adults is due to drug reactions, foods are becoming an increasingly important trigger, affecting adults of all ages, with a wide variation in food triggers which are often quite different to those reported in children.

Recent Findings: Peanuts are well known to cause anaphylaxis in some adult populations, but other legumes such as soy may be more relevant in others.

The Diagnosis of Allergy to Lipid Transfer Proteins.

Purpose Of Review: To provide an update on the diagnosis of non-specific Lipid Transfer Protein (nsLTP) allergy.

Recent Findings: More publications report the presence of nsLTP allergy in Northern European countries and nsLTP sensitisation in children. Individuals are more likely to have severe reactions if there is recognition of increasing numbers of LTP components.

Food allergy-A holistic approach to dietary management. A joint EAACI Research & Outreach Committee and INDANA review.

Following a diagnosis of IgE-mediated food allergy, to secure the best outcome, the patient should receive individualized advice tailored to their specific needs, which considers the type and presentation of the food involved, level of exclusion required, risk of cross-contamination and any variance required for age, ethnicity, financial issues, and lifestyle. Issues such as food labels "may contain" statements, and variation in the threshold of reaction and impact of cofactors should also be considered. Most important is the need to ensure that the diagnosis is robust, especially given the nutritional, psychological, and socioeconomic issues that can affect an individual with a diagnosis of food allergy.

New arrivals in anaphylaxis to foods.

Purpose Of Review: More people are excluding wheat from their diet, or turning to a more sustainable diet in which includes meat substitutes or is mainly or wholly plant-based. This increases the availability of new foods and with it the increasing likelihood of novel allergens.

Recent Findings: There is a growing body of evidence which suggests that allergies to seeds and legumes are increasing potentially due to their use in concentrated form in vegan or health foods.

The immune-supportive diet in allergy management: A narrative review and proposal.

The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune-supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses the existing evidence for a relationship between nutrition, immune function, and allergic disease from a clinical perspective.

BSACI guideline for the diagnosis and management of pollen food syndrome in the UK.

Pollen food syndrome (PFS) is a highly prevalent food allergy affecting pollen-sensitized children and adults. Sufferers experience allergic symptoms when consuming raw plant foods, due to the homology between the pollen allergens and unstable proteins in these foods. The triggers involved can vary depending on the pollen sensitization, which in turn is affected by geographical location.

Anaphylaxis across Europe: are pollen food syndrome and lipid transfer protein allergy so far apart?

Purpose Of Review: Traditionally pollen-food syndrome (PFS) is considered to be a mild cross-reacting food allergy affecting only Northern Europe, with lipid transfer protein (LTP) allergy being more severe and mainly occurring in Southern Europe. This review seeks to update the reader on both types of plant food allergy and to determine whether the stereotypical presentations of these plant food allergies remain the same, with a particular focus on reaction severity.

Recent Findings: Recent findings suggest that both these types of plant food allergy occur in children and adults.

Impact of cannabis knowledge and attitudes on real-world practice.

Background: Increased cannabis consumption worldwide challenges allergists because of an upsurge in cannabis allergy and need to discuss cannabis with patients.

Objective: To determine the knowledge, attitudes, and practices regarding cannabis among allergists and their approach to recognizing and diagnosing suspected cannabis allergy.

Methods: The International Allergist Canna Knowledge, Attitudes, and Practices Survey was completed by members from 3 International Allergy Societies.

A Pilot Study to Evaluate the Dietary Intake of Adults Attending a Food Allergy Clinic, and Compare the Results Against the Final Diagnostic Outcome.

The impact of poor diet on growth and development in children with a food allergy is well-recognized and researched. Food allergy is an increasing problem in adults, as are food intolerances. Another issue is the rising number of individuals adopting a vegetarian or vegan lifestyle.

BSACI 2021 guideline for the management of egg allergy.

This guideline advises on the management of patients with egg allergy. Most commonly egg allergy presents in infancy, with a prevalence of approximately 2% in children and 0.1% in adults.

Non-specific lipid-transfer proteins: Allergen structure and function, cross-reactivity, sensitization, and epidemiology.

