Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry
Sabine Dölle, Veronika Höfer, Wojciech Francuzik, Anatol‐Fiete Näher, Maria Beatrice Bilò, Ewa Cichocka‐Jarosz, Lucila Camargo Lopes de Oliveira, Montserrat Fernández‐Rivas, Blanca E. García, Karin Hartmann, Uta Jappe, Alice Köhli, Lars Lange, Ioana Maris, Tihomir B. Mustakov, Katja Nemat, Hagen Ott, Nikolaos G. Papadopoulos, Claudia Pföhler, Franziska Ruëff, D. Sabouraud-Leclerc, Thomas Spindler, Philippe Stock, Regina Treudler, Christian Vogelberg, Nicola Wagner, Margitta Worm
Abstract
Background Food is one of the most common elicitors of anaphylaxis, with an increasing incidence over recent years. Objectives To characterize elicitor-specific phenotypes and identify factors enhancing the risk or severity of food-induced anaphylaxis (FIA). Methods We analyzed data from the European Anaphylaxis Registry applying an age- and sex-matched analysis of associations (Cramer’s V) for single food triggers and calculated odds ratios (ORs) for severe FIA. Results We identified 3,427 cases of confirmed FIA showing an age-dependent elicitor ranking (for children: peanut, cow’s milk, cashew, and hen’s egg; and for adults: wheat flour, shellfish, hazelnut, and soy). The age- and sex-matched analysis revealed defined symptom patterns for wheat and cashew. Wheat-induced anaphylaxis was more frequently associated with cardiovascular symptoms (75.7%; Cramer’s V = 0.28) and cashew-induced anaphylaxis with gastrointestinal symptoms (73.9%; Cramer’s V = 0.20). Furthermore, concomitant atopic dermatitis was slightly associated with anaphylaxis to hen’s egg (Cramer’s V = 0.19) and exercise was strongly associated with anaphylaxis to wheat (Cramer’s V = 0.56). Additional factors influencing the severity were alcohol intake in wheat anaphylaxis (OR = 3.23; CI, 1.31-8.83) and exercise in peanut anaphylaxis (OR = 1.78; CI, 1.09-2.95). Conclusions Our data show that FIA is age-dependent. In adults, the range of elicitors inducing FIA is broader. For some elicitors, the severity of FIA seems to be related to the elicitor. These data require confirmation in future studies considering a clear differentiation between augmentation and risk factors in FIA. Food is one of the most common elicitors of anaphylaxis, with an increasing incidence over recent years. To characterize elicitor-specific phenotypes and identify factors enhancing the risk or severity of food-induced anaphylaxis (FIA). We analyzed data from the European Anaphylaxis Registry applying an age- and sex-matched analysis of associations (Cramer’s V) for single food triggers and calculated odds ratios (ORs) for severe FIA. We identified 3,427 cases of confirmed FIA showing an age-dependent elicitor ranking (for children: peanut, cow’s milk, cashew, and hen’s egg; and for adults: wheat flour, shellfish, hazelnut, and soy). The age- and sex-matched analysis revealed defined symptom patterns for wheat and cashew. Wheat-induced anaphylaxis was more frequently associated with cardiovascular symptoms (75.7%; Cramer’s V = 0.28) and cashew-induced anaphylaxis with gastrointestinal symptoms (73.9%; Cramer’s V = 0.20). Furthermore, concomitant atopic dermatitis was slightly associated with anaphylaxis to hen’s egg (Cramer’s V = 0.19) and exercise was strongly associated with anaphylaxis to wheat (Cramer’s V = 0.56). Additional factors influencing the severity were alcohol intake in wheat anaphylaxis (OR = 3.23; CI, 1.31-8.83) and exercise in peanut anaphylaxis (OR = 1.78; CI, 1.09-2.95). Our data show that FIA is age-dependent. In adults, the range of elicitors inducing FIA is broader. For some elicitors, the severity of FIA seems to be related to the elicitor. These data require confirmation in future studies considering a clear differentiation between augmentation and risk factors in FIA.