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Food allergies and food-induced anaphylaxis are important health problems. Several cofactors modulating the onset of anaphylaxis have been identified. In the presence of cofactors, allergic reactions may be induced at lower doses of food allergens and/or become severe. Exercise and concomitant infections are well-documented cofactors of anaphylaxis in children. Other factors such as consumption of nonsteroidal anti-inflammatory drugs, alcohol ingestion, and stress have been reported. Cofactors reportedly play a role in approximately 30% of anaphylactic reactions in adults and 14%–18.3% in children. Food-dependent exercise-induced anaphylaxis (FDEIA) is the best-studied model of cofactor-induced anaphylaxis. Wheat-dependent exercise-induced anaphylaxis, the most common FDEIA condition, has been studied the most. The mechanisms of action of cofactors have not yet been fully identified. This review aims to educate clinicians on recent developments in the role of cofactors and highlight the importance of recognizing cofactors in food allergies and food-induced anaphylaxis.

Aim: Food-induced anaphylaxis is most common in the paediatric population and has an unpredictable course. The aim of this paper was to perform a demographic and clinical assessment of food-induced anaphylaxis in children using molecular diagnosis. Materials and methods: The study included 541 children aged 0–18 years who developed 893 sudden reactions to food. Levels of IgEs against 112 allergen molecules were measured in each child. We analysed demographic and clinical data in two age groups. The aetiology of anaphylaxis was determined at the level of source allergens and at the level of allergen molecules. We also determined the risk factors for severe clinical course of reactions. Results: A total of 631 food-induced anaphylactic reactions developed by 421 children were included in the analysis. The group of children aged 0–6 years was mostly composed of boys (p = 0.0023) and children with atopic dermatitis (p = 0.0001). Also, cutaneous and mucosal symptoms were more common (p < 0.0001), and milk casein, Bos d 8, was the most common cause of anaphylaxis in this group (p < 0.0001). In the group of 7–18-year-olds, anaphylaxis was more common in children with no asthma or atopic dermatitis (p = 0.0001); hazelnuts (p = 0.0005) and, in terms of allergen molecules, walnut 2S albumin, Jug r 1 (p = 0.0011), were a more common cause of reaction; as well as exercise-induced anaphylaxis (p < 0.0001) and cardiovascular symptoms (p = 0.0247) were more common. In the study population, more severe anaphylaxis was more common in children without asthma or atopic dermatitis (p = 0.0428) and in the case of anaphylaxis induced by cashew nut 2S albumin, Ana o 3 (p < 0.0001) and wheat allergen, Tri a 14 (p = 0.0143). Conclusions: Molecular diagnostics allows for a detailed assessment of the aetiology and the risk of severe food-induced anaphylaxis.

Food-induced anaphylaxis is the most frequent type of anaphylaxis and the most common cause of fatal acute hypersensitivity reactions in children It typically occurs after accidental food exposure, after inhalation of food allergen, cutaneous contact and controlled oral food challenge There is no consensus on a universal clinical definition of anaphylaxis or a uniform symptoms severity score Recent advances in molecular allergology allow, in many cases, the detailed identification of the allergenic molecule responsible for anaphylaxis Along with the development of precision medicine, new phenotypes and endotypes of anaphylaxis are being defined The anaphylaxis course is entirely unpredictable, and even initially mild symptoms may herald a potentially fatal reaction At the same time, a significant proportion of immediate food hypersensitivity episodes are mild and known as systemic allergic reactions The occurrence and severity of clinical course of food-induced anaphylaxis are influenced by factors related directly to the child, coexisting diseases, the type and the nature of the allergen, or the presence of cofactors The unpredictable course of anaphylaxis justifies immediate treatment based on rapid intramuscular administration of adrenaline, regardless of severity Delayed adrenaline administration is associated with higher incidence of severe course and death Appropriate and prompt treatment of anaphylaxis is even more critical during the COVID-19 pandemic due to difficult access to medical facilities, hence current treatment plans for food-induced anaphylaxis emphasise the need to administer adrenaline immediately after the onset of the first, even mild, but rapidly progressive symptoms and recommend that the patient have at least two adrenaline autoinjectors © 2021 Medical Communications All rights reserved

