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Prevalence of adverse reactions to food in Germany - A population study
Allergy
Abstract
A population study was performed to identify the prevalence of all kinds of adverse reactions to food.
In a representative cross-sectional survey performed in 1999 and 2000 in Berlin, 13 300 inhabitants of all ages were addressed by questionnaire. This questionnaire was answered by 4093 persons. All respondents mentioning any sign of food intolerance or the existence of allergic diseases (n = 2298) were followed up by telephone and, in case food intolerance could not be ruled out by patient history, were invited to attend to the clinic for personal investigation including double-blind, placebo-controlled food challenge tests (DBPCFC).
The self-reported lifetime prevalence of any adverse reaction to food in the Berlin population (mean age 41 years) was 34.9%. Eight hundred and fourteen individuals were personally investigated according to the guidelines. The point prevalence of adverse reactions to food confirmed by DBPCFC tests in the Berlin population as a mean of all age groups was 3.6% (95% confidence interval [3.0-4.2%]) and 3.7% in the adult population (18-79 years, 95% confidence interval [3.1-4.4.%]). Two and a half percent were IgE-mediated and 1.1% non-IgE-mediated, females were more frequently affected (60.6%). Based on a statistical comparison with available data of adults from the nationwide German Health Survey from 1998, adverse reactions to food in the adult population of Germany (age 18-79) were calculated with 2.6% [2.1-3.2%]).
The study gives for the first time information about the point prevalence of both immunological and nonimmunological adverse reactions to food and underlines the relevance of this issue in public health. The data also show that an individualized stepwise approach including provocation tests is mandatory to confirm the diagnosis.
... FHS is believed to affect 1.5% of adults and 6-8% of children (Bock 1987;Fuglsang et al. 1994; Jansen et al. 1994;Zuberbier et al. 2004) and is more common in atopic individuals (Kurukulaaratchy et al. 2003) . Cow's milk, eggs, peanut and tree nuts, soy and wheat are among the most common food allergens in infants and children ( The few studies which have addressed the prevalence of FHS have mainly investigated adult populations ; Young et al. 1994) or have been hospital based studies where the population rate has been extrapolated from assessment of children referred to paediatric clinics for a general health check (Bock 1987). ...
... Cow's milk, eggs, peanut and tree nuts, soy and wheat are among the most common food allergens in infants and children ( The few studies which have addressed the prevalence of FHS have mainly investigated adult populations ; Young et al. 1994) or have been hospital based studies where the population rate has been extrapolated from assessment of children referred to paediatric clinics for a general health check (Bock 1987). Recently, one population based study utilising food challenges, has been published looking at the prevalence of food allergy in both adults and children (Zuberbier et al. 2004). ...
... A recent cross-sectional survey (1999 -2000) from Germany reported that 34.9% of people experienced an adverse reaction to food at some point in their life (Zuberbier et al. 2004). The point prevalence of adverse reactions to food confirmed by DBPCFC in the Berlin population was calculated as 3.6% and in the adult population 3.7% (18-79 years). ...
p> Introduction: It is unclear at present which type of food challenge (open vs. double blind) is best suited for the diagnosis of food hypersensitivity (FHS) in children.
This research aimed to assess 1) what is the best approach for the diagnosis of FHS; 2) how maternal dietary and infant feeding and weaning practices influence the development of FHS; 3) the role of a personal or family history of atopy in dietary practices.
Methods: A birth cohort of children born during 2001 - 2002 was recruited at the ante-natal clinic and followed prospectively for two years. In addition, three sets of school cohorts were approached to participate in the study. To address the first aim, all cohorts were utilised and the use of open food challenges (OFC) and double blind placebo controlled food challenges (DBPCFC) were assessed in the diagnosis of FHS. To address the second aim the birth cohort was used. A food frequency questionnaire (FFQ) was developed and validated to obtain the information on the maternal diet. Standardised questionnaires were developed and used prospectively to assess feeding and weaning practices and their influence on the infant’s FHS. To address the third aim the family history of atopy was obtained during recruitment of the birth cohort.
Results: We found that the positive predictive value of the one-day OFC challenges was higher than the one-week OFC. The data therefore suggest that OFC may be suitable for diagnosing immediate (objective) symptoms, whereas a DBPCFC may be needed for the diagnosis of delayed (subjective) symptoms.
Fruit and vegetable intake during pregnancy, food avoidance during lactation and weaning age of the infant affected the development of FHS.
A family history of atopy positively affected exclusive breast feeding at three months and delayed introduction of peanuts into the infant’s diet by six months. </p
... In de onderzoeken onder de algemene bevolking lijkt een verhoogd sIgE of een positieve huidpriktest zonder symptomen van allergie (asymptomatische sensibilisatie) een vaak voorkomend fenomeen [Pereira 2005;Venter 2006a;Zuberbier 2004]. Sensibilisatie komt ruim tweemaal zo vaak voor als aangetoonde voedselallergie [Eller 2009]. ...
... In een populatieonderzoek onder Duitse volwassenen (n = 13.300, dwarsdoorsnedeonderzoek, 31% respons), bleek twee derde van de allergische reacties IgE-gemedieerd en een derde niet-IgEgemedieerd [Zuberbier 2004]. ...
... De puntprevalentie van voedselallergie werd geschat op 3,7% (95%-BI 3,1 tot 4,4). De meest voorkomende allergenen waren gerelateerd aan een kruisovergevoeligheid voor pollen [Zuberbier 2004]. ...
... Independently of using or not other diagnostic tests, namely oral provocation procedures, most studies on the prevalence of food allergies in the general population have been based upon an initial step involving the application of a questionnaire, which must be validated in order to be useful in terms of analysis. [8][9][10][11][12] Thus far, only one study on the prevalence of food allergies in the general population has been performed in Portugal, limited to a sample of 659 adult participants older than 39 years old, where the authors performed a large, health and nutrition questionnaire, including questions not only related with food allergy, but also to demographic characteristics and social dietary habits. 13 Furthermore, as far as we know, no validated questionnaires, or clinical history screening questionnaires for epidemiological studies of adverse food reactions (AFR) as an initial approach to the study of food allergies in adults have been developed in Portuguese speaking countries. ...
... In the control group, mean re-application time was 8 AE 7 weeks (range: 2-34 weeks; median and mode: 2 weeks), thereby allowing analysis of the variability of replies to each of the items of the questionnaire. Temporal stability was calculated by determining Spearman's Rho correlation coefficient for 8 items (items number 5,9,[11][12][13][14][15]17) which were regarded as indispensable, since they objectively characterized the development of adverse food reactions, and due to the "yes-no" binary answer type. The set of 8 previously mentioned items, both globally and also taking gender, age, time interval between test and retest, as well as the volunteers' source of referral (diagnosed patients and Health Care Centres) into account are shown in Table 3 inadvertent ingestion of suspect foods or ingestion by self-initiative to see whether they could tolerate the foods. ...
... Finally, the low temporal stability may also have been due to a memory bias as previously referred, since it was not possible to analyse this item separately from the variability between groups (non-food allergic controls versus patients with food allergies) using Spearman's coefficient, given the relatively limited size of the sample. In spite of these aforementioned factors potentially affecting the "8 crucial questions" (items 5,9,[11][12][13][14][15]17), 6 of these questions maintained an optimal degree of temporal stability which afforded the whole of the test a high level of reproducibility. ...
Background & aims
As far as we know, no screening questionnaire has been developed and validated for identification of adverse food reactions in Portuguese-speaking adults, as an initial approach towards the investigation of cases of possible food allergy. Thus, the objective of this study was to develop and validate a screening questionnaire of food allergy in adult Portuguese-speaking patients.
Methods
This was a multicentre, cross-sectional study using a simple random sample of 186 adults between 18 and 82 years old from various parts of the centre of Portugal. Intelligibility of the questionnaire was first assessed in 24 patients with confirmed IgE- or non-IgE-mediated food allergy, and in 24 volunteers without food allergies. The 17-item questionnaire was subsequently applied by phone to 78 food allergic patients (66 IgE-mediated and 12 non-IgE mediated) and to 60 non-food allergic volunteers, with subsequent reassessment (re-test). Face and content validity, intelligibility, construct validity, and test-retest reliability (temporal stability) were analysed.
Results
Face and content validity allowed item reduction from 30 to 17 items with adequate content validity index >0.78. Construct validity was confirmed in the 66 confirmed IgE-mediated food allergic patients, 12 non-IgE-mediated food allergic patients, and 60 non-allergic patients. Test-Retest Reliability (general temporal stability) of the test had a Spearman correlation coefficient value of 0.845 for the retest. Cohen's Kappa values for the relevant questions were greater than 0.890 for almost all items. No differences were found when sex, age, and volunteers' recruitment origin were analysed. An inverse relationship was found between reliability and retest time interval.
Conclusions
Due to the quick and easy implementation, confirmation of face, content and construct validity as well as high temporal reproducibility, this screening questionnaire may be a useful study tool for an initial approach to detection of food allergies in adults.
... For this study, we took into account the fact that 3168 adolescents aged between 1023 years old (mean age: 14.3 AE 1.1; 51.7% female) were registered in 7 secondary schools of the cities of Castelo Branco, and Covilhã, in central Portugal. Based on an estimated prevalence of 4%, 13,22,23 and considering a 95% confidence interval and a margin of error of 2%, we calculated that we would need a representative sample of 399 adolescents (STATA Statistical Package Ò ). Considering an expected reply rate of 40%, we reset the sample size to 779 adolescents. ...
... Open oral challenges were performed in cases with positive clinical history, SPT and/or SPPT, and sIgE levels to suspect foods, and also in those cases in which clinical history was unclear and SPT results, as well as specific IgE levels, were negative or discrepant. Open challenge tests were carried out with suspect food, 22 in accordance with published guidelines. 10,11,27 In those cases in which individuals did not avoid the suspect foods, in spite of having symptoms, an elimination diet for at least 7 days before the oral challenge was carried out and monitored. ...
... Previous studies have shown that self-reports tend to overestimate food allergies. [12][13][14][15]17,22,30,33,[36][37][38] This discrepancy may be partly due to an information bias based upon an enhanced self-perception of symptoms which are wrongly ascribed to food ingestion. Cultural factors, health literacy, or accessibility to a medical diagnosis may be involved 15,33 (in our study, only 16% of the adolescents that reported foodassociated symptoms had ever seen an allergist for that reason). ...
Background & aims
The objective of the present study was to determine, for the first time, the prevalence and clinical features of food allergy in Portuguese adolescents.
