Davis, P.A., M. Jenab, J.P. Vanden Heuvel, T. Furlong, S. Taylor, 2008. Tree nut and peanut consumption in relation to chronic and metabolic diseases including allergy. J. Nutr. 138: 1757S-1762S.
The New and Emerging Research session highlighted the emerging understanding of both the positive and negative effects of nuts consumption on health. The limited nature of both experimental and epidemiological evidence for positive relationship(s) between nut intake and health were noted. Study inconsistency and limitations, particularly survey methodology, were explored. Recent results from epidemiologic studies indicating a potential negative association between nut and seed intake and cancer risk were reviewed. The ability of walnuts to reduce endothelin suggests an interesting biochemical mechanism of nut action that may affect other endothelin-associated diseases, which should be further explored. The effects of nuts and their constituents on a nuclear receptor screen (PPAR, β/, , LXR, β, RXR, β, , PXR, and FXR) have been explored. Nut allergenicity and approaches necessary to minimize this effect were also described. In contrast to the positive effects, nut allergies present tree nut-allergic consumers with health challenges. The Food Allergy and Anaphylaxis Network stressed the importance of ensuring that consumers with food allergies have legible, accurate food labels. The Food Allergen Labeling and Consumer Protection Act has engendered precautionary, worst-case allergen scenario labeling statements with unknown benefits to consumer health. Issues of cross-contamination due to shared equipment and shared facilities highlighted the need to rely on allergen control programs that use ELISA technology and have increased understanding of nut allergens. Ultimately, to maximize the positive benefits of nuts, the consumer must be provided with all the information required to make an informed choice.
Vierk, K.A., K.M. Koehler, S.B. Fein, D.A. Street, 2007. Prevalence of self-reported food allergy in American adults and use of food labels. J Allergy Clin Immunol. 119:1504-10.
Background: Few population-based studies in the United States have determined the prevalence of food allergy in adults and the problems these individuals might have with reading food labels. Objective: The objectives of this study are to report the prevalence of self-reported food allergy, to identify the characteristics of food allergy reactions, and to describe the use of labels among adults with food allergy. Methods: Questions from the US Food and Drug Administration’s 2001 Food Safety Survey were analyzed to determine the prevalence of food allergy and opinions about food labels in the management of food allergy. Results: The prevalence of self-reported food allergy is 9.1% among all survey respondents, with 5.3% of all respondents reporting a doctor-diagnosed food allergy. The prevalence of food allergy to the 8 most common allergens (peanut, tree nuts, egg, milk, wheat, soybeans, fish, and crustacean shellfish) is self-reported as 2.7% among respondents with doctors’ diagnoses. Several label issues, such as words on some ingredient lists being too technical or hard to understand and food labels not always alerting persons to new ingredients, were reported as serious or very serious obstacles for managing an allergy. Conclusion: The prevalence of self-reported doctor-diagnosed food allergy among US adults is 5.3%, and a large portion of adults with food allergy found certain label issues a serious problem for managing their food allergy. Clinical implications: The findings provide a needed source of population-based prevalence data of food allergy among US adults. Label issues identified are useful in understanding the difficulties of managing a food allergy.
Fleischer, D.M., 2007. The natural history of peanut and tree nut allergy. Current Allergy and Asthma Reports. 7:175–181.
Peanut and tree nut allergies were once thought to be permanent. Recent studies have shown that about 20% and 10%, respectively, of young patients may outgrow peanut and tree nut allergies. For the majority of patients, however, the natural history is not favorable. In addition, approximately 8% of patients who outgrow peanut allergy may suffer a recurrence. The rising prevalence of these allergies, coupled with the knowledge that allergic reactions to these foods have the potential to be severe or fatal and that accidental exposures are common, makes developing effective treatments to alter the natural history of peanut and tree nut allergies even more crucial for those who will not outgrow them. At this time, avoidance of the offending foods and being prepared to treat a potential reaction after accidental ingestion is the only treatment, but many promising therapeutic interventions are being investigated.
Clark, A.T., K. Anagnostou, P. W. Ewan, 2007. Cashew nut causes more severe reactions than peanut: case matched comparison in 141 children. Allergy. 62:913–916.