Globally, food processing patterns are becoming more sophisticated and modernized for meeting abrupt increase in demand of allegen free food. The stance of availability of allergens free food is a rather hectic task to implement and consumers most probably become prone to them. Anaphylaxis is a serious health-related syndrome due to the adverse response of immune system. It aggravates by the consumption of foods that contain allergens by ultimately activating basophils and mast cells. There are more or less ten prominent foods that trigger anaphylaxis after the ingestion. Hence, avoiding allergen-containing food can limit the proliferation of anaphylaxis. In this article, the occurrence of allergic reactions with respect to sex disparities, most probable food allergens, diagnostic approaches and its management are discussed.

Anaphylaxis is an acute life-threatening condition affecting several body systems. It might have a rapid onset and lead to a lethal outcome. The major provoking factors for the development of anaphylactic reactions in childhood are food allergens. High hypersensitivity to one food allergen can make it difficult for a family to find a substitution for an allergenic product. Food-induced anaphylactic reaction to quite a number of food allergens is a serious problem for both the physician and the family of an allergic child necessitating organization of appropriate and safe nutrition. In real life, the standard recommendation for the patient – to strictly follow the rules of the elimination diet with exclusion of the causative allergen and all cross-reactive allergens – often becomes unrealizable. There is a serious risk of developing new allergic reactions due to accidental intake of the triggering allergens because of incorrect food labelling by manufacturers. The objective of the work is to present a clinical case report that demonstrates the importance of performing allergy component testing (ImmunoCAP ISAC-112,) for identification of the full spectrum of allergens with subsequent assessment of allergenic molecules as triggering allergens and shows serious difficulties in the elaboration of recommendations on a personalised diet that should be adequate and safe for a child with a history of recurrent episodes of food-induced anaphylaxis. Key words: children, life-threatening reactions, allergy component testing, food labelling, food-induced anaphylaxis, food allergens

Infant anaphylaxis has been increasing in incidence; however, significant gaps in the literature remain. The aim of this article is to review the most recent literature pertaining to infant anaphylaxis and discuss recent findings related to epidemiology, diagnosis, management, and prevention. There is no accurate report of the incidence and prevalence of anaphylaxis in infancy. Food is the most common trigger for infant anaphylaxis reported. The diagnosis of anaphylaxis in infants is often missed, and, even when the diagnosis is made, epinephrine continues to be under-utilized. An epinephrine autoinjector with a shorter needle and lower dose is now available for infants. Concise criteria specifically focusing on infant anaphylaxis is needed to streamline its diagnosis and management. Diagnosis is underrecognized in infants leading to improper treatment. When the diagnosis is made, epinephrine continues to be under-utilized and under-prescribed in infants.

Background Food allergies are common among children, and food-induced anaphylaxis (FIA) is a serious disease with a risk of death; however, there is yet to be a large-scale epidemiological study on causative foods in Japan. The purpose of this study was to identify foods that cause FIA in Japan. Methods We identified 9,079 patients from the Japanese Diagnosis Procedure Combination Database who were admitted for treatment for FIA from April 1, 2014 through March 31, 2017. We extracted data on patient sex, age, use of epinephrine injections on the first day, prescription for epinephrine self-injection on the day of discharge, length of stay, readmission, and causative foods. Results The most common causative food was eggs, followed by wheat, milk, peanuts, and buckwheat. The most common causative food in each age group was eggs among 0-3-year-olds, milk among 4-6-year-olds, peanuts among 7-19-year-olds, and wheat among those aged 20 years and older. Epinephrine was used at admission among about 40%, 50% and over 60% of cases in which the causative food was eggs; wheat, milk and peanuts; and buckwheat, respectively. The proportion of cases with a prescription for epinephrine self-injection at discharge was highest among those in which the causative food was wheat, followed by peanuts, buckwheat, milk, and eggs. Conclusions FIA due to peanuts has become as common in Japan as it is in the West. These results suggest the importance of taking measures to prevent peanut allergies because children cannot make adequate decisions regarding food.

