Hidden fish substance triggers allergy.

Food allergy (hypersensitivity) is a form of adverse food reaction caused by an immunological response to a particular food. IgE-mediated food allergy is responsible for most immediate-type food-induced hypersensitivity reactions. The prevalence of food allergy in the general population, not including oral allergy syndrome, is about 1-2%. While adults might tend to be allergic to fish, crustaceans, peanuts, and tree nuts, children, on the other hand, tend to be allergic to cow's milk, egg white, wheat, and soy. Food is the most common eliciting factor of anaphylaxis (45%), followed by drugs (29%), and insect stings (21%). Our study describes a 3 1/2-year-old boy who is allergic to fish consumed via ingestion and inhalation. This case is a good example of how easily people with food allergies can unintentionally consume foods to which they allergic, and is a clear demonstration of the dangers of such effects.     

Food-specific serum IgG4 and IgE titers to common food antigens in irritable bowel syndrome

INTRODUCTION: Food hypersensitivity is a common perception among irritable bowel syndrome (IBS) patients. Data from dietary elimination and food challenge studies support an etiopathological role of diet in IBS, but there are no well-established tests to identify food hypersensitivity. AIM: To compare IgG4 and IgE titers to common food antigens in IBS and controls. METHOD: One hundred and eight IBS [52 diarrhea-predominant (D-IBS); 32 constipation-predominant (C-IBS); 24 alternating (Alt-IBS)], and 43 controls were included in the study. IgG4 and IgE titers and skin prick testing (SPT) to 16 common foods including milk, eggs, cheese, wheat, rice, potatoes, chicken, beef, pork, lamb, fish, shrimps, soya bean, yeast, tomatoes, and peanuts were measured. RESULTS: IBS had significantly higher IgG4 titers (mug/L) to wheat (395 IQR +/- 1,011 vs 0 IQR +/- 285, p < 0.001), beef (1,079 IQR +/- 930 vs 617 IQR +/- 435, p < 0.001), pork (481 IQR +/- 379 vs 258 IQR +/- 496, p < 0.001), and lamb (241 IQR +/- 460 vs 167 IQR +/- 232, p= 0.009) compared to controls. These differences were maintained across all three subgroups. The antibody titers to potatoes, rice, fish, chicken, yeast, tomato, and shrimps were not significantly different. No significant difference in IgE titers was observed between IBS and controls. SPT was positive for only a single antigen in 5 of 56 patients tested with the same panel of foods. No correlation was seen between the pattern of elevated IgG4 antibody titers and patients' symptoms. CONCLUSION: Serum IgG4 antibodies to common foods like wheat, beef, pork, and lamb are elevated in IBS patients. In keeping with the observation in other atopic conditions, this finding suggests the possibility of a similar pathophysiological role for IgG4 antibodies in IBS.     

Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet

Irritable bowel syndrome (IBS) in the outpatient with chronic inflammatory bowel disease (IBD) is a difficult but important challenge to recognize and treat. It is very helpful to have effective treatment approaches for IBS that are practical and use minimal medications. Because of the underlying chronic inflammation in IBD, IBS symptoms occur with increased frequency and severity, secondary to increased hypersensitivity to foods and beverages that stimulate the gastrointestinal tract. This paper discusses how to treat IBS in the IBD outpatient, with emphasis on using a food and beverage intolerance, avoidance diet. The adverse effects of many foods and beverages are amount dependent and can be delayed, additive, and cumulative. The specific types of foods and beverages that can induce IBS symptoms include milk and milk containing products; caffeine containing products; alcoholic beverages; fruits; fruit juices; spices; seasonings; diet beverages; diet foods; diet candies; diet gum; fast foods; condiments; fried foods; fatty foods; multigrain breads; sourdough breads; bagels; salads; salad dressings; vegetables; beans; red meats; gravies; spaghetti sauce; stews; nuts; popcorn; high fiber; and cookies, crackers, pretzels, cakes, and pies. The types of foods and beverages that are better tolerated include water; rice; plain pasta or noodles; baked or broiled potatoes; white breads; plain fish, chicken, turkey, or ham; eggs; dry cereals; soy or rice based products; peas; applesauce; cantaloupe; watermelon; fruit cocktail; margarine; jams; jellies; and peanut butter. Handouts that were developed based upon what worsens or helps IBS symptoms in patients are included to help patients learn which foods and beverages to avoid and which are better tolerated.     

