- Hugh A Sampson, MD
Hugh A Sampson, MD
- Kurt Hirschhorn Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Scott H Sicherer, MD, FAAAAI
Scott H Sicherer, MD, FAAAAI
- Section Editor — Food Allergy
- Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
- John M Kelso, MD
John M Kelso, MD
- Section Editor – Anaphylaxis
- Division of Allergy, Asthma, and Immunology
- Scripps Clinic, San Diego, CA
Food allergy affects about 6 to 8 percent of children less than five years of age and up to 4 percent of the general population in the United States . Anaphylaxis is "a serious allergic reaction that is rapid in onset and may cause death," a definition developed by a consensus of international experts . Food is responsible for up to one-half of reported anaphylaxis cases presenting to emergency departments in developed countries around the world [3-5]. Food is the leading cause among identified triggers of anaphylaxis in children and young adults outside of the hospital setting [6,7].
This topic will review unique features of anaphylaxis caused by food, the characteristics of patients at risk for such reactions, and the foods which most often induce anaphylaxis. Differences between food-induced anaphylaxis in children and adults and important issues in the diagnosis and management of this disorder are also discussed.
Aspects of anaphylaxis that are not unique to food-induced reactions, such as diagnosis, acute treatment, and pathophysiology, are presented elsewhere. (See "Anaphylaxis: Emergency treatment" and "Pathophysiology of anaphylaxis" and "Anaphylaxis: Confirming the diagnosis and determining the cause(s)".)
A detailed discussion of the use of skin testing and in vitro testing to diagnose food allergy is found separately. (See "Diagnostic evaluation of food allergy".)
TYPES OF FOOD-INDUCED ANAPHYLAXIS
Food-induced anaphylaxis refers to a serious allergic reaction following the ingestion of a food, which is generally rapid in onset and may progress to death.
- Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol 2010; 125:S116.
- Sampson HA, Muñoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006; 117:391.
- Brown AF, McKinnon D, Chu K. Emergency department anaphylaxis: A review of 142 patients in a single year. J Allergy Clin Immunol 2001; 108:861.
- Sampson HA. Anaphylaxis and emergency treatment. Pediatrics 2003; 111:1601.
- Smit DV, Cameron PA, Rainer TH. Anaphylaxis presentations to an emergency department in Hong Kong: incidence and predictors of biphasic reactions. J Emerg Med 2005; 28:381.
- Simons FER, Chad ZH, Gold M. Anaphylaxis in children: realtime reporting from a national network. Allergy Clin Immunol Int-J World allergy Org 2004; Suppl:242.
- Wang J, Sampson HA. Food anaphylaxis. Clin Exp Allergy 2007; 37:651.
- Romano A, Di Fonso M, Giuffreda F, et al. Food-dependent exercise-induced anaphylaxis: clinical and laboratory findings in 54 subjects. Int Arch Allergy Immunol 2001; 125:264.
- Palosuo K, Alenius H, Varjonen E, et al. A novel wheat gliadin as a cause of exercise-induced anaphylaxis. J Allergy Clin Immunol 1999; 103:912.
- Sicherer SH. Food protein-induced enterocolitis syndrome: case presentations and management lessons. J Allergy Clin Immunol 2005; 115:149.
- Gupta R, Sheikh A, Strachan DP, Anderson HR. Time trends in allergic disorders in the UK. Thorax 2007; 62:91.
- Gupta R, Sheikh A, Strachan D, Anderson HR. Increasing hospital admissions for systemic allergic disorders in England: analysis of national admissions data. BMJ 2003; 327:1142.
- Poulos LM, Waters AM, Correll PK, et al. Trends in hospitalizations for anaphylaxis, angioedema, and urticaria in Australia, 1993-1994 to 2004-2005. J Allergy Clin Immunol 2007; 120:878.
- Rudders SA, Banerji A, Vassallo MF, et al. Trends in pediatric emergency department visits for food-induced anaphylaxis. J Allergy Clin Immunol 2010; 126:385.
- Ross MP, Ferguson M, Street D, et al. Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance System. J Allergy Clin Immunol 2008; 121:166.
- Lieberman P, Camargo CA Jr, Bohlke K, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2006; 97:596.
- Umasunthar T, Leonardi-Bee J, Hodes M, et al. Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy 2013; 43:1333.
- Branum AM, Lukac, SL. Food allergy among US children: Trends in prevalence and hospitalizations. Centers for Disease Control and Prevention, NCHS data brief, no. 10. October 2008. http://www.cdc.gov/nchs/data/databriefs/db10.htm (Accessed on July 27, 2010).
- Hompes S, Köhli A, Nemat K, et al. Provoking allergens and treatment of anaphylaxis in children and adolescents--data from the anaphylaxis registry of German-speaking countries. Pediatr Allergy Immunol 2011; 22:568.
