Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry

Sabine Dölle-Bierke¹, Veronika Höfer¹, Wojciech Francuzik¹, Anatol-Fiete Näher², Maria Beatrice Bilo³, Ewa Cichocka-Jarosz⁴, Lucila C Lopes de Oliveira⁵, Montserrat Fernandez-Rivas⁶, Blanca E García⁷, Karin Hartmann⁸, Uta Jappe⁹, Alice Köhli¹⁰, Lars Lange¹¹, Ioana Maris¹², Tihomir Bogdanov Mustakov¹³, Katja Nemat¹⁴, Hagen Ott¹⁵, Nikolaos G Papadopoulos¹⁶, Claudia Pföhler¹⁷, Franziska Ruëff¹⁸, Dominique Sabouraud-Leclerc¹⁹, Thomas Spindler²⁰, Philippe Stock²¹, Regina Treudler²², Christian Vogelberg²³, Nicola Wagner²⁴, Margitta Worm²⁵

Affiliations

¹ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.
² Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Division of Information and Research Data Management, Robert Koch Institute, Berlin, Germany.
³ Department of Clinical and Molecular Sciences, Università, Politecnica delle Marche, Ancona, Italy; Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy.
⁴ Department of Pediatrics, Pulmonology-Allergology-Dermatology Clinic, Jagiellonian University Medical College, Krakow, Poland.
⁵ Division of Allergy, Clinical Immunology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
⁶ Allergy Department, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain.
⁷ Allergology Service. Hospital Universitario de Navarra. Pamplona, Spain.
⁸ Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.
⁹ Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North, German Center for Lung Research, Borstel, Germany; Interdisciplinary Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany.
¹⁰ Division of Allergology, University Children's Hospital Zurich, Zürich, Switzerland; Division of Paediatric Allergology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.
¹¹ Department of Pediatrics, GFO-Kliniken Bonn, St Marien-Hospital, Bonn, Germany.
¹² Department of Paediatrics and Child Health, University College Cork/Bon Secours Hospital Cork, Cork, Ireland.
¹³ Clinic of Allergy, Medical University Sofia, Sofia, Bulgaria.
¹⁴ Pediatric Pulmonology and Allergology, Kinderzentrum Dresden-Friedrichstadt, Dresden, Germany; University Allergy Center Dresden, University Hospital Dresden, Dresden, Germany.
¹⁵ Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany.
¹⁶ Allergy Department, Second Pediatric Clinic, University of Athens, Athens, Greece.
¹⁷ Saarland University Medical Center, Department of Dermatology, Homburg/Saar, Germany.
¹⁸ Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.
¹⁹ Pediatrics Unit, University Hospital Reims, Reims, France.
²⁰ Fachklinik Prinzregent Luitpold, Scheidegg, Germany.
²¹ AKK Altonaer Kinderkrankenhaus GmbH, Hamburg, Germany.
²² Department of Dermatology, Venerology, and Allergology, University Leipzig Medical Faculty, Leipzig Interdisciplinary Allergy Centre-CAC, Leipzig, Germany.
²³ Division of Pediatric Pneumology and Allergology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany.
²⁴ Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
²⁵ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. Electronic address: margitta.worm@charite.de.

PMID: 36990430
DOI: 10.1016/j.jaip.2023.03.026

Free article

Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry

Sabine Dölle-Bierke et al. J Allergy Clin Immunol Pract. 2023 Jul.

Free article

. 2023 Jul;11(7):2069-2079.e7.

doi: 10.1016/j.jaip.2023.03.026. Epub 2023 Mar 27.

