IgE-mediated food allergy throughout life

Abstract

Food allergy (FA) is an increasing problem throughout the world. In the last two decades, the frequency of FA has increased in both children and adults. The prevalence differs according to the research methodology, age and geographic regions, ranging between 2.0 to 10.0%. The most common form of FA is IgE mediated FA. In this form, patients may present with life-threatening condition as anaphylaxis or milder conditions like urticaria, angioedema, sneezing and nausea alone. The gold standard in the diagnosis of FA is oral provocation tests. Epidermal skin prick tests and specific IgE measurements as well as component resolved diagnostic techniques are helpful in the diagnosis and follow-up of patients. In this review, the epidemiology, diagnosis, follow-up and prognosis of Ig-E mediated FA in children and adults are discussed and some specific forms of FA such as pollen food allergy syndrome, alpha-gal allergy and food dependent exercise induced anaphylaxis are explained.

Current and Future Strategies for the Diagnosis and Treatment of the Alpha-Gal Syndrome (AGS)

“… 55 Cofactors, such as acetylsalicylic acid (ASA) or alcohol, are well-known amplifiers of α-Gal reactions. 6 Due to the wide difference between symptomatology of AGS patients, sensitivity to α-Gal can be truly variable. 30 However, it has been observed that pork kidney intake, and no other product like muscle meat, even in the coadministration of cofactors, is a key element to raise AGS symptoms.…”

“… 43 , 70 First, blood must be processed within 24 hours after being collected in order to guarantee that basophil viability and reactivity are preserved. 6 , 71 Second, questions regarding reproducibility and cost must be addressed before BAT implementation in practicing allergists. 72 Unfortunately, methodology, concentration and markers are not standardized between laboratories in order to allow result comparison and test validation.…”

“… 43 Although most cases are not emergency cases, invasive techniques are required for in shock patients treatment. 6 Furthermore, established protocols, symptomatology, or information about the AGS characteristics are not available due to the wide natural history and variety of subjects all over the world. Herein we present some of the most common strategies and routinary methodology in AGS treatment/management when the disease is diagnosed.…”

“…Vulnerable patients should be taught on nutrition facts label reading, awareness of hidden exposures and be provided with a written plan on how to promptly operate in case of an allergic reaction. 6 , 42 , 61 Clinicians must also inform patients of the risk of onset anaphylaxis not only due to cetuximab but also because of heparin, gelatin-containing vaccines and mammalian heart valves. 94 The fact that numerous pharmaceutical products contain animal-derived excipients makes it harder to avoid all potentially immunogenic antigens.…”

“… 8 The other clinical presentations of AGS comprise immediate hypersensitivity to α-Gal-containing drugs, firstly discovered using the monoclonal antibody cetuximab in anticancer therapy. 6 , 9 There is growing evidence of allergic reactions caused by the α-Gal present in mammalian substances such as gelatin, glycerin, lactic acid and magnesium stearate used in the preparation process of several medications, 9 , 10 such as gelatin-containing products (vaccines and volume colloids), mammalian serum-based antivenom and even various analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs). 2 , 6 , 11 , 12 The IgE initial sensitization is caused by hard-bodied tick bites from different species according to geographic location and is attributed to α-Gal-containing tick salivary glycoproteins, but also other tick salivary biomolecules without α-Gal modifications such as prostaglandin E2 (PGE2).…”