title: Can we identify patients at risk of life-threatening allergic reactions to food?
abstract: Anaphylaxis has been defined as a 'severe, life-threatening generalized or systemic hypersensitivity reaction'. However, data indicate that the vast majority of food-triggered anaphylactic reactions are not life-threatening. Nonetheless, severe life-threatening reactions do occur and are unpredictable. We discuss the concepts surrounding perceptions of severe, life-threatening allergic reactions to food by different stakeholders, with particular reference to the inclusion of clinical severity as a factor in allergy and allergen risk management. We review the evidence regarding factors that might be used to identify those at most risk of severe allergic reactions to food, and the consequences of misinformation in this regard. For example, a significant proportion of food-allergic children also have asthma, yet almost none will experience a fatal food-allergic reaction; asthma is not, in itself, a strong predictor for fatal anaphylaxis. The relationship between dose of allergen exposure and symptom severity is unclear. While dose appears to be a risk factor in at least a subgroup of patients, studies report that individuals with prior anaphylaxis do not have a lower eliciting dose than those reporting previous mild reactions. It is therefore important to consider severity and sensitivity as separate factors, as a highly sensitive individual will not necessarily experience severe symptoms during an allergic reaction. We identify the knowledge gaps that need to be addressed to improve our ability to better identify those most at risk of severe food-induced allergic reactions.
authors.affiliation: Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.
authors.forename: P J
authors.identifier: 0000-0001-9862-5161
authors.initials: PJ
authors.lastname: Turner
authors.affiliation: Food Allergy Research and Resource Program, Department of Food Science and Technology, University of Nebraska, Lincoln, NE, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Baumert
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Beyer
authors.affiliation: Section of Paediatrics (Allergy and Infectious Diseases) & MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Boyle
authors.affiliation: Food Standards Agency, London, UK.
authors.forename: C-H
authors.initials: CH
authors.lastname: Chan
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Clark
authors.affiliation: Safety and Environmental Assurance Centre, Unilever, Colworth Science Park, Sharnbrook, Bedford, UK.
authors.forename: R W R
authors.initials: RW
authors.lastname: Crevel
authors.affiliation: Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: DunnGalvin
authors.affiliation: Servicio de Alergia, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Rivas
authors.affiliation: Allergy Action, Farnborough, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Gowland
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Grabenhenrich
authors.affiliation: Food Standards Agency, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hardy
authors.affiliation: TNO, Zeist, The Netherlands.
authors.forename: G F
authors.initials: GF
authors.lastname: Houben
authors.affiliation: Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: O'B Hourihane
authors.affiliation: Department of Paediatrics, Centre for Food Allergy Diagnosis and Treatment, University of Padua, Veneto, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Muraro
authors.affiliation: Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark.
authors.forename: L K
authors.initials: LK
authors.lastname: Poulsen
authors.affiliation: Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: Pyrz
authors.affiliation: TNO, Zeist, The Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: Remington
authors.affiliation: German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)), Mönchengladbach, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schnadt
authors.affiliation: Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Ree
authors.affiliation: School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.|The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
authors.forename: C
authors.initials: C
authors.lastname: Venter
authors.affiliation: Allergy-Center Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Worm
authors.affiliation: Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK.
authors.forename: E N C
authors.initials: EN
authors.lastname: Mills
authors.affiliation: The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.|NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust and Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK.
authors.forename: G
authors.initials: G
authors.lastname: Roberts
authors.affiliation: Allergy Unit, Department of Dermatology, University Hospital, University Zürich, Zürich, Switzerland.
authors.forename: B K
authors.initials: BK
authors.lastname: Ballmer-Weber
mesh_terms: D000485:Allergens / Q000276:immunology*; D000707:Anaphylaxis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D000818:Animals; D005502:Food / Q000009:adverse effects*; D005511:Food Handling / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology; D005525:Food-Processing Industry / Q000331:legislation & jurisprudence / Q000592:standards; D006801:Humans; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D000485:Allergens
keywords: anaphylaxis; food allergy; risk assessment