Authors

Affiliations

¹ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.
² Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Division of Information and Research Data Management, Robert Koch Institute, Berlin, Germany.
³ Department of Clinical and Molecular Sciences, Università, Politecnica delle Marche, Ancona, Italy; Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy.
⁴ Department of Pediatrics, Pulmonology-Allergology-Dermatology Clinic, Jagiellonian University Medical College, Krakow, Poland.
⁵ Division of Allergy, Clinical Immunology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
⁶ Allergy Department, Hospital Clinico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain.
⁷ Allergology Service. Hospital Universitario de Navarra. Pamplona, Spain.
⁸ Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.
⁹ Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North, German Center for Lung Research, Borstel, Germany; Interdisciplinary Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany.
¹⁰ Division of Allergology, University Children's Hospital Zurich, Zürich, Switzerland; Division of Paediatric Allergology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.
¹¹ Department of Pediatrics, GFO-Kliniken Bonn, St Marien-Hospital, Bonn, Germany.
¹² Department of Paediatrics and Child Health, University College Cork/Bon Secours Hospital Cork, Cork, Ireland.
¹³ Clinic of Allergy, Medical University Sofia, Sofia, Bulgaria.
¹⁴ Pediatric Pulmonology and Allergology, Kinderzentrum Dresden-Friedrichstadt, Dresden, Germany; University Allergy Center Dresden, University Hospital Dresden, Dresden, Germany.
¹⁵ Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany.
¹⁶ Allergy Department, Second Pediatric Clinic, University of Athens, Athens, Greece.
¹⁷ Saarland University Medical Center, Department of Dermatology, Homburg/Saar, Germany.
¹⁸ Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.
¹⁹ Pediatrics Unit, University Hospital Reims, Reims, France.
²⁰ Fachklinik Prinzregent Luitpold, Scheidegg, Germany.
²¹ AKK Altonaer Kinderkrankenhaus GmbH, Hamburg, Germany.
²² Department of Dermatology, Venerology, and Allergology, University Leipzig Medical Faculty, Leipzig Interdisciplinary Allergy Centre-CAC, Leipzig, Germany.
²³ Division of Pediatric Pneumology and Allergology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany.
²⁴ Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
²⁵ Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. Electronic address: margitta.worm@charite.de.

PMID: 36990430
DOI: 10.1016/j.jaip.2023.03.026

Abstract

Background: Food is one of the most common elicitors of anaphylaxis, with an increasing incidence over recent years.

Objectives: To characterize elicitor-specific phenotypes and identify factors enhancing the risk or severity of food-induced anaphylaxis (FIA).

Methods: We analyzed data from the European Anaphylaxis Registry applying an age- and sex-matched analysis of associations (Cramer's V) for single food triggers and calculated odds ratios (ORs) for severe FIA.

Results: We identified 3,427 cases of confirmed FIA showing an age-dependent elicitor ranking (for children: peanut, cow's milk, cashew, and hen's egg; and for adults: wheat flour, shellfish, hazelnut, and soy). The age- and sex-matched analysis revealed defined symptom patterns for wheat and cashew. Wheat-induced anaphylaxis was more frequently associated with cardiovascular symptoms (75.7%; Cramer's V = 0.28) and cashew-induced anaphylaxis with gastrointestinal symptoms (73.9%; Cramer's V = 0.20). Furthermore, concomitant atopic dermatitis was slightly associated with anaphylaxis to hen's egg (Cramer's V = 0.19) and exercise was strongly associated with anaphylaxis to wheat (Cramer's V = 0.56). Additional factors influencing the severity were alcohol intake in wheat anaphylaxis (OR = 3.23; CI, 1.31-8.83) and exercise in peanut anaphylaxis (OR = 1.78; CI, 1.09-2.95).

Conclusions: Our data show that FIA is age-dependent. In adults, the range of elicitors inducing FIA is broader. For some elicitors, the severity of FIA seems to be related to the elicitor. These data require confirmation in future studies considering a clear differentiation between augmentation and risk factors in FIA.

Keywords: Cashew; Food anaphylaxis; Hazelnut; Peanut; Phenotype; Risk factors; Shellfish; Wheat.

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Comment in

Correct nomenclature of wheat allergy dependent on augmentation factors.
Brockow K, Faihs V, Kugler C, Biedermann T. Brockow K, et al. J Allergy Clin Immunol Pract. 2023 Nov;11(11):3562-3563. doi: 10.1016/j.jaip.2023.08.025. J Allergy Clin Immunol Pract. 2023. PMID: 37945213 No abstract available.

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Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry

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Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry

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