Highlights in Nonhymenoptera Anaphylaxis
Highlights in Nonhymenoptera Anaphylaxis
Purpose of Review: The purpose of this review is to summarize new interesting findings in both research and clinical practice of nonhymenoptera anaphylaxis with particular emphasis on food and drug allergy.
Recent Findings: Recent findings include some aspects of crossreactivity among betalactams, nonsteroidal anti-inflammatory drugs with special attention to an immunogenic metabolite of diclofenac and the mode of diclofenac-induced basophil degranulation. Also, new insights into the sometimes atypical anaphylaxis-like reactions after administration of monoclonal antibodies and the immunologic response to these molecules will be discussed, as well as the role of low-dose pholcodine exposure on the development of sensitization to neuromuscular blocking agents.
In food-related anaphylaxis, a significant increase of incidents has been observed over the last few years, especially among children of less than 5 years of age. Unfortunately, the severity of subsequent reactions cannot be predicted from the reaction history. Tree nuts and peanuts are the most important elicitors of fatal food-induced anaphylaxis.
Summary: In food-related anaphylaxis, prospectively evaluated marker allergens that are indicative of a potential anaphylactic reaction are still lacking. The drug groups covered in this review are of special interest either due to their prominent role as allergens or due to new findings.
In 2001, European Academy of Allergology and Clinical Immunology (EAACI) published a rather broad definition of anaphylaxis with the aim of harmonizing the manifold meanings that have been attributed to this term. In 2004, the World Allergy Organization (WAO) accepted this definition for global use. On the basis of that definition, this review will cover new insights and developments in 'severe, life-threatening, generalized or systemic hypersensitivity reactions caused by allergic, both immunoglobulin (Ig)E-mediated and non-IgE-mediated, or nonallergic mechanisms', elicited by either food or drugs. In a review of 601 patients suffering from anaphylaxis - excluding cases resulting from Hymenoptera stings or immunotherapy - Webb and Lieberman found food (22%) and medication (11%) to be the two most common elicitors of anaphylaxis apart from 59% of so-called idiopathic anaphylaxis cases. The survey done by Brown of 1149 anaphylactic reactions of all origins identified 22% drug-induced and 18% food-related anaphylaxes.
Abstract and Introduction
Abstract
Purpose of Review: The purpose of this review is to summarize new interesting findings in both research and clinical practice of nonhymenoptera anaphylaxis with particular emphasis on food and drug allergy.
Recent Findings: Recent findings include some aspects of crossreactivity among betalactams, nonsteroidal anti-inflammatory drugs with special attention to an immunogenic metabolite of diclofenac and the mode of diclofenac-induced basophil degranulation. Also, new insights into the sometimes atypical anaphylaxis-like reactions after administration of monoclonal antibodies and the immunologic response to these molecules will be discussed, as well as the role of low-dose pholcodine exposure on the development of sensitization to neuromuscular blocking agents.
In food-related anaphylaxis, a significant increase of incidents has been observed over the last few years, especially among children of less than 5 years of age. Unfortunately, the severity of subsequent reactions cannot be predicted from the reaction history. Tree nuts and peanuts are the most important elicitors of fatal food-induced anaphylaxis.
Summary: In food-related anaphylaxis, prospectively evaluated marker allergens that are indicative of a potential anaphylactic reaction are still lacking. The drug groups covered in this review are of special interest either due to their prominent role as allergens or due to new findings.
Introduction
In 2001, European Academy of Allergology and Clinical Immunology (EAACI) published a rather broad definition of anaphylaxis with the aim of harmonizing the manifold meanings that have been attributed to this term. In 2004, the World Allergy Organization (WAO) accepted this definition for global use. On the basis of that definition, this review will cover new insights and developments in 'severe, life-threatening, generalized or systemic hypersensitivity reactions caused by allergic, both immunoglobulin (Ig)E-mediated and non-IgE-mediated, or nonallergic mechanisms', elicited by either food or drugs. In a review of 601 patients suffering from anaphylaxis - excluding cases resulting from Hymenoptera stings or immunotherapy - Webb and Lieberman found food (22%) and medication (11%) to be the two most common elicitors of anaphylaxis apart from 59% of so-called idiopathic anaphylaxis cases. The survey done by Brown of 1149 anaphylactic reactions of all origins identified 22% drug-induced and 18% food-related anaphylaxes.
