Symptoms and food allergies Discover the connectiondiagnostics.thermofisher.com/content/dam/diagnostics/en/... · 2020. 7. 12. · Specific IgE blood testing helps you diagnose allergy,

Specific IgE blood testing helps you diagnose allergy, allowing you to prepare a management plan.

Symptoms and food allergies

Discover the connection

Mike commonly experiences G.I. symptoms, and his parents don’t know why

Milk

Wheat bread

Egg

Soy milk

FOOD ALLERGY

Disc ver theCONNECTI N


DISCOVER THE

CONNECTION

32

Food allergies: A serious health problem

Food allergies are among the most common allergic disorders

• The prevalence of food allergies is estimated to be 3-7%1-3

Food allergies negatively impact quality of life for patients and caregivers

Social isolation

among children due to food restrictions

Anxiety among children

and parents regarding school attendance and

social events

Evaluation of food allergies improved patient management and overall well-being1

Common food allergy symptoms—different causes

ECZEMA

GI SYMPTOMS

FAILURE TO THRIVEANAPHYLAXIS

TINGLING OR ITCHING

IN THE MOUTH

RESPIRATORY SYMPTOMS

Is it allergy?

• Food allergy is self-reported 6 times more often than its actual prevalence, causing unnecessary worry4

• Gastrointestinal (GI) symptoms caused by food intolerance, lactose intolerance, celiac disease, or irritable bowel syndrome (IBS) are often confused with food allergy5,6

Specific IgE testing helps identify IgE sensitization to food



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54

The higher the sIgE, the more likely it is contributing to symptoms but even very low levels can contribute to symptoms.1,9

* Factors to consider for a final diagnosis: age, degree of atopy, allergen load, type of sensitizing allergens, previous symptoms, other triggering factors.

Pro

port

ion

of in

divi

dual

s w

ith

sym

ptom

atic

alle

rgy

(pro

babi

lity

%)

100

80

60

40

20

0

0.1 0.3 1 3 10 30 100

Low

Common

High

Very high

Symptom relation Uncommon

sIgE antibody concentration (kUA/l)

Specific IgE blood testing can easily be performed irrespective of a patient’s age, skin condition, medication,

disease activity, and/or pregnancy status

As in all diagnostic testing, any diagnosis or treatment plan must be made by the physician based on test results, individual patient history, the physician’s knowledge of the patient, and the physician’s clinical judgement.

Specific IgE blood testing results plus case history improves confidence in diagnosis

Case history alone may not be enough...

NIH Guidelines advise that diagnosis should be based on case history in combination with diagnostic testing1

Confidence in diagosis has been shown to increase when specificIgE results are added to clinical history7,8

Study among patients with symptoms of eczema, wheezing and/or asthma, and rhinitis in primary care.7,8

Adapted from: Duran-Tauleria E. Allergy 2004; 59 (suppl 78): 35-41. Niggemann B. Pediatr Allergy Immunol. 2008; 19:325-331.

100

75

50

25

0

50%

90%

Case history only

% o

f pat

ient

s

(n=1101)Addition ofSpecific IgE



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76

Discover the most common food allergies

Eight allergens account for 90% of food allergies in children/young people1,6

Specific IgE blood test provides a simple approach to support a comprehensive allergy diagnosis

WHEAT PEANUTS

SOY TREE NUTS

SHELLFISH EGG

MILK FISH 1 WHOLE ALLERGENS

• Identifies food sensitization

2• Helps

identify the individual proteins causing the symptoms

ALLERGENCOMPONENTS

ALLERGENCOMPONENTS

Knowing which protein your patient is sensitized to can help you develop a management plan.12,14-18

A specific IgE blood test that detects sensitization to cow’s milk is the first step in discovering your patient’s allergy. Milk Allergen Component tests can help you determine the likelihood of reaction to baked goods, such as cookies or cheese pizza, as well as the likelihood of allergy persistence.

Characteristics of individual proteins

of children with cow’s milk allergy

do not react to baked milk.12

75%



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Milk Allergen Component testing can help determine which proteins your patient is sensitized to

*In clinical studies, extensively baked muffin, waffle, and cheese pizza were heated to the point of protein denaturation.

