Findings presented Monday at the American College of Allergy, Asthma & Immunology (ACAAI) 2015 Annual Scientific Meeting suggest that testing the siblings of children diagnosed with food allergies is not advisable. These tests often return positive results even though the child does not have allergy. False positives generally lead to food avoidance which may increase the risk for developing an allergy later in life.
“Many children are sensitized to a food, so they will have a positive test result, but that does not mean they have a true food allergy,” said Ruchi Gupta, MD, lead researcher on the study from the Northwestern University Feinberg School of Medicine in Chicago.
The study involved 478 children with confirmed food allergy and 642 of their siblings. Each sibling was given skin prick tests and serologic immunoglobulin E (sigE) for cows milk, egg white, soybean, wheat, peanut, walnut, sesame seed, a fish mix and a shellfish mix. The siblings were then observed for 2 hours after ingesting the foods for clinical signs of allergy, including hives, breathing difficulties or shortness of breath, repetitive coughing, wheezing or chest tightness, throat tightness, choking or difficulty swallowing, tongue swelling, fainting, dizziness, light-headedness or decreased consciousness, and vomiting.
Food allergy was defined as a positive skin prick test plus symptoms, while sensitization was defined as a positive skin prick test or positive sigE and an absence of symptoms.
While parents of children diagnosed with food allergies battle to keep their kids safe, a new study shows that it is not only their children that are at risk for developing life-threatening anaphylaxis at school.
The study, to be presented at the American Academy of Pediatrics (AAP) National Conference & Exhibition in Washington DC this week, looked at schools that participated in the EPIPENS4SCHOOLS program during the 2013-14 school year. The program, sponsored by Mylan Specialty, provides stock epinephrine auto-injectors to 59,000 public and private, elementary, middle and high schools across the United States for use during anaphylactic emergencies.
Among the 6,019 schools responding to the survey, 919 anaphylactic events were reported with 22% of the cases occurring in individuals with no prior history of allergy. These children would not have had access to their own prescribed auto-injector.
Researchers at the Cincinnati Children’s Hospital Medical Center may have solved a crucial piece of the puzzle in determining why some people with food allergies have relatively mild reactions while others suffer full-blown anaphylaxis.
The team fed egg white to mice specially bred to react to the protein. They found that the mice with large quantities of mucosal mast cells (MMC9) in their intestines produced large quantities of interleukin 9 (IL-9) – known to amplify reactions. The mice with MMC9 cells subsequently reacted with severe anaphylaxis-like symptoms while those without them did not. The source of IL-9 was previously unknown.
The researchers then eliminated the MMC9 cells in the mice with an antibody and the anaphylactic symptoms ceased. When the mast cells were restored, the reactions returned.
The September Issue of The Journal of Dermatology includes a case report by Akiko Yagami, MD, from the Fujita Health University School of Medicine, of a 30 year old woman who suffered anaphylactic symptoms after eating soy. She had no history of soy allergy or eczema prior to becoming an esthetician at age 23, but started developing symptoms of itchy eczema a few months after starting working with cosmetic lotions.
She tested positive to an IgE test for soy as well as for skin prick tests to soy extract, soy milk, and a cosmetic lotion frequently used by the patient.
Bipartisan legislation was introduced in the Senate Wednesday to help travelers coping with severe food allergies. The Air Access to Emergency Epinephrine Act, promoted by Food Allergy Research and Education (FARE), is cosponsored by a bipartisan group of senators.
The bill has three major components. It:
- Calls for airlines to maintain stock epinephrine auto-injectors aboard and train crew members to recognize the symptoms of anaphylaxis and how to administer the medication;
- Directs the Government Accountability Office (GAO) to conduct a study and report to Congress on air carrier policies related to passengers with food allergies. The report will cover a range of topics including the variability of existing policies, how they are applied, how staff are trained and how passengers learn about and utilize them;
- Directs the Federal Aviation Administration (FAA) to clarify that the epinephrine ampules currently included in medical emergency kits are intended for use during anaphylactic emergencies.
As reported in the Daily Mail, a new UK study published in the medical journal Allergy finds that for every child diagnosed with a milk allergy via blood and skin prick tests, another goes undiagnosed that will suffer a reaction.
Dr Kate Grimshaw, a specialist pediatric dietitian at Southampton Children’s Hospital, reported that not all allergies can be detected by measuring levels of immunoglobulin E (IgE) antibody, which is linked to allergic reactions.
Dr Grimshaw, who participated in the EuroPrevall study funded by the European Union, said:
We know that sometimes if a child is seen for a possible food allergic reaction – to any food, not just milk – but tests show there is no measurable IgE, then a possible food reaction may be ruled out, when in fact the child may be reacting to the food, just not via IgE. This research will hopefully highlight to GPs and non-allergy specialists that just because an IgE test is negative, the child may in fact be reacting to a food and further investigations should be carried out.
The study, which followed over 9,000 babies from nine European countries until age two, found that 1.3% of children from the UK reacted to milk within two hours, but only 45% had IgE levels associated with symptoms.
ABC News Australia reports that a study of hospital admissions in the country from 2005 to 2013 found a 50% jump in children admitted for anaphylaxis.
Professor Mimi Tang of the Murdoch Children’s Research Institute (MCRI) said the highest rates of hospital admission were for younger children, but that rates for older children aged 5-14 more than doubled.
“What we think is happening is that more children are getting food allergies but of concern, these allergies tend to be peanut, tree nut and shellfish that you don’t grow out of,” she said.
DBV Technologies, the firm that received the Food and Drug Administration’s (FDA) Breakthrough Therapy Designation for their peanut patch in April, issued a press release stating that the board overseeing their milk patch Phase I trial found no safety concerns and is recommending the therapy progress on to Phase II.
Phase I studies focus on the safety of a new therapy while Phase II studies focus on a therapy’s efficacy. Pending a review of the Phase I data by the FDA and approval of the proposed Phase II protocol, the firm expects to continue on to the Phase II study in the second half of 2015.
DBV describes Viaskin® as “an electrostatic patch, based on Epicutaneous Immunotherapy, or EPIT®, which administers an allergen directly onto the superficial layers of the skin to activate the immune system by specifically targeting antigen-presenting cells without allowing passage of the antigen into the bloodstream.” In other words, the patch therapy introduces increasing quantities of an allergen through the skin and by doing so desensitizes the individual to that allergen.
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A team from the University of Pennsylvania identified 233 quick-service restaurants in the Center City District of Philadelphia and conducted a study of the 187 that agreed to participate. Staff were asked to respond to a tablet-based survey that assessed their knowledge, attitudes, and practices related to food allergy.
The results were both heartening and disturbing: “Despite their high motivation to help food allergic patrons, respondents knew little about how to prevent or respond to adverse events,” as quoted in the summary on the American Public Health Association (APHA) website.
In a study of discharge data collected over 5 years from over 200 hospitals in Illinois, it was determined that emergency room visits and hospitalizations of children with severe food allergies rose an average of 30% each year between 2008 and 2012.
The study, led by Dr. Ruchi Gupta, professor of pediatrics at Northwestern University Feinberg School of Medicine and attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago, focused on children that suffered anaphylaxis, a potentially fatal allergic reaction.
Previously, white children and those from higher-income families were affected most by food allergies, but the study shows that the rates of Hispanic, African American and lower-income children are skyrocketing as well.
“This study shows that severe food allergies are beginning to impact children of all races and income. This is no longer primarily a disease of children who are white and/or from middle-to-high income families. Nobody is immune to it,” said Dr Gupta.
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