DG Research 2nd Workshop on Food Allergy in the European Research Area Brussels, 10-11th Dec 2007 Allergenic potential

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1 DG Research 2nd Workshop on Food Allergy in the European Research Area Brussels, 10-11th Dec 2007 Allergenic potential Dr. Montserrat Fernