Increasing specific immunoglobulin E levels correlate with the risk of anaphylaxis during an oral food challenge

Background

Oral food challenges (OFCs) are necessary to diagnose food allergies; however, these tests can cause anaphylaxis. Higher specific immunoglobulin E (sIgE) levels to causative food have been associated with a positive OFC. To date, no data have been found to indicate the factors associated with severe symptoms or anaphylaxis among challenge‐positive patients. This study aimed to clarify the association of sIgE with causative foods and anaphylaxis during OFC among the whole study population and challenge‐positive patients.

Methods

This cross‐sectional study collected symptom and severity data between June 2012 and December 2016 during an open OFC to diagnose food allergy or confirm tolerance acquisition. We analyzed the risk factors for anaphylaxis during OFC.

Results

A total of 2272 cases were analyzed (median age: 3.5 years; egg: 1166 cases; milk: 589 cases; wheat: 388 cases; and peanut: 129 cases). Among 979 challenge‐positive patients, anaphylactic reactions were observed in 334 cases. A statistically significant association was observed between anaphylaxis during OFC and higher sIgE levels to causative foods (odds ratio: 2.71, 95% confidence interval: 1.94‐3.78, for the third compared to the first tertile, P‐value for trend <.001). Only gastrointestinal, respiratory, cardiovascular, and neurological symptoms were also statistically significantly associated with higher sIgE levels to causative foods.

Conclusions

The risk of all symptoms, except skin symptoms, during OFCs increased with increasing sIgE levels, and this consequently increased anaphylaxis during OFCs. The mechanism of how sIgE affects the prevalence of gastrointestinal, respiratory, cardiovascular, and neurological symptoms or anaphylaxis is unknown; thus, further study is required.     

The impact of oral food challenges for food allergy on quality of life: A systematic review

Background

Food allergy significantly impairs health‐related quality of life (HRQL). Currently, it is still unknown whether diagnostic interventions for food allergy improve HRQL. We aim to assess the impact of diagnostic interventions for food allergy on HRQL.

Methods

A systematic search was performed in MEDLINE, Embase, Cochrane Library, and CINAHL focused on patients with a (suspected) food allergy who underwent diagnostic interventions (ie, skin prick test, specific IgE, or oral food challenges [OFC]) and in whom HRQL was assessed. The mean difference between HRQL before and after the diagnostic intervention was calculated. A minimal clinically important difference of 0.5 was considered clinically relevant for the food allergy quality of life questionnaire.

Results

Seven of 1465 original identified publications were included in which the impact of an OFC on HRQL was investigated (total patients n = 1370). No other diagnostic interventions were investigated. Food allergy‐specific parent‐reported HRQL improved significantly after an OFC irrespective of the outcome in children with a suspected food allergy in two publications. The change was considered clinically relevant in one of two publications. In addition, parent‐reported HRQL improved after an OFC to assess the eliciting dose in children with a confirmed food allergy. The parental burden was significantly reduced after an OFC to assess resolution of food allergy. A meta‐analysis could not be performed due to the limited numbers of, and considerable heterogeneity between, eligible publications.

Conclusion

An OFC is associated with an improved food allergy‐specific HRQL and a reduced parental burden of food allergy.     

The predictive value of skin prick testing for challenge-proven food allergy: a systematic review

Immunoglobulin E-mediated (IgE) food allergy affects 6-8% of children, and the prevalence is believed to be increasing. The gold standard of food allergy diagnosis is oral food challenges (OFCs); however, they are resource-consuming and potentially dangerous. Skin prick tests (SPTs) are able to detect the presence of allergen-specific IgE antibodies (sensitization), but they have low specificity for clinically significant food allergy. To reduce the need for OFCs, it has been suggested that children forgo an OFC if their SPT wheal size exceeds a cutoff that has a high predictability for food allergy. Although data for these studies are almost always gathered from high-risk populations, the 95% positive predictive values (PPVs) vary substantially between studies. SPT thresholds with a high probability of food allergy generated from these studies may not be generalizable to other populations, because of highly selective samples and variability in participant's age, test allergens, and food challenge protocol. Standardization of SPT devices and allergens, OFC protocols including standardized cessation criteria, and population-based samples would all help to improve generalizability of PPVs of SPTs.     

