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Anaphylaxis is an acute, potentially fatal, systemic hypersensitivity reaction that warrants prompt diagnosis and management. It continues to be challenging to anticipate who may be at risk of a severe, life-threatening allergic reaction. Anaphylaxis can be caused by a range of allergens, such as certain foods, medications, latex, insect stings, etc. Cofactors that augment the severity of clinical symptoms and increase the risk of poor outcomes include exercise, stress, infectious diseases, underlying mast cell disease, active allergic disease such as asthma, advanced age, intake of certain medications, history of previous anaphylaxis, and delayed or missed administration of adrenaline. According to the European Anaphylaxis Registry, food is the major elicitor of anaphylaxis, especially eggs, cow milk, and nuts, in children and adolescents. Reaction to insect venom has also been noted in young adulthood. Early recognition of signs and symptoms and prompt treatment are crucial in anaphylaxis management to avoid serious and even fatal outcomes. It is crucial for both individuals and clinicians to identify the cause of anaphylaxis. Biomarkers of anaphylaxis, such as histamine, tryptase, platelet activation factor (PAF), chymase, carboxypeptidase A3, dipeptidyl peptidase I (DPPI), basogranulin, CCL-2, hsa-miR-451a, may be useful in diagnosis and management. The purpose of this review article is to present a comprehensive overview of current evidence and expert opinions regarding the risk factors that predispose individuals to anaphylaxis. Additionally, it provides insights into potential biomarkers and genetic markers for accurate diagnosis and management. This review underscores the significance of expert guidance in enhancing patient outcomes and enabling self-management of anaphylactic episodes., Competing Interests: George DuToit has received financial funding and honorarium from Aimmune and DBV. He has received speaker fees from BSAG, ALK-Abello, and DBV. Peter Smith received research grant from Mylan (now Viatris), GSK and Sanofi. He has also received honoria for participating in AZ and Viatris Advisory Boards. Antonella Muraro serves as a consultant for Novartis, Viatris, DVB Technology, and Aimmune Therapeutics Ireland. She has received speaker fees from Novartis, Viatris, DVB Technology, Nestle Health Sciences and Aimmune Ireland. Adam T Fox serves as a member of consultant for Independent Drug Monitoring Committee for ALK-Abello sublingual immunotherapy trials and has received consultancy fees from GS1 and LG. Graham Roberts has received consultant fees from ALK-Abello, Viatris, DBV, and Astra Zeneca. Johannes Ring serves as a consultant for Viatris. He has received speaker fees from Galderma, Viatris, Bencard, Sanofi and AbbVie. Margitta Worm has received speaker fees from ALK-Abelló Arzneimittel GmbH, Mice Service GmbH, Bencard Allergie GmbH Novartis AG, Biotest AG, Actelion Pharmaceuticals Deutschland GmbH, Sanofi-Aventis Deutschland GmbH, HAL Allergie GmbH, Aimmune Therapeutics UK Ltd., Lilly Deutschland GmbH, med update GmbH, streamedup! GmbH, DERFO mbH, Meinhardt Congress GmbH, Phadia GmbH, Agentur Herzberg, ECM GmbH, Amgen GmbH, FomF GmbH. She also received honoria from Bencard Allergie GmbH, Novartis Pharma GmbH, Biotest AG, Sanofi-Aventis Deutschland GmbH, HAL Allergie GmbH, DBV Technologies S.A., Aimmune Therapeutics UK Ltd., Regeneron Pharmaceuticals, Inc, Mice Service GmbH, Leo Pharma GmbH, Boehringer Ingelheim Pharma GmbH & Co.KG, Stallergenes GmbH, Swixx Biopharma, RTI Health Solutions, Pharm Research Associates (UK) Ltd, AstraZeneca GmbH, Worg Pharmaceutics (Hangzhou) Co. Ltd. for participating as an advisory board member., (© 2024 Published by Elsevier Inc. on behalf of World Allergy Organization.)

Background: In the LEAP (Learning Early About Peanut Allergy) trial, early consumption of peanut in high-risk infants was found to decrease the rate of peanut allergy at 5 years of age. Sequential epitope-specific (ses-)IgE is a promising biomarker of clinical peanut reactivity., Objective: We sought to compare the evolution of ses-IgE and ses-IgG 4 in children who developed (or not) peanut allergy and to evaluate the immunomodulatory effects of early peanut consumption on these antibodies., Methods: Sera from 341 children (LEAP cohort) were assayed at baseline, 1, 2.5, and 5 years of age, with allergy status determined by oral food challenge at 5 years. A bead-based epitope assay was used to quantitate ses-IgE and ses-IgG 4 to 64 sequential epitopes from Ara h 1 to Ara h 3 and was analyzed using linear mixed-effect models., Results: In children avoiding peanut who became peanut allergic, the bulk of peanut ses-IgE did not develop until after 2.5 years. Minimal increases of ses-IgE occurred after 1 year in consumers, but not to the same epitopes as those in children developing peanut allergy. No major changes in ses-IgE were seen in nonallergic or sensitized children. IgE in sensitized consumers was detected against peanut proteins. ses-IgG 4 increased over time in most children regardless of consumption or allergy status., Conclusions: Early peanut consumption in infants at high risk of developing peanut allergy appears to divert the immunologic response to a presumably "protective" effect. In general, consumers tend to generate ses-IgG 4 earlier and in greater quantities than nonconsumers do, whereas only avoiders tend to generate significant quantities of ses-IgE., (Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

The history of pediatric allergology (PA) in Europe is relatively youthful, dating back to 1984, when a small group of pediatricians founded the European Working Group on Pediatric Allergy and Immunology-later giving rise to ESPACI (European Society on Pediatric Allergology and Clinical Immunology). In 1990, the first dedicated journal, Pediatric Allergy and Immunology (PAI), was founded. There are striking differences across Europe, and even within European countries, in relation to the training pathways for doctors seeing children with allergic disease(s). In 2016, the EAACIClemens von Pirquet Foundation (CvP) organized and sponsored a workshop with the European Academy of Allergy and Clinical Immunology (EAACI) Pediatric Section. This collaboration focussed on the future of PA and specifically on education, research, and networking/ advocacy. The delegates representing many countries across Europe have endorsed the concept that optimal care of children with allergic diseases is delivered by pediatricians who have received dedicated training in allergy, or allergists who have received dedicated training in pediatrics. In order to meet the needs of children and families with allergic disease(s), the pediatric allergist is highly encouraged to develop several networks. Our challenge is to reinforce a clear strategic approach to scientific excellence to across our member base and to ensure and enhance the relevance of European pediatric research in allergy. With research opportunities in basic, translational, clinical, and epidemiologic trials, more trainees and trained specialists are needed and it is an exciting time to be a pediatric allergologist., (© 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)