Globally, food consumption patterns are becoming more sophisticated and diversified for meeting abrupt increase in projections of food demands. The stance of availability of allergens hazard free food is a rather hectic task to implement and consumers most probably become prone to them. There is no phenomenon for investigating or identifying presence of allergens in food sample by visual inspection. So, majority of individuals possessing food intolerance have confronted with anaphylactic symptoms. Anaphylaxis is an attention attenuating concern because of its increasing invasion in different residential zones of the world. The degree of morbidity and mortality of food allergy were underestimated since a long period of times by its victims and consultant medical staff. With the passage of time the sustainability and resistance of immune regulatory responses of human being become infirm. Hence, as a result of that immune regulatory impairments human susceptible start being prone to severe anaphylactic symptoms such as shortness of breath, swelling of throat and tongue, low blood pressure, vomiting, itchy rash and tingling of nose. The causal agents for provoking anaphylaxis are mast cells and basophils. There are more or less ten prominent foods which trigger anaphylaxis after their ingestion. Hence, avoidance from being in confront with allergen food can limit proliferation of anaphylaxis.

Food-induced allergic reactions are diagnosed through corroboration of a suggestive clinical history with appropriate confirmatory tests. The major confirmatory tests include skin prick tests and serum specific immunoglobulin E (sIgE) levels. When the diagnosis is inconclusive, oral food challenges are performed (1).

BACKGROUND: Anaphylaxis is a potentially life-threatening allergic reaction. The overall prevalence of anaphylaxis appears to be rising in children, but temporal trends among infants and toddlers are not well studied. OBJECTIVE: To characterize the trends in U.S. emergency department (ED) visits and hospitalizations among infants and toddlers with anaphylaxis from 2006–2015. METHODS: We conducted a study of temporal trends in anaphylaxis among children (age

Food allergies and food-induced anaphylaxis (FIA) in children is a major public health issue with little confirmed understanding of cause or cure. As FIA is growing in incidence and prevalence, and Australia has one of the highest incidences of FIA and food allergies in the world, there are concerns that the problem has become an epidemic. Substantial improvements in public awareness and education are needed to keep children safe and free from incidence.

This study provides a preliminary investigation of food insecurity (FIS), food assistance program utilization (Supplemental Nutrition Assistance Program [SNAP], food banks), and history of food-ind...

BACKGROUND Food is the leading cause of anaphylaxis in children seen in emergency departments in the United States, yet data on emergency department visits and hospitalizations related to food-induced anaphylaxis are limited. The objective of our study was to examine national time trends of pediatric food-induced anaphylaxis-related emergency department visits and hospitalizations. METHODS We conducted an observational study using a national administrative claims database from 2005 through 2014. Participants were younger than 18 years with an emergency department visit or hospitalization for food-induced anaphylaxis. Outcome measures of our study included time trends of pediatric food-induced anaphylaxis-related emergency department visits and hospitalizations, including observations (in an emergency department or a hospital unit), inpatient admissions, and intensive care unit admissions. RESULTS During the study period, participants had 7310 food-induced anaphylaxis-related emergency department visits. Emergency department visits for food-induced anaphylaxis increased by 214% (P