Food-protein-induced enterocolitis syndrome caused by fish

IntroductionFood protein-induced enterocolitis syndrome (FPIES) occurs in infants. Typical symptoms include profuse vomiting and/or diarrhea several hours after ingestion of a given food. The disorder is a non-IgE mediated food hypersensitivity. The most frequently involved foods are milk and soy, but some cases of FPIES induced by solid foods have been described. We report 14 patients with FPIES due to fish protein.Material and methodsHistory and physical examination, skin prick test (SPT) with fish allergens and Anisakis simplex, prick-by-prick test with implicated fish and determination of specific IgE antibodies against fish were performed. In eight children atopy patch test (APT) were also performed. In nine patients an open oral food challenge with the implicated fish was carried out.ResultsThere were six boys and eight girls, aged from 9 to 12 months at diagnosis, with between two and six reactions to the offending fish proteins before the diagnosis was established. Four patients had a previous history of atopy. Presenting symptoms included diarrhea in two patients, profuse vomiting in six patients, and recurrent vomiting and subsequent diarrhea in three patients. In addition to these symptoms, associated septic appearance, apathy and lethargy were present in the remaining three patients. Onset of symptoms occurred a few minutes after fish ingestion in two patients and from 60 minutes to 6 hours in the 12 remaining patients. SPT to fish were negative in all patients. Serum food-specific IgE antibodies were negative in all patients except one. APT was positive in three patients. Open oral challenge (OC) was performed in nine infants and was positive in all. The patients were followed-up for between 1 and 7 years after diagnosis, and follow-up OC tests were performed after fish had been eliminated from the patients’ diet for 3-4 years. Four patients became clinically tolerant to the causal food. Three patients currently tolerate only one type of fish (swordfish).ConclusionsWe report 14 patients with FPIES caused by fish protein. The symptoms suggest a form of cell-mediated, non-IgE mediated food hypersensitivity. The gold standard for diagnosis is OC, although caution should be exercised in infants with several reactions or a recent diagnosis. After a period of elimination of the causal food from the diet, tolerance can develop.     

IgE-mediated food allergy--extensive review of the literature

Adverse reactions to food, i.e. food allergy and intolerance have gained considerable attention. This overview focuses on the diagnosis and management of IgE-mediated food allergy that is believed to be responsible for most immediate-type food-induced hypersensitivity reactions. Clinically, these reactions are characterised by a variety of signs and symptoms that occur within minutes or hours after consumption of the offending food. Reactions may be limited or more generalised with involvement of the skin, nose, eyes, and/or lungs. In more severe cases, cardiovascular symptoms including hypotension, shock, cardiac dysrhythmias and death can occur. In food-allergic individuals, IgE is produced against naturally occurring food components, primarily glycoproteins that usually retain their allergenicity after heating and/or proteolysis. While adults tend to be allergic to fish, crustaceans, peanuts and tree nuts, children tend to be allergic to cow's milk, egg white, wheat and soy more frequently. "Emerging" food allergens include tropical fruits, sesame seeds, psyllium, spices and condiments. These allergies frequently represent a cross-allergy to an allergen derived from another source, e.g. pollens or natural rubber latex. The evaluation of IgE-mediated food allergy relies on a careful history, physical examination, appropriate skin testing or in vitro testing with food extracts, and/or double blind, placebo-controlled food challenges. Avoidance remains the mainstay of therapy. However, allergens may be "hidden" and labelling can be non-precise or misleading, thereby severely hampering prevention. Patients with severe allergies should keep at hand an emergency kit with adrenaline, an antihistamine and an injectable rapid onset-of-action corticosteroid. At present there is no evidence to support the use of immunotherapy, except for research purposes. Production of "hypoallergenic" food is hampered by incomplete methods for assessing the allergenic potential of such novel foods.     

Immunoblot studies in birch pollen-allergic patients with and without fruit hypersensitivity: part I: antibody pattern for birch pollen extract.

