Kirsi M. Järvinen


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

In This Article

Which Foods?

Peanut, tree nuts, fish, and shellfish are the most commonly implicated foods in anaphylaxis, although milk is a common trigger in children (Table 2).[18,32,33,39•,40–43] In addition, lipid transfer protein has been reported as the most common food to induce anaphylaxis in southern Europe.[40] Galactose-alpha-1,3-galactose (α-gal), a carbohydrate commonly expressed on nonprimate mammalian proteins, has been identified as a trigger in late-onset anaphylaxis or urticaria.[44••]

Most of the anaphylactic reactions occur to ingested food allergens; however, reports on anaphylaxis to inhaled food allergens have been reported including fish, shellfish, seeds, soybeans, cereal grains, egg, milk, and other foods in the form of allergen flour in the air and vapors during cooking or roasting.[45] However, skin exposure to or inhalation of peanut butter did not result in systemic or respiratory reactions in highly peanut-sensitized children.[46]

Most known food allergens are proteins that are resistant to enzymatic digestion and heat, and therefore, the allergenicity of food can be modified by the degree of enzymatic digestion and heating.[25] Underdigestion of food proteins places patients with food allergy at a higher risk for more severe allergic reactions.[47,48] In wheat-dependent, exercise-induced anaphylaxis, exercise induces the activation of tissue transglutaminase. This results in generation of high molecular weight complexes of omega-5 gliadin, a wheat allergen, that bind IgE with increased intensity leading to activation of mast cells and anaphylaxis.[49] Heating egg and milk proteins results in tolerance by 70–75% of patients who otherwise react to nonheated egg or milk, which is likely due to modification of the protein structure.[50,51] Children reactive to extensively heated milk (but not egg) were at higher risk for systemic reactions treated with epinephrine than those children tolerant to heated milk but reactive to unheated milk.[50,51]


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