Post-mortem investigation in cases of fatal anaphylaxis is required to provide clarifications on the presence of macroscopic pathological changes, histological features, and immunohistochemical positivity suggestive of the diagnosis, on biochemical evidence of anaphylaxis and on the presence of serological data indicative of the allergen responsible for the anaphylactic reaction. We describe the case of a 16-year-old boy with a medical history of allergic asthma, celiac disease, and known food-induced allergy for fish, fresh milk, peanuts, hazelnuts, walnuts, apples, kiwis, and peaches. Acute onset of dyspnea followed by cyanosis of the lips and respiratory failure was described immediately after having an ice cream sandwich. Unsuccessful rescues were immediately attempted with oral administration of betamethasone, intramuscular injection of adrenaline, and cardiopulmonary resuscitation. A complete post-mortem examination was performed. Serum dosage of mast cell beta-tryptase from femoral blood detecting serum values of 41.4 mg/l. Determination of specific IgE on cadaveric blood samples confirmed the anamnestic data related to sensitization for several food allergens, including cod parvalbumin, tropomyosin, brazil nut, omega-5-gliadin of foods derived from wheat and gluten. The cause of death was identified in a cardiorespiratory failure due to anaphylactic shock in a poly-allergic subject and anaphylaxis was ascribed to the wheat contained in the ice cream sandwich eaten immediately before the onset of respiratory symptoms. The need is to implement an interdisciplinary approach capable to ascertain the sensitivity and specificity of the diagnostic tests currently in use as well as to evaluate the possibility of introducing new biomarkers in practice.

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Food anaphylaxis is on the increase, with those who have an allergy to peanuts, tree nuts, milk, and seafood at the highest risk of developing such a reaction. However, the diet in many societies is increasingly varied, much of the food consumed is prepared outside the home, and meals are often composed of many different ingredients. Anaphylaxis may occur to a composite food, and it may be unclear whether the reaction is due to contamination or to a culprit allergen present in an added ingredient. Composite foods can contain many allergic proteins present in small amounts, which do not always have to be labeled, unless they feature in European or US labeling regulations. These "hidden" allergens include mustard, celery, spices, lupine, pea, natural food colourings, and preservatives, but can occasionally include allergenic material from contaminants such as cereal mites. Hidden allergens can provoke severe reactions to seemingly unconnected foods which might then lead to a diagnosis of idiopathic anaphylaxis. The same problem can arise with two well-known types of food allergy; wheat-dependant exercise induced anaphylaxis and allergy to non-specific Lipid Transfer Protein allergens, both of which might only manifest when linked to a cofactor such as exercise. Many of these risk factors for food anaphylaxis have a common link; the public's engagement with popular concepts of health and fitness. This includes the development of a food and exercise culture involving the promotion and marketing of foods for their health-giving properties i.e., meat substitutes, wheat substitutes, supplements and alternative, or "natural" remedies for common ailments. Some of these foods have been reported as the cause of severe allergic reactions, but because they are often viewed as benign unlikely causes of severe allergic reactions, could be considered to be hidden allergens. The best resource to elicit the likelihood of a hidden allergen provoking an allergic reaction is to take a detailed history of the allergic reaction, presence of co-factors, foods suspected, type of food and where it was consumed. A good knowledge of commonly used ingredients, and list of potential hidden allergen suspects are essential tools for the food allergy detective.

Baseggio Conrado and colleagues note that, although hospital admissions for food induced anaphylaxis increased between 1998 and 2018, the case fatality rate for confirmed food anaphylaxis decreased over this 20 year period, from 0.7% to 0.19%.1 Improved survival might result from better management, but misclassification of deaths should also be considered, especially as fatalities are rare. Having evaluated deaths for the United Kingdom Fatal Anaphylaxis Registry (UKFAR), we raise the …

Food allergens are frequent causes of anaphylaxis. In particular in children and adolescents they are the most frequent elicitors of severe allergic reactions, and in adults food allergens rank third behind insect venom and drugs. Since July 2006 severe allergic reactions from Germany, Austria, and Switzerland are collected in the anaphylaxis registry. Currently 78 hospitals and private practises are connected. From July 2006 until February 2009 1,156 severe allergic reactions were registered. Among children and adolescents (n = 187, age range from 3 months to 17 years) food allergens were the most frequent triggers, comprising 58% of cases. In the adult group (n = 968, 18 - 85 years) food allergens were in the third position (16.3%) behind insect venom and drugs. In children legumes (31%) and in particular peanuts were frequently responsible food allergens, followed by tree nuts (25%) with hazelnut being the most frequent elicitor. In adults fruits (13.4%) most often induced severe food-dependent anaphylaxis, but also animal products (12.2%); among these most frequently crustaceans and molluscs. Cofactors were often suspected in food-dependent anaphylaxis, namely in 39% of the adult group and in 14% of the pediatric group. In adults drugs (22%) and physical activity (10%) were reported to be the most frequent cofactors, in children physical activity was suspected in 8.7% and drugs in 2.6%. Concomitant diseases like atopic dermatitis, allergic asthma, or allergic rhinoconjunctivitis were reported in 78% of children and adolescents and in 67% of the adults. In conclusion, food-induced anaphylaxis, its cofactors and concomitant diseases are age-dependent. The data offers to identify risk factors of anaphylaxis.