• Susceptible to heat denaturation11

• HIGHER RISK of reaction to fresh milk10,12

• LOWER RISK of reaction to baked milk10,12*

• Patient likely to “outgrow” milk allergy13

α-lactalbuminBos d 4 / f 76


• HIGHER RISK of reaction to fresh milk10,12

• LOWER RISK of reaction to baked milk10,12*

• Patient likely to “outgrow” milk allergy13

β-lactoglobulinBos d 5 / f 77

Cow’s milkf 2

• High levels of cow’s milk IgE may predict the likelihood of sensitivity, but may not be solely predictive of reactions to baked milk or allergy duration10

• Resistant to heat denaturation12

• HIGHER RISK of reaction to all forms of milk10,12,14

• Patient unlikely to “outgrow” milk allergy with high levels of specific IgE to casein13

CaseinBos d 8 / f 78


• Avoid all forms of cow’s milk

• Unlikely to become tolerant of cow’s milk over time

• Avoid cow’s milk and baked milk products (yogurt, cookies, cakes), as well as products processed with milk (chocolate, sausage, potato chips)

+/- +/- +

α-lactalbuminBos d 4 / f 76

β-lactoglobulinBos d 5 / f 77

CaseinBos d 8 / f 78

Management Considerations

+

+

-

+

-

+

-

-

-

• Avoid fresh milk

• Likely to tolerate baked milk products

• Baked milk oral food challenge with a specialist may be appropriate

• Likely to outgrow allergy



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CONNECTION

1110

A specific IgE blood test that detects sensitization to egg white is the first step in discovering your patient’s allergy. Egg Allergen Component tests can help you determine the likelihood of reaction to products baked with egg, such as muffins or cookies, as well as the likelihood of allergy persistence.

of children with egg allergy

do not react to baked egg.27

70%

Knowing which protein your patient is sensitized to can help you develop a management plan.19,20,27,28


*In clinical studies, extensively baked muffin and waffle were heated to the point of protein denaturation.


• HIGHER RISK of reaction to uncooked egg19,21

• LOWER RISK of reaction to baked egg19,21*

• Patient likely to “outgrow” egg allergy22

OvalbuminGal d 2 / f 232

• Resistant to heat denaturation20

• HIGHER RISK of reaction to all forms of egg19

• Patient unlikely to “outgrow” egg allergy with high levels of specific IgE to ovomucoid23-26

OvomucoidGal d 1 / f 233

Egg Whitef 1

• High levels of egg white IgE may predict the likelihood of sensitivity, but may not be solely predictive of reactions to baked egg or allergy duration19


• Avoid all forms of egg

• Consider repeating IgE component test biennially during childhood to determine potential tolerance

• Patients sensitized to ovalbumin with low levels of IgE to ovomucoid may react to egg that is not fully baked

+/- +

OvalbuminGal d 2 / f 232

OvomucoidGal d 1 / f 233


+ -

• Avoid uncooked eggs

• Likely to tolerate baked egg

• Baked egg oral food challenge with a specialist may be appropriate

• Consider repeating IgE component test biennially during childhood to determine potential tolerance

• May be transferred via breast milk, so mothers of infants with egg allergy should take caution when breast-feeding

Egg Allergen Component testing can help determine which proteins your patient is sensitized to

of patients sensitized to peanut

may not be at risk for a systemic reaction.29

77.6%




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1312

• VARIABLE RISK of systemic reaction including anaphylaxis32

• Often accompanied by sensitization to other peanut proteins33

• Cross-reactive with fruits with pits (e.g., peaches)32

Ara h 9f 427

• HIGHER RISK of systemic reaction including anaphylaxis34,35

• Sensitization to Ara h 2 is nearly always associated with clinical peanut allergy 30

Ara h 1, 2, 3f 422, f 423, f 424

Ara h 8f 352

• LOWER RISK of systemic reaction30

• Risk of mild, localized symptoms, such as itching/tingling of the lips, mouth, and oropharynx31

• Cross-reactive with pollens (e.g., birch)31

Peanutf 13

• High levels of peanut IgE can predict the likelihood of peanut sensitivity, but may not be solely predictive of reactions or allergic response29

A specific IgE blood test that detects sensitization to the whole peanut is the first step in discovering the likelihood of a systemic reaction and the necessary precautions that may be prescribed.

Knowing which protein your patient is sensitized to can help you develop a management plan.29,30,36-38


Ara h 8f 352

Ara h 9f 427

Ara h 1, 2, 3f 422, f 423, f 424


+Oral food challenge (OFC) with a specialist may be recommended. High likelihood that patient may pass OFC. If patient passes an OFC:

• Foods prepared with or around peanuts may be consumed

• Patient not restricted to peanut-free zones

+/- +/- +

• Choose peanut-free zones for patient’s safety

• Consider prescribing epinephrine auto-injector

• Family, colleagues, and teachers should be made aware of allergy and have a plan

+ -+/-

• If there is no clinical history of symptoms, please see considerations above

• If there is a clinical history of symptoms, please see considerations below

- -+

Peanut Allergen Component testing can help determine which proteins your patient is sensitized to



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1514

Alice, 2 years old:

• Alice has suffered from eczema since early infancy

• For the last couple of months, she has been experiencing gastrointestinal distress, and hives

• Doctor suspects food allergy and orders the appropriate specific IgE food profile to help identify possible IgE food sensitivities.