Methods
Cross-sectional study performed in various secondary schools in central Portugal. Randomly selected adolescents replied to a validated food allergy questionnaire. Those who reported an adverse food reaction were seen at participating hospitals, where clinical history was taken, skin prick (SPT) and prick-prick skin (SPPT) tests were performed, and food allergen-specific IgE levels (sIgE) were determined. An open oral challenge was performed in selected cases. Cases of positive clinical history of immediate (up to 2 h after ingestion) reaction in association with positive food sIgE levels and/or SPT were classified as IgE-associated probable food allergy and as confirmed IgE-mediated food allergy if food challenges were positive. Cases of positive clinical history of delayed (more than 2 h after ingestion) and negative food sIgE levels independently of positive SPT or SPPT results, were classified as non-IgE associated probable food allergy.
Results
The prevalence of probable food allergy in Portuguese adolescents was 1.41% (95% CI: 0.90–2.03%), with fresh fruits, shellfish, nuts, and peanut as the most frequently implicated foods. IgE-mediated probable food allergy occurred in 1.23% (95% CI: 0.67–1.72%) of cases, with fresh fruits, shellfish, and nuts mainly involved. Cutaneous symptoms were most frequently reported.
Conclusions
The prevalence of probable food allergies in Portuguese adolescents is low, is mostly related to fresh fruits, shellfish, nuts, and peanut, and most frequently involves cutaneous symptoms.
... Data recorded were reported as "studies"; therefore, one row may combine data extracted from more than one paper reporting from the same study. Nineteen out of the 32 included studies were crosssectional studies, [9][10][11][12][13][14][15]19,23,24,[27][28][29][32][33][34][35][36][37][38][42][43][44]52 12 were cohort studie s, [16][17][18][20][21][22]25,26,30,31,39,40,[45][46][47][48][49][50][51]53 and one study was a nested casecontrol study. 41 Only estimates of point and lifetime prevalence were available across the studies. ...
... allergy or sensitization was investigated in 29 studies31,32,[34][35][36][37][38][39][40][41][42][43][44][48][49][50][51][52][53] of which 20 were included in metaanalysis. The overall lifetime and point prevalence of self-reported hazelnut allergy were 0.8% (95% CI 0.5-1.1) ...
In 2014, the European Academy of Allergy and Clinical Immunology (EAACI) published the first systematic review that summarized the prevalence of food allergy (FA) and food sensitization in Europe for studies published 2000–2012. However, only summary estimates for tree nut allergy (TNA) were feasible in that work. In the current update of that systematic review, we summarized the prevalence of tree nut allergy/sensitization to individual tree nuts. Six databases were searched for relevant papers published 2012–2021 and 17 eligible studies were added to the 15 studies already identified between 2000 and 2012, giving a total of 32 studies. Of the investigated tree nuts, meta‐analysis was possible for hazelnut, walnut, almond, and in few cases, for cashew, and Brazil nut. The lifetime self‐reported prevalence was 0.8% (95% CI 0.5–1.1) for hazelnut and 0.4% (0.2–0.9) for walnut. The point self‐reported prevalence was 4.0% (2.9–5.2) for hazelnut, 3.4% (2.0–4.9) for Brazil nut, 2.0% (1.1–2.9) for almond, and 1.8% (1.1–2.5) for walnut. Point prevalence of food challenge‐confirmed TNA was 0.04% (0.0–0.1) for hazelnut and 0.02% (0.01–0.1) for walnut. Due to paucity of data, we could not identify any meaningful and consistent differences across age groups and European regions.
... food allergies, mast cell disturbances, and elimination diets, respectively. However, there is a significant difference between self-reported and objective proven food intolerance, as shown by placebo-controlled, double-blind randomized trials [4,5]. This discrepancy may be overcome by endoscopic confocal laser endomicroscopy (eCLE). ...
... This high rate of self-reported adverse reaction to food in patients with functional bowel disease also has been reported in the literature [12]. In contrast, the rate of objective proven food intolerance as shown by placebo-controlled, double-blind randomized trials is very low [4,5]. The findings of our study suggest that eCLE could reduce the gap between subjective feeling and objective measurable adverse reaction to food. ...
Background and study aims Gastrointestinal symptoms assumed to be caused by food intolerance are reported frequently in the general population. There is a significant difference between self-reported and objective proven food intolerance, as shown by placebo-controlled, double-blind, randomized trials. This discrepancy may be overcome by endoscopic confocal laser endomicroscopy (eCLE).
Patients and methods In an observational study we evaluated 34 patients with functional abdominal pain and adverse reaction to food by eCLE and local duodenal food challenge for the first time. Spontaneous and food-induced transfer of fluorescein into the duodenal lumen was detected 10 minutes after intravenously application of fluorescein and 10 minutes after duodenal food challenge (DFC).
Results Of the patients, 67.6 % responded with a fluorescein leakage into the duodenal lumen. Frequency rank order of food antigens that induced a response were soy (50 %), wheat (46.1 %), milk (20 %), egg (12 %), and yeast (11.5 %), respectively. Of the patients, 23.5 % showed spontaneous leakage of fluorescein, suggesting leaky gut syndrome. Histology of duodenal biopsies and mast cell function were normal. Overall, 69.5 % of patients improved with food exclusion therapy and 13 % were symptom-free according to eCLE.
Conclusions The results of our study indicate that eCLE is a clinically useful tool to evaluate patients with functional abdominal pain and adverse reaction to food and to create individualized dietary therapy with clinical benefit for patients.
... Eurostat, Luxembourg, http://epp.eurostat.ec.europa. eu) might be due to gender-and age-specific prevalence rates for allergic diseases (4). Compared with the EU27 population, older women and men are slightly underrepresented in the reference population used in this study, younger women are more frequent. ...
... Regional variations of sensitization rates to inhalant allergens in Europe have been investigated in several large European studies such as the European Community Respiratory Health Survey (ECRHS) (13,14), the International Study of Asthma and Allergies in Childhood (ISAAC) (15) and other multi-country studies (16)(17)(18) or general population surveys in selected European countries (4,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). As a landmark study of allergic diseases, the ECRHS was the first population-based study to make broad comparisons across Europe for nine common allergens (Alternaria, Cladosporium, grass, birch, olive, Parietaria, Ambrosia, D. pteronyssinus and cat) and some regional ones (29,30). ...
Background: Skin prick testing is the standard for diagnosing IgE-mediated allergies. However, different allergen extracts and different testing procedures have been applied by European allergy centres. Thus, it has been difficult to compare results from different centres or studies across Europe. It was, therefore , crucial to standardize and harmonize procedures in allergy diagnosis and treatment within Europe. Aims: The Global Asthma and Allergy European Network (GA 2 LEN), with partners and collaborating centres across Europe, was in a unique position to take on this task. The current study is the first approach to implement a standardized procedure for skin prick testing in allergies against inhalant allergens with a standardized pan-European allergen panel. Methods: The study population consisted of patients who were referred to one of the 17 participating centres in 14 European countries (n = 3034, median age = 33 years). Skin prick testing and evaluation was performed with the same 18 allergens in a standardized procedure across all centres. Results: The study clearly shows that many allergens previously regarded as untypical for some regions in Europe have been underestimated. This could partly be related to changes in mobility of patients, vegetation or climate in Europe. Conclusion: The results of this large pan-European study demonstrate for the first time sensitization patterns for different inhalant allergens in patients across Europe. The standardized skin prick test with the standardized allergen battery should be recommended for clinical use and research. Further EU-wide monitoring of sensitization patterns is urgently needed.
... Nevertheless, the prevalence of hen's egg allergy in adults average 0.02 to 0.6% across European countries. 1,2 Although hen's egg allergy in adulthood is predominantly a persistent allergy developed in childhood, it can also be newly developed later in life. 3 In a study conducted in the United States, 29% of all hen's egg allergic adults suffered from an adult-onset allergy. ...
... So far, sensitization to hen's egg extracts, components and linear epitopes is solely studied in children although persistent and newly onset hen's egg allergy do appear in adults with a prevalence of 0.02 to 0.6% across European countries. 1,2 In the present study, we showed great overlap in sIgE levels to hen's egg extracts or single components between allergic and tolerant, but sensitized adults. ...
Background:
Although hen's egg allergy is more prevalent in children, up to 0.6% of adults from different European countries suffers from a persistent or newly-onset hen's egg allergy, making accurate diagnosis in adults necessary. However, sensitisation to hen's egg extracts, components and linear epitopes are solely studied in children.
Methods:
Hen's egg allergic (n=16) and tolerant (n=20) adults were selected by sensitisation towards recombinant components rGal d 1 and/or 3. Sensitisation profiles towards egg white and yolk extract and the native components Gal d 1, 2, 3 and 4 were respectively evaluated with the ImmunoCAP or the EUROLINE system. Characterisation of linear epitopes was performed with a peptide microarray containing 15mer peptides representing the entire sequence of mature Gal d 1 and 3.
Results:
Overall, sIgE titres against hen's egg extracts and single components overlapped largely between allergic and tolerant adults. Although the median sIgE/sIgG4 ratio to Gal d 1 was increased in allergic adults, the range was comparable between both groups. Clinically relevant sensitisation to Gal d 1 was confirmed by sIgE-binding to the linear epitopes aa30-41, aa39-50 or aa84-95 in 6/13 allergic adults, mainly suffering from objective symptoms. In comparison, these epitopes were recognized by 1/15 tolerant patient. Only a few linear epitopes were detected for Gal d 3, suggesting a greater importance of conformational epitopes for the recognition of Gal d 3.
Conclusion and clinical relevance:
Specific IgE-binding to linear epitopes of Gal d 1 is highly specific in identifying hen's egg allergic adults with objective symptoms.
... Hyppigheden af selvopfattet fødevareoverfølsomhed er overdrevet. I flere studier er der beskrevet stor diskrepans mellem selvrapporteret forekomst af fødevareoverfølsomhed (10-35%) sammenholdt med diagnosticeret (1,4-8%) [6][7][8][9][10]. ...
