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Different Triggers for the Diagnosis of Individual Food Allergies in Multiple Food Allergic Patients
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
Arnon Elizur, MD, Jennifer B Bollyky, MD, Whitney Block, MSN, CPNP, FNP-BC, Kari C. Nadeau, MD PhD FAAAAI
Rationale:

The diagnosis of IgE-mediated food allergy is typically triggered by a reaction to a specific food followed by identification of food specific IgE. It is unclear whether the same algorithm applies for patients with multiple food allergies.

Methods:

Multiple food-allergic patients enrolled in oral immunotherapy research study (n=60), were asked about the event that prompted their allergy evaluation, reasons for eliminating various foods, any previous reactions, and diagnostic tests performed for each food. Differences between various food items were examined.

Results:

Patients were diagnosed with a mean of 8+/-1.7 food allergies (peanut, n=50; walnut, n=58; pecan, n=58; cashew, n=58; pistachio, n=58; hazelnut, n=58; almond, n=47; egg, n=30; milk, n=29; sesame, n=23; soy, n=9 and wheat, n=5). Allergy evaluation was triggered by a suspected reaction to a specific or non-specific food (73.3% and 11.7% of patients, respectively), eczema (21.6%) or by other symptoms (rectal bleeding, repeated emesis or family history of food allergy) in 10%. While milk-allergy diagnosis was triggered by a previous reaction in most cases (55%), it occurred in 20-30% in patients with peanuts, egg, wheat, sesame and soy allergies and in <10% of tree-nuts. Cross contamination fear was the trigger for eliminating tree-nuts in 35-45% of the patients compared to <10% in other foods. No exposure was ever recorded to most eliminated foods.

Conclusions:

Most patients with multiple food allergies reacted to a single food but additional food allergies were diagnosed based on sensitization only or cross contamination fear. This practice may lead to un-necessary and potentially harmful elimination diets.