Atopy patch test for the diagnosis of food protein-induced enterocolitis syndrome

Food protein-induced enterocolitis syndrome (FPIES) is thought to be a non-IgE mediated food allergy syndrome. Affected infants typically demonstrate gastrointestinal symptoms after hours after ingestion of the offending food. Traditional allergy testing is not useful for this disorder because tests for food specific IgE are routinely negative. A diagnostic oral food challenge (OFC) is the only method to confirm the diagnosis of FPIES. This prospective study was undertaken to determine whether the atopy patch test (APT) is able to predict the results of the OFC. Nineteen infants with suspected FPIES by clinical history underwent APT to the suspected foods. After APT was performed, subjects underwent OFC to determine whether FPIES was present. The results of APT and OFC were compared and used to calculate sensitivity and specificity of the APT. APT predicted the results of oral food challenges in 28/33 instances. There were 16 cases of FPIES confirmed by oral food challenges. In all 16 cases of FPIES, the APT was positive to the suspected food. However, the APT was positive in five instances where the oral food challenge was negative. All 12 patients with a negative APT had a negative oral food challenge to the suspected food. APT appears to be a promising diagnostic tool for the diagnosis of FPIES.     

Prevalence of food allergy among preschool children in northern Thailand

Background: The epidemiology and clinical spectrum of food allergies (FA) confirmed by oral food challenge tests (OFC) in the Southeast Asian countries are limited. The aim of the present study was to examine the prevalence and characteristics of FA among preschool children in northern Thailand. Methods: Five hundred and forty‐six children aged 3–7 years living in Chiang Mai, Thailand participated in this study. A cross‐sectional parent questionnaire survey was conducted. Families with children reporting FA were invited to undergo further investigations with skin prick testing, serum specific IgE, and OFC. Results: A total of 452 out of 546 questionnaires (82.8%) were returned. Forty‐two children (9.3%) were reported to have FA. The five leading allergic foods reported were shrimp, cow's milk, fish, chicken eggs, and ant eggs. The most commonly reported symptom was a skin rash (78.0%), followed by abdominal pain and vomiting (31.1%). Anaphylaxis was found in two children (3.4%), from ant eggs allergy. Eighteen children underwent OFC; five of them were positive to shrimp, fish, and crab. Either skin prick test or serum‐specific IgE was positive in these children. Factors associated with parent‐reported FA included personal and family history of atopic dermatitis. Conclusions: The prevalence of IgE‐mediated FA confirmed on OFC was ≥1.11% (95% confidence interval: 0.41–2.98%). The most common causative food was shrimp. Ant eggs were a unique food allergen causing severe reactions in preschool children in northern Thailand.     

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??Abstract??Objective To investigate the diagnostic value of mean diameter of SPT in food allergic infants. Methods Totally 91 infants suspected with food allergy ??median age 7.35±2.94 months?? were selected??and all patients received family history inquiry??skin prick test and open food challenge.The mean diameter of SPT was measured??and OFC was performed to confirm food allergy.Diagnostic value of skin prick test, including the sensitivity and specificity, was calculated.In addition??receiver operating characteristic curve??ROC?? was plotted and area under the curve??AUC??was calculated to quantify the accuracy of the parameter.The SPSS software package version 13.0 for windows was used for all statistical analysis. Results A total of 128 babies received food challenge test?? in which there were 109 times of OFC positive and 19 times negative??totally 79 infants were diagnosed with FA.The induced symptoms of food challenge test included skin symptoms??70.6%??, gastrointestinal symptoms??20.2%??, rest with crying?? coughing?? rubbing eyes??etc.??9.2%??.When the rash MD was ≥3 mm??the sensitivity of SPT diagnosis milk??egg white and protein allergy was 19%??60.6% and 60.5% respectively??the area under ROC curve of rash MD in the milk??egg white??protein was 0.718??0.604 and 0.716 respectively?? the rates of three food SPT test results complying with the OFC were 44.4%??53.7% and 65.9%??the rates being 62.5%?? 58.3% and 31.3% in positive family history??when family history was negative??the area under the ROC curve of rash MD was 0.793. In the cases with positive family history??the area of ROC curve was 0.533.When rash MD of milk??egg white and protein was ≥2.2??5.0??4.7 mm or the rash MD was ≥3.25mm in children with a negative family history??SPT FA diagnostic specificity could be up to 100%. Conclusion SPT has some value in the diagnosis of FA. By finding the critical value of SPT FA and comprehensive analysis of family history??doctors can improve the diagnostic rate of FA. SPT can prevent some suspicious FA infants from food challenge test. It is very important to obtain rapid clinical diagnosis and to reduce the risk and burden to their families.     

