Showing papers by "Scott H. Sicherer published in 1999"

Prevalence of peanut and tree nut allergy in the US determined by a random digit dial telephone survey

Abstract: Background: Allergy to peanuts and tree nuts (TNs) is one of the leading causes of fatal and near-fatal food-induced allergic reactions. These allergies can be lifelong and appear to be increasing in prevalence. Despite the seriousness of these allergies, the prevalence of peanut and TN allergy in the general population is unknown. Objective: We sought to determine the prevalence of peanut and TN allergy among the general population of the United States. Methods: We used a nationwide, cross-sectional, random digit dial telephone survey with a standardized questionnaire. Results: A total of 4374 households contacted by telephone participated (participation rate, 67%), representing 12,032 individuals. Peanut or TN allergy was self-reported in 164 individuals (1.4%; 95% confidence interval [CI], 1.2%-1.6%) in 151 households (3.5%; 95% CI, 2.9%-4.0%). The prevalence of reported allergy in adults (1.6%) was higher than that found in children under 18 years of age (0.6%). In 131 individuals, details of the reactions were obtained. When applying criteria requiring reactions to be typical of IgE-mediated reactions (hives, angioedema, wheezing, throat tightness, vomiting, and diarrhea) within an hour of ingestion, 10% of these subjects were excluded. Among the remaining 118 subjects, allergic reactions involved 1 organ system (skin, respiratory, or gastrointestinal systems) in 50 subjects, 2 in 45 subjects, and all 3 in 23 subjects. Forty-five percent of these 118 respondents reported more than 5 lifetime reactions. Only 53% of these 118 subjects ever saw a physician for the allergic reaction, and only 7% had self-injectable epinephrine available at the time of the interview. The prevalence of peanut and TN allergy was adjusted by assuming that 10% of the remaining 33 subjects without a description of their reactions would also be excluded and correcting for a 7% false-positive rate for the survey instrument. A final "corrected" prevalence estimate of 1.1% (95% CI, 1.0%-1.4%) was obtained. Conclusions: Peanut and/or TN allergy affects approximately 1.1% of the general population, or about 3 million Americans, representing a significant health concern. Despite the severity of reactions, about half of the subjects never sought an evaluation by a physician, and only a few had epinephrine available for emergency use. (J Allergy Clin Immunol 1999;103:559-62.)

Food hypersensitivity and atopic dermatitis: Pathophysiology, epidemiology, diagnosis, and management ☆ ☆☆

Abstract: Laboratory and clinical investigations over the past two decades have demonstrated that food allergy plays a pathogenic role in a subset of patients, primarily infants and children, with atopic dermatitis (AD). Approximately 40% of infants and young children with moderate to severe AD have food allergy, but identifying this subset of patients and isolating the relevant food allergens requires a high index of suspicion, the use of appropriate laboratory tests, and, in some cases, physician-supervised oral food challenges. Removal of the causal food protein(s) leads to clinical improvement but requires a great deal of education because most of the common causal foods (egg, milk, wheat, soy, peanut, and so forth) are ubiquitous in the food supply, and food elimination diets risk causing nutritional deficits. Fortunately, most food allergies resolve in early childhood, and food allergy is not a common cause for AD in older children and adults.

Food allergy: When and how to perform oral food challenges

Abstract: In many situations, the diagnosis of food allergy rests simply upon a history of an acute onset of typical symptoms, such as hives and wheezing, following the isolated ingestion of a suspected food, with confirmatory laboratory studies of positive prick skin tests or Radioallergosorbent tests. However, the diagnosis is more complicated when multiple foods are implicated or when chronic diseases, such as asthma or atopic dermatitis, are evaluated. The diagnosis of food allergy and identification of the particular foods responsible is also more difficult when reactions are not mediated by IgE antibody, as is the case with a number of gastrointestinal food allergies. In these latter circumstances, well-devised elimination diets followed by physician-supervised oral food challenges are critical in the identification and proper treatment of these disorders. Because childhood food allergies to common allergenic foods such as milk, egg, wheat and soy are usually outgrown, oral food challenges are also an integral part of the long-term management of these children.