- Dalal I, Binson I, Reifen R, et al. Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel. Allergy 2002; 57:362.
- Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001; 107:191.
- Webb LM, Lieberman P. Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol 2006; 97:39.
- Bock SA, Muñoz-Furlong A, Sampson HA. Further fatalities caused by anaphylactic reactions to food, 2001-2006. J Allergy Clin Immunol 2007; 119:1016.
- Commins SP, James HR, Stevens W, et al. Delayed clinical and ex vivo response to mammalian meat in patients with IgE to galactose-alpha-1,3-galactose. J Allergy Clin Immunol 2014; 134:108.
- Turner PJ, Baumert JL, Beyer K, et al. Can we identify patients at risk of life-threatening allergic reactions to food? Allergy 2016; 71:1241.
- Sampson HA, Muñoz-Furlong A, Bock SA, et al. Symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol 2005; 115:584.
- Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol 2005; 95:217.
- Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med 1992; 327:380.
- Braganza SC, Acworth JP, Mckinnon DR, et al. Paediatric emergency department anaphylaxis: different patterns from adults. Arch Dis Child 2006; 91:159.
- Simons FE, Sampson HA. Anaphylaxis: Unique aspects of clinical diagnosis and management in infants (birth to age 2 years). J Allergy Clin Immunol 2015; 135:1125.
- Grimshaw KE, King RM, Nordlee JA, et al. Presentation of allergen in different food preparations affects the nature of the allergic reaction--a case series. Clin Exp Allergy 2003; 33:1581.
- Walzer M. Absorption of allergens. J Allergy 1942; 13:554.
- Pumphrey R. Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol 2004; 4:285.
- Sampson MA, Muñoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol 2006; 117:1440.
- Pumphrey RS, Gowland MH. Further fatal allergic reactions to food in the United Kingdom, 1999-2006. J Allergy Clin Immunol 2007; 119:1018.
- Pumphrey RS, Stanworth SJ. The clinical spectrum of anaphylaxis in north-west England. Clin Exp Allergy 1996; 26:1364.
- Klein JS, Yocum MW. Underreporting of anaphylaxis in a community emergency room. J Allergy Clin Immunol 1995; 95:637.
- Sørensen HT, Nielsen B, Ostergaard Nielsen J. Anaphylactic shock occurring outside hospitals. Allergy 1989; 44:288.
- Campbell RL, Hagan JB, Manivannan V, et al. Evaluation of national institute of allergy and infectious diseases/food allergy and anaphylaxis network criteria for the diagnosis of anaphylaxis in emergency department patients. J Allergy Clin Immunol 2012; 129:748.
- Pumphrey RS. Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000; 30:1144.
- Lin RY, Schwartz LB, Curry A, et al. Histamine and tryptase levels in patients with acute allergic reactions: An emergency department-based study. J Allergy Clin Immunol 2000; 106:65.
- Brown SG, Blackman KE, Heddle RJ. Can serum mast cell tryptase help diagnose anaphylaxis? Emerg Med Australas 2004; 16:120.
- ECC Committee, Subcommittees and Task Forces of the American Heart Association. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005; 112:IV1.
- Joint Task Force on Practice Parameters, American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology, Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol 2005; 115:S483.
- Anaphylaxis in schools and other childcare settings. AAAAI Board of Directors. American Academy of Allergy, Asthma and Immunology. J Allergy Clin Immunol 1998; 102:173.
- The Food Allergy and Anaphylaxis Network. www.foodallergy.org (Accessed on November 05, 2007).
- The American Academy of Allergy, Asthma and Immunology. www.aaaai.org (Accessed on November 05, 2007).
- The American College of Allergy, Asthma and Immunology. www.acaai.org (Accessed on November 05, 2007).
- TYPES OF FOOD-INDUCED ANAPHYLAXIS
- IgE-mediated anaphylaxis
- Food-dependent, exercise-induced anaphylaxis
- Hypotensive reactions in infants with enterocolitis
- CAUSATIVE FOODS
- RISK FACTORS
- CLINICAL FEATURES
- Time course
- - Biphasic anaphylaxis
- - Protracted anaphylaxis
- Signs and symptoms
- Evolution of symptoms during reactions
- Differences between children and adults
- Factors affecting presentation
- FATAL REACTIONS
- Features of fatal food reactions
- Delayed administration of epinephrine
- ISSUES IN DIAGNOSIS
- Application of diagnostic criteria to food-induced anaphylaxis
- Laboratory tests
- Differential diagnosis
- ISSUES IN PREVENTION AND LONG-TERM MANAGEMENT
- Verification of the culprit allergen
- Allergen avoidance education
- Preparation for recurrent reactions
- - Epinephrine
- - Areas of uncertainty
- - Medical identification
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Epidemiology and clinical manifestations
- Diagnosis and management