Labial food challenge in children with food allergy

The current increase in the prevalence of food allergies appears to have several causes including better screening, improved diagnosis and changes in both the techniques used by food manufacturers and eating habits. Labial food challenge (LFC)is simple, rapid to perform and is associated with only low risks of systemic reaction. It is thus an appealing alternative to the oral food challenge (OFC) for pediatric use.
We report a series of 202 LFC performed over two years in 142 children with food allergy suspected from the case history, positive skin prick tests and specific serum IgE assays: 156 LFC were positive; and 46 negative, followed by positive single-blind, placebo-controlled food challenges (SB-PCFC). The foods provoking reactions were egg white (75 cases), peanut (60 cases), mustard (23 cases), cow's milk (13 cases), cod (8 cases), kiwi fruit, shrimp (4 cases each), chicken, peanut oil (3 cases each), hazel nuts (2 cases), and snails, apple, fennel, garlic, chilli peppers, pepper, and duck (1 case each). LFC positivity was mostly (89. 7% of cases) manifested as a labial edema with contiguous urticaria. There were systemic reactions in 4. 5% of cases: generalized urticaria, hoarseness and rapid-onset and generalized eczema. The 46 infants with negative LFC results had positive SBPCFC. The reactions were in 34 cases generalized urticaria, 10 cases asthma attacks, 2 cases early and generalized eczema, and in one case general anaphylactic shock. The sensitivity of the LFC was 77%. The LFC was easy to perform with children. Positive results indicate the presence of food allergy, but negative results require further investigations preferably double-blind, placebo-controlled food challenge (DBPCFC)     

Adverse reactions to food additives in children: A retrospective study and a prospective survey

BackgroundAllergic reactions to food additives are often suspected by families. The aim of this study was to describe oral food challenge (OFC) outcomes in a pediatric cohort with a suspected diagnosis of allergy to food additives (food dyes or sodium benzoate).MethodsAll patients who underwent an open OFC to carmine red, cochineal red, erythrosine, patent blue V, tartrazine, yellow sunset S, and/or sodium benzoate were included. A survey was sent to families after testing to evaluate whether the OFC results had altered feeding behaviors with food additives.ResultsTwenty-three patients were included. The main suspected food was candy (n = 11/23; 48%). Only one OFC out of 45 was formally positive for the carmine and cochineal red. Subsequently, most OFCs were negative (44/45; 97.8%). Despite the negativity of the challenge, four families out of 14 reported occurrences of supposed allergic reactions to food additives and six out of 15 continued to completely avoid the additive of concern in their children's diet.ConclusionsAllergies to food additives remain rare. Even if an IgE-mediated allergy was excluded with a negative OFC, families remained suspicious about ready-made products. Health professionals and parents should be reassured about the low risk of food dye intolerance or allergies.     

Ocena przydatności doustnej prowokacji pokarmowej metodą podwójnie ślepą kontrolowaną placebo u dzieci leczonych eliminacyjną dietą bezmleczną

Introduction

The gold standard for the diagnosis of food allergy is a double-blind placebo-controlled food challenge (DBPCFC). Open food challenge is recommended in younger children because of the limited impact of symptoms subjectivization during its duration.