Self-reported allergic reactions to peanut on commercial airliners ☆ ☆☆

Abstract: Background: Allergic reactions to food occurring on commercial airlines have not been systematically characterized. Objective: We sought to describe the clinical characteristics of allergic reactions to peanuts on airplanes. Methods: Participants in the National Registry of Peanut and Tree Nut Allergy who indicated an allergic reaction while on a commercial airliner were interviewed by telephone. Results: Sixty-two of 3704 National Registry of Peanut and Tree Nut Allergy participants indicated a reaction on an airplane; 42 of 48 patients or parental surrogates contacted confirmed the reaction began on the airplane (median age of affected subject, 2 years; range, 6 months to 50 years). Of these, 35 reacted to peanuts (4 were uncertain of exposure) and 7 to tree nuts, although 3 of these 7 reacted to substances that may have also contained peanut. Exposures occurred by ingestion (20 subjects), skin contact (8 subjects), and inhalation (14 subjects). Reactions generally occurred within 10 minutes of exposure (32 of 42 subjects), and reaction severity correlated with exposure route (ingestion > inhalation > skin). The causal food was generally served by the airline (37 of 42 subjects). Medications were given in flight to 19 patients (epinephrine to 5) and to an additional 14 at landing/gate return (including epinephrine to 1 and intravenous medication to 2), totaling 79% treated. Flight crews were notified in 33% of reactions. During inhalation reactions as a result of peanut allergy, greater than 25 passengers were estimated to be eating peanuts at the time of the reaction. Initial symptoms generally involved the upper airway, with progression to the skin or further lower respiratory reactions (no gastrointestinal symptoms). Conclusions: Allergic reactions to peanuts and tree nuts caused by accidental ingestion, skin contact, or inhalation occur during commercial flights, but airline personnel are usually not notified. Reactions can be severe, requiring medications, including epinephrine. (J Allergy Clin Immunol 1999;103:186-9.)

Food and drug reactions and anaphylaxis Self-reported allergic reactions to peanut on commercial airliners

Abstract: BACKGROUND Allergic reactions to food occurring on commercial airlines have not been systematically characterized. OBJECTIVE We sought to describe the clinical characteristics of allergic reactions to peanuts on airplanes. METHODS Participants in the National Registry of Peanut and Tree Nut Allergy who indicated an allergic reaction while on a commercial airliner were interviewed by telephone. RESULTS Sixty-two of 3704 National Registry of Peanut and Tree Nut Allergy participants indicated a reaction on an airplane; 42 of 48 patients or parental surrogates contacted confirmed the reaction began on the airplane (median age of affected subject, 2 years; range, 6 months to 50 years). Of these, 35 reacted to peanuts (4 were uncertain of exposure) and 7 to tree nuts, although 3 of these 7 reacted to substances that may have also contained peanut. Exposures occurred by ingestion (20 subjects), skin contact (8 subjects), and inhalation (14 subjects). Reactions generally occurred within 10 minutes of exposure (32 of 42 subjects), and reaction severity correlated with exposure route (ingestion > inhalation > skin). The causal food was generally served by the airline (37 of 42 subjects). Medications were given in flight to 19 patients (epinephrine to 5) and to an additional 14 at landing/gate return (including epinephrine to 1 and intravenous medication to 2), totaling 79% treated. Flight crews were notified in 33% of reactions. During inhalation reactions as a result of peanut allergy, greater than 25 passengers were estimated to be eating peanuts at the time of the reaction. Initial symptoms generally involved the upper airway, with progression to the skin or further lower respiratory reactions (no gastrointestinal symptoms). CONCLUSIONS Allergic reactions to peanuts and tree nuts caused by accidental ingestion, skin contact, or inhalation occur during commercial flights, but airline personnel are usually not notified. Reactions can be severe, requiring medications, including epinephrine.

Cow's milk protein‐specific IgE concentrations in two age groups of milk‐allergic children and in children achieving clinical tolerance

