Can we identify patients at risk of life‐threatening allergic reactions to food?

Abstract

Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of foodtriggered anaphylactic reactions are not life-threatening. Nonetheless, severe lifethreatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.

Reactions of Buckwheat-Hypersensitive Patients during Oral Food Challenge Are Rare, but Often Anaphylactic

“…Although severe reactions could not be predicted [20], a previous reaction to BW was a risk factor for positive reactions to a BW OFC in our study. Similarly, a history of a prior reaction was reported to be a risk factor for a multisystemic reaction in wheat OFC [21].…”

Food‐induced fatal anaphylaxis: From epidemiological data to general prevention strategies

“…5 It has been proposed that this reflects increased risk-taking in this age group; however, at least in the United Kingdom (UK), the increased risk persists into the fourth decade of life where arguably, risk-taking is less common, and thus, there may be an age-dependent physiological POUESSEL ET AL. 5,27 Non-food allergens are more common as a cause of fatal anaphylaxis in mid-late adulthood; this is probably due to associated comorbidities (especially cardiovascular and neurological diseases) and polypharmacy. 5,27 Non-food allergens are more common as a cause of fatal anaphylaxis in mid-late adulthood; this is probably due to associated comorbidities (especially cardiovascular and neurological diseases) and polypharmacy.…”

Ratios of specific IgG4 over IgE antibodies do not improve prediction of peanut allergy nor of its severity compared to specific IgE alone

“…1 Altogether, this limits the prognostic value of serum IgE tests and their contribution to the diagnosis of peanut allergy. In addition, it is also not clear why symptom severity varies between patients.…”