Aim

The aim of the study was the assessment of usefulness of DBPCFC in confirmation of tolerance to cow's milk proteins after a period of elimination diet in children with a positive result of the open challenge and evaluation of the clinical cow's milk allergy symptoms in children.

Material and methods

The analysis included the medical records of 80 children between 7 and 48 months of age using dairy-free diet. After a period of elimination diets and resolution of clinical signs in these patients open provocation tests were conducted, the results of which were positive. For this reason, they have been qualified for DBPCFC in order to confirm or rule out the persistence of allergy to cow's milk proteins.

Results

The application of DBPCFC method allowed to rule out allergy to cow's milk proteins in 80% of the children. The elimination diet has been used for an average of 13.18 months, it was more often based on the whey hydrolysate. The average age of patients was 18.7 months. An analysis of the clinical symptoms showed that the most common form was atopic dermatitis (76.25%).

Conclusions

DBPCFC is an effective method of showing the children's acquisition of tolerance for cow's milk proteins (which were not tolerated earlier) after a period of elimination diet; the method has a high clinical value. A strong influence of parent's emotional factors on the objective assessment of clinical reactions of the child is an argument for using blind trials.     

Various initial presentations of Epstein‐Barr virus infection‐associated post‐transplant lymphoproliferative disorder in pediatric liver transplantation recipients: Case series and literature review

PTLD is a rare but potentially life‐threatening condition, which shows a higher prevalence in children than in adults. From 129 children who underwent LT, we reported 5 cases with biopsy‐proven PTLD at a single teaching hospital. Four patients had shared clinical presentations including fever, lymphadenopathy, and splenomegaly. They were noted to be given a prolonged course of IS due to the management of comorbid complications such as acute cellular rejection or severe food allergy or eosinophilic gastrointestinal disease. The other one patient presented with upper gastrointestinal bleeding from gastric mass during an early post‐transplantation period. Notably, hypoalbuminemia was noted in all reported patients. Similar to previous studies, both EBV serology mismatch between the donor and recipient with high EBV viral load were noted in all except one case, whose EBV serology was unknown before LT. At least one episode of CMV reactivation was also observed in 3 of 5 patients prior to the PTLD diagnosis. The histopathology revealed 1 of 5 early PTLD, 1 of 5 polymorphic PTLD, and 3 of 5 monomorphic PTLD. The treatment included IS withdrawal, chemotherapy, and/or rituximab. One patient died of multiorgan dysfunction, one remains in complete remission, and three patients are either still on treatment or await response evaluation. Even though most of our reported PTLD cases had shared manifestations with fever, lymphadenopathy, splenomegaly, EBV serology mismatch, and high EBV viral load, various initial presentations such as respiratory symptoms, hypoalbuminemia, and prolonged use of IS from other causes such as significant food allergy were noted.     

A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy

Background  

Cow's milk is the most common food allergen in infants and the diagnosis of cow's milk allergy is difficult, even with the use of several diagnostic tests. Therefore, elimination diets and challenge tests are essential for the diagnosis and treatment of this disorder. The aim of this study is to report the clinical presentation and nutritional status of children evaluated by pediatric gastroenterologists for the assessment of symptoms suggestive of cow's milk allergy.     

Parental food allergy information needs: a qualitative study

Objective

To examine information needs and preferences of parents regarding food allergy.

Design

Qualitative study including in‐depth semi‐structured interviews and focus group discussions. Data were audio‐recorded, transcribed verbatim and analysed using the constant comparative method, aided by participant checking of interview summaries, independent reviewers and qualitative analysis software.

Participants

84 parents of children with food allergy.

Setting

Three paediatric allergy clinics and a national consumer organisation.

Results

Most parent participants had received third level education (72%) and 39% had occupational backgrounds in health and education. Parents experienced different phases in their need for information: at diagnosis when there is an intense desire for information, at follow‐up when there is continuing uncertainty about allergy severity and appropriate management, and at new events and milestones. They preferred information to be provided in a variety of formats, with access to reliable individualised advice between clinic appointments, within the context of an ongoing relationship with a health professional. Parents wished to know the reasoning behind doctor''s opinions and identified areas of core information content, including unaddressed topics such as what to feed their child rather than what to avoid. Suboptimal information provision was cited by parents as a key reason for seeking second opinions.