Formål: At undersøge, om en informationsfilm sammen med den vanlige mundtlige og skriftlige information ville gøre, at børn og unge oplevede at føle sig bedre forberedt til fødevareprovokation. Baggrund: En fødevareprovokation kan være svær for børn og unge at gennemføre. Information og forberedelse af børn og unge før procedurer på hospitalet, som f.eks. en fødevareprovokation, er vigtig, for at de får en god oplevelse, gennemfører testen og dermed opnår det bedst mulige testresultat. Metode og design: Studiet er et kvalitetsudviklingsprojekt designet som et før-efter studie, hvor kontrolgruppen fik vanlig mundtlig og skriftlig information og interventionsgruppen yderligere så en informationsfilm om fødevareprovokationen. Effekten blev målt med et selvudviklet spørgeskema specifikt udviklet til dette studie. Resultater: I alt 34 børn og unge deltog. Studiets resultater tydede på, at deltagerne, der så filmen, følte sig bedre forberedt. Resultaterne skal tolkes med forsigtighed, da det er et lille studie, og der er brugt en historisk kontrolgruppe. Studiet kan inspirere til yderligere interventionsstudier med et større sample og med anvendelse af validerede spørgeskemaer. Konklusion: En informationsfilm synes at være et godt supplement til mundtlig og skriftlig information til børn og unge i forhold til at forberede dem på en fødevareprovokation. Relevans for klinisk praksis: Der bør tænkes mere i visuel og direkte information til børn og unge. Keywords: Børn og unge, fødevareprovokation, information inden procedurer, visuel information, film
... The European Food Safety Authority (EFSA) defines foods additives as "substances added intentionally to foodstuffs to perform certain technological functions, for example to color, to sweeten or to help preserve foods" (European Food Safety Authority, 2023) Food additives are common ingredients in more than 50% of foods, and around 10% or more containing at least five additives (Chazelas et al., 2020). Although the reported prevalence of hypersensitivity reactions to food additives has been cited to be as high as 4.9%, the actual prevalence as measured by rigorous methods such as double-blind placebo-controlled studies is very low, ranging from 0.05 to 0.4% (Young et al., 1987;Osterballe et al., 2005;Zuberbier et al., 2004). In addition, some studies evaluating reactions to food additives excluded not only multiple additives, but also foods high in naturally occurring aromatic compounds, with challenges often to a mix of additives, making it difficult to determine the true effect of a specific additive (Guida et al., 2000;Rajan et al., 2014;Magerl et al., 2010). ...
... Approximately 30% of the German population suffers from Food Hypersensitivity (FH) [28], [20]. It is common among children [24], [19], young adults [20], and elderly people [12]. ...
... В клинической практике диагностические инструменты для выявления пищевых компонентов, вызывающих желудочно-кишечные симптомы, неспецифичны. Однако, как показали двойные слепые плацебо-контролируемые исследования [3,4], существует значительная разница между самооценкой и объективно доказанной пищевой непереносимостью. Цель исследования -оценка активности кишечных карбогидраз у пациентов с синдромом раздраженного кишечника, имеющих симптомы непереносимости пищевых продуктов. ...
The aim was to evaluate the activity of intestinal carbohydrases in patients with irritable bowel syndrome (IBS) with symptoms of food intolerance. Material and methods. 126 patients with IBS (83 women and 43 men, median age – 32.0 years (Q1–Q3: 27–38 years)) were examined. The diagnosis of IBS was established on the basis of Roman Criteria IV. A questionnaire was conducted for all patients to identify food intolerances, according to the results of which the patients were divided into three groups: the first – patients with isolated intolerance to foods with a high content of FODMAP; the second – patients with isolated intolerance to milk and dairy products; the third – patients with combined intolerance. To determine the activity of intestinal carbohydrates: lactase, sucrose, maltase and glucoamylase, all patients underwent esophagogastroduodenoscopy with biopsy samples from the duodenum. The activity of carbohydrases was determined by the Dahlquist method in the modification of N.I. Belostotsky. The control group consisted of 30 conditionally healthy people (10 men and 20 women, median age – 33.9 years (Q1–Q3: 24–35)), comparable in age and gender with patients with IBS. The activity of intestinal enzymes in this group was within the reference values. Statistical data processing was carried out using the computer program Statistica 8.0. Results. According to the results of the survey, it was found that out of 126 patients with IBS, 52 (41.3%) patients believed that they had food intolerance to certain foods. Isolated intolerance to foods with a high content of FODMAP was noted by 13 (10.3%) patients, 16 (12.7%) patients believed that they had isolated intolerance to milk and dairy products, and 23 (18.3%) patients indicated combined intolerance. In patients with IBS and isolated intolerance to foods high in FODMAP, the median activity of glucoamylase was 120.0 (68.5–209.2) ng/mg of glucose per 1 mg of tissue per minute (ng/mg × min), maltase – 630.5 (480.7–951.0) ng/mg × min, sucrose – 50.0 (32.8–68.8) ng/mg × min, lactase – 10.5 (5.5–40.5) ng/mg × min. Comparing the activity of carbohydrases with the control group revealed the statistically significant difference (p < 0.05) for each enzyme studied.In the group of patients with IBS and isolated intolerance to milk and dairy products, the median activity of all the intestinal enzymes studied was also lower than that in the control group: the activity of glucoamylase was 107.0 (64.0–174.0) ng/mg × min, maltase – 622.0 (481.5–887.0) ng/mg × min, sucrose – 48.0 (35.5-60.0) ng/mg × min, lactase – 8.0 (3.0–22.5) ng/mg × min. Among patients with IBS and the presence of combined intolerance to foods (with a high content of FODMAP and dairy products), the median activity of all enzymes significantly differed from the control group (p < 0.05). The activity of glucoamylase was 107.5 (57.5–194.2) ng/mg × min, maltase – 627.0 (480.7–911.7) ng/mg × min, sucrose - 47.5(34.8–61.5) ng/mg × min, lactase - 9.0 (4.0–28.8) ng/mg × min. Conclusion. Food intolerance was noted in 52 (41.3%) patients with IBS. Among the patients who noted the presence of all the studied food intolerances (isolated or combined intolerance to milk and dairy products, as well as products with a high content of FODMAP), a significant decrease in the activity of intestinal enzymes (glucoamylase, lactase, sucrose and maltase) was found compared with the control (p < 0.05), which may indicate the presence of they have disaccharidase deficiency
... arasında saptanırken, Almanya'da 4093 kişide %0.18 saptanmıştır. 7,8 Atopik bireylerde prevalansın %2-7'ye kadar arttığı görülmektedir. 9 Besin alerjisinin toplumun yaklaşık %5'ini etkilediği düşünüldüğünde tanıda öncelikle besin alerjilerinin düşünülmesi önerilmektedir. ...
Kullanılan binlerce besin katkı maddelerinin sadece küçük bir kısmı alerjik veya alerji benzeri reaksiyonlarla ilişkilendirilmiştir. Besin katkı maddeleri ürtiker ve/veya anjioödem, astım ve anafilaksi semptomlarının başlamasından sorumlu olabilir. Besin katkı maddelerine karşı alerji gelişimi için ipuç- ları, reaksiyonun yemek yedikten dakikalar ila birkaç saat içinde meydana gelmesi, alakasız birçok be- sine karşı benzer reaksiyon öyküsünün olması ve evde hazırlandığında tolere edilirken ticari formlarla reaksiyon olmasıdır. Kronik idiyopatik ürtiker/anjioödemli geniş hasta serileri semptomların besin katkı maddelerinden kaynaklanmadığı sonucunu desteklemektedir. Sülfitler, astımlı hastaların yaklaşık %5'inde alevlenmelere neden olabilirken, sülfit duyarlı hastalar sıklıkla ağır ve/veya steroide bağımlı astımlılardır. Besin katkı maddelerine karşı immünoglobülin E aracılı anafilaksi gelişebilir. Besin katkı maddelerine karşı alerji değerlendirmesi ayrıntılı klinik öykü, fizik muayene, şüpheli besinler veya izole katkı maddeleri ile alerji deri prik, serum spesifik IgE ve oral provokasyon testlerini içerir. Bu prosedürler bir alerji uzmanı tarafından yapılmalıdır.
... Gluten is a common concern for people around the world, especially in the United States, where nearly onethird of the population have to reduce the intake of this protein. Numerous studies have been conducted on the adverse reactions of gluten and its impact on the health of certain population groups [16][17][18]. ...
Introduction. The number of people with celiac disease is rapidly increasing. Gluten, is one of the most common food allergens,
consists of two fractions: gliadins and glutenins. The research objective was to determine the optimal conditions for estimating
gliadins by using enzyme-linked immunosorbent assay (ELISA).
Study objects and methods. The experiment involved wheat flour samples (0.10, 0.20, 0.25, 0.50, and 1.0 g) suspended in different
solvents (ethanol, methanol, 1-propanol, and isopropanol) of different concentrations (40, 50, 60, 70, 80, and 90% v/v). The samples
were diluted with Tris buffer in ratios of 1:50, 1:100, 1:150, and 1:200. The gliadin test was performed using a Gliadin/Gluten Biotech
commercial ELISA kit (Immunolab).
Results and discussion. The optimal conditions for determining gliadin proteins that provided the highest gliadin concentration were:
solvent – 70% v/v ethanol, extract:Tris buffer ratio – 1:50, and sample weight – 1.0 g.
Conclusion. The obtained results can be of great importance to determine gliadin/gluten concentrations in food products by rapid analysis methods.
... Studies on the epidemiology of food allergy in Germany are limited. A study from 2004 found a prevalence of food allergy, confirmed by double-blind, placebo-controlled food challenge of 3.7% in adults [8] and 4.2% in children [9]. A study of adult health in Germany (DGES), conducted in 2008 -2012, found a lifetime prevalence of food allergy of 6.4% in women and 2.9% in men and for the total cohort of adults of 4.7% (95% confidence interval 4.1 -5.4) [10]. ...
... Studies on the epidemiology of food allergy in Germany are limited. A study from 2004 found a prevalence of food allergy, confirmed by double-blind, placebo-controlled food challenge of 3.7% in adults [8] and 4.2% in children [9]. A study of adult health in Germany (DGES), conducted in 2008 -2012, found a lifetime prevalence of food allergy of 6.4% in women and 2.9% in men and for the total cohort of adults of 4.7% (95% confidence interval 4.1 -5.4) [10]. ...
... Most larger prevalence studies in Europe did not include pear while in most apple allergic patients pear also causes symptoms [9]. One systematic review by Zuidmeer et al. [10] found a study on pear allergy [11] reporting 0.3% pear allergy in Germany. Furthermore, Rodriquez et al. [12] performed skin prick tests in 26 patients in Spain with adverse reactions to Rosaceae fruits, and 18 patients with positive SPT for apple appeared to be positive for pear as well (69%). ...
Approximately 70% of birch pollen allergic patients in Europe experience hypersensitivity reactions to Immunoglobulin E (IgE) cross-reactive food sources. This so-called pollen-food syndrome (PFS) is defined by allergic symptoms elicited promptly by the ingestion of fruits, nuts, or vegetables in these patients. So far, in the literature, less attention has been given to Bet v 1 cross-reactive symptoms caused by pear (Pyrus communis). In the Netherlands, pears are widely consumed. The primary objective of this study was to measure the type and severity of allergic symptoms during pear challenges in birch pollen allergic patients, with a positive history of pear allergy, using two different pear varieties. Fifteen patients were included, skin prick test (SPT), prick-to-prick test (PTP), specific Immunoglobulin E (sIgE), and single-blind oral challenges were performed with two pear (Pyrus communis) varieties: the ‘Cepuna’ (brand name Migo®) and the ‘Conference’ pears. All patients were sensitized to one or both pear varieties. A total of 12 out of 15 participants developed symptoms during the ‘Cepuna’ food challenge and 14/15 reacted during the ‘Conference’ challenge. Challenges with the ‘Cepuna’ pears resulted in less objective symptoms (n = 2) in comparison with challenges with ‘Conference’ pears (n = 7). Although we did not find significance between both varieties in our study, we found a high likelihood of fewer and less severe symptoms during the ‘Cepuna’ challenges. Consequently selected pear sensitized patients can try to consume small doses of the ‘Cepuna’ pear outside the birch pollen season.