About 40-70% of birch pollen allergic patients show allergic symptoms after ingesting or handling raw fruits. Several investigations have indicated a partial immunological identity between birch pollen and stone fruit. To further clarify this association, we investigated 59 patients with allergic symptoms (conjunctivitis, rhinitis, and asthma during the birch pollen season) and 18 nonatopic controls by skin prick test (SPT) and RAST with birch pollen, fresh apple, cherry, and peach as well as freshly prepared fruit extracts. According to a questionnaire dealing with symptoms after ingestion of raw fruits, the subjects were divided into groups with (35 FH+) and without (24 FH-) fruit hypersensitivity. IgE, IgG, IgG1, IgG4, IgA, and IgM binding patterns to birch pollen extracts were performed with 33 sera (12 FH+, 11 FH-, and 10 nonatopic controls) using the immunoblot-technique. Patients with FH+ expressed a significantly stronger sensitization to birch pollen than patients without FH-, as measured by RAST and SPT. Native fruits induced stronger SPT reactions than fruit extracts, and patients with FH+ showed a significantly higher skin index with all fruits and fruit extracts tested. Specific IgE, IgG, IgG1, IgG4, IgM and IgA to birch pollen extracts could be detected by immunoblot in all groups, albeit with different frequencies and intensities. From this data we conclude that fruit hypersensitivity is related more to the 17 kd and 67-85 kd than to the 26-28 kd or 36 kd protein bands of the birch pollen extract. The relationship of specific IgE > IgG > IgM to a single protein band seems to be associated with the development of symptomatic type I allergy.     

Specific IgE to Common Food Allergens in Children with Atopic Dermatitis

Background: Atopic dermatitis is a major public health problem, often starting in early childhood and sometimes followed by other allergic diseases. Although hypersensitivity to foods is assumed to play an essential role in the development of atopic dermatitis in some patients, little is known about common food allergens in Iranian children with atopic dermatitis. Objectives: This study was designed to identify probable food allergens in Iranian children with atopic dermatitis and find the relationship between food sensitization and the severity of atopic dermatitis. Methods: This study included 90 children aged 2-48 months with atopic dermatitis. Skin prick tests for cow's milk, hen's egg, almond, potato and soybean were done. Serum specific IgE to 20 food allergens was also screened. Results: Among children with atopic dermatitis, the frequency of food sensitization was 40% by skin prick test and 51% by food-specific IgE. Children with atopic dermatitis were most commonly sensitized to cow's milk (31%), hen's egg (17.7%), tree nuts (17.7%), wheat (12.2%), potato (11.1%), tomato (8.8%) and peanut (8.8%). In 42 children with moderate to severe eczema, sensitivity to food allergens was 78.5% by skin prick test and 88% by serum specific IgE evaluation. Conclusion: Our results showed that cow's milk, hen's egg and tree nuts were the most common food allergens in Iranian children with atopic dermatitis. Sensitization to foods was much higher in patients with moderate to severe atopic dermatitis. Determining specific IgE in children with atopic dermatitis can be helpful in managing these patients.     

Diet and gastric cancer: a casecontrol study in Fujian Province, China

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Involvement of hidden allergens in food allergic reactions.

BACKGROUND: Hidden allergens in foods can induce allergic reactions. Currently it is not possible to estimate the exact prevalence of these reactions but they are clearly a growing problem. OBJECTIVE: The purpose of this study was to provide an overview of the role of hidden allergens (their importance, the types of food involved, and the severity of reactions) in allergic reactions in our geographical area. METHODS: A retrospective study was carried out in an adult population. Over a five year period, a total of 530 food reactions were reviewed. RESULTS: One hundred nineteen reactions (22.4%) were considered to be due to hidden allergens. Thirty-two percent of these were anaphylactic reactions. The most common hidden allergen was the Anisakis simplex larvae present in fish and shellfish. Fish allergens hidden in other foods caused reactions in 35% of fish-allergic patients. Twenty-two per cent of allergic reactions caused by eggs were due to egg allergens hidden in foods. All but one of the reactions caused by hidden legume allergens occurred in soy-allergic patients. Reactions caused by hidden fruits and hidden nuts were very uncommon. CONCLUSION: Hidden allergens were the cause of a quarter of all food allergic reactions, mainly as a result of contamination and carelessness on the part of the patient. A simplex was the hidden allergen most frequently involved. Fruits and nuts were not frequent hidden allergens in our area. Reactions due to other uncommon foods such as soy, mustard, flavourings, and honey were multiple and usually went unnoticed. Only if the sources of hidden allergens are determined will it be possible to avoid such substances and thus guarantee the safety of the allergic patient.     