Conclusion

Parents with children with food allergies have unmet information needs. Study findings may assist in the design and implementation of targeted educational strategies which better meet parental needs and preferences.     

Lactose Intolerance and Other Disaccharidase Deficiency

Intolerance to foods which contain lactose can cause a range of intestinal and systemic symptoms. These symptoms are caused by Lactase deficiency which is encoded by a single gene (LCT) of ≈ 50 kb located on chromosome 2q21. In some food items, lactose has been missed because of “hidden” lactose due to inadequately labeled, confusing diagnosis of lactose intolerance based on dietary restriction of dairy foods. Two polymorphisms, C/T13910 and G/A22018, linked to hypolactasia, correlate with breath hydrogen and symptoms after lactose. The key in the management of lactose intolerance is the dietary removal of lactose. Patients diagnosed as lactose intolerant must be advised of “risk” foods, inadequately labeled, including processed meats, bread, cake mixes, soft drinks, and lagers. This review highlights the types, symptoms and management of lactose intolerance and also highlights differences from milk allergy which closely mimics the symptoms of lactose intolerance.     

Dual Food and Energy Hardship and Associated Child Behavior Problems

Objective

To examine dual food and energy hardship and internalizing and externalizing behavior problems in 9-year-old children.

Consensus classification of pediatric hepatocellular tumors: A report from the Children's Hepatic tumors International Collaboration (CHIC)

Background

Liver tumors are rare in children with histologic heterogeneity that makes diagnosis challenging. Systematic histopathological review, performed as part of collaborative therapeutic protocols, identified relevant histologic subtypes that are important to distinguish. The Children's Hepatic tumors International Collaboration (CHIC) was established to study pediatric liver tumors on a global scale and led to establishment of a provisional consensus classification for use in international clinical trials. The current study is the validation of this initial classification and first large-scale application by international expert reviewers.

Procedure

The CHIC initiative includes data from 1605 children treated on eight multicenter hepatoblastoma (HB) trials. Review of 605 available tumors was performed by seven expert pathologists from three consortia (US, EU, Japan). Cases with discordant diagnoses were collectively reviewed to reach a final consensus diagnosis.

Results

Of 599 cases with sufficient material for review, 570 (95.2%) were classified as HB by all consortia, and 29 (4.8%) as non-HB, which included “hepatocellular neoplasm, NOS” and malignant rhabdoid tumors. 453 of 570 HBs were classified as epithelial by final consensus. Some patterns (i.e., small cell undifferentiated, macrotrabecular, cholangioblastic) were selectively identified by reviewers from different consortia. All consortia identified a similar number of mixed epithelial–mesenchymal HB.

Conclusions

This study represents the first large-scale application and validation of the pediatric malignant hepatocellular tumors consensus classification. It is a valuable resource to train future generations of investigators on accurate diagnosis of these rare tumors and provides a framework for further international collaborative studies and refinement of the current classification of pediatric liver tumors.     

婴幼儿鸡蛋与牛奶过敏食物皮肤点刺试验的诊断价值

目的 通过对皮肤点刺试验疹团平均直径与开放性食物激发试验的相关性研究,获得有确诊食物过敏价值的皮肤点刺试验界值点,为简化临床诊断程序提供依据.方法 采用前瞻性研究,选择重庆医科大学附属儿童医院儿保科可疑食物过敏儿童173名,均进行皮肤点刺试验及开放性食物激发试验.测量并记录皮肤点刺试验疹团平均直径,通过开放性食物激发试验确诊食物过敏患儿.采用SPSS 13.0软件包进行统计学处理.将开放性食物激发试验作为诊断的金标准,通过四格表计算疹团平均直径的敏感度、特异度、阳性预测值及阴性预测值.通过受试者工作特征曲线及曲线下面积对疹团平均直径诊断价值进行评价;同时获取具有100%诊断价值的平均直径界值点.结果 173名婴幼儿年龄范围1～24个月,平均(9.39±5.67)个月共进行271次食物激发试验(其中阳性结果123次),99例婴幼儿被确诊为食物过敏.食物激发试验诱发症状主要表现为皮肤症状(87.0%),其次是胃肠道症状(9.8%).蛋白、蛋黄、牛奶皮肤点刺试验的受试者工作特征曲线的曲线下面积分别为0.794、0.804及0.904.当皮肤点刺试验疹团平均直径≥3 mm时,敏感度在71%～87%之间,特异度在31%～57%之间.当蛋白、蛋黄、牛奶皮肤点剌试验疹团平均直径分别≥8.5、5.5、5.5 mm时,皮肤点刺试验对食物过敏的诊断准确率可达100%.结论 皮肤点刺试验疹团平均直径对食物过敏的临床诊断准确性较好,通过其100%诊断界值点,可避免部分可疑食物过敏患儿进行食物激发试验.