Anaphylaxis is a potentially life-threatening severe systemic reaction and food allergy is one of its most frequent causes. Diagnosis of food-induced anaphylaxis requires diagnostic criteria for anaphylaxis based on clinical features and a comprehensive history. Adrenaline is a first-line treatment along with support measures. Epinephrine (adrenaline) is the first choice drug in anaphylaxis because it is the only medication that has been proved to reduce hospitalization and death. Long-term treatment based on an accurate identification of the anaphylaxis trigger, a clear education and training of the patients, their family and the community, under the coordination of a trained allergist, is strongly recommended in order to avoid future events.

Anaphylaktische Reaktionen auf Lebensmittel sind im Rahmen einer Nahrungsmittelallergie moglich und gehoren mit Insektengiften und Arzneimitteln zu den haufigsten Auslosern schwerer allergischer Reaktionen. Die Daten aus dem Anaphylaxie-Register zeigen, dass im Kleinkindesalter die haufigsten Ausloser schwerer allergischer Reaktionen Huhnereiweis und Milcheiweis sind. Ab dem Schulalter sind dagegen Erdnusse und Haselnusse haufige Ausloser schwerer allergischer Reaktionen. Weitere haufige Ausloser anaphylaktischer Reaktionen im Kindesalter sind Weizen und Soja. Im Erwachsenenalter sind europaweit, so zeigen die Daten aus dem Anaphylaxie-Register, die haufigsten Ausloser schwerer allergischer Reaktionen die Nahrungsmittel Weizen, Soja, Sellerie, Krusten- und Schalentiere sowie Haselnusse. Seltene Ausloser einer nahrungsmittelabhangigen Anaphylaxie sind gemas Daten aus dem Anaphylaxie-Register im deutschsprachigen Raum Senf und Kohl, wobei zu berucksichtigen ist, dass regionale Unterschiede auftreten konnen. Bis Marz 2015 wurden an das Anaphylaxie-Register 17 Todesfalle gemeldet, wobei 7 durch Nahrungsmittel ausgelost wurden. Kofaktoren konnen die Auslosung und/oder den Schweregrad einer lebensmittelabhangigen Anaphylaxie beeinflussen. Hierzu gehoren korperliche Anstrengung aber auch z. B. die Einnahme bestimmter Medikamente oder auch psychische Belastung, wobei die Datenlage hier heterogen ist. Das Management der lebensmittelabhangigen Anaphylaxie beinhaltet die Akutversorgung gemas der aktuellen Leitlinie sowie das Langzeitmanagement, wobei hier Schulungsmasnahmen und Aufklarung zur Verbreitung des entsprechenden Nahrungsmittels von besonderer Bedeutung sind.

Background Food allergy including anaphylaxis is an increasing clinical problem in many countries. Little information is available regarding prevalence, causative foods and time trends in the New Zealand adult population. Objective This cross-sectional study investigated the incidence of hospital presentation with food-induced anaphylaxis in New Zealand among adults and adolescents over a 10-year period. Methods Ministry of Health hospital discharge data from 2002 to 2011 were analysed using food allergy and anaphylaxis-related International Classification of Diseases (ICD) codes to identify acute hospital presentations. Results There was an average annualised rate of hospital food-induced anaphylaxis presentations of 4.8 per 100 000 adults (aged ≥15 years) for the period reviewed. Subgroup analyses revealed significant differences by gender, age group and ethnicity, notably higher rates in females, younger adults (15–34 years) and Pacific Island populations. Seafood was the most common food allergen group, followed by nuts. Time trend analysis revealed a 1.7-fold increase in the 10-year period, mainly attributable to an increase in rates in the Pacific Island population. Conclusions These data confirm food-induced anaphylaxis as an increasing problem in New Zealand and show significant differences in incidence of hospital presentation in different ethnic populations. Future research will be required to understand and address disparities in the incidence of these conditions.