Study of food allergy in the Spanish population

BackgroundThe aim of the study was to investigate the prevalence of food allergy in patients referred to our Allergy Unit and to evaluate the diagnostic methods used.MethodsWe selected 674 patients referred to the Allergy Unit of our hospital from May 2002 to October 2004. The prevalence of symptoms was determined by a standardized questionnaire, prick-prick test, and serum specific IgE. In a second phase, double- blind oral challenge tests were administered.ResultsFood allergy was found in 106 patients (15.7%): 71 adults (67 %) and 35 children (33 %). The prevalence of food allergen sensitization was 14 % in adults and 20.8 % in children. A total of 89.6 % of the patients experienced symptoms immediately. Only 29.2% the patients of sought medical attention and adrenaline was administered to five (16.1 %). The foods most frequently involved in allergic reactions were fruits (56.6%) and tree nuts (22.6%).The most common symptoms were oral allergy syndrome (46.2 %), urticaria (32.1 %), and anaphylaxis (14.2 %).Combining the results of the questionnaire with those of prick-prick tests in patients whose allergy was confirmed by double-blind, placebo-controlled food challenge (9.1 %) showed a sensitivity of 95.5 %, a negative predictive value of 96 %, a specificity of 75 % and a positive predictive value of 73%.Conclusions1. The prevalence of food allergy in our sample was 9.1 %. 2. The foods most frequently involved in allergic reactions were fruits and tree nuts. 3. The most common symptoms were oral allergy syndrome, urticaria, and anaphylaxis. 4. Combining our questionnaire with in vivo tests allowed us to diagnose 75-96% of patients with no food allergy and 95 % of food allergy patients.     

Sensitization in early age to food allergens in children with atopic dermatitis

BackgroundClinical and laboratory evidence increasingly supports the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the prevalence of clinically significant food hypersensitivity among children with AD remains an unanswered question.ObjectiveTo prospectively determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a dermatology department for evaluation of AD, and to analyze the clinical relevance of these sensitizations in AD.MethodsWe studied 44 infants of both sexes, aged less than 12 months old, who attended the dermatology department with symptoms of AD. Compliance with Hanifin-Rajka criteria was confirmed and the severity of AD was evaluated using the SCORAD index. IgE-mediated sensitization to cow's milk, alpha-lactalbumin, beta-lactoglobulin, casein, eggwhite, egg-albumin, ovomucoid and foods introduced into the diet was studied using the skin prick test (SPT) and measurement of specific serum IgE (sIgE) by CAP System fluorescein-enzyme immunoassay.Cow's milk, as well as suspected foods from the clinical history or those with a positive SPT and/or sIgE, were withdrawn from the diet to evaluate improvement in AD, and an open controlled challenge test was carried out.ResultsOf the 44 patients studied, sensitization to foods was detected in 27 (61%). No changes were observed in AD during the elimination diet or when the eliminated foods were subsequently reintroduced into the diet. The results of open controlled food challenges were positive in 12 patients (27 %).ConclusionsA high prevalence of food sensitization was found in infants with AD. The most frequent sensitization observed was to egg, although with little clinical relevance since this food had not been introduced into the diet.In the sample studied, the clinical relevance of the observed food hypersensitivities was confirmed in relation to AD. Further studies are required to confirm these results.     

Cow's Milk Anaphylaxis in Children First Report of Iranian Food Allergy Registry

Cow's milk anaphylaxis is the most common food-induced anaphylaxis in Iranian children. The clinical and laboratory findings of cow's milk anaphylaxis are evaluated in this study. All children who had experienced cow's milk anaphylaxis and had been referred to Immunology, asthma and allergy research center during a 5-year period were considered. After fulfilling a questionnaire, patients underwent measurement of total IgE and cow's milk-specific IgE by Immunocap test and Skin prick test (SPT) with cow's milk extract. Patients with a convincing history and one positive cow's milk-specific IgE test (SPT or Immunocap test) and patients with both positive tests were enrolled, in this study.Out of 49 patients, 59.2% were male. Patients' mean age was 5 years old and their mean age at the time of first attack was 5.7 months (SD = 4.3). Most of the patients have experienced more than one episode of anaphylaxis (79.5%) and in 85.7% of all cases, first attack occurred during the first year of life. Severity grading 1-5 were 2%, 6.1%, 18.4%, 69.4%, 4.1% respectively. Most common manifestations were cutaneous 98%, Respiratory 91.8%, Gastrointestinal 55.1%, Cardiovascular 46.9% and neurologic 46.9% signs and symptoms respectively. Twenty four patients showed positive SPT. Mean total IgE was 239.6±3.3 (IU/mL) and mean cow's milk-specific IgE was 19.28±27.2 (IU/mL). Most patients showed reactions only after ingestion of cow's milk or after dairy foods (81.6%).It is concluded that cow's milk anaphylaxis may happen early in life. Regarding the severity of attacks and remarkable number of patients with several attacks, poor knowledge about this disorder is evident.     

