Reviews and feature articleAdvances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2010
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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Guidelines for the diagnosis and management of food allergy in the United States: summary
J Allergy Clin Immunol
(2010) - et al.
Food allergy
J Allergy Clin Immunol
(2010) - et al.
US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up
J Allergy Clin Immunol
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A population-based study on peanut, tree nut, fish, shellfish, and sesame allergy prevalence in Canada
J Allergy Clin Immunol
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Trends in pediatric emergency department visits for food-induced anaphylaxis
J Allergy Clin Immunol
(2010) - et al.
The natural history of soy allergy
J Allergy Clin Immunol
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Potential mechanisms for the hypothesized link between sunshine, vitamin D, and food allergy in children
J Allergy Clin Immunol
(2010) - et al.
Can early introduction of egg prevent egg allergy in infants? A population-based study
J Allergy Clin Immunol
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Maternal consumption of peanut during pregnancy is associated with peanut sensitization in atopic infants
J Allergy Clin Immunol
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Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982-1999
J Allergy Clin Immunol
(2010)
Involvement of mast cells in eosinophilic esophagitis
J Allergy Clin Immunol
Measurement of IgE antibodies to shrimp tropomyosin is superior to skin prick testing with commercial extract and measurement of IgE to shrimp for predicting clinically relevant allergic reactions after shrimp ingestion
J Allergy Clin Immunol
Is the detection of IgE to multiple Bet v 1-homologous food allergens by means of allergen microarray clinically useful?
J Allergy Clin Immunol
Utility of peanut-specific IgE levels in predicting the outcome of double-blind, placebo-controlled food challenges
J Allergy Clin Immunol
Human IgE antibody serology: a primer for the practicing North American allergist/immunologist
J Allergy Clin Immunol
Contribution of IgE and immunoglobulin free light chain in the allergic reaction to cow’s milk proteins
J Allergy Clin Immunol
Food allergen advisory labeling and product contamination with egg, milk, and peanut
J Allergy Clin Immunol
Risks associated with foods having advisory milk labeling
J Allergy Clin Immunol
Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine
J Allergy Clin Immunol
Administration of influenza vaccines to patients with egg allergy
J Allergy Clin Immunol
Administration of influenza vaccines to egg allergy patients: update for the 2010-2011 season
J Allergy Clin Immunol
Peanut oral immunotherapy is not ready for clinical use
J Allergy Clin Immunol
Cow’s milk epicutaneous immunotherapy in children: a pilot trial of safety, acceptability, and impact on allergic reactivity
J Allergy Clin Immunol
Anaphylaxis
Allergy Clin Immunol
Gene expression analysis in predicting the effectiveness of insect venom immunotherapy
J Allergy Clin Immunol
Imported fire ant field reaction and immunotherapy safety characteristics: the IFACS study
J Allergy Clin Immunol
Successful use of omalizumab for prevention of fire ant anaphylaxis
J Allergy Clin Immunol
Fluctuation of blood and skin plasmacytoid dendritic cells in drug-induced hypersensitivity syndrome
J Allergy Clin Immunol
IgE-mediated hypersensitivity to cephalosporins: Cross-reactivity and tolerability of penicillins, monobactams, and carbapenems
J Allergy Clin Immunol
Selective allergic reactions to clavulanic acid: a report of 9 cases
J Allergy Clin Immunol
Sublingual desensitization for buprenorphine hypersensitivity
J Allergy Clin Immunol
Our evolving understanding of the functional role of filaggrin in atopic dermatitis
J Allergy Clin Immuol
Cytokine modulation of atopic dermatitis filaggrin skin expression
J Allergy Clin Immunol
Recent insights into atopic dermatitis and implications for management of infectious complications
J Allergy Clin Immunol
Secreted virulence factor comparison between methicillin-resistant and methicillin-sensitive Staphylococcus aureus, and its relevance to atopic dermatitis
J Allergy Clin Immunol
Dendritic cells: bridging innate and adaptive immunity in atopic dermatitis
J Allergy Clin Immunol
Association between varicella zoster virus infection and atopic dermatitis in early and late childhood: a case-control study
J Allergy Clin Immunol
Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis
J Allergy Clin Immunol
Guidelines for the diagnosis and management of food Allergy in the United States: report of the NIAID-sponsored Expert Panel
J Allergy Clin Immunol
DRACMA (Diagnosis and Rationale for Action Against Cow’s Milk Allergy): a summary report
J Allergy Clin Immunol
A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations
J Allergy Clin Immunol
National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006
J Allergy Clin Immunol
Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics
J Allergy Clin Immunol
Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy
J Allergy Clin Immunol
Mast cells infiltrate the esophageal smooth muscle in patients with eosinophilic esophagitis, express TGF-beta1, and increase esophageal smooth muscle contraction
J Allergy Clin Immunol
Variants of thymic stromal lymphopoietin and its receptor associate with eosinophilic esophagitis
J Allergy Clin Immunol
Glucocorticoid-regulated genes in eosinophilic esophagitis: a role for FKBP51
J Allergy Clin Immunol
Immunologic features of infants with milk or egg allergy enrolled in an observational study (Consortium of Food Allergy Research) of food allergy
J Allergy Clin Immunol
Glycation of a food allergen by the Maillard reaction enhances its T-cell immunogenicity: role of macrophage scavenger receptor class A type I and II
J Allergy Clin Immunol
Peanut-induced intestinal allergy is mediated through a mast cell-IgE-FcepsilonRI-IL-13 pathway
J Allergy Clin Immunol
Cited by (29)
Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber
2015, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Our findings imply that grass pollen exposure through environmental air induced a worsening of eczematous lesions, mainly of air-exposed rather than covered skin areas. Therefore we suppose that because of dysfunction of the epidermal barrier,29 in patients with AD, allergen exposure is followed by direct penetration of the allergen into the skin. Previously published data on epicutaneous aeroallergen sensitization in patients with AD support the hypothesis that direct contact between the allergen and preactivated cells of the innate and adaptive immune system located in the skin can occur.30
Food allergy: A practice parameter update - 2014
2014, Journal of Allergy and Clinical ImmunologyClinical Significance of Immunoglobulin E
2014, Middleton's Allergy: Principles and Practice: Eighth EditionInhibitory effects of polysaccharide-rich extract of Phragmites rhizoma on atopic dermatitis-like skin lesions in NC/Nga mice
2013, Life SciencesCitation Excerpt :IL-4 was not detectable in the serum of NC/Nga mice (data not shown) although the topical application of extracts from Alnus japonica was reported to reduce serum levels of IL-4 (Choi et al., 2011). Atopic dermatitis seems to result from various factors including genetic polymorphism, dysregulation of immune cells, innate immune dysfunction and Th1/Th2 cytokine imbalance (Bohm and Bauer, 1997; Sicherer and Leung, 2011). Of these, the immunological hallmark of AD is a Th1/Th2 imbalance leading to IgE over-expression and hyperactivation.
Comparative study of sensitization to five principal foods in North African and Sub-Saharan African children between 3 and 14years of age
2013, Revue Francaise d'AllergologieThe changing CARE for patients with food allergy
2013, Journal of Allergy and Clinical ImmunologyCitation Excerpt :The one current significant labeling exemption is related to highly refined oils derived from food allergens.41 The US Food Allergen Labeling and Consumer Protection Act does not regulate the use of advisory labeling, such as “may contain” or “manufactured on equipment with,” which are often used to describe possible cross-contact and that can result in clinical exposure.43-45 Consideration has been given to better understanding and defining safe food allergy thresholds below which it is unlikely that an adverse food reaction will occur.46
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.