G Pouessel, C Jean-Bart, A Deschildre. Clin Exp Allergy. 2020;50(1):74–81 To characterize food anaphylaxis among infants and compare them to children 1–6 years of age. The Allergy Vigilance Network (AVN) in France is a registry to which French allergists voluntarily contribute data on anaphylaxis. Cases of children under the age of 7years, from 2002–2018, were analyzed. Children aged 1–6 years were labeled pre-school age. Infants were 12 months or younger. These groups were compared regarding demographics, atopic history, allergic triggers and anaphylactic reactions. From 2002 to 2018, 1951 …

Food allergy and anaphylaxis are examples of type I hypersensitivity, also known as immediate hypersensitivity Peanut allergy seems to be the most common food allergy Food-induced anaphylaxis seems to be the most common reason for anaphylaxis in children

Anaphylaxis is a common, serious, systemic allergic reaction. In the United States, the change of annual hospitalization rates by anaphylaxis-trigger foods and risk factors associated with severity remain unclear.Hospital discharge records of food-induced anaphylactic reactions of individuals younger than 20 years were obtained from Kids' Inpatient Database in 2006, 2009, and 2012 and were weighted to estimate the number of hospitalizations in the United States. We identified annual hospitalization rates by patients' characteristics and anaphylaxis-trigger foods and investigated factors associated with severity and use of mechanical ventilation with multivariable logistic regression.A total of 3427 hospitalizations were obtained, and annual hospitalization rates showed a significantly increasing trend from 1.2 per 100,000 children in 2006 to 1.5 per 100,000 children in 2012 (P0.001). The leading causes of hospitalizations due to food-induced anaphylaxis were peanuts (0.35-0.48 per 100,000 children), tree nuts and seeds (0.20-0.32 per 100,000 children), and milk products (0.09-0.13 per 100,000 children), with significantly increasing trends during 2006-2012. Milk products were significantly associated with severity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3-2.9). Ages between 13 and 20 years (OR, 2.7; 95% CI, 1.4-5.1) and comorbidity of asthma (OR, 2.1; 95% CI, 1.3-3.4) were significantly associated with the use of mechanical ventilation.The annual hospitalization rates in the entire United States showed an increasing trend during 2006-2012. The rates of peanuts, tree nuts and seeds, and milk products demonstrated upward trends. Milk products, ages between 13 and 20 years, and comorbidities of asthma were related to severity and morbidity.

This review aims to provide an update of recent advances in the epidemiology, clinical features and diagnosis, and management of food-induced anaphylaxis (FIA). Food allergy prevalence and FIA rates continue to rise, but FIA fatalities are stable. Basophil and mast cell activation tests promise more accurate identification of food triggers. Oral, sublingual, and epicutaneous immunotherapy can desensitize a significant portion of subjects. Epinephrine use for FIA remains sub-optimal. As the burden of food allergy continues to increase, it appears that the corresponding increase in research focused on this epidemic is beginning to bear fruit. The stable number of FIA fatalities in the face of an ongoing epidemic indicates lives have already been saved. The emergence of new diagnostic tests and interventional therapies may transform the management of FIA in the coming years.

