title: Food-induced anaphylaxis: mast cells as modulators of anaphylactic severity.
abstract: A food-induced anaphylactic reaction can occur within seconds to a few hours following exposure to the causal food allergen and often affects multiple organ systems including gastrointestinal, cutaneous, respiratory, and cardiovascular. A conundrum in the allergy field is that consumption of the same allergen can cause reactions of vastly different severity in separate individuals; one patient may experience a mild non-life-threatening reaction characterized by pruritis of lips or urticaria whereas another may experience a life-threatening reaction that involves respiratory and cardiovascular compromise leading to loss of consciousness and sometimes death. While there are tests available to determine the predictive risk value of a positive food challenge test or clinical reactivity, there is currently no reliable method to distinguish between individuals who are at risk of mild non-life-threatening versus life-threatening reaction. Recent research has significantly advanced our understanding of the involvement of immune pathways in the effector phase of food-induced anaphylaxis; a void remains regarding our understanding of the contribution of these pathways to severity of disease. In this review, we discuss mild non-life-threatening versus life-threatening food-induced anaphylaxis and factors (co-morbidities and immune activation) that predispose individuals to more severe disease. Furthermore, we summarize recent advancements in our understanding of the involvement of underlying immune pathways in systemic and food-induced anaphylaxis in mouse systems and discuss how these pathways may contribute to more severe disease phenotype.
authors.affiliation: Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA. simon.hogan@cchmc.org
authors.forename: Simon P
authors.initials: SP
authors.lastname: Hogan
authors.forename: Yui Hsi
authors.initials: YH
authors.lastname: Wang
authors.forename: Richard
authors.initials: R
authors.lastname: Strait
authors.forename: Fred D
authors.initials: FD
authors.lastname: Finkelman
mesh_terms: D000485:Allergens / Q000009:adverse effects* / Q000276:immunology; D000707:Anaphylaxis / Q000209:etiology / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D000818:Animals; D005502:Food / Q000009:adverse effects*; D008047:Lip Diseases / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000473:pathology; D008407:Mast Cells / Q000276:immunology* / Q000473:pathology; D051379:Mice; D011537:Pruritus / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000473:pathology; D012720:Severity of Illness Index; D014581:Urticaria / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000473:pathology
chemical_list: D000485:Allergens