Food allergy in children is a major health concern,and its prevalence is rising.It is often over-diagnosed by parents,resulting occasionally in unnecessary exclusion of some important food.It also causes stress,anxiet...Food allergy in children is a major health concern,and its prevalence is rising.It is often over-diagnosed by parents,resulting occasionally in unnecessary exclusion of some important food.It also causes stress,anxiety,and even depression in parents and affects the family’s quality of life.Current diagnostic tests are useful when interpreted in the context of the clinical history,although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations.Although the oral food challenge is the current gold standard for making the diagnosis,it is only available to a small number of patients because of its requirement in time and medical personnel.New diagnostic methods have recently emerged,such as the Component Resolved Diagnostics and the Basophil Activation Test,but their use is still limited,and the latter lacks standardisation.Currently,there is no definite treatment available to induce life-long natural tolerance and cure for food allergy.Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food,usually taken by accident.New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy.If standardised and widely implemented,this may result in decreasing the prevalence of food allergy.展开更多
The diagnosis of food allergy in clinical practice has not been standardized,and food allergy is overdiagnosed in patients with atopic dermatitis(AD).This overdiagnosis of food allergy leads to unnecessary elimination...The diagnosis of food allergy in clinical practice has not been standardized,and food allergy is overdiagnosed in patients with atopic dermatitis(AD).This overdiagnosis of food allergy leads to unnecessary elimination diets that may exert potential adverse effects on the health of children with AD.Unlike classic IgE-mediated food allergy,food allergy in patients with AD may manifest as non-eczematous reactions,isolated eczematous reactions,or a combination of these reactions.The diagnosis of food allergy in children with AD should be made based on a thorough clinical history(detailed allergic history and feeding history),clinical manifestations,and laboratory workup including skin prick testing,serum specific IgE measurement,atopy patch testing,and oral food challenges.Once an underlying food allergy is confirmed in a patient with AD,comprehensive management is generally recommended.Avoidance of the food allergen is the main treatment approach,but there is a need for regular clinical follow-up,including evaluation of the nutritional status and supervision of growth and development.Multidisciplinary cooperation between dermatologists,nutritionists,and pediatricians is required.展开更多
Background： Wheat-dependent, exercise-induced anaphylaxis （WDEIA） is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise chall...Background： Wheat-dependent, exercise-induced anaphylaxis （WDEIA） is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge： however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria tbr Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria t＇or Chinese WDE1A patients. Methods： We prospectively included 283 clinically diagnosed WDEIA patients from January 1,2010 to June 30, 2014, and in tile meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by lbod other than wheat. 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic （ROC） curves were plotted, areas under curve （AUC） tbr specific immunoglobin E （slgE） were compared to evaluate the diagnostic value of lgE specific to wheat, gluten, and 0）-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis. Results： We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 （73.3%） reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% （425/567） occurred during exercise. The highest AUC （0.910） was observed for sIgE for gluten, followed by omega-5 gliadin （AUC 0.879）. Combined gluten- and co-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents. Conclusions： In this study, we proposed diagnostic criteria and management of WDEIA patients in China, Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive slgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without perforating a food exercise challenge.展开更多
文摘Food allergy in children is a major health concern,and its prevalence is rising.It is often over-diagnosed by parents,resulting occasionally in unnecessary exclusion of some important food.It also causes stress,anxiety,and even depression in parents and affects the family’s quality of life.Current diagnostic tests are useful when interpreted in the context of the clinical history,although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations.Although the oral food challenge is the current gold standard for making the diagnosis,it is only available to a small number of patients because of its requirement in time and medical personnel.New diagnostic methods have recently emerged,such as the Component Resolved Diagnostics and the Basophil Activation Test,but their use is still limited,and the latter lacks standardisation.Currently,there is no definite treatment available to induce life-long natural tolerance and cure for food allergy.Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food,usually taken by accident.New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy.If standardised and widely implemented,this may result in decreasing the prevalence of food allergy.
文摘The diagnosis of food allergy in clinical practice has not been standardized,and food allergy is overdiagnosed in patients with atopic dermatitis(AD).This overdiagnosis of food allergy leads to unnecessary elimination diets that may exert potential adverse effects on the health of children with AD.Unlike classic IgE-mediated food allergy,food allergy in patients with AD may manifest as non-eczematous reactions,isolated eczematous reactions,or a combination of these reactions.The diagnosis of food allergy in children with AD should be made based on a thorough clinical history(detailed allergic history and feeding history),clinical manifestations,and laboratory workup including skin prick testing,serum specific IgE measurement,atopy patch testing,and oral food challenges.Once an underlying food allergy is confirmed in a patient with AD,comprehensive management is generally recommended.Avoidance of the food allergen is the main treatment approach,but there is a need for regular clinical follow-up,including evaluation of the nutritional status and supervision of growth and development.Multidisciplinary cooperation between dermatologists,nutritionists,and pediatricians is required.
基金This study was supported by grants from the CAMS Innovation Fund for Medical Sciences （No. 2016-12M-1-003） and the Natural Science Foundation of China （No. 81273277）.
文摘Background： Wheat-dependent, exercise-induced anaphylaxis （WDEIA） is an allergic reaction induced by intense exercise combined with wheat ingestion. The gold standard for diagnosis of WDEIA is a food exercise challenge： however, this test is unacceptable for Chinese WDEIA patients and unable to be approved by the Ethics Committee of Chinese hospitals due to substantial risk. There are no diagnostic criteria tbr Chinese WDEIA patients. The aim of present study was to propose new practical diagnosis criteria t＇or Chinese WDE1A patients. Methods： We prospectively included 283 clinically diagnosed WDEIA patients from January 1,2010 to June 30, 2014, and in tile meanwhile, three groups were enrolled which included 133 patients with the history of anaphylaxis induced by lbod other than wheat. 186 recurrent urticaria patients, and 94 healthy participants. Clinical comprehensive evaluation by allergists used as the reference gold standard, receiver operator characteristic （ROC） curves were plotted, areas under curve （AUC） tbr specific immunoglobin E （slgE） were compared to evaluate the diagnostic value of lgE specific to wheat, gluten, and 0）-5 gliadin. Patients were followed up by telephone questionnaire 1 year after diagnosis. Results： We reviewed 567 anaphylactic reactions in 283 WDEIA patients. Of these anaphylactic reactions, 415 （73.3%） reactions were potentially life-threatening anaphylaxis. Among the 567 anaphylactic reactions, 75% （425/567） occurred during exercise. The highest AUC （0.910） was observed for sIgE for gluten, followed by omega-5 gliadin （AUC 0.879）. Combined gluten- and co-5 gliadin-specific IgE testing provided sensitivity and specificity of 73.1% and 99.0%, respectively. During the 1-year follow-up period, repeat anaphylaxis was rare when patients observed strict avoidance of wheat products combined with exercise or other triggering agents. Conclusions： In this study, we proposed diagnostic criteria and management of WDEIA patients in China, Our present study suggested that confirmed anaphylactic reactions triggered by wheat with positive slgE to gluten and omega-5-gliadin may provide supportive evidence for clinicians to make WDEIA diagnosis without perforating a food exercise challenge.
