Kirsi M. Järvinen


Curr Opin Allergy Clin Immunol. 2011;11(3):255-261. 

In This Article

Who is at Risk?

The majority of patients with food-induced anaphylaxis have a prior history of a reaction to foods.[18,26,27] Among children with a known food allergy, 16–18% developed a reaction at school,[28,29] and 60% of those with a known peanut allergy had an accidental peanut exposure in 5 years.[30] However, also patients without a known allergy may be at risk for food-induced anaphylaxis. Among peanut-allergic and tree nut-allergic reactions, 25% occurred in patients without a known allergy.[29]

Patients with asthma and adolescents are at increased risk for severe food anaphylaxis.[3,31–33] Although data have not been reproduced, the severity of co-existing other atopic diseases has also been associated with likelihood of developing life-threatening allergic reactions to peanut and tree nuts.[34] It has been appreciated that reactions generally worsen as children get older and with development of asthma.[35] Adolescents and young adults are also at higher risk as they engage in risky behaviors and often deny symptoms.[36] Furthermore, use of β-blockers, angiotensin-converting enzyme (ACE) or monoamine oxidase inhibitors, or tricyclic antidepressants may diminish the efficacy of epinephrine or increase the severity of anaphylactic reactions.[35,37]

Although the allergy tests correlate with the risk of reactivity to foods, they do not correlate with the severity of reactions. However, recognition of more numerous IgE-binding epitopes by patients' specific IgE antibodies increases the likelihood of a more severe reaction.[38] It has also been shown that ACE concentrations are significantly lower in peanut-induced and tree nut-induced anaphylactic reactions, which progressed into severe pharyngeal edema.[34]


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