Abstract：

Objective Mean diameter is the most common used parameter for wheal response assessment after skin prick test.This study aimed to investigate the diagnostic capacity of mean diameter according to the outcome of oral food challenge, and to determine the cut-off points that could render food challenges unnecessary.Method Data of 173 children referred to the Division of Primary Child Health Care for the evaluation of suspected food allergy were prospectively studied.All children underwent skin prick test and open food challenge to the relevant food(s) in clinic.The mean wheal diameter of skin prick test was measured, and open food challenge was performed to confirm food allergy. The SPSS software package version 13.0 for windows ( SPSS, Chicago, IL,USA) was used for all statistical analysis.Open food challenge was taken as the gold standard for diagnosis.Diagnostic capacity of skin prick test, including the sensitivity, specificity, positive predictive value, negative predictive value, was calculated by cross-table.In addition, receiver operating characteristic curve ( ROC ) was plotted and area under the curve ( AUC ) was calculated to quantify the accuracy of the parameter.Result For the 173 children,271 open food challenges were performed with egg white, egg yolk and cow's milk, In which 123 were positive, 99 children were diagnosed as food allergy.Cutanuous symptoms ( 87.0% ) were most common, followed by gastrointestinal symptoms (9.8% ).The AUC of mean diameter was 0.794 for egg white, 0.804 for egg yolk and 0.904 for cow's milk.The sensitivity of skin prick test with a cut-off value of ≥3 mm was ranged from 71% to 87%,while the specificity was between 31% and 57%.The authors also defined food specific skin prick test mean diameters that were 100% diagnostic for allergy to egg white ( ≥8.5 mm), egg yolk ( ≥5.5 mm), cow's milk ( ≥5.5 mm).Conclusion Predictive decision points for a positive outcome of food challenges can be calculated for egg and cow's milk using mean diameter.It may help to simplify the diagnostic procedure of food allergy.     

Fish allergy in childhood

Fish and its derived products play an important role in human nutrition, but they may also be a potent food allergen. Fish can be an ingested, contact, and inhalant allergen. Gad c I, a Parvalbumin, the major allergen in codfish, is considered as fish and amphibian pan‐allergen. Prevalence of fish allergy appears to depend on the amount of fish eaten in the local diet. In Europe, the highest consumption occurs in Scandinavian countries, Spain and Portugal. In Spain, fish is the third most frequent allergen in children under 2 yr of age after egg and cow’s milk. An adverse reaction to fish may be of non‐allergic origin, due to food contamination or newly formed toxic products, but the most frequent type of adverse reactions to fish are immunologic‐mediated reactions (allergic reactions). Such allergic reactions may be both IgE‐mediated and non‐IgE‐mediated. Most cases are IgE‐mediated, due to ingestion or contact with fish or as a result of inhalation of cooking vapors. Some children develop non‐IgE‐mediated type allergies such as food protein induced enterocolitis syndrome. The clinical symptoms related to IgE‐mediated fish allergy are most frequently acute urticaria and angioedema as well as mild oral symptoms, worsening of atopic dermatitis, respiratory symptoms such as rhinitis or asthma, and gastrointestinal symptoms such as nausea and vomiting. Anaphylaxis may also occur. Among all the species studied, those from the Tunidae and Xiphiidae families appear to be the least allergenic.     