Specific IgE blood test results:

Cow’s milk: 12.3 kUA/l

The test results indicate that Alice is sensitized to milk, but not other food sensitization. To help evaluate if Alice reacts to milk in baked goods, her doctor orders Allergen Component tests for cow’s milk proteins.

Allergen Component results (kUA/l):

Doctor’s Interpretation:

• Her test results show IgE sensitization to labile proteins, which indicates that she may be able to tolerate milk in baked foods

• Alice is not sensitized to Casein and is likely to outgrow her milk sensitization

Doctor’s recommendations:

• Her parents are advised not to give Alice fresh cow’s milk

• He also made the recommendation to see the local allergist to consider a baked milk food challenge

Based on her history, Alice’s doctor advised that Alice should avoid fresh milk.

α-lactalbuminBos d 4

β-lactoglobulinBos d 5

CaseinBos d 8

2.2 kUA/l 8.5 kUA/l <0.1 kUA/l

The connection: Alice’s case

Now, make the connection for your patients

You’ve discovered the connection

• Food allergy: A serious health problem for individuals and society.

• Specific IgE blood testing helps identify IgE sensitzation to food

• NIH Guidelines advise that diagnosis should be based on case history in combination with diagnostic testing1

1. National Institute of Allergy and Infection Diseases, National Institutes of Health. Report of the NIH Expert Panel on Food Allergy Research. 2006. Retrieved from www3.niad.nih.gov/topics/foodAllergy/research/ReportFood/Allergy.htm. 2. U.S. Census Bureau. State and County QuickFacts.2010 Retrieved from quickfacts.census.gov/qfd/states/00000.html. 3. Liu AH, Jaramillo R, Sicherer SH, Wood RA, Bock AB, Burks AW, Massing M, Cohn RD, Zeldin DC. National prevalence and risk factors for food allergy and relationships to asthma. Result from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010; 126:798-806. 4. Nwaru BI, et al. Allergy. 2014;69:62-75. 5. Sicherer SH. Pediatrics. 2003;111:1609-16. 6. Burks AW, et al. J Allergy Clin Immunol. 2012;129:906-20. 7. Adapted from Duran-Tauleria E, et al. Allergy. 2004;59 Suppl 78:35-41. 8. Adapted from Niggemann B, et al. Pediatr Allergy Immunol. 2008;19:325-31. 9. Yunginger JW, et al. J Allergy Clin Immunol. 2000;105(6pt1):1077-1084. 10. Shek LP, Bardina L, Castro R, Sampson HA, Beyer K. Humoral and cellular responses to cow milk proteins in patients with milk-induced IgE-mediated and non-IgE-mediated disorders. Allergy. 2005;60(7):912-919. 11. Wal JM. Bovine milk allergenicity. Ann Allergy Asthma Immunol. 2004;93(5 Suppl 3):S2-S11. 12. Nowak-Wegrzyn A, Bloom KA, Sicherer SH, et al. Tolerance to extensively heated milk in children with cow’s milk allergy. J Allergy Clin Immunol. 2008;122(2):342-347. 13. Sicherer SH, Sampson HA. Cow’s milk protein-specific IgE concentrations in two age groups of milk-allergic children and in children achieving clinical tolerance. Clin Exp Allergy. 1999;29(4):507-512. 14. Boyano-Martínez T, García-Ara C, Pedrosa M, Díaz-Pena JM, Quirce S. Accidental allergic reactions in children allergic to cow’s milk proteins. J Allergy Clin Immunol. 2009;123(4):883-888. 15. Caubet, J, et al. Utility of casein-specific IgE levels in predicting reactivity to baked milk. J Allergy Clin Immunol. 2013;131(1):222-224. 16. CM Allergy Review. Diagnosis of cow’s milk allergy in children: determining the gold standard? Expert Rev. Clin. Immunol. 2014;10(2):257-267. 17. Kim, J, et al. Dietary baked milk accelerates the resolution of cow’s milk allergy in children. J Allergy Clin Immunol. 2011;128(1):125-131. 18. Ito, K, et al. The usefulness of casein-specific IgE and IgG4 antibodies in cow’s milk allergic children. Clinical and Molecular Allergy. 2012;10:1:1-7. 19. Ando H, Movérare R, Kondo Y, et al. Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy Clin Immunol. 2008;122(3):583-588. 