Differentiating Food Allergies from Food Intolerances

Adverse reactions to foods are extremely common, and generally they are attributed to allergy. However, clinical manifestations of various degrees of severity related to ingestion of foods can arise as a result of a number of disorders, only some of which can be defined as allergic, implying an immune mechanism. Recent epidemiological data in North America showed that the prevalence of food allergy in children has increased. The most common food allergens in the United States include egg, milk, peanut, tree nuts, wheat, crustacean shellfish, and soy. This review examines the various forms of food intolerances (immunoglobulin E [IgE] and non–IgE mediated), including celiac disease and gluten sensitivity.

Oily fish,coffee and walnuts: Dietary treatment for nonalcoholic fatty liver disease

Rates of non-alcoholic fatty liver disease(NAFLD) are increasing worldwide in tandem with the metabolic syndrome, with the progressive form of disease, nonalcoholic steatohepatitis(NASH) likely to become the most common cause of end stage liver disease in the not too distant future. Lifestyle modification and weight loss remain the main focus of management in NAFLD and NASH, however, there has been growing interest in the benefit of specific foods and dietary components on disease progression, with some foods showing protective properties. This article provides an overview of the foods that show the most promise and their potential benefits in NAFLD/NASH, specifically; oily fish/fish oil, coffee, nuts, tea, red wine, avocado and olive oil. Furthermore, it summarises results from animal and human trials and highlights potential areas for future research.     

Prevalence of latex sensitization in health care workers of a general hospital in Palermo, Sicily.

STUDY OBJECTIVE: To assess the prevalence of latex sensitization in a group of hospital employees in a general hospital. DESIGN: Cross-sectional study on hypersensitivity to latex gloves among health-care workers. SETTING: A general hospital in Palermo, Sicily. PATIENTS: 196 health-care workers answered a questionnaire about their case history of allergic diseases (i. e., rhinitis and/or asthma) and about symptoms after wearing latex gloves. All subjects were tested by skin prick test (SPT) with commercial latex extract and aeroallergens and had blood draw for total serum IgE and latex-specific IgE testing and glove-use test. MAIN RESULTS: 42% of the subjects who answered the questionnaire reported at least one symptom after wearing latex gloves. All symptoms were local, and none of the subjects reported systemic reactions. The most common symptom was itching, but none of subjects with only itching presented a positive SPT or specific serum IgE to latex. The SPT to latex was positive in 19 of 196 subjects (9.7%). Specific IgE to latex were found in 15/196 subjects (7.6%). Glove-use test was positive in 14/196 (7.1%). CONCLUSIONS: The overall prevalence of latex sensitivity in health-care workers in our epidemiological setting is 7.1%. An accurate diagnosis must take in account the integration of in vivo and in vitro tests with previous history of allergic disease.     

Prevalence of food allergy in 137 latex-allergic patients.

There have been reports of increased prevalence of certain food allergies in patients with Type I latex allergy (LA). A detailed food allergy history was obtained from 137 patients with LA. Latex allergy was defined by positive history of IgE mediated reactions to contact with latex and positive skin prick test to latex and/or positive in vitro test (AlaSTAT and/or Pharmacia CAP). Food allergy was diagnosed by a convincing history of possible IgE mediated symptoms occurring within 60 minutes of ingestion. We identified 49 potential allergic reactions to foods in 29 (21.1%) patients. Foods responsible for these reactions include banana 9 (18.3%), avocado 8 (16.3%), shellfish 6 (12.2%), fish 4 (8.1%), kiwi 6 (12.2%), tomato 3 (6.1%), watermelon, peach, carrot 2 (4.1%) each, and apple, chestnut, cherry, coconut, apricot, strawberry, loquat, one (2.0%) each. Reactions to foods included local mouth irritation, angioedema, urticaria, asthma, nausea, vomiting, diarrhea, rhinitis, or anaphylaxis. Our study confirms the earlier reports of increased prevalence of food allergies in patients with LA. We also report increased prevalence of shellfish and fish allergy not previously reported. The nature of cross reacting epitopes or independent sensitization between latex and these foods is not clear.     