... Food allergy is a common disease. It affects ~ 5 -6% of children [1] and 2 -3% of adults [2]. Symptoms of food allergy can be mild in the sense of an oral allergy syndrome, which is more common in adults in the context of pollen-associated food allergy, or can manifest as a systemic reaction in the sense of anaphylaxis. ...
Food allergies are a common medical problem, with children being the most affected patient group. The standard of care of food allergy consists of the acute treatment in case of a reaction and food avoidance in the long term, which influences the quality of life of patients. In this article, current developments for the causal treatment of food allergy including specific immunotherapy and biologics will be discussed. Epicutaneous and oral immunotherapy are currently in clinical development for the treatment of food allergy, and the results demonstrate good tolerability and efficacy with an increase in the oral threshold level. Biologics and, in particular, anti-IgE are currently investigated for their therapeutic use in food allergies. The results are promising, suggesting efficacy and tolerability.
... Reported symptoms are nonspecific and include abdominal pain, nausea, bloating, and diarrhea. Interestingly, when rechallenged with the offending food, only 2%-3% develop recurrent symptoms (81,83). Patients with IBS are more likely than the general population to report adverse reactions to food, with prevalence rates as high as 50% (84)(85)(86). ...
Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensive literature search; 9 questions focused on diagnostic testing; 16 questions focused on therapeutic options. Consensus was obtained using a modified Delphi approach, and based on GRADE methodology, we endorse the following: We suggest that a positive diagnostic strategy as compared to a diagnostic strategy of exclusion be used to improve time to initiating appropriate therapy. We suggest that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. We suggest that fecal calprotectin be checked in patients with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. We recommend the use of chloride channel activators and guanylate cyclase activators to treat global IBS with constipation symptoms. We recommend the use of rifaximin to treat global IBS with diarrhea symptoms. We suggest that gut-directed psychotherapy be used to treat global IBS symptoms. Additional statements and information regarding diagnostic strategies, specific drugs, doses, and duration of therapy can be found in the guideline.
... prevalence of adverse food reactions among a 4093 patient sample population, with con rmatory clinical testing to support this prevalence. Within this study, the most common allergens with con rmatory IgE testing were nuts, apples/pears, stone fruit, vegetables, other fruit, our, milk, and egg (27). ...
Background It is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades – particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic.
Methods We conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018 – July 2020. We included patients with IgE-mediated symptoms, including the pollen-food syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease.
Results
The most common culprit food identified was shellfish, followed by finfish, pollen-food syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent.
Conclusions Adult-onset food allergy – particularly with resultant anaphylaxis – is an important phenomenon to recognize, even when patients have previously tolerated the food in question.
... A more objective 2004 cross-sectional study on German patients of all age groups found a 2.6% prevalence of adverse food reactions among a 4093 patient sample population, with confirmatory clinical testing to support this prevalence. Within this study, the most common allergens with confirmatory IgE testing were nuts, apples/pears, stone fruit, vegetables, other fruit, flour, milk, and egg [27]. Again, the issue of which allergens present with adultonset symptoms fails to be outlined by either of the aforementioned studies. ...
Background:
It is a putatively understood phenomenon that the overall prevalence of allergic disease has been increasing in recent decades-particularly in industrialized nations. Despite this, there is a relative scarcity of data concerning the development of food-related allergic disease in the adult population. In addition, the paucity of data as it pertains to the Canadian population is particularly marked when compared to other nations. We sought to determine common culprit foods and the reactions they elicited in a series of 14 patients seen in the Winnipeg allergy and immunology clinic.
Methods:
We conducted a retrospective review of patients identified by academic allergists in Winnipeg, Manitoba as fitting criteria for adult-onset IgE-mediated food allergy from May 2018-July 2020. We included patients with IgE-mediated symptoms, including the pollen-food syndrome which developed at the age of 16 or later. We collected data regarding the food which induced the reaction, what the reaction was, and any concomitant atopic disease.
Results:
The most common culprit food identified was shellfish, followed by finfish, pollen-food syndrome, and wheat/flour. The most common reaction experienced was anaphylaxis, followed by food-dependent exercise-induced anaphylaxis and isolated (muco)cutaneous symptoms. With regard to concomitant atopic disease, allergic rhinitis/rhinoconjunctivitis stood out as the most prevalent.
Conclusions:
Adult-onset food allergy-particularly with resultant anaphylaxis-is an important phenomenon to recognize, even when patients have previously tolerated the food in question.
Las enfermedades alérgicas se presentan como un desafío cada vez más relevante en la vida cotidiana de millones de personas en todo el mundo, ya que pueden manifestarse de diversas formas, afectando nuestra calidad de vida y generando incertidumbre y preocupación. Su prevalencia ha experimentado un notable aumento en las últimas décadas, estimándose que entre un 10% y un 30% de la población mundial puede verse afectada por algún tipo de alergia en algún momento de su vida. Aunque las nuevas técnicas diagnosticas y nuevos tratamientos en el campo de la alergología nos están ayudando a abordar estas enfermedades con mayor precisión, nunca debemos olvidar que la historia clínica es una herramienta irremplazable en el diagnóstico de las enfermedades alérgicas, ya que proporciona información detallada sobre la exposición a desencadenantes alérgicos, los patrones de síntomas, los antecedentes médicos y familiares, y la respuesta a tratamientos previos. Esta información es fundamental para desarrollar un plan de manejo efectivo y personalizado para cada paciente.
Background and study aims Gastrointestinal adverse reaction to food (GARF) is reported frequently in the general population and even more in patients with disorders of the gut brain axis. However, there is a significant difference between self-reported and objective proven GARF. The aim of the study was to characterize a mucosal correlate of GARF by endoscopic confocal laser endomicroscopy (eCLE) with duodenal food challenge (DFC).
Patients and methods In an observational and proof of concept study we evaluated 71 patients with disorders of the gut brain axis without (group I, n=19) and with (group II, n=52) GARF by eCLE and DFC. Spontaneous and food induced transfer of fluorescein into duodenal lumen was detected 10 minutes following intravenously application of fluorescein and 10 minutes after DFC.
Results According to Rom IV, the patients (group I/II) could be classified as irritable bowel syndrome (IBS) 32%/31%, functional abdominal pain without changes in bowel movement 47 %/48 %, functional abdominal bloating/distension 0 %/10 %, functional diarrhea 5 %/ 2 %, and unspecified functional bowel disorder 16 %/10 %, respectively. 21 %/27 % of the patients responded with a fluorescein leakage into the duodenal lumen before and 74 %/69 % following to DFC. Frequency rank order of food components that induced a response were soy (55.5 %/60 %), wheat (60 %/45.5 %), egg (35.7 %/8.3), milk (30 %/18.2 %) and yeast (10 %/6.6 %), respectively. Histology of duodenal biopsies, number, form and distribution of intraepithelial lymphocytes and mucosal mast cells as well as mast cell function were normal. Overall, 14 %/79 % reported main symptom benefit following a food exclusion therapy according to eCLE and DFC that was significant different between the groups.
Conclusion The results of our study indicate that eCLE with DFC is a technique to clinically evaluate patients with disorders of the gut brain axis and GARF resulting in a high proportion of patients reporting symptom benefit upon food exclusion dietary advice focussed on the results of eCLE.
An increasing number of people worldwide suffer from adverse reactions to food (ARF). ARF can have both an immunological and a non-immunological background, which is relevant for both diagnosis and treatment. In everyday clinical practice, exact classification of ARF is sometimes challenging, as the symptoms can be relatively unspecific and overlap between ARF subgroups. In addition, some test systems frequently used in clinical routine have significant limitations. This concerns both their sensitivity and specificity as well as the relatively high resource demands. Use of artificial intelligence (AI) could represent a method to improve diagnosis of ARF in the future. Initial studies suggest that the use of AI can predict the individual risk of developing a food allergy as well as the allergic potential of new food proteins with a high degree of certainty. These and other examples of the successful use of AI applications in the diagnosis of ARF are encouraging and should provide an incentive for further studies.
IgE-vermittelte Nahrungsmittelallergien beruhen in Deutschland überwiegend auf Kreuzreaktionen mit pollenassoziierten PR10-Proteinen im Sinne einer sekundären
Nahrungsmittelallergie. Seltener werden Allergien gegen Speicherproteine (in z. B. Nüssen oder Hülsenfrüchten) oder gegen Lipid-Transfer-Proteine (LTP) diagnostiziert. Letztere stellen in Mittelmeerländern dagegen die häufigste
Ursache für Anaphylaxien nach Verzehr pflanzlicher Nahrungsmittel dar.
Hier berichten wir über eine 40-jährige Patientin mit über Jahre wiederholt auftretenden Anaphylaxien nach Verzehr von bspw. Wal- oder Haselnüssen sowie Weintrauben. Die Reaktionen traten oft im Zusammenhang mit zeitgleichem
Alkoholkonsum auf und konnten auf eine LTP-Allergie zurückgeführt werden.
Zusammenfassung
Zunehmend mehr Menschen ernähren sich aus gesundheitlichen und Umweltaspekten ausschließlich von pflanzlichen Nahrungsmitteln (vegan). Dabei werden vielfach Hülsenfrüchte (wie Soja, Linsen, Erbsen), Schalenfrüchte (Cashew, Macadamia, Mandel, Pekan‐, Para‐ und Walnuss), Samen und Saaten (wie Chia, Leinsamen) oder (Pseudo‐)Getreide (wie Quinoa, Buchweizen) verzehrt. Vegane Milchalternativen sind Hafer‐, Mandel‐ und Sojadrinks, auch Käse‐ sowie Fleischersatzprodukte basieren oft auf einer Sojagrundlage. Gleichzeitig nimmt die Prävalenz von Nahrungsmittelallergien weltweit zu. Pflanzenallergene aus Hülsen‐ und Schalenfrüchten, die in der veganen Ernährung die Hauptproteinquelle ausmachen, zählen zu den häufigsten Auslösern von Nahrungsmittelallergien bei Erwachsenen. Dabei kommt es bei Allergien auf Speicherproteine (wie Gly m 5 und Gly m 6 aus der Sojabohne) zu teils schweren anaphylaktischen Reaktionen. Besonderes Augenmerk liegt weiter auf hochverarbeiteten Ersatzprodukten, die Pflanzenproteinisolate (zum Beispiel Erbsenmehl) in konzentrierter Form enthalten und damit allergologisch problematisch werden können. In diesem Artikel geben wir einen Überblick über wichtige Allergene und neue Allergenquellen in ausgesuchten veganen Nahrungsmitteln und betrachten die vegane Ernährung unter allergologischen Aspekten.