20. Benhamou AH, Caubet JC, Eigenmann PA, et al. State of the art and new horizons in the diagnosis and management of egg allergy. Allergy. 2010;65(3): 283-289. 21. Shin M, Han Y, Ahn K. The influence of the time and temperature of heat treatment on the allergenicity of egg white proteins. Allergy Asthma Immunol Res. 2013;5(2):96-101. 22. Tomicic S, Norrman G, Fälth-Magnusson K, Jenmalm MC, Devenney I, Böttcher MF. High levels of IgG4 antibodies to foods during infancy are associated with tolerance to corresponding foods later in life. Pediatr Allergy Immunol. 2009;20(1):35-41. 23. Urisu A, Yamada K, Tokuda R, et al. Clinical significance of IgE-binding activity to enzymatic digests of ovomucoid in the diagnosis and the prediction of the outgrowing of egg white hypersensitivity. Int Arch Allergy Immunol. 1999;120(3):192-198. 24. Bernhisel-Broadbent J, Dintzis HM, Dintzis RZ, Sampson HA. Allergenicity and antigenicity of chicken egg ovomucoid (Gal d III) compared with ovalbumin (Gal d I) in children with egg allergy and in mice. J Allergy Clin Immunol. 1994;93(6):1047-1059. 25. Montesinos E, Martorell A, Félix R, Cerdá JC. Egg white specific IgE levels in serum as clinical reactivity predictors in the course of egg allergy follow up. Pediatr Allergy Immunol. 2010;21(4 pt 1):634-639. 26. Järvinen KM, Beyer K, Vila L, Bardina L, Mishoe M, Sampson HA. Specificity of IgE antibodies to sequential epitopes of hen’s egg ovomucoid as a marker for persistence of egg allergy. Allergy. 2007;62(7):758-765. 27. Lemon-Mulé H, Sampson HA, Sicherer SH, Shreffler WG, Noone S, Nowak-Wegrzyn A. Immunologic changes in children with egg allergy ingesting extensively heated egg. J Allergy Clin Immunol. 2008;122(5):977-983. 28. Boyano Martínez, T, et al. Validity of specific IgE antibodies in children with egg allergy. Clinical and Experimental Allergy. 2001;13:1464-1469. 29. Nicolaou N, Poorafshar M, Murray C, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol. 2010;125(1):191-197. 30. Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012;130(2):468-472. 31. Mittag D, Akkerdaas J, Ballmer-Weber BK, et al. Ara h 8, a Bet v 1-homologous allergen from peanut, is a major allergen in patients with combined birch pollen and peanut allergy. J Allergy Clin Immunol. 2004;114(6):1410-1417. 32. Lauer I, Dueringer N, Pokoj S, et al. The non-specific lipid transfer protein, Ara h 9, is an important allergen in peanut. Clin Exp Allergy. 2009;39(9):1427-1437. 33. Movérare R, Ahlstedt S, Bengtsson U, et al. Evaluation of IgE antibodies to recombinant peanut allergens in patients with reported reactions to peanut. Int Arch Allergy Immunol. 2011;156(3):282-290. 34. Peeters KA, Koppelman SJ, van Hoffen E, et al. Does skin prick test reactivity to purified allergens correlate with clinical severity of peanut allergy? Clin Exp Allergy. 2007;37(1):108-115. 35. Asarnoj A, Movérare R, Östblom E, et al. IgE to peanut allergen components: relation to peanut symptoms and pollen sensitization in 8-year-olds. Allergy. 2010;65(9):1189-1195. 36. Dang, T, et al. Increasing the accuracy of peanut allergy diagnosis by using Ara H 2. J Allergy Clin Immunol. 2012;129(4):1056-1063. 37. Nicolaou, N, et al. Quantification of specific IgE to whole peanut extract and peanut components in predication of peanut allergy. J Allergy Clin Immunol. 2011:1-2. 38. Vereda, A, et al. Peanut allergy: Clinical and immunologic differences among patients from 3 different geographic regions. J Allergy Clin Immunol. 2010;3(2):1-5.

Opportunities for Specific IgE blood Testing

Patient visit Test

Recurring symptom

presentation

Back-to-school exam

Annual physical exam

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Symptoms and food allergies Discover the connectiondiagnostics.thermofisher.com/content/dam/diagnostics/en/... · 2020. 7. 12. · Specific IgE blood testing helps you diagnose allergy,

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