Increase in atopic sensitization rate among Dutch children with symptoms of allergic disease between 1994 and 2014

Background

The prevalence of symptoms of allergic diseases has increased significantly during the last decades. However, studies into time trends of atopic sensitization among children are limited and have focused on aeroallergen sensitization. We aimed to investigate time trends in the prevalence and degree of atopic sensitization to inhalant and food allergens among children (0‐17 years) with symptoms of allergic disease.

Methods

Sensitization data of all children tested in our clinical laboratory during 1994‐2014 were analyzed. Sensitization was detected using the ImmunoCAP system and defined as a specific IgE level of ≥0.35 kU/L. Trends in sensitization rates to 5 food and 5 aeroallergens for different age categories were investigated with logistic regression, adjusted for age and sex.

Results

Sensitization data of 18 199 children were analyzed. Between 1994 and 2014, a steady and statistically significant increase in overall sensitization rate was found (from 40.5% in 1994 to 48.9% in 2014, adjusted odds ratio [aOR] 1.01 per year, 95% confidence interval [CI] 1.00 to 1.01, P = .003). This increase in sensitization rate was mainly explained by increasing aeroallergen sensitization among 4‐ to 11‐year‐old children (aOR 1.02, 95% CI 1.01 to 1.02, P < .001). We found no increase in sensitization rates to food and aeroallergens in other age categories. The degree of sensitization did not change significantly during the study period (all tests P > .15).

Conclusion

We observed a statistically significant increase in sensitization rate between 1994 and 2014 among children with symptoms of allergic disease. This was mainly explained by increasing aeroallergen sensitization among 4‐ to 11‐year‐olds.     

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??Food protein-induced enterocolitis syndrome??FPIES??is a non-IgE mediated gastrointestinal allergic disorder??and the pathogenesis is still unknown. The clinical manifestations include repetitive severe vomiting and diarrhea. Acute FPIES can result in dehydration??lethargy and even shock. Chronic FPIES is mainly characterized by weight loss and growth retardation. FPIES mainly affects infants and toddlers. Common allergen includes milk??soybean??oats??fish and eggs. The diagnosis is based on typical clinical manifestations and the fact that avoiding possible food source can alleviate the symptoms. If necessary??oral food challenge??OFC?? is required to confirm the diagnosis or to find out the food allergy sources. The key treatment measures are to avoid allergen food and to carry out symptomatic treatment during acute phase.     

Addressing risk management difficulties in children with food allergies

Risk is a concept inherent in every medical procedure. It can be defined as the probability of an adverse event in a defined population over a specified period of time. In the frame of food allergy management, it might be related to a diagnostic procedure, a treatment, or the consumption of foods. The risk of an adverse event can also be augmented by individual factors. This rostrum article discusses various aspects faced by children with food allergies in the light of risk, and their practical implications. Identifying personal risks for severe reaction, such as unstable asthma, and correcting them whenever possible also contribute to a reduction of the risk inherent to food allergy. Among the facets discussed, oral food challenges (OFC) are the most common diagnostic procedures implying an inherent risk. The risk of OFCs can be minimized by correct indication and timing of the test, a safe setting, as well as by ensuring that the patient is otherwise well without potential stressor potentially increasing the risk of a more severe reaction. Oral immunotherapy (OIT) has been studied as a potential treatment for increasing the threshold dose for reaction, and thus reducing the risk of accidental reaction. Nevertheless, the procedure is not devoid of risk as the patients may and do often react during the course of the procedure. Ingestion of trace amounts in processed foods, mainly in community settings such as restaurants, schools, or day care, represents a potential risk of reactions, although for a minority of patients. Precautionary allergen labeling (PAL) is a widespread strategy to reduce the potential risk of reactions due to traces. However, PAL is currently inefficient due to inconsistent labeling, also not indicating a clear maximum amount possibly present in the manufactured food. Finally, cost-effectiveness needs to be considered in risk management, as many risk reduction procedures are clearly not cost-effective.