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      Position paper of the EAACI: food allergy due to immunological cross-reactions with common inhalant allergens.

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          Abstract

          In older children, adolescents, and adults, a substantial part of all IgE-mediated food allergies is caused by cross-reacting allergenic structures shared by inhalants and foods. IgE stimulated by a cross-reactive inhalant allergen can result in diverse patterns of allergic reactions to various foods. Local, mild, or severe systemic reactions may occur already after the first consumption of a food containing a cross-reactive allergen. In clinical practice, clinically relevant sensitizations are elucidated by skin prick testing or by the determination of specific IgE in vitro. Component-resolved diagnosis may help to reach a diagnosis and may predict the risk of a systemic reaction. Allergy needs to be confirmed in cases of unclear history by oral challenge tests. The therapeutic potential of allergen immunotherapy with inhalant allergens in pollen-related food allergy is not clear, and more placebo-controlled studies are needed. As we are facing an increasing incidence of pollen allergies, a shift in sensitization patterns and changes in nutritional habits, and the occurrence of new, so far unknown allergies due to cross-reactions are expected.

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          Prevalence of common food allergies in Europe: a systematic review and meta-analysis.

          B I Nwaru, L Hickstein, S Panesar … (2014)
          Allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish constitutes the majority of food allergy reactions, but reliable estimates of their prevalence are lacking. This systematic review aimed to provide up-to-date estimates of their prevalence in Europe.Studies published in Europe from January 1, 2000, to September 30, 2012, were identified from searches of four electronic databases. Two independent reviewers appraised the studies and extracted the estimates of interest. Data were pooled using random-effects meta-analyses. Fifty studies were included in a narrative synthesis and 42 studies in the meta-analyses. Although there were significant heterogeneity between the studies, the overall pooled estimates for all age groups of self-reported lifetime prevalence of allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish were 6.0% (95% confidence interval: 5.7-6.4), 2.5% (2.3-2.7), 3.6% (3.0-4.2), 0.4% (0.3-0.6), 1.3% (1.2-1.5), 2.2% (1.8-2.5), and 1.3% (0.9-1.7), respectively. The prevalence of food-challenge-defined allergy to cow's milk, egg, wheat, soy, peanut, tree nuts, fish, and shellfish was 0.6% (0.5-0.8), 0.2% (0.2-0.3), 0.1% (0.01-0.2), 0.3% (0.1-0.4), 0.2% (0.2-0.3), 0.5% (0.08-0.8), 0.1% (0.02-0.2), and 0.1% (0.06-0.3), respectively. Allergy to cow's milk and egg was more common among younger children, while allergy to peanut, tree nuts, fish, and shellfish was more common among the older ones. There were insufficient data to compare the estimates of soy and wheat allergy between the age groups. Allergy to most foods, except soy and peanut, appeared to be more common in Northern Europe. In summary, the lifetime self-reported prevalence of allergy to common foods in Europe ranged from 0.1 to 6.0%. The heterogeneity between studies was high, and participation rates varied across studies reaching as low as <20% in some studies. Standardizing the methods of assessment of food allergies and initiating strategies to increase participation will advance this evidence base. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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            Allergy assessment of foods or ingredients derived from biotechnology, gene-modified organisms, or novel foods.

            Michael Poulsen (2004)
            The introduction of novel proteins into foods carries a risk of eliciting allergic reactions in individuals sensitive to the introduced protein and a risk of sensitizing susceptible individuals. No single predictive test exists to perform a hazard assessment in relation to allergenic properties of newly expressed proteins in gene-modified organisms (GMOs). Instead, performance of a weighted risk analysis based on the decision tree approach has been suggested. The individual steps of this analysis comprise sequence homology to known allergens, specific or targeted serum screens for immunoglobulin E (IgE) cross-reactions to known allergens, digestability studies of the proteins in simulated gastric and/or intestinal fluids, and animal studies. These steps are discussed and five examples of risk evaluation of GMOs or novel foods are presented. These include ice-structuring protein derived from fish, microbial transglutaminase, GMO-soybeans, amylase and the Nangai nut.
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              GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe.

              L Heinzerling, G J Burbach, G Edenharter … (2009)
              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. 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. 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. 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. 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.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Allergy
                Title: Allergy
                ISSN (Electronic): 1398-9995
                ISSN (Print): 0105-4538
                Publication date (Electronic): Sep 2015
                Volume: 70
                Issue: 9
                Affiliations
                [1 ] Department of Dermatology and Allergy, Hannover Medical University, Hannover, Germany.
                [2 ] Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
                [3 ] Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.
                [4 ] Division of Paediatric Pneumology and Immunology, Charité University Hospital, Berlin, Germany.
                [5 ] Allergy Division, Hospital General de Castellón, Castellón, Spain.
                [6 ] Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
                [7 ] Associated Center for Molecular Allergology (CAAM), Latina, Italy.
                [8 ] The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy.
                [9 ] Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg and Department of Dermatology and Allergy, Biederstein, Technische Universität München (TUM), Munich, Germany.
                [10 ] Allergy Clinic Copenhagen University Hospital at Gentofte, Copenhagen, Denmark.
                [11 ] Division of Allergology, Paul-Ehrlich Institute, Langen, Germany.
                [12 ] Department of Dermatology and Allergy, of Charité - Universitätsmedizin Berlin, Berlin, Germany.
                [13 ] Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria.
                Article
                DOI: 10.1111/all.12666
                PubMed ID: 26095197
                SO-VID: e6c7b759-5bd6-4bb3-97fd-86d145c4e36e
                Copyright © © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
                History

                Keywords: IgE,allergens,cross-reactive,food allergy,inhalant,sensitization
                Data availability:
                Keywords: IgE, allergens, cross-reactive, food allergy, inhalant, sensitization

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