Risk factors for severe pediatric food anaphylaxis in Italy

Calvani, Mauro; Cardinale, Fabio; Martelli, Alberto M.; Muraro, Antonella; Pucci, Neri; Savino, Francesco; Zappalà, Daniela; Panetta, Valentina

doi:10.1111/j.1399-3038.2011.01200.x

Cited by 98 publications

(73 citation statements)

References 31 publications

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“…Particularly the prevalence of asthma appears quite higher in patients who report food anaphylaxis than in the general population of Torino, the most populous town of the same Region, according to a recent epidemiological study [27]. A history of asthma appears to be a major risk factor for life-threatening anaphylactic reactions to food [28][29][30], but it is not particularly specific, as about a third of food allergic patients have asthma. Many of our patients (one-third of adults) had the oral allergic syndrome, mainly due to pollen-food allergy, as it is commonly observed in Northern Italy [22].…”

Section: Resultsmentioning

confidence: 99%

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

et al. 2013

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There are wide differences in estimated incidence and prevalence of anaphylaxis because of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. We aimed to estimate the incidence of food anaphylaxis based on the database of Piemonte Region (Italy) Reference Center for Severe Allergic Reactions. All cases of severe food allergic reactions reported in 2010 were studied. Clinical data associated to the reports were evaluated according to National Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network diagnostic criteria of anaphylaxis. 75 % of the 778 cases were classified as food anaphylaxis (incidence of 13/100,000 personyears, ranging from 9.9 in adults to 29/100,000 person-years in children). Nuts were the most frequent foods causing anaphylaxis. Milk and eggs were responsible for anaphylaxis more often in children, while peach, vegetables and crustaceans were in adults. Cardiovascular symptoms were more frequent in adults. Gastrointestinal involvement was more frequent in children. A high prevalence of respiratory allergic comorbidities was observed. Food is an important cause of anaphylaxis, particularly in subjects with respiratory allergic comorbidities. Children and adults differ in triggers and clinical presentation of anaphylaxis.Keywords: Anaphylaxis, Food allergy, Epidemiology, Allergy Introduction Population-based studies estimate the incidence of anaphylaxis in western countries to be in the range of 4-50 per 100,000 person-years [1, 2], with a true lifetime prevalence in the range of 0.05-2 % [3]. Foods are reported to be the most important trigger of anaphylaxis, being responsible for 33.2-56 % of all anaphylaxis cases [4]. The other two principal triggers of anaphylaxis are insect stings and drugs [1,5]. The relative contribution of each of these triggers to anaphylaxis may differ according to the study design, study population, or geographic area. The wide differences in the estimated incidences and prevalences of anaphylaxis are the direct result of the absence, until recently, of a universal consensus on the definition of anaphylaxis and the different source of collected data. For this reason in 2005 the National Institute of Allergy and Infectious Disease (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) developed a very useful preliminary definition, based on diagnostic criteria [6]. The symposium defined anaphylaxis as: "a serious allergic reaction that is rapid in onset and may cause death". Clinically, involvement of at least two organs (skin or mucosal tissue, cardiovascular apparatus, breathing apparatus, gastrointestinal tract) is required, or a sudden reduced blood pressure along with a temporal relationship (generally minutes) to a potential causative agent. A problematic issue with this definition, which may explain the under-reporting or misreporting of anaphylaxis cases, is the failure to agree among health care providers on the severity threshold for classi...

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Section: Resultsmentioning

confidence: 99%

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

et al. 2013

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“…Recent clinical studies reveal that some patients with atopic dermatitis (AD) in early life may have a higher risk of developing food allergy 6– 9 . Infants with atopic eczema are prone to be sensitized to egg at only 4 months of age 10 .…”

Section: Epidermal Thymic Stromal Lymphopoietin and Interleukin-33 Inmentioning

confidence: 99%

Developing food allergy: a potential immunologic pathway linking skin barrier to gut

Wang

2016

F1000Res

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Immunoglobulin E (IgE)-mediated food allergy is an adverse reaction to foods and is driven by uncontrolled type-2 immune responses. Current knowledge cannot explain why only some individuals among those with food allergy are prone to develop life-threatening anaphylaxis. It is increasingly evident that the immunologic mechanisms involved in developing IgE-mediated food allergy are far more complex than allergic sensitization. Clinical observations suggest that patients who develop severe allergic reactions to food are often sensitized through the skin in early infancy. Environmental insults trigger epidermal thymic stromal lymphopoietin and interleukin-33 (IL-33) production, which endows dendritic cells with the ability to induce CD4 +TH2 cell-mediated allergic inflammation. Intestinal IL-25 propagates the allergic immune response by enhancing collaborative interactions between resident type-2 innate lymphoid cells and CD4 +TH2 cells expanded by ingested antigens in the gastrointestinal tract. IL-4 signaling provided by CD4 +TH2 cells induces emigrated mast cell progenitors to become multi-functional IL-9-producing mucosal mast cells, which then expand greatly after repeated food ingestions. Inflammatory cytokine IL-33 promotes the function and maturation of IL-9-producing mucosal mast cells, which amplify intestinal mastocytosis, resulting in increased clinical reactivity to ingested food allergens. These findings provide the plausible view that the combinatorial signals from atopic status, dietary allergen ingestions, and inflammatory cues may govern the perpetuation of allergic reactions from the skin to the gut and promote susceptibility to life-threatening anaphylaxis. Future in-depth studies of the molecular and cellular factors composing these stepwise pathways may facilitate the discovery of biomarkers and therapeutic targets for diagnosing, preventing, and treating food allergy.

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“…D'après les données de ce registre entre 1992 et 2012, 78 % des patients décédés d'une anaphylaxie alimentaire avaient un asthme sous-jacent [11]. Dans l'étude italienne de Calvani et al concernant 163 cas d'anaphylaxie chez l'enfant, un antécédent d'asthme était associé à un risque augmenté de sifflement (OR : 2,2 ; IC 95 % : 1,1-4,5) et surtout d'arrêt respiratoire lors de l'anaphylaxie (OR : 6,9 ; IC 95 % : 1,4-34,2) [12]. Une étude anglaise portant sur un suivi en méde-cine générale de patients âgés de un à 79 ans, confirmait que l'incidence de l'anaphylaxie était deux fois plus grande chez les patients asthmatiques [13].…”

Section: L'asthme : Un Facteur De Risque Majeur En Cas D'allergie Aliunclassified

À qui prescrire un dispositif auto-injectable d’adrénaline ? Position des groupes de travail « Anaphylaxie », « Allergie alimentaire », « Insectes piqueurs » sous l’égide de la Société française d’allergologie

Pouessel

Deschildre

Beaudouin³

et al. 2016

Revue Française d'Allergologie

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Risk factors for severe pediatric food anaphylaxis in Italy

Abstract: A clinical history of asthma and chronic/relapsing gastrointestinal symptoms (probably linked to food allergy) may predict the development of respiratory and gastrointestinal symptoms and the severity of anaphylaxis.

Cited by 98 publications

References 31 publications

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

Incidence of food anaphylaxis in Piemonte region (Italy): data from registry of Center for Severe Allergic Reactions

Developing food allergy: a potential immunologic pathway linking skin barrier to gut

À qui prescrire un dispositif auto-injectable d’adrénaline ? Position des groupes de travail « Anaphylaxie », « Allergie alimentaire », « Insectes piqueurs » sous l’égide de la Société française d’allergologie

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