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JACI Highlights - July 2004
New Developments in food allergy: Old questions remain
Dr Lack In recent years there have been substantial advances in our understanding of food allergies. Thus the May and June issues of Journal of Allergy and Clinical Immunology comprise 17 original articles and editorials relating to new developments in the orders of food allergies, their diagnosis, management and extent of new food allergies in the population. These are highlighted in an editorial article by Dr Lack in the July issue of the journal. There are several key messages that emerge. Up to 6% of children in the US and 4% of the adult population appear to suffer from IgE mediated food allergy. This clearly represents an increase over the past few decades. One article by Dr Sicherer and colleagues highlights the importance of fish and shellfish allergy which has been found in a recent large telephone in the United Stated to affect 2.3% of the population. These allergies occur largely in adults and they are significant in that they can cause severe anaphylactic reactions. Clinicians have been aware for many years that minute amounts of peanut exposure can lead to the development of peanut allergy. Perry and colleagues measured peanut protein on table surfaces and on the hands of people eating peanuts after using various cleaning techniques. They also looked at the amount of peanut that can be measured in the air during naturally occurring exposure. They found that while most cleaning agents remove peanut allergen from table tops, peanut allergen was detectable on a third of table tops after cleaning with dish washing liquid. Furthermore, peanut was detectable on a quarter of people's hands after washing with water alone and on half of hands after washing with a hand sanitizer. Soap and water completely eliminated peanut presence on the hands. No aerosolised peanut was detected in the air during naturally occurring situations. This article illustrates both how peanut adheres to human skin and to kitchen surfaces and can lead to clinical reactions through indirect exposure. This indirect exposure is an important cause of allergic reactions. Simple hand washing measures with soap and water and cleaning of table surfaces will remove detectable allergen from all surfaces. This is good news for patients with peanut allergy and should comprise part of patient management and education about how to avoid peanut allergen. Worryingly however these findings raise the possibility that low levels of exposure to peanut in the environment might actually lead to sensitization, the process whereby a persons immune response is switched on to develop peanut allergy. Dr Simons highlights the importance of injectable Epinephrine (EpiPen) and points out the important point that currently that we do not have sufficient does of automated injections for patients. Developing different ranges of doses, more suitable particularly for the pediatric population, is an important priority.
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