Allergy to pollens from Betulaceae and Corylaceae in a Mediterranean area (Genoa, Italy)--a ten-year retrospective study.

Allergy to pollens from Betulaceae and Corylaceae is becoming a leading problem in Genoa, a northern Mediterranean area in Italy. The results of a 10-year retrospective study on combined observations both on the aerobiological presence of Betulaceae and Corylaceae pollens (Alnus, Corylus, Ostrya) and on the incidence of positive SPT in the allergic population living in the same area are reported. Among 3473 patients suffering from seasonal respiratory allergy with positive SPT to one or more pollens, 558 (16.06%) showed SPT positivity to Betulaceae and/or Corylaceae pollens, both isolated and associated with other allergens. These patients suffered from winter or early spring hay fever, with a high incidence of bronchial asthma. A statistically significant increase (0.02 < p < 0.05) in the number of these sensitizations from 1981 to 1990 has been observed. Some possible explanations for this phenomenon, including an increase in the total amount of local airborne pollens, are suggested. About 24% of the patients with positive SPT to these pollens referred oral allergic syndrome associated with the ingestion of some foods, especially apples and nuts, with or without other additional clinical symptoms.     

Food hypersensitivity in patients with seasonal rhinitis in Ankara

BackgroundFood hypersensitivity (FH) affects 1-2% of the adult population and is more common in atopic individuals. The aim of this study was to determine the frequency of FH and risk factors for its development in patients with seasonal rhinitis (SR) in our allergy clinic.MethodsWe performed a retrospective study based on the medical records of 774 patients out of 955 patients diagnosed with SR in an adult allergy clinic between 1 January 1991 and 31 December 2003.ResultsThe mean age of the patients was 29.1 ± 9.29 and 62.7 % were females. The most common major complaints were due to nasal symptoms in 82.3 %. The mean duration of SR was 6.8 ± 6.8 years. Patients were symptomatic for a mean of 3.5 ± 1.7 months per year. Skin prick tests (SPT) with common aeroallergens were positive in 685 patients (90.3 %), and the most common sensitivity was against timothy (85.1 %). The most common accompanying allergic disease was FH in 14%. FH according to history and the results of SPT performed with food allergens were discordant. The most common clinical manifestations of FH were oral allergy (49.1 %) and cutaneous symptoms (38.9 %). Risk factors for the development of FH in patients with SR were dermatological symptoms, rhinitis duration > 5 years, symptom duration > 3 months per year, SPT reactivity to Artemisia vulgaris, tree pollen allergens (Corylus avellena, Betula verrucosa), and bee allergy.ConclusionFH was the most common (14 %) accompanying allergic disease in patients with SR. SPT with food allergens have limited diagnostic value for food allergy and/or intolerance. Risk factors for developing FH in patients with SR in Turkey were dermatological symptoms, duration of rhinitis > 5 years, duration of rhinitis symptoms > 3 months per year, and SPT reactivity to Corylus avellena.     

Accidents graves par allergie alimentaire en France : fréquence,caractéristiques cliniques et étiologiques. Première enquête du Réseau dˈallergovigilance,avril–mai 2001

The first questionnaire of the ‘Allergy Vigilance Network’ concerns severe anaphylactic reactions that occurred during 1 month (April or May 2001). The first results obtained from 100 members of the Network (74 allergologists-GPs, 15 pediatricians-allergologists, eight lung specialists-allergologists and three dermatologists-allergologists) were collected. The analysis of these 100 answers reveals the occurrence of 163 severe reactions: laryngeal angioedema (51.5%), anaphylactic shock (39.9%), acute asthma (8.6%). These reactions concern 46.6% children under 15 years of age and 53.4% adults. The most frequent allergens are peanuts and nuts (27.6%), food cross-reacting with latex (11%), egg (8.6%), fish (6.7%), crustaceans (5.5%), milk (4.3%), sesame (4.3%), wheat (3.6%), legumes (3.6%), shellfish (3%), mustard (1.8%), celery (1.8%), and additives (carmine, alpha-amylase and sulfites: 1.8%). Severe reactions in France could be estimated between 15,000 and 30,000 per year. Acute asthma is less commonly reported, mainly by lung specialists, and is probably underestimated. The ability of nuts to induce severe allergic reactions is confirmed. This survey underlines the increased frequency of severe reactions to food cross-reacting with latex and to sesame. The frequency of food allergens could be influenced by the season; this enquiry will be renewed in January 2002.