Background: Cashew nut allergy is becoming common, but the risk of severe reactions in comparison with peanut allergy is unknown. Method: A case-matching study of children with a recent history of a reaction after definite nut ingestion, with positive skin prick test. Children whose worst ever reaction was to cashew nut (cashew group), were matched with two children each whose worst ever reaction was to peanut (peanut group) for sex, age of reaction and presentation, amount ingested, and asthma. Severity of the worst clinical reactions to date was compared. Results: A total of 47 children in the cashew group were matched to 94 in the peanut group. There were no differences in clinical features between groups for matching criteria, except asthma (more prevalent in the peanut group). Wheezing and cardiovascular symptoms were reported more frequently during reactions in the cashew compared with the peanut group: odds ratios (OR) 8.4 (95% CI: 3.2–22.0) and 13.6 (95% CI: 5.6–32.8), respectively. The cashew group received intramuscular adrenaline more frequently: OR 13.3 (95% CI: 5.5–32.2). Overall, the OR for a severe reaction (severe dyspnoea and/or collapse) in the cashew group was 25.1 (95% CI: 3.1–203.5). Conclusions: Previous studies show cashew nut can cause severe reactions; this is the first study to show by case-matching that severe clinical reactions occur more frequently in cashew compared with peanut allergy. The nut type which caused the worst reaction to date should be considered when providing emergency medication.
Rona, R.J., T. Keil, C. Summers, D. Gislason, L. Zuidmeer, E. Sogergren, S.T. Sigurdardottir, T. Lindner, K. Goldhahn, J. Dahlstrom, D. McBride, C. Madsen, 2007. The prevalence of food allergy: a meta-analysis. Allergy Clin Immunol. 120:638-646.
Background: There is uncertainty about the prevalence of food allergy in communities. Objective: To assess the prevalence of food allergy by performing a meta-analysis according to the method of assessment used. Methods: The foods assessed were cow’s milk, hen’s egg, peanut, fish, shellfish, and an overall estimate of food allergy. We summarized the information in 5 categories: self-reported symptoms, specific IgE positive, specific skin prick test positive, symptoms combined with sensitization, and food challenge studies. We systematically searched MEDLINE and EMBASE for publications since 1990. The meta-analysis included only original studies. They were stratified by age groups: infant/preschool, school children, and adults. Results: A total of 934 articles were identified, but only 51 were considered appropriate for inclusion. The prevalence of self-reported food allergy was very high compared with objective measures. There was marked heterogeneity between studies regardless of type of assessment or food item considered, and in most analyses this persisted after age stratification. Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food. Conclusion: There is a marked heterogeneity in the prevalence of food allergy that could be a result of differences in study design or methodology, or differences between populations. Clinical implications: We recommend that measurements be made by using standardized methods, if possible food challenge. We need to be cautious in estimates of prevalence based only on self-reported food allergy.
Vlieg-Boerstra, B.J., S. van der Heide, C.M.A. Bijleveld, J. Kukler, E.J. Duiverman, S.A.A. Wolt-Plompen, A.E.J. Dubois, 2006. Dietary assessment in children adhering to a food allergen avoidance diet for allergy prevention. European Journal of Clinical Nutrition. 60:1384–1390.
Objective: The purpose of this investigation was to verify if avoidance of allergenic foods in children adhering to a food allergen avoidance diet from birth was complete and feasible, and whether dietary assessment can be used as a tool in predicting the outcome of double-blind, placebo-controlled food challenges (DBPCFCs). Design: Children adhering to an allergen avoidance diet from birth underwent DBPCFCs. The investigator-dietician verified whether the elimination was complete, using food frequency questionnaires for common allergenic foods. Setting: University Medical Centre Groningen, the Netherlands. Subjects: Thirty-eight children aged 1–13 years, who were consecutively referred to the University Medical Centre Groningen for DBPCFC between January 2002 and February 2004. Results: Among the 38 children undergoing DBPCFCs, there were 15 challenges with egg, 15 with peanut, five with hazelnut and three with soy. Fifteen food challenges (39%) were positive. Small quantities of allergenic foods were inadvertently present in the diets of 13 patients (34%), were possibly present in the diets of 14 patients (37%) and could not be identified in the diets of 11 patients (29%). Seven patients (54%) who had inadvertently ingested small quantities of allergenic foods without sequelae had a positive DBPCFC. Conclusion: Dietary avoidance was incomplete and not feasible in most cases. Tolerance of small amounts of allergenic foods does not preclude positive challenge reactions. Dietary assessment does not seem a useful tool in predicting the outcome of DBPCFC in children adhering to an elimination diet. Sponsorship: The Stichting Astma Bestrijding (Foundation for the Prevention of Asthma), The Netherlands.