A vegan diet is increasingly en vogue , i.e., a diet based on plants, in which animal products are completely avoided, often for health and environmental reasons. The menu is supplemented with pulses (e.g., soy, lentils, peas), nuts (e.g., cashew, macadamia, almond, pecan, para, walnut) and seeds (e.g., chia, flaxseed) or pseudo‐grains (quinoa, buckwheat). Indeed, the product range is expanding to include vegan foods such as milk alternatives (e.g., oat, almond, soy drinks) and cheese or meat substitutes (e.g., soy‐based). Food allergies are also on the rise, with an increasing prevalence worldwide. It is worthy of note that the main allergens of anaphylactic reactions to food in adults are predominantly of plant origin, mainly pulses and nuts ‐ the very foods that form the main source of protein in the vegan diet. In this context, allergies to storage proteins (e.g., Gly m 5 and Gly m 6 from soya beans) can lead to severe anaphylactic reactions, while highly processed substitute products containing plant protein isolates (e.g., pea flour) in concentrated form continue to be of particular concern and may therefore be allergologically problematic. In this article, we aim to provide an overview of allergens and emerging allergen sources in vegan foods and highlight the anaphylaxis risk of the vegan diet.
The clinical symptomatology of atopic eczema comprises a colorful spectrum of skin lesions from infiltrated erythema, erosive excoriated lesions, and lichenified areas to pruriginous papules and nodules going along with intense itch sensations. Some authors have called itch the “primary lesion.” The lesions show typical distributions over the body according to the age—with extensor sides and face in infants and involvement of the big flexures (knee, elbow, neck) in older children and adults. There seem to be differences between ethnic groups with a more follicular papular variant on the extensor sides in African populations and more exudative lesions with truncal involvement in Asia. Minimal manifestations comprise lid eczema, cheilitis sicca, infranasal and infra-auricular erosions, finger and toe eczema as well as localized forms in the genital area or on the scalp. So-called stigmata of atopy represent characteristic skin changes not necessarily qualifying as disease but rather constitutional signs like hyperlinearity of palms and soles (ichthyosis palms), infraorbital fold (atopy fold), periorbital halo, rarification of lateral eyebrows (Hertoghe), and white dermographism. In differential diagnosis, other forms of eczema and other inflammatory skin diseases have to be distinguished, especially infectious but also malignant skin diseases like some forms of cutaneous lymphoma or drug reactions. Associated diseases include classical atopic respiratory diseases, anaphylaxis, especially against foods, ocular and ear diseases, and certain genodermatoses. Among neuropsychiatric diseases, attention deficit hyperactivity syndrome (ADHS) is discussed; probably severe itch and sleep loss due to atopic eczema in early childhood may contribute to the development of ADHS in some individuals. Complications include skin infections especially with herpes simplex (“eczema herpeticum”) but also other viral and bacterial infections. Some diseases seem to be rarely associated with atopic eczema like insulin-dependent juvenile diabetes mellitus type I, rheumatic arthritis, psoriasis, and melanocytic nevi. There are well-accepted diagnostic criteria most notably those by Hanifin and Rajka or the UK working party. Severity can be assessed using the scoring system AD (SCORAD), the eczema area and severity index (EASI) but also for self-orientation the patient-oriented eczema measure (POEM). For severe forms of eczema, it is adequate to also include quality of life aspects with the dermatology life quality index (DLQI) and further new and more specific instruments.KeywordsClinical symptomatologyLichenificationPrurigo nodulesStigmata of atopyDifferential diagnosisAssociated diseasesComplicationsSeverity scoring SCORAD,EASIPOEM
In 2014, the European Academy of Allergy and Clinical Immunology published prevalence estimates for food allergy (FA) and food sensitization (FS) to the so‐called eight big food allergens (i.e. cow's milk, egg, wheat, soy, peanut, tree nuts, fish and shellfish) in Europe for studies published between 2000 and 2012. The current work provides 10‐year updated prevalence estimates for these food allergens. A protocol was registered on PROSPERO before starting the research (reference number CRD42021266657). Six databases were searched for studies published 2012–2021, added to studies published up to 2012, resulting in a total of 93 studies. Most studies were graded as at moderate risk of bias. The overall pooled estimates for all age groups of self‐reported lifetime prevalence were as follows: cow's milk (5.7%, 95% confidence interval 4.4–6.9), egg (2.4%, 1.8–3.0), wheat (1.6%, 0.9–2.3), soy (0.5%, 0.3–0.7), peanut (1.5%, 1.0–2.1), tree nuts (0.9%, 0.6–1.2), fish (1.4%, 0.8–2.0) and shellfish (0.4%, 0.3–0.6). The point prevalence of food challenge‐verified allergy were as follows: cow's milk (0.3%, 0.1–0.5), egg (0.8%, 0.5–1.2), wheat (0.1%, 0.01–0.2), soy (0.3%, 0.1–0.4), peanut (0.1%, 0.0–0.2), tree nuts (0.04%, 0.02–0.1), fish (0.02%, 0.0–0.1) and shellfish (0.1%, 0.0–0.2). With some exceptions, the prevalence of allergy to common foods did not substantially change during the last decade; variations by European regions were observed.
Hintergrund und Ziele: Die physiologische Anzahl und Verteilung von Mastzellen im Magen-Darm-Trakt von Kindern und Jugendlichen ist bisher nicht ausreichend definiert und es existieren zur histopathologischen Beurteilung keine Normalwerte. Unser Ziel der vorliegenden Arbeit war die Ausarbeitung eben dieser physiologischen Normalwerte sowie der zur Abgrenzung einer Pathologie erforderlichen Grenzwerte. Wir führten eine systematische Untersuchung der Mastzellverteilung vom Ösophagus bis zum Rektum, sowohl bei gesunden Patienten, als auch bei Patienten mit einer gastrointestinalen Nahrungsmittelallergie durch. Methoden: Neun Kinder und Jugendliche, welche in der initialen histologischen Begutachtung keine auffälligen Befunde aufgewiesen hatten und bei denen die endoskopischen Maßnahmen aufgrund notwendiger Überwachung, beispielsweise im Rahmen einer Kontrolle nach Abtragung eines singulären juvenilen Polypen des Darms, durchgeführt wurden, dienten als Referenzkohorte. Bei all diesen Patienten war eine chronisch-entzündliche Erkrankung (z.B. Morbus Crohn, Colitis ulcerosa, Zöliakie) sowie eine allergische Erkrankung ausgeschlossen. Ergänzend erfolgte die Untersuchung von 15 Patienten mit gastrointestinalen Beschwerden, welche auf eine gastrointestinale Nahrungsmittelallergie zurückgeführt wurden. Alle Biopsien wurden mittels Immunhistochemie untersucht. Dabei wurde CD 117 (c-Kit) als zuverlässiger Marker für die Identifizierung der Mastzellen in der Lamina propria genutzt. Ergebnisse: Wir fanden deutliche Unterschiede der Mastzellverteilung in allen Abschnitten des kindlichen Magen-Darm-Trakts. Die höchste Anzahl von Mastzellen in beiden Gruppen, sowohl bei den symptomatischen als auch den Kontrollpatienten, wurden im Duodenum, terminalen Ileum, Coecum und Colon ascendens gefunden. Die niedrigste Anzahl lag im Ösophagus vor. Signifikante Unterschiede zwischen den 2 beiden Gruppen bestanden im Magencorpus (22.1±4.0/ high power field [HPF] vs. 32.0±10.1 /HPF; p=0.034) und im Colon ascendens (44.8±10.4 /HPF vs. 60.4±24.3 /HPF; p=0.047). Schlussfolgerungen: Die Anzahl von Mastzellen in der Schleimhaut des Magen- Darm-Trakts von Kindern und Jugendlichen ist höher als in der Vergangenheit angenommen und berichtet. Dabei besteht eine erhebliche Überschneidung zwischen Gesunden und Patienten mit einer gastrointestinalen Nahrungsmittelallergie. Unsere Ergebnisse zeigen detaillierte Informationen bezüglich der Verteilung und der Anzahl von Mastzellen bei Allergiepatienten des Kindesalters und erlauben erstmals eine Abschätzung physiologischer Werte in diesem Altersbereich. Hinsichtlich der Diagnostik von gastrointestinalen Nahrungsmittelallergien sollten begleitend aber weitere Laboruntersuchungen in diese integriert werden.
Food allergy (FA) is increasingly reported in Europe, however, the latest prevalence estimates were based on studies published a decade ago. The present work provides the most updated estimates of the prevalence and trends of FA in Europe. Databases were searched for studies published between 2012 and 2021, added to studies published up to 2012. In total, 110 studies were included in this update. Most studies were graded as moderate risk of bias. Pooled lifetime and point prevalence of self‐reported FA were 19.9% (95% CI 16.6–23.3) and 13.1% (95% CI 11.3–14.8), respectively. The point prevalence of sensitization based on specific IgE (slgE) was 16.6% (95% CI 12.3–20.8), skin prick test (SPT) 5.7% (95% CI 3.9–7.4), and positive food challenge 0.8% (95% CI 0.5–0.9). While lifetime prevalence of self‐reported FA and food challenge positivity only slightly changed, the point prevalence of self‐reported FA, sIgE and SPT positivity increased from previous estimates. This may reflect a real increase, increased awareness, increased number of foods assessed, or increased number of studies from countries with less data in the first review. Future studies require rigorous designs and implementation of standardized methodology in diagnosing FA, including use of double‐blinded placebo‐controlled food challenge to minimize potential biases.
Diese Dissertation ist Teil einer großen Studie zu dem Thema Oligoantigene Diät bei Kindern und Jugendlichen mit Aufmerksamkeitsdefizit/ Hyperaktivitätsstörung (ADHS) und beschäftigt sich explizit mit der Anamnese und einer Beobachtungsphase vor Diätbeginn.
Derzeit werden ADHS-Erkrankte in Deutschland leitlinienkonform anhand Psychoedukation und Pharmaka therapiert. Eine Alternative bietet die Oligoantigene Diät nach Egger, bei der Betroffenen mit einer individuellen Ernährungsberatung langfristig geholfen werden kann. Diese beruht auf der Annahme, dass eine Unverträglichkeit auf Nahrungsmittel die ADHS-Symptomatik auslöst bzw. verstärkt. Diese Therapiemethode wird derzeit nur bei Hinweisen (Anamnese und Beobachtung) auf einen Zusammenhang zwischen aufgenommener Nahrung und ADHS-Symptomatik in Betracht gezogen (Banaschewski et al., 2018).
