Disease-Based Food Allergies Ebisawa M, Ballmer-Weber BK, Vieths S, Wood RA (eds): Food Allergy: Molecular Basis and Clinical Practice. Chem Immunol Allergy. Basel, Karger, 2015, vol 101, pp 191–198 (DOI: 10.1159/000371702)
Anaphylaxis in Food Allergy Robbie D. Pesek a, b · Stacie M. Jones a, b a Division of Allergy and Immunology, University of Arkansas for Medical Sciences and b Arkansas Children’s Hospital, Little Rock, Ark., USA
Abstract Food allergy is a known trigger of anaphylaxis. Although the awareness of food allergies has improved, food-related allergic reactions and anaphylaxis still commonly occur. The recognition of anaphylaxis, its prompt treatment, and patient education are important for the prevention of future food reactions. Patients and health care providers should also recognize the importance of epinephrine as the primary treatment of anaphylaxis. When food-related anaphylaxis occurs, patients should receive education regarding their food allergies, an epinephrine auto-injector, and follow-up with a food allergy specialist to reduce the risk of future food-related reactions. © 2015 S. Karger AG, Basel
Introduction
Anaphylaxis is defined as a ‘serious allergic reaction that is rapid in onset and might cause death’ [1]. The overall prevalence of anaphylaxis due to all causes is estimated to be 0.05–2% and is increasing. Over the last decade alone, there has
been an 18% increase in the number of cases. Of all causes of anaphylaxis, food accounts for up to 50% of cases that present to emergency departments [2, 3]. In children, food allergy is the most common cause of anaphylaxis outside of the hospital setting, with most reactions occurring inside of the home and affecting patients who are aware of their allergies [4]. The most commonly implicated foods in children include milk, eggs, wheat, soy, peanuts, tree nuts, fish and shellfish, while peanuts, tree nuts, fish, and shellfish are the most common in adults [5]. Approximately 150–200 people die each year from food-induced anaphylaxis, and 300–500 million US dollars in health care costs are spent for food-induced allergic reactions and anaphylaxis in the USA [6, 7]. It is also believed that many cases of anaphylaxis are miscoded or underreported. The prompt recognition of symptoms of anaphylaxis, the correct identification of offending foods, and early treatment are vitally important for managing anaphylaxis and preventing future food reactions. Downloaded by: UCONN Storrs 137.99.31.134 - 5/25/2015 7:06:53 PM
Table 1. Diagnostic criteria for anaphylaxis Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled: (1) Acute onset of an illness (within minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g. generalized hives, pruritis, flushing, or swollen lips-tongue-uvula) And at least one of the following: a) Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, or hypoxemia) b) Reduced blood pressure (BP) or associated symptoms of end-organ dysfunction (e.g. hypotonia (collapse), syncope, or incontinence) (2) Two or more of the following, occurring rapidly after the exposure of a patient to a likely allergen (within minutes to several hours): a) Involvement of the skin-mucosal tissue (e.g. generalized hives, itch-flush, or swollen lips-tongue-uvula) b) Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, or hypoxemia) c) Reduced BP or associated symptoms of end-organ dysfunction (e.g. hypotonia (collapse), syncope, or incontinence) d) Persistent gastrointestinal symptoms (e.g. crampy abdominal pain or vomiting) (3) Reduced BP after the exposure of a patient to a known allergen (within minutes to several hours) a) Infants and children: low systolic BP (age-specific) or a greater than 30% decrease in systolic BP* b) Adults: systolic BP
Anaphylaxis in Food Allergy Robbie D. Pesek a, b · Stacie M. Jones a, b a Division of Allergy and Immunology, University of Arkansas for Medical Sciences and b Arkansas Children’s Hospital, Little Rock, Ark., USA
Abstract Food allergy is a known trigger of anaphylaxis. Although the awareness of food allergies has improved, food-related allergic reactions and anaphylaxis still commonly occur. The recognition of anaphylaxis, its prompt treatment, and patient education are important for the prevention of future food reactions. Patients and health care providers should also recognize the importance of epinephrine as the primary treatment of anaphylaxis. When food-related anaphylaxis occurs, patients should receive education regarding their food allergies, an epinephrine auto-injector, and follow-up with a food allergy specialist to reduce the risk of future food-related reactions. © 2015 S. Karger AG, Basel
Introduction
Anaphylaxis is defined as a ‘serious allergic reaction that is rapid in onset and might cause death’ [1]. The overall prevalence of anaphylaxis due to all causes is estimated to be 0.05–2% and is increasing. Over the last decade alone, there has
been an 18% increase in the number of cases. Of all causes of anaphylaxis, food accounts for up to 50% of cases that present to emergency departments [2, 3]. In children, food allergy is the most common cause of anaphylaxis outside of the hospital setting, with most reactions occurring inside of the home and affecting patients who are aware of their allergies [4]. The most commonly implicated foods in children include milk, eggs, wheat, soy, peanuts, tree nuts, fish and shellfish, while peanuts, tree nuts, fish, and shellfish are the most common in adults [5]. Approximately 150–200 people die each year from food-induced anaphylaxis, and 300–500 million US dollars in health care costs are spent for food-induced allergic reactions and anaphylaxis in the USA [6, 7]. It is also believed that many cases of anaphylaxis are miscoded or underreported. The prompt recognition of symptoms of anaphylaxis, the correct identification of offending foods, and early treatment are vitally important for managing anaphylaxis and preventing future food reactions. Downloaded by: UCONN Storrs 137.99.31.134 - 5/25/2015 7:06:53 PM
Table 1. Diagnostic criteria for anaphylaxis Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled: (1) Acute onset of an illness (within minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g. generalized hives, pruritis, flushing, or swollen lips-tongue-uvula) And at least one of the following: a) Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, or hypoxemia) b) Reduced blood pressure (BP) or associated symptoms of end-organ dysfunction (e.g. hypotonia (collapse), syncope, or incontinence) (2) Two or more of the following, occurring rapidly after the exposure of a patient to a likely allergen (within minutes to several hours): a) Involvement of the skin-mucosal tissue (e.g. generalized hives, itch-flush, or swollen lips-tongue-uvula) b) Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, or hypoxemia) c) Reduced BP or associated symptoms of end-organ dysfunction (e.g. hypotonia (collapse), syncope, or incontinence) d) Persistent gastrointestinal symptoms (e.g. crampy abdominal pain or vomiting) (3) Reduced BP after the exposure of a patient to a known allergen (within minutes to several hours) a) Infants and children: low systolic BP (age-specific) or a greater than 30% decrease in systolic BP* b) Adults: systolic BP