Sicherer, S.H., D.Y.M. Leung, 2006. Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects. J Allergy Clin Immunol. 118:170-177.
This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin disease that were reported primarily in the Journal in 2005. Although studies documented deficiencies in community management of anaphylaxis, guidelines and National Institutes of Health summary reports provide direction toward improved research and education. At least 9% of young children ‘‘outgrow’’ a tree nut allergy. Advances in food allergy diagnosis include reports of probability of reactions to peanut at various peanut-specific IgE concentrations and skin test response size and the utility of evaluating IgE binding to specific epitopes. Future food allergy treatments might include selection of ‘‘less allergenic’’ fruit cultivars, genetic silencing of major allergens, and treatment of allergic patients with Chinese herbal remedies. Osteopontin might be a useful biomarker for success of venom immunotherapy. Progress in our understanding of the immunology of atopic dermatitis and autoimmune urticaria has also been made. These observations will likely contribute toward optimizing management of these common allergic disorders.
Lee, L.A., A.Wesley Burks, 2006. Food allergies: prevalence, molecular characterization, and treatment/prevention strategies. Annu Rev Nutr. 26:3.1–3.27.
A significant proportion of the population is either affected by or concerned about food allergy. Our knowledge about food allergens and how they stimulate the immune system has increased dramatically over the past decade. However, reasons for the increased prevalence of food allergy are not clear. The diagnosis of food allergy requires that the patient and caregivers examine all foods for the presence of potential allergens in order to prevent inadvertent ingestion and further reactions. Fortunately, many children develop tolerance to allergenic foods after a period of dietary elimination. Various immunotherapy approaches are under investigation to alleviate or prevent food-induced reactions in those who have persistent food allergies.
Crespo, J.F., J.M. James, C. Fernandez-Rodriguez, J. Rodriguez, 2006. Food allergy: nuts and tree nuts. British Journal of Nutrition. 96, Suppl. 2, S95-S102.
Nuts are a well-defined cause of food allergy, which affect approximately 1% of the general population in the UK and the USA. There do appear to be differences in the frequency of nut allergy between different countries because of different dietary habits and cooking procedures. For example, in the USA and France, peanuts are one of the most frequent causes of food allergy, but in other countries, it seems to be less common. Genetic factors, in particular, appear to play a role in the development of peanut allergy. While the majority of nut allergens are seed storage proteins, other nut allergens are profilins and pathogenesis-related protein homologues, considered as panallergens because of their widespread distribution in plants. The presence of specific IgE antibodies to several nuts is a common clinical finding, but the clinical relevance of this cross-reactivity is usually limited. Allergic reactions to nuts appear to be particularly severe, sometimes even life-threatening, and fatal reactions following their ingestion have been documented. Food allergy is diagnosed by identifying an underlying immunological mechanism (i.e. allergic testing), and establishing a causal relationship between food ingestion and symptoms (i.e. oral challenges). In natural history investigations carried out in peanut-allergic children, approximately 20% of the cases outgrew their allergy or developed oral tolerance. The treatment of nut allergies should include patient and family education about avoiding all presentations of the food and the potential for a severe reaction caused by accidental ingestion. Patients and families should be instructed how to recognize early symptoms of an allergic reaction and how to treat severe anaphylaxis promptl
Sathe, S.K., H.H. Kshirsagar, K.H. Roux, 2005. Advances in seed protein research: A perspective on seed allergens. J Food Sci. 70(6):r93–r120.
For various reasons, a considerable majority of the global population must rely on plant proteins obtained from cereals, legumes (including oilseeds), fruits, vegetables, and nuts to satisfy dietary protein needs and requirements. Edible seeds are a significant source of proteins in livestock production and in the manufacture of pet foods. In addition, edible seeds are important sources of carbohydrates (including dietary fiber), minerals, and certain vitamins in human and animal food supply. For various reasons, edible seeds are underutilized as human food. To fully exploit this renewable natural resource to its full potential, focused research efforts are warranted. With increased number of seed proteins being identified as food allergens, renewed interest in seed proteins is evident. In this article, a brief overview of seed proteins with special reference to their allergenicity is provided. An attempt is made to identify areas needing further research.