28 Kinder nahmen an der Studie teil, 16 (57,14%) Kinder schlossen erfolgreich als Responder ab (Besserung der ADHS-Symptomatik anhand der ADHD-Rating Scale (ARS) um ≥40% über den Zeitraum der Diät) und erhielten im Anschluss eine individuelle Ernährungsempfehlung. In dieser Dissertation wird analysiert, ob Reaktionen auf diese Unverträglichkeiten bereits vor Diätbeginn in der Anamnese, oder in der 2-wöchigen Beobachtungsphase (gewohnte Kost ohne Einschränkungen) ersichtlich waren. Es stellt sich die Frage, ob eine Oligoantigene Diät bei jedem Kind mit ADHS durchgeführt werden sollte. Die Analyse erfolgt anhand Ernährungsprotokollen und des täglich ausgefüllten Conners3 Global-Index (C3-GI) Elternfragebogens.
In this article, the current recommendations from the recently updated S2k guideline on the management of immunoglobulin E (IgE)-mediated food allergy are presented. These include information on the frequency of food allergies, food allergy prevention, clinical pictures and differential diagnostics, as well as food allergy diagnostics including in vivo and in vitro diagnostics, and finally aspects of the course and therapy of food allergy.
Although the relationship between diet and chronic spontaneous urticaria (CSU) remains elusive, several patients seek dietary modifications as they are easy and cost-effective. Adequate patient education and counseling are crucial as modified diets may be beneficial for a subset of antihistamine refractory CSU patients, and no modality currently exists to identify these patients. Elimination of food items based exclusively on patient history may lead to unnecessary restrictions in most cases resulting in nutritional deficiencies and impaired quality of life. Several dietary strategies have been tried till date with varying rates of success and evidence. This review highlights the various dietary strategies along with their levels of evidence, which may help the treating dermatologists and physicians to counsel CSU patients and make evidence-based treatment decisions. There is grade A recommendation for the elimination of food additives (artificial pseudoallergens), personalized diets, vitamin D supplementation, Diamine oxidase supplementation and probiotics (in children), grade B recommendation for dietary elimination of red meat, fish and their products, natural pseudoallergens (fruits, vegetables, and spices), and low-histamine diet, while dietary elimination of gluten (with concomitant celiac disease) has grade C recommendation. Notably, elimination diets should be continued for at least 3 consecutive weeks to assess their effectiveness.
Background
Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as “may contain traces of” is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin.
Methods
MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life‐threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results.
Results
In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds.
Conclusion
Based on the literature studied for this review, it can be stated that cross‐contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement “this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product” for a voluntary declaration on processed food packages. This level of avoidance of cross‐contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.
The practice of food allergy (FA) for clinicians has boomed, with a dramatic rise in the number of patients and families seeking care and with many advances on several fronts. The practice itself sometimes is evidence-based science and sometimes an art of pattern and phenotype recognition. This article examines the tools for diagnosis and management and therapy options available to physicians providing care for patients with FA. The article touches on pressing needs of clinicians and highlights the rapid and important movements in national and international support and advances that will have a positive impact on the field of FA.
Objective
Perceived food intolerance (PFI) is a distressing condition reported by 3% - 35% of individuals, whereas prevalence of food allergy is 0.9%–3%. The present paper aims to systematically review the evidence for psychological, clinical and psychosocial factors associated with PFI in order to advance the current understanding.
Methods
Articles published from 1970 until October 2020 were identified. Case-control, prospective cohort, cross-sectional and retrospective studies published in English that a) included a subject population of adults over 18 with PFI and b) examined psychological, clinical and/or psychosocial factors of PFI were reviewed against inclusion criteria. Methodological quality was assessed, data extracted, and a narrative synthesis conducted.
Results
Of 2864 abstracts identified, thirty-six articles met inclusion criteria. Evidence consistently found PFI is associated with female sex, and individuals with PFI often report physical health complaints including gastrointestinal and extraintestinal symptoms, and gastrointestinal and atopic conditions. Evidence for an association between psychological factors and PFI was inconsistent, although some suggested increased levels of common mental disorders and distress. Findings regarding psychosocial factors were mixed and sociodemographic data were infrequently collected.
Conclusions
PFI is associated with female sex and gastrointestinal and extraintestinal complaints. Limited high-quality evidence supports the role of psychological factors associated with PFI. High-quality research using prospective and longitudinal designs with multivariate analyses is needed. Future research should explore modifiable psychological factors as potential targets for intervention and identify clinical and psychosocial risk factors of PFI to aid in formulating a biopsychosocial model of PFI.
Hintergrund und Ziele: Unverträglichkeitsreaktionen gegen Nahrungsmittel sind häufig und umfassen alle nahrungsabhängigen Beschwerden. Dabei werden immunologisch bedingte Nahrungsmittelallergien von nicht immunologisch bedingten Nahrungsmittelintoleranzen differenziert. Kohlenhydratverwertungsstörungen wie die Laktose-, Fruktose- und Sorbitmalabsorption zählen zu den häufigsten nicht immunologischen Unverträglichkeiten von Nahrungsmitteln, während die Histaminintoleranz mit einer Prävalenz von etwa 1 bis 3 % der Gesamtbevölkerung deutlich seltener ist. Diese basiert auf einer Abbaustörung von überwiegend exogen aufgenommenem Histamin (histaminreiche Lebensmittel, u.a. Fleisch, Käse und Alkohol). Als Pathomechanismus wird eine verminderte Aktivität des intestinalen Enzyms Diaminoxidase (DAO) vermutet, welche Histamin abbaut. Die Symptomatik der Histaminintoleranz ist sehr vielfältig und kann sich an fast allen Organsystemen manifestieren. Die Beschwerden umfassen gastrointestinale (Bauchschmerzen, Diarrhoe, Meteorismus), kutane (Urtikaria, Pruritus, Flush), respiratorische (Asthmaanfälle, Rhinorrhoe) sowie kardiale (Hypotonie, Arrhythmien) Symptome und Kopfschmerzen. Der Nachweis dieser Erkrankung ist aufgrund der eingeschränkten labortechnischen Möglichkeiten erschwert. Die aktuelle S1-Leitlinie der DGAKI, der GPA, des AeDA und der SGAI empfiehlt bei Verdacht auf Unverträglichkeit gegenüber oral aufgenommenem Histamin eine orale Provokation mit Histamindihydrochlorid in aufsteigender Dosierung zur Festlegung einer individuellen Toleranzdosis durchzuführen. Laborchemisch kann eine erniedrigte DAO-Aktivität auf eine Histaminintoleranz hinweisen. Aufgrund der noch etwas niedrigen Sensitivität wurde der Test wiederholt kontrovers diskutiert. In der vorliegenden Studie sollten daher Tagesprofile der DAO und des Histamins erstellt werden, um dieses Diagnostikum innerhalb von Patientengruppen mit Verdacht auf Histaminintoleranz, Nahrungsmittelallergikern und Gesunden zu vergleichen. Methoden: In dieser prospektiven Kohortenstudie wurden 65 Patientin eingeschlossen und drei Gruppen zugeordnet. Eine Woche vor und während der Untersuchungen nahmen alle Probanden normale Mischkost zu sich. Neben einer Ernährungsanalyse wurde eine detaillierte Anamnese inklusive eines Fragebogens zu den vorliegenden Beschwerden erhoben. Allen Teilnehmern wurden Blutproben entnommen und zur Abklärung einer IgE- induzierten Allergie auf Gesamt-IgE und spezifische IgE gegen Nahrungsmittelallergene untersucht. Probanden mit positiven spezifischen IgE wurden als Nahrungsmittelallergiker eingestuft. Probanden mit Beschwerden, aber mit negativen spezifischen IgE und niedrigen Gesamt-IgE, wurden der Gruppe mit Verdacht auf Histaminintoleranz zugeordnet. Gesunde Kontrollprobanden zeigten keine nahrungsabhängigen Beschwerden und unauffällige Blutparameter. Anschließend wurden bei allen Probanden wiederholt Blutentnahmen über einen Zeitraum von 24 Stunden durchgeführt, um die Schwankungen der DAO-Aktivität im Serum (gemessen mit REA) und des Histaminspiegels im Plasma (gemessen mit ELISA) zu erfassen und somit ein Tagesprofil dieser beiden Parameter zu erstellen. Ergebnisse und Beobachtungen: Insgesamt wurden 64 Probanden in die Studie eingeschlossen, davon 10 Gesunde. 21 Patienten wurden aufgrund deutlich erhöhter Gesamt-IgE sowie positiver spezifischer IgE gegen Nussmischung, Weizen- und Roggenmehl, Sellerie, Tomate, Sojabohne und Milcheiweiß als Nahrungsmittelallergiker kategorisiert. Bei 33 Patienten wurde eine Histaminintoleranz vermutet. Tatsächlich lag bei 24 % (8 von 33) dieser Patienten eine Abbaustörung des exogen aufgenommenen Histamins vor, charakterisiert durch erhöhte Histaminspiegel und eine signifikant erniedrigte DAO-Aktivität im Tagesverlauf. Trotz typischer klinischer Symptome wiesen die restlichen 25 Probanden mit Verdacht auf Histaminintoleranz normale Histaminspiegel und DAO-Aktivitäten auf, die daher im weiteren Verlauf als „Patienten mit Nahrungsmittelhypersensitivität“ bezeichnet wurden. Bei diesen Probanden zeigten sich im Rahmen der Untersuchungen eher Nahrungsmittelintoleranzen gegen Fruktose, Laktose und Sorbit. Ebenso zeigte sich in dieser Gruppe häufiger ein Diarrhö-dominante Reizdarmsyndrom-Kategorisierung. Die klinische Symptomatik der Patienten mit Histaminabbaustörung, Nahrungsmittelhypersensitivität und Nahrungsmittelallergien reichte von typischen gastrointestinalen Beschwerden (Übelkeit, Erbrechen, Bauchschmerzen, Diarrhoe), kutanen Reaktionen (Pruritus, Urtikaria), respiratorischen Beschwerden (nasale Obstruktion, Rhinorrhoe, Asthmaanfälle) bis zu Kopfschmerzen und unterschied sich nicht wesentlich zwischen den Gruppen. Auch die Analyse sowohl der Tageszufuhr an Makronährstoffen, des Alkohol- und Nikotinkonsums sowie weiterer Parameter im Blut ergab keine signifikanten Unterschiede. Schlussfolgerungen: Bei einem relevanten Anteil der Patienten mit Verdacht auf Histaminintoleranz geht eine verminderte DAO-Aktivität mit erhöhten Histaminspiegeln im Blut einher und weist somit auf das Vorliegen einer Histaminintoleranz hin. Allein anhand der klinischen Symptomatik kann die Histaminintoleranz nicht von anderen Nahrungsmittelintoleranzen und Nahrungsmittelallergien differenziert werden. Dies wird zusätzlich durch die fehlende Korrelation zwischen subjektiven Beschwerden und den im Blut gemessenen Histaminparametern erschwert. Weitere Untersuchungen sind essentiell, um das Nachweisverfahren der Histaminintoleranz zu verbessern. Hierbei sollte möglicherweise die wiederholte Bestimmung des Histaminspiegels im Plasma und der DAO-Aktivität im Serum berücksichtig werden.