Background: Discovered and described 40 years ago, non-specific lipid transfer proteins (nsLTP) are present in many plant species and play an important role protecting plants from stressors such as heat or drought. In the last 20 years, sensitization to nsLTP and consequent reactions to plant foods has become an increasing concern.

Aim: The aim of this paper is to review the evidence for the structure and function of nsLTP allergens, and cross-reactivity, sensitization, and epidemiology of nsLTP allergy.

The diagnosis and management of allergic reactions in patients sensitized to non-specific lipid transfer proteins.

Sensitization to one or more non-specific lipid transfer proteins (nsLTPs), initially thought to exist mainly in southern Europe, is becoming accepted as a cause of allergic reactions to plant foods across Europe and beyond. The peach nsLTP allergen Pru p 3 is a dominant sensitizing allergen and peaches a common food trigger, although multiple foods can be involved. A frequent feature of reactions is the requirement for a cofactor (exercise, alcohol, non-steroidal anti-inflammatory drugs, Cannabis sativa) to be present for a food to elicit a reaction.

Can patients with oral allergy syndrome be at risk of anaphylaxis?

Purpose Of Review: Oral allergy syndrome, also known as pollen-food syndrome (PFS), is a condition usually associated with adults and characterized by mild transient oropharyngeal symptoms. The purpose of this review is to determine whether systemic or anaphylactic reactions do occur and if so, who is affected and what are the triggers.

Recent Findings: An increasing number of studies demonstrate that PFS occurs all age groups, and a significant number of affected adults do experience systemic and anaphylactic reactions.

Upskilling healthcare professionals to manage clinical allergy.

It has long been recognised that given the high prevalence and considerable impact of allergic disease globally, there needs to be a focus on appropriate training for clinical professionals. The health-economic consequences of allergic disease are significant, with both direct healthcare costs (doctor, nurse and dietitian consultations, hospital admissions and prescribed medications) and indirect costs (lost school and work time, reduced productivity and over-the-counter medications). There is also a well-recognised impairment of quality of life, with less tangible costs including anxiety, distress, discomfort, disability and, occasionally, death.

Food-Induced Anaphylaxis: Role of Hidden Allergens and Cofactors.

Food anaphylaxis is on the increase, with those who have an allergy to peanuts, tree nuts, milk, and seafood at the highest risk of developing such a reaction. However, the diet in many societies is increasingly varied, much of the food consumed is prepared outside the home, and meals are often composed of many different ingredients. Anaphylaxis may occur to a composite food, and it may be unclear whether the reaction is due to contamination or to a culprit allergen present in an added ingredient.

Lipid Transfer Protein allergy in the United Kingdom: Characterization and comparison with a matched Italian cohort.

Background: Although pollen-related food allergy occurs in all European populations, lipid transfer protein (LTP) allergy is considered to manifest mainly in Mediterranean countries. We aimed to characterize adults presenting with LTP allergy in a northern European country.

Method: The clinical history and sensitization patterns of subjects born and residing in the United Kingdom (UK), with a prior diagnosis of LTP allergy and sensitization to the peach LTP allergen Pru p 3, were compared to UK subjects with pollen food syndrome (PFS).

Nutritional Issues in Food Allergy.

Diet and nutrition play an important role in the development and management of food allergy. The diet of expectant mothers can have an effect on their offspring in terms of allergic outcomes. A host of confounding factors may influence this, with a maternal diet rich in fruits and vegetables, fish, vitamin D-rich foods associated with a lower risk of allergic disease in their children.

When nutrition and allergy collide: the rise of anaphylaxis to plant foods.

Purpose Of Review: Interest in nutrition is increasing, but in the world of internet health gurus, whilst the nutritional benefits of fruits and vegetables are extolled, wheat is often vilified. This review will assess the positive nutritional effects of plant foods in relation to allergy prevention, the effectiveness of gluten-avoidance and the likelihood of anaphylaxis to fruits and vegetables.

Recent Findings: Although the numbers of people who report gluten sensitivity is rising, hard evidence of mass sensitivity to gluten is scant.