Abstract: Background IgE-mediated cow's milk protein allergy (CMPA) is usually outgrown in children by the age of 3 years. The immunological responses to cow's milk proteins in children who achieve tolerance, in comparison with those who remain allergic, however, are not well described. Objective To compare the level of cow's milk protein-specific IgE among children with documented CMPA under the age of 3 years, another group over the age of 9 years (persistent allergy), and in another group of children in whom clinical tolerance developed. Methods Stored sera from children with CMPA were analysed for IgE antibodies specific for whole cow's milk, casein, whey, α-lactalbumin (ALA), β-lactoglobulin (BLG), and bovine serum albumin (BSA) using the Pharmacia CAP System FEIA. Results Within each group of CMPA children, the concentration of specific IgE antibody to casein proteins was not significantly different from that to whey proteins. However, children in the group with CMPA over 9 years of age had significantly greater concentrations of whole milk (P = 0.02) and casein-specific (P = 0.04) IgE antibodies compared with the group of children with CMPA under age 3 years. Children under the age of 3 years had a higher median concentration of casein-specific IgE (20.2 vs. 5.5, P = 0.04) than another group of 11 children (mean age 3.5 years), who later lost their milk allergy. Out of 16 children who lost sensitivity to milk, 75% had milk-specific IgE levels below 14.3 kUA/L (median, 1.3 kUA/L). Conclusions Although a dominant allergenic milk protein fraction was not identified within either of the two age groups, those with persistent CMPA over age 9 years had significantly elevated levels of milk and casein-specific IgE compared with younger children with CMPA.

Peanut-induced anaphylactic reactions

Abstract: Food allergies, particularly to peanuts, are a common cause of anaphylaxis. Approximately 125 people die each year in the USA secondary to food-induced anaphylaxis. Clinical anaphylaxis is a syndrome of diverse etiology and dramatic presentation of symptoms associated with the classic features of type I, IgE-mediated hypersensitivity [1]. Typically the term anaphylaxis connotes an immunologically-mediated event that occurs after exposure to certain foreign substances. This reaction results from the generation and release of a variety of potent biologically active mediators and their concerted effects on various target organs. Anaphylaxis is recognized by cutaneous, respiratory, cardiovascular, and gastrointestinal signs and symptoms occurring singly or in combination. This article focuses on allergic reactions to peanuts that manifest as signs and symptoms involving multiple target organs or the cardiovascular system alone.

Manifestations of food allergy: evaluation and management

Abstract: The term "food allergy" refers to adverse immunologic reactions to food Food allergy is usually mediated by IgE antibody directed to specific food proteins, but other immunologic mechanisms can also play a role The primary target organs for food allergic reactions are the skin, the gastrointestinal tract and the respiratory system Both acute reactions (hives and anaphylaxis) and chronic disease (asthma, atopic dermatitis and gastrointestinal disorders) may be caused or exacerbated by food allergy The foods most commonly causing these reactions in children are milk, egg, peanuts, soy, wheat, tree nuts, fish and shellfish; in adults, they are peanuts, tree nuts, shellfish and fish The diagnosis of food allergy requires a careful search for possible causes, confirmation of the cause(s) with supporting tests, including specific tests for IgE (ie, prick skin tests, radioallergosorbent tests) and, in some cases, oral food challenges Treatment consists of elimination of the causal food(s) along with medical treatment, including the prompt self-administration of epinephrine in the event of a serious reaction

Severe Mycobacterial and Salmonella Infections In Interleukin-12Receptor-Deficient Patients

Abstract: 1. de Jong R, 2. Altare F, 3. Haagen I-A, 4. et al. (1998) Science. 280:1435–1438. [OpenUrl][1][Abstract/FREE Full Text][2] #### Purpose of the Studies Bacille Calmette-Guerin (BCG) and nontuberculous mycobacteria (NTM) are poorly virulent mycobacteria that sometimes cause disseminated disease in children. It was recently discovered that complete interferon gamma (IFN-γ) receptor deficiency causes a predisposition for this type of infection, and lack of mature granulomas; partial deficiency leads to a milder course of infection with mature granuloma formation. Some patients with disseminated NTM infections, however, do not have this defect. Because interleukin-12 (IL-12) is a potent inducer of IFN-γ, this study evaluated the possibility that IL-12 receptor abnormalities were responsible for disseminated BCG or NTM in the patients without … [1]: {openurl}?query=rft.jtitle%253DScience%26rft.stitle%253DScience%26rft.issn%253D0036-8075%26rft.aulast%253DJong%26rft.auinit1%253DR.%2Bd.%26rft.volume%253D280%26rft.issue%253D5368%26rft.spage%253D1435%26rft.epage%253D1438%26rft.atitle%253DSevere%2BMycobacterial%2Band%2BSalmonella%2BInfections%2Bin%2BInterleukin-12%2BReceptor-Deficient%2BPatients%26rft_id%253Dinfo%253Adoi%252F10.1126%252Fscience.280.5368.1435%26rft_id%253Dinfo%253Apmid%252F9603733%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=sci&resid=280/5368/1435&atom=%2Fpediatrics%2F104%2FSupplement_2%2F397.3.atom