Zusammenfassung. Es wurden 15 von insgesamt 131 Patienten mit chronischer Urtikaria 2 – 11 Jahre nach der ursprünglichen ASS-Provokation –
die im Rahmen der Urtikaria-Diagnostik durchgeführt worden war – unter entsprechenden Vorsichtsmaßnahmen erneut mit ASS exponiert.
Dabei reagierte nur noch ein Patient 7 Jahre nach der Erstprovokation in der ursprünglichen Intensität. Ein weiterer entwickelte
nach 4 Jahren nur noch eine stark abgeschwächte Symptomatik. Von drei weiteren Patienten, die ausschließlich auf ASS-Einnahme
mit Quaddelschüben reagierten, sonst aber nicht an einer chronischen Urtikaria litten, reagierte auch nur noch ein Patient
vier Jahre nach der 1. Testung mit Hautschwellungen und Juckreiz. Die Intoleranzschwelle war dabei jedoch deutlich angehoben.
Diese Untersuchungen sprechen dafür, daß sich die Empfindlichkeit gegen intoleranzauslösende Substanzen relativ rasch abschwächt
und auch wieder ganz abklingen kann.
The past several years have witnessed a growing public awareness and concern about adverse reactions to foods. Although the scientific community's interest in this topic has grown also, much needs to be learned about the prevalence, etiology, and symptoms related to these disorders. Reasons why double-blind placebo-controlled food challenges are mandatory for the diagnosis of food allergy in the research setting are discussed. A practical office approach for evaluating complaints of potential adverse reactions to foods is presented.
One hundred adult patients with a history of oral allergy syndrome (OAS) after ingestion of fruits and vegetables, 77 patients with hay fever and 13 with skin prick tests and RAST positive to pollens but without seasonal symptoms, and 32 normal nonallergic control subjects, had Phadebas RAST and skin prick tests with commercial extracts (CSPT) and with fresh foods (FFSPT) to assess the reliability of these three tests. Sensitivity was better with FFSPT for carrot, celery, cherry, apple, tomato, orange, and peach; better with CSPT for peanut, pea, and walnut; and better with RAST for hazelnut. Specificity, negative predictive value, and positive predictive value of the three tests were determined for apple, carrot, hazelnut, orange, pea, peanut, and tomato. Specificity in the patient groups ranged between 40% (pea) and 100% (apple) for CSPT, between 61% (peanut) and 87% (carrot) for RAST, and between 42% (carrot) and 93% (peanut) for FFSPT. However, all tests were negative in the control group. Thus, false positive results may result from cross-reactivity with pollen allergens. The diagnostic accuracy of these tests in the population with OAS proved comparable for peanut, carrot, hazelnut, and pea. FFSPT proved more sensitive than CSPT or RAST in confirming a history of OAS to certain alimentary allergens, such as apple, orange, tomato, carrot, cherry, celery, and peach.
There is now enough experience with the use of double-blind, placebo-controlled, food challenge (DBPCFC) to recommend its use as an office procedure for most patients complaining of adverse reactions to foods. This manual discusses the practical methods required for the allergist to undertake DBPCFC in the office. Thorough histories supplemented by food allergen skin testing are used to design a DBPCFC that carefully attempts to reproduce the history of food-induced symptoms described by the patient. Precautions that must be taken are delineated before challenge, as is treatment that may be required if a reaction occurs. For those foods to which challenges are positive, longitudinal evaluation with repeated challenge at appropriate intervals help to determine whether or not the problem will resolve over a period of time.
We did a population study to identify the prevalence of reactions to eight foods commonly perceived to cause sensitivity in the UK. A cross-sectional survey of 7500 households in the Wycombe Health Authority area and the same number of randomly-selected households nationwide was followed up by interviews of positive respondents from the Wycombe Health Authority area. Those who agreed entered a double-blind, placebo-controlled food challenge study to confirm food intolerance. 20.4% of the nationwide sample and 19.9% of the High Wycombe sample complained of food intolerance. Of the 93 subjects who entered the double-blind, placebo-controlled food challenge, 19.4% (95% confidence interval 11.4%-27.4%) had a positive reaction. The estimated prevalence of reactions to the eight foods tested in the population varied from 1.4% to 1.8% according to the definition used. Women perceived food intolerance more frequently and showed a higher rate of positive results to food challenge. There is a discrepancy between perception of food intolerance and the results of the double-blind placebo-controlled food challenges. The consequences of mistaken perception of food intolerance may be considerable in financial, nutritional, and health terms.
The prevalence of food allergy and intolerance (FA/FI) was studied in a random sample (n = 1483) of the Dutch adult population. First, the self-reported FA/FI reactions were investigated by questionnaire. Subsequently, in a clinical follow-up study, it was determined in how many cases this self-reported FA/FI could be objectively confirmed by double-blind placebo-controlled food challenge. More than 10% of the population (12.4%) reported FA/FI to specific food(s). Of the 144 subjects potentially available for the clinical follow-up study, 73 completed the whole protocol. In 12 subjects FA/FI could be confirmed by double-blind placebo-controlled food challenge. This indicates a minimum prevalence of FA/FI in the population of 0.8% (12 of 1483). Assuming that FA/FI is equal among participants, nonparticipants, and dropouts, the prevalence of FA/FI in the Dutch adult population is estimated to be 2.4%. The food (ingredients) involved included pork, white wine, and menthol. Two persons reacted to additives. In three persons glucose intolerance was observed. However, these specific intolerances probably do not reflect the distribution in the general population because the study population formed an extremely heterogeneous group, both with regard to the offending foods and the symptoms. The majority of the subjects had no serious complaints that required medical advice. We conclude that there is a gap between self-reported FA/FI and FA/FI that can be objectively confirmed by double-blind placebo-controlled food challenge.
Of a total of 131 patients suffering from chronic urticaria, 15 were cautiously re-exposed to ASA after an initial provocative exposure during an urticaria test programme 2-11 years before. Only 1 of these patients, who had undergone the initial provocative test 7 years earlier, reacted at the same intensity; 1 other patient reacted with much less intense symptoms 4 years after the original test. Among 3 other patients, who merely reacted to ASA intake with urticarial eruptions and did not suffer from chronic urticaria, only 1 presented 4 years after the initial exposure with oedema of the skin and itching. The tolerance threshold was markedly higher. These results suggest that the sensitivity to intolerance-inducing agents is reduced relatively quickly and may subside completely in most cases.
The results from a population study on respiratory symptoms and bronchial hyperresponsiveness in relation to symptoms of food intolerance and sensitization to food allergens are reported.
The study included 1,812 men and women, aged 20 to 44 years and residents in three areas of Sweden who participated in the European Community Respiratory Health Survey. The prevalence of IgE sensitization to egg white, fish, wheat, peanut, soy, and milk was assayed by CAP-RAST and the prevalence of symptoms of food intolerance was determined by a standardized questionnaire.
The study group included a random sample of 1,397 subjects from the general population at the three centers. Of these, 85 (6%) had specific IgE antibodies to one of the food allergens and 345 (25%) reported symptoms of food intolerance. After enrichment with subjects suffering from symptoms of asthma, the sample included a total of 1,812 individuals of which 144 subjects had specific IgE antibodies to one or more of the food allergens studied. Of these 144, 52% reported food intolerance but only 16% related the symptoms to any of the food allergens in the panel. Sensitization to food allergens was more common in atopic subjects, subjects reporting current asthma, and subjects with bronchial hyperresponsiveness (P < .001). These associations remained significant after adjustment for the degree of allergic sensitization, whether defined as the number of positive skin prick tests or as total serum IgE levels.
Although sensitization to food allergens is not uncommon in adults, the correlation to specific symptoms of food intolerance is weak. Sensitization to food allergens may have special relevance to asthma and bronchial hyperresponsiveness.
A 24-year-old Japanese woman had suffered for 2 years from attacks of urticaria, dyspnoea and syncope associated with exercise after the ingestion of wheat. Specific IgE measurements revealed RAST class 2 for wheat and gluten (a major wheat protein), and class 3 for rye. Skin prick tests with wheat, bread, gluten and udon (a Japanese noodle made of wheat) were all positive. Food-dependent exercise-induced anaphylaxis (FDEIA) caused by wheat was suspected. Challenge tests with bread were performed. Exercise following ingestion of 64 g, but not 45 g, of bread induced generalized urticaria. Challenge tests with udon also triggered allergic reaction in a dose-dependent manner: 200 g, but not 100 g or 150 g, of udon elicited wealing and erythema with exercise. Ingestion of bread or udon alone failed to elicit any allergic reaction. This is the first case of FDEIA in which the dependence of the triggering allergic reaction on the amount of allergen ingested was clearly confirmed.
Despite increasing awareness of peanut allergy, little is known of its prevalence. We report on a two-stage interview survey conducted in Great Britain.
A total of 16434 adults (aged 15+ years) reported their own allergies and atopies and named cohabitants with peanut allergy (stage 1). Follow-up interviews were conducted with identified sufferers from peanut allergy (stage 2).
At stage 1, peanut allergy was reported in 58 respondents and 205 other household members. When we accounted for cases where peanut allergy was unconfirmed or newly reported at stage 2, the prevalence, based on 124 confirmed sufferers, was estimated as 0.48% (95% confidence interval 0.40%-0.55%). The prevalence in children (0.61%, 0.41%-0.82%) was slightly higher than in adults; age-of-onset was strikingly earlier. Prevalence was strongly associated with other atopies, particularly tree-nut allergy. Cases tended significantly to cluster in households. Half of cases had never consulted a doctor. Exactly 7.4% reported being hospitalized after a reaction.
Peanut allergy is reported by 1 in 200 of the population and is commoner in those reporting other atopies. The fact of similar rates in children and adults argues against a recent marked rise in prevalence. The frequency and potential lethality of this disorder emphasize the need for sufferers to demographic factors, other food allergies, atopic conditions, and allergy in family/household members. Our study comprised a screening survey and detailed interviews with sufferers identified. The frequency and potential lethality of this disorder emphasize the need for sufferers to receive correct medical advice on management [corrected].
Atopic dermatitis is commonly associated with food allergy. In addition to skin prick tests (SPTs) and measurements of specific IgE levels, the atopy patch test (APT) has recently been introduced into the diagnostic procedure for food allergy.
Our aim was to evaluate whether a combination of allergologic tests could improve the prognostic value of the individual tests for positive food challenge results. We hypothesized that the combination of a positive APT result plus proof of specific IgE, a positive SPT result, or both would render double-blind, placebo-controlled, food challenges unnecessary.
One hundred seventy-three double-blind, placebo-controlled, food challenges were performed in 98 children (median age, 13 months) with atopic dermatitis. All children were subjected to SPTs, APTs, and determination of specific IgE. Sensitivity, specificity, and positive and negative predictive values were calculated.
Ninety-five (55%) of 173 oral provocations were assessed as positive. For evaluating suspected cow's milk (CM) allergy, the APT was the best single predictive test (positive predictive value [PPV], 95%), and the combination of a positive APT result with evidence of specific IgE or an APT result together with a positive skin prick test response optimized the PPV to 100%. For hen's egg (HE) allergy, the APT was also the best single predictive test (PPV, 94%). The combination of 2 or more tests did not exceed the APT's predictive value. In both CM and HE challenges, the predictability of oral challenges depended on the level of specific IgE. For wheat allergy, the APT proved to be the most reliable test, and the PPV of 94% could not be improved by a combination with other allergologic tests.
The combination of positive APT results and measurement of levels of specific IgE (CM, > or = 0.35 kU/L; HE, > or = 17.5 kU/L) makes double-blind, placebo-controlled, food challenges superfluous for suspected CM and HE allergy.
Food allergy (FA) is an important health problem for which epidemiologic studies are needed.
We performed an epidemiologic survey in France to determine the prevalence, clinical pictures, allergens, and risk factors of FA.
This study was conducted on 33,110 persons who answered a questionnaire addressed to a representative sample of the French population on a scale of 1:1000 (44,000 subjects aged </=60 years). One thousand one hundred twenty-nine persons with FA selected during phase 1 received a second questionnaire.
The reported prevalence of FA is 3.52%: 3.24% evolutionary FA; 0.12% asymptomatic cases thanks to eviction diets; and 0.17% cured FA. The subjects were characterized by overrepresentation of city dwellers (80% vs 76%), women (63% vs 50%), and health care personnel (11% vs 4%). Fifty-seven percent (vs 17%) presented with atopic diseases (P <.01). FA was often persistent, lasting more than 7 years in 91% of the adults. The most frequent allergens were 14% Rosaceae, 9% vegetables, 8% milk, 8% crustaceans, 5% fruit cross-reacting with latex, 4% egg, 3% tree nuts, and 1% peanut. Sensitization to pollen was significantly correlated with angioedema, asthma, rhinitis, and fruit allergy (P <.01). FA was 4 times more frequent in patients with latex allergy. The main manifestations of FA were atopic dermatitis for subjects under 6 years of age, asthma for subjects between 4 and 6 years of age, and anaphylactic shock in adults over 30 years of age (P <.007). Shocks were correlated with alcohol or nonsteroidal anti-inflammatory drug intake (P <.01 and P <.04, respectively).
The prevalence of FA is estimated at 3.24% (range, 3.04% to 3.44%) in France. This study emphasizes the increasing risk of FA in well-developed countries and draws attention to certain FA risk factors, such as the intake of drugs (nonsteroidal anti-inflammatory drugs, beta-blockers, and angiotensin-converting enzyme inhibitors) or alcohol, intolerance of latex gloves, and socioprofessional status.
In some subjects, specific foods trigger anaphylaxis when exercise follows ingestion (specific food-dependent exercise-induced anaphylaxis, FDEIAn). Skin test and/or RAST positivity to foods suggest an IgE-mediated pathogenic mechanism. Others suffer from anaphylaxis after all meals followed by exercise, regardless of the food eaten (nonspecific FDEIAn). We sought to identify the culprit foods with a diagnostic protocol.
We collected detailed histories and performed skin prick tests (SPT) with 26 commercial food allergens, prick plus prick tests (P+P) with 15 fresh foods (including 9 assessed with SPT), and RAST for 31 food allergens. Treadmill stress tests were administered after a meal without any positive food (food plus exercise challenge, FEC).
Among the 54 patients, 6 could not recall any suspect food. The other 48 suspected a specific food in at least one episode. The most frequent were tomatoes, cereals and peanuts. Fifty-two subjects were positive to at least one food (22 to more than 20), whereas 2 showed no positive results. All suspect foods were positive. SPT, P+P and RAST displayed different degrees of sensitivity. Each test disclosed some positivities not discovered by others. Two subjects reacted to FEC. Overall, 48 patients probably had specific FDEIAn and the other 6 nonspecific FDEIAn.
It is useful to test both in vivo and in vitro an extensive panel of foods. Avoidance of foods associated with skin test and/or RAST positivity for at least 4 h before exercise has prevented further episodes in all our patients with specific FDEIAn.
Food allergy and food intolerance (FA/FI) are believed to be frequent medical problems; however, information from epidemiologic studies in adults is scarce. The objective was to determine the frequency of FA/FI and allergic sensitization to food in a large adult sample. Furthermore, the associations between FA/FI and other outcomes of atopy were studied.
Within a population-based, nested, case-control study, a standardized interview was performed to obtain detailed information on FA/FI and the history of atopic diseases. In addition, a skin prick test with 10 common food and nine aeroallergens was performed.
Overall, 20.8% of the 1537 studied subjects (50.4% female, age median 50 years) reported FA/FI (women 27.5%, men 14.0%; OR 2.35, CI 1.80-3.08). Nuts, fruits, and milk most frequently led to adverse effects, and the sites of manifestation were oral (42.9%), skin (28.7%), gastrointestinal (13.0%), systemic (3.2%), and multiple (12.2%). One-quarter of the subjects (25.1%) were sensitized to at least one food allergen in the prick test, with hazelnut (17.8%), celery (14.6%), and peanut (11.1%) accounting for most of the positive reactions. The corresponding frequency estimates for the representative study base (n=4178) were 15.5% for reported adverse reactions and 16.8% for allergic sensitization. Relevant concomitant sensitization to food and aeroallergens was observed. Food-allergic subjects (positive history and sensitization to corresponding allergen) suffered significantly more often from urticaria, asthma, atopic eczema, and especially hay fever (73.1%) than controls (3.0%). Furthermore, hay fever was treated significantly more often in subjects who suffered from concomitant food allergy.
FA/FI in adults is frequently reported and associated with other manifestations of atopy. Hay fever in conjunction with FA/FI tends to be clinically more severe since therapeutic needs are enhanced.
Atopic dermatitis is frequently associated with food allergy. In general, clinically manifested food allergy is regarded as IgE mediated. However, there are some children with food allergy for whom IgE hypersensitivity cannot be proven.
The aim was to evaluate the percentage of children with positive double-blind, placebo-controlled food challenge (DBPCFC) results but without any proof of IgE sensitization and to characterize this subgroup of children.
Two hundred eight DBPCFCs were performed in 139 children (median age, 13 months) with atopic dermatitis and suspected food-related clinical symptoms. All children were subjected to skin prick tests (SPTs), determination of specific IgE, and atopy patch tests.
One hundred eleven (53%) of 208 oral food challenge results were assessed as positive. Positive challenge results were separated into 2 groups according to IgE positivity: negative SPT and negative specific IgE results in serum (group A, n = 12) and positive SPT, specific IgE, or both results in serum (group B, n = 99). The atopy patch test results; the distribution of early, late, or both clinical reactions; the age of the children; and the total IgE levels all showed no significant differences between the 2 groups. However, wheat challenge results were more often positive among the apparently non-IgE-sensitized children, and hen's egg challenge results were more often positive in the sensitized group (P < .05).
Around 10% of positive DBPCFC results are not IgE mediated. Therefore not the proof of specific IgE but the suspicion of food-related symptoms should be the indication to perform oral food challenges, especially in the case of wheat. Otherwise, some children will not receive diagnoses for food allergy and be denied the benefits of a specific diet.
Pseudoallergic reactions (PARs) against both additives and natural foods have been reported to elicit chronic urticaria, but in natural food the responsible ingredients are largely unknown.
The study was aimed at identifying novel pseudoallergens in food and focused on evaluating tomatoes, white wine, and herbs as frequently reported food items eliciting wheal responses in urticaria.
In 33 patients with chronic urticaria and PARs to food (proved by means of elimination diet and subsequent re-exposure with provocation meals), oral provocation tests were performed with field-grown tomatoes, organically grown white wine (whole food, steam distillates, and residues), oily extracts from herbs, and food additives. In addition, skin biopsy specimens from patients were studied for in vitro mast-cell histamine release with tomato distillate alone or on subsequent stimulation with anti-IgE, substance P, and C5a.
Seventy-six percent of patients reacted to whole tomato (steam distillate, 45%; residue, 15%), 50% to food additives, 47% to herbs, and 44% to whole wine (extract, 27%; residue, 0%). Histamine, protein, and high levels of salicylate were only found in residues. The tomato distillate was further analyzed by means of mass spectroscopy, identifying low molecular-weight aldehydes, ketones, and alcohol as major ingredients. In vitro histamine release was not caused by tomato extract itself but was enhanced by means of subsequent stimulation with substance P and C5a but not by anti-IgE.
Aromatic volatile ingredients in food are novel agents eliciting PARs in chronic urticaria. Histamine, salicylate, and a direct mast-cell histamine release are not involved in this reactivity to naturally occurring pseudoallergens.
Adverse reactions after ingestion of alcoholic beverages are common. Metabolic differences in individuals and also the histamine content in alcoholic beverages have been implicated. By contrast pure ethanol has rarely been reported as a cause of hypersensitivity reactions and its mechanism has not been clarified yet.
To determine whether ethanol itself accounts for alcohol hypersensitivity in patients with anaphylactic reactions after alcohol intake. In search of possible pathomechanisms all patients were analysed by skin prick testing and sulfidoleukotriene production of peripheral leucocytes using ethanol and its metabolites.
Double-blind, placebo-controlled food challenges with a cumulated amount of 30 mL ethanol were performed in 12 adult patients with a positive history of adverse reactions after consumption of different alcoholic beverages. Skin prick tests and measurement of sulfidoleukotriene production were performed using different concentrations of ethanol and acetaldehyde from 50 to 1000 mm.
Oral challenges with pure ethanol were positive in six out of eleven patients. All challenge-positive patients, but also four out of five challenge-negative patients, showed an increased sulfidoleukotriene production in-vitro compared with healthy controls. Skin prick tests using alcoholic beverages, ethanol, acetaldehyde and acetic acid were negative in all patients (12/12).
Our study shows that ethanol itself is a common causative factor in hypersensitivity reactions to alcoholic beverages. These reactions occur dose-dependent and a non-IgE-mediated pathomechanism is likely, because skin prick tests were negative in all cases. Increased sulfidoleukotriene production was determined in some patients, but is no reliable predictor. Therefore oral provocation tests remain indispensable in making the diagnosis of ethanol hypersensitivity.
German National Health Survey: public use file
- H Stolzenberg
Stolzenberg H. German National
Health Survey: public use file. Berlin:
Robert Koch Institute, 2000.
The prevalence of reactions to food additives in a survey population
- E Young
- S Patel
- R R Stoneham
- J D Wilkonson
Young E, Patel S, Stoneham RR,
Wilkonson JD. The prevalence of
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