Reviews and feature article
Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2010

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This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin disease that were reported in the Journal in 2010. Key epidemiologic observations include an apparent increase in peanut allergy, with more than 1% of children affected, and increasing evidence that early food allergen exposure, rather than avoidance, might improve allergy outcomes. Advances in food allergy diagnosis include improved insights into prognosis and estimation of severity through component-resolved diagnostics and characterization of IgE binding to specific epitopes. Regarding treatment, oral and epicutaneous immunotherapy show promise. Studies of drug allergies show insights into pathophysiology, and studies on insect hypersensitivity reveal improved diagnostic methods. Genetic and functional studies have revealed the important role of epidermal differentiation products in the pathogenesis of atopic dermatitis. Cross-talk between the atopic immune response with the innate immune response have also been found to predispose to infection in patients with atopic dermatitis. New therapeutic approaches to control chronic urticaria have also been identified during the past year.

Section snippets

Food allergy

A milestone publication toward improving care of patients with food allergies is the National Institute of Allergy and Infectious Diseases (NIAID)–sponsored “Guidelines for the diagnosis and management of food allergy in the United States.”1, 2 The guidelines were based on a comprehensive independent literature review with evidence grading, which was used by an expert panel. The expert panel received guidance from a coordinating committee of diverse stakeholders and from public comment to

Treatment

Current treatment requires avoidance, which is complicated by factors such as confusing labeling on manufactured products or risks of exposure to residual food proteins in vaccines. Ford et al35 evaluated a sample of 401 foods for the presence of milk, egg, or peanut when those foods had advisory labels (eg, “may contain”) or did not have such warnings. Overall, 5.3% of the products with advisory labels had detectable protein, whereas 1.9% of products with no warnings were contaminated. The

Anaphylaxis

An updated practice parameter47 emphasizes the importance of the medical history, early administration of epinephrine, and prevention strategies. In a United Kingdom database patients aged 10 to 79 years were evaluated for anaphylaxis through International Classification of Disease, Ninth Revision, classification and record review.48 The database included 1,111,124 person-years of data and estimated an anaphylaxis incidence rate of 34.4 per 100,000 person-years. Rates were higher in persons

Hypersensitivity to stinging insects

Several studies address the diagnosis and management of insect venom allergy. Cross-reactive carbohydrate epitopes among insect venoms and pollens reduce the accuracy of diagnostic tests. Mitterman et al54 used recombinant nonglycosylated allergens to differentiate patients with pollen and insect allergy and also differentiate subjects reactive to bee and wasp venom. Jin et al55 evaluated cross-reactivity between yellow jacket and honeybee hyaluronidase using inhibition studies with

Drug allergy

The drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms is a reaction that involves reactivation of herpes viruses. Sugita et al60 observed that plasmacytoid dendritic cell numbers decreased in the circulation and increased in the skin of affected patients. It remains to be determined whether this shift is the cause or result of viral reactivation and whether the shift predisposes to autoimmunity that is sometimes observed after a reaction. In another

Mechanisms of barrier dysfunction

Although various candidate gene studies have implicated the involvement of adaptive and innate immune response genes in patients with atopic dermatitis (AD), there has recently been particular interest in skin barrier dysfunction genes (Fig 1).67 Loss-of-function mutations in the structural epidermal protein filaggrin (FLG) have been a widely replicated major risk factor for eczema and are providing new insights into disease mechanisms in patients with AD. The FLG gene mutation findings are

Urticaria and angioedema

Gandhi et al104 described 3 unrelated families with a new hereditary disease of cold urticaria called familial atypical cold urticaria (FACU). Thirty-five subjects were described with FACU (family A, 17; family B, 8; and family C, 10), displaying an autosomal dominant pattern of inheritance. All tested subjects had negative cold stimulation time test results. Completed questionnaires revealed that all affected subjects had lifelong symptoms that began in early childhood with pruritus, erythema,

Conclusions and summary

In the year since our last review,113 numerous exciting advances have been reported in the Journal. In particular, basic and clinical-translational studies are bringing us closer to improving the diagnosis and treatment of food allergies primarily through component-resolved diagnostics and epitope analysis. Studies of oral immunotherapy are encouraging, but more needs to be done to characterize risks and efficacy because there are clear limitations. Advances have also been made in our

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    Disclosure of potential conflict of interest: S. H. Sicherer is a consultant for the Food Allergy Initiative and receives research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases. D. Y. M. Leung had declared that he has no conflict of interest.

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