Recent recommendations to introduce peanut products to infants for peanut allergy prevention requires a focused assessment of infant anaphylaxis.This study describes the symptomatology of food-induced anaphylaxis (FIA) in infants (12 months) compared with older pediatric cohorts.Retrospective review between June 2015 and June 2017 of children presenting with FIA at a large urban children's hospital emergency department (ED).A total of 357 cases of FIA were evaluated: 47 in infants (12 months), 43 in toddlers (12-24 months), 96 in young children (2-6 years), and 171 in school-aged children (6 years). Infants presented with gastrointestinal (GI) involvement more frequently than any other age group (89% vs 63% [P = .003], 60% [P.001], and 58% [P.001]). Additionally, infants and young children presented with skin involvement more frequently than school-aged children (94% and 91% vs 62% [P.001]). Respiratory symptoms were more common in older cohorts (17% in infants vs 44% in young children [P.001] and 54% in school-aged children [P.001]). Egg and cow's milk were more common causes of FIA in infants compared with school-aged children (egg, 38% vs 1% [P.001]; milk, 17% vs 7% [P = .03]). Only 21% of infants with FIA had eczema, and 36% had a history of food allergy.Infants with FIA primarily presented with GI and skin manifestations. Egg was the most common food trigger in infants. Most infants with FIA did not have eczema or a history of food allergy.

Rates of food-induced anaphylaxis among children remain uncertain. In addition, little is known about the demographics of children who have experienced food-induced anaphylaxis resulting in emergency department (ED) visits and/or subsequent hospitalizations.To evaluate trends in ED visits and hospital admissions due to food-induced anaphylaxis among Illinois children and to identify socioeconomic variation in trend distribution.Illinois hospital discharge data compiled by the Illinois Hospital Association were used to identify ED visits or hospitalizations for food-induced anaphylaxis in Illinois hospitals from 2008-2012. Data for children aged 0 to 19 years who were Illinois residents and received a diagnosis of food-induced anaphylaxis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes (995.60 through 995.69) were included for analysis.There was a significant increase in the rate of ED visits and hospital admissions due to food-induced anaphylaxis among children in Illinois during the 5-year period, with an annual percent increase of 29.1% from 6.3 ED visits and hospital admissions per 100,000 children in 2008 to 17.2 in 2012 (P.001). Increases in visit frequency were observed for all study variables, including age, sex, race/ethnicity, insurance type, metropolitan status, hospital type, and allergenic food. Visits were most frequent each year for Asian children and children with private insurance. However, the annual percent increase in visits was most pronounced among Hispanic children (44.3%, P.001) and children with public insurance (30.2%, P.001).ED visits and hospital admissions for food-induced anaphylaxis have increased during a 5-year period among children in Illinois, regardless of race/ethnicity and socioeconomic status.

Food allergy is increasing; as a consequence, food-induced anaphylaxis is also becoming a growing problem. Our understanding of the mechanisms of tolerance is still basic and requires much more research before it becomes helpful in guiding our interventions. However, empirical approaches with oral immunotherapy and food introduction manipulation appear promising, although standardization is required before employing them on a large scale. Furthermore, education and public health measures can be helpful for the increasing proportion of the population at risk.

Anaphylaxis should be treated with early administration of intramuscular Adrenalin; however, fatalities may still occur even with this therapy. We report a patient with near-fatal anaphylaxis due to milk whose symptoms persisted and were resistant to any therapeutic attempt; however, the patient had a prompt resolution of the anaphylaxis shortly after a nasogastric tube placement with gastric drainage, suggesting that this procedure ended the ongoing absorption of additional allergen from the gastrointestinal tract. We suggest that nasogastric drainage of gastric contents should be considered as part of the therapy in severe food-induced anaphylaxis.

S De Schryver, A Clarke, S La Vieille. Pediatr Allergy Immunol. 2017;28(7):715–717 To survey a group of children who presented with food-induced anaphylaxis to a known food allergen. The authors sought to estimate the percentage of anaphylaxis cases attributed to food labeling issues, to assess the presence or lack of adult supervision, and to identify risk factors associated with unsupervised reactions. The study included a subgroup of children from the Cross-Canada Anaphylaxis Registry, recruited from emergency departments of 3 hospitals in Ontario and Quebec. Within 18 months of recruitment, participants were contacted to complete a telephone survey. The median age of respondents was 6.1 years, and 60.9% were boys. Emergency department physicians who attended the anaphylactic reactions (involvement of 2 …