STUDY POPULATION. Data were analyzed from the anaphy-laxis registry of German-speaking countries, which included 197 reported anaphylactic reactions from children and adolescents between 2006 and 2009. This database is based on an online questionnaire for providers of allergy specialty care in Germany, Austria, and Switzerland. METHODS. The questionnaire included demographic data, clinical symptoms, the cause of reaction, accompanying or possible aggravating factors, history of previous reaction , and treatment. To focus on reactions that involved life-threatening symptoms, only children who experienced reactions with at least 1 pulmonary or cardio-vascular symptom were included in the analysis. RESULTS. The most frequently affected organ systems involved in anaphylaxis cases of children and adolescents were the skin (89%) and respiratory tract (87%). Car-diovascular (47%) and gastrointestinal manifestations (43%) were noted less frequently. The most common triggering allergens were foods (58% of cases), followed by insect venoms (24%) and drugs (8%). Peanut was the most frequent food allergen provoking anaphylaxis, followed by tree nuts, cow's milk, and egg. Accompanying or aggravating factors, such as exercise, drug use, coexisting infection, psychological stress, and menses, were noted in 18% of all cases. Only 26% had a history of a previous reaction. Treatment data demonstrated that antihistamines were given 87% of the time and corticosteroids were given 85% of the time, but epi-nephrine was given only 22% of the time. CONCLUSIONS. Use of registry data can provide insight into the features of children presenting with anaphylaxis. Food allergens were the most common triggers for anaphylaxis and possible aggravating factors were noted in nearly 1 in 5 cases, with exercise being the most common. The low frequency of epinephrine administration suggests ongoing need for education for both families and physicians. REVIEWER COMMENTS. This study aimed to characterize children with life-threatening anaphylactic reactions by selecting those with cardiovascular and/or pulmonary involvement. Consistent with other studies, food aller-gens (most commonly peanut) were the most frequent trigger for reaction. The rate of accompanying or aggravating factors suggests that these should be considered in evaluation of all children with anaphylaxis. The low rate of epinephrine use is concerning, especially given that this study focused on more severe reactions, although this is consistent with most other studies of anaphylaxis from around the world. et al. Clin Exp Allergy. 2011;42(2):284-292 PURPOSE OF THE STUDY. To evaluate the rate at which adrenaline autoinjectors are used during anaphylactic reactions by patients who have had them prescribed, and to assess the number of devices used for each reaction. STUDY POPULATION. Participants (N 5 969) were children and teenagers aged 18 years or less who had been prescribed an adrenaline autoinjector for at least 1 year, recruited from 14 pediatric allergy clinics throughout the Unite...

Food allergy is becoming an increasing problem worldwide with an estimated 6-8% of children affected at some point in their childhood. The perceived prevalence of food allergy is even higher with an estimated 20% of children adhering to some form of elimination diet. Against this background, accurate diagnosis is essential to prevent the imposition of unnecessarily restrictive diets on young children. Raising clinical awareness amongst health professionals as to the clinical characteristics, epidemiology, investigation, and management of food allergic disorders is key to tackling this growing problem. In this article, three separate cases of children with poor nutrition and secondary morbidity are presented, highlighting the varying scenarios in which these conditions can be encountered. In the first child, the features clinically displayed were hypocalcemic seizures and rickets due to prolonged breast feeding, poor weaning, and inadequate dietary supplementation. The second case reveals the dangers of complementary diagnostic allergy testing leading to poor nutrition as a consequence of an unsupervised elimination diet. The last report describes a child with multiple food allergies, failure to thrive, and protein losing enteropathy to highlight the diversity of nutritional problems faced by allergists and to underline the importance of specialist dietetic input in the management of a child with food allergy.

Food avoidance remains the main strategy in prevention of anaphylaxis in children with acute food allergies. To achieve this aim, product labelling needs to be clear and accurate and parents educated on optimal avoidance measures. Food product labelling although improved often still remains ambiguous. The aim of this study was to understand and quantify the attitudes of parents of children with nut allergy towards labels informing that the product could contain nuts. An anonymous questionnaire was filled out by parents of children with nut allergy attending a tertiary paediatric allergy clinic to assess response to differing descriptive labelling of foods containing nuts. In 184 questionnaire responses, 80% of parents would not purchase a product labelled 'not suitable for nut allergy sufferers' or 'may contain nuts'. However, other labels including 'this product does not contain any nuts but is made in a factory that uses nuts', 'cannot guarantee is nut free' and 'may contain traces of nuts' were avoided by only around 50% of parents. Previous allergic reaction to nut products had no bearing on outcome. Additionally, large numbers of parents did not read labels for the presence of nuts in non-food products. A large number of patients with nut allergy continue risk-taking by either ignoring warning labels on foods or assuming that there is a gradation of risk depending on the wording of label warnings. Further tightening of labelling legislation and improved education would help to decrease the risk of anaphylaxis.

Regeneron; serves the American College of Allergy, Asthma, and Immunology as deputy editor of the Annals of Allergy, Asthma, and Immunology and is a member of the American Board of Allergy and Immunology outside the submitted work; and is on the medical advisory board (unpaid) of the International FPIES Association. L. Lange Background: Tolerance development is an important clinical outcome for infants with cow's milk allergy. Objective: This multicenter, prospective, randomized, doubleblind, controlled clinical study (NTR3725) evaluated tolerance development to cow's milk (CM) and safety of an amino acidbased formula (AAF) including synbiotics (AAF-S) comprising prebiotic oligosaccharides (oligofructose, inulin) and probiotic Bifidobacterium breve M-16V in infants with confirmed IgEmediated CM allergy. Methods: Subjects aged < _13 months with IgE-mediated CM allergy were randomized to receive AAF-S (n 5 80) or AAF (n 5 89) for 12 months. Stratification was based on CM skin prick test wheal size and study site. After 12 and 24 months, CM tolerance was evaluated by double-blind, placebo-controlled food challenge. A logistic regression model used the all-subjects randomized data set. Results: At baseline, mean 6 SD age was 9.36 6 2.53 months. At 12 and 24 months, respectively, 49% and 62% of subjects were CM tolerant (AAF-S 45% and 64%; AAF 52% and 59%), and not differ significantly between groups. During the 12-month intervention, the number of subjects reporting at least 1 adverse event did not significantly differ between groups; however, fewer subjects required hospitalization due to serious adverse events categorized as infections in the AAF-S versus AAF group (9% vs 20%; P 5 .036). Conclusions: After 12 and 24 months, CM tolerance was not different between groups and was in line with natural outgrowth. Results suggest that during the intervention, fewer subjects receiving AAF-S required hospitalization due to infections. (J Allergy Clin Immunol 2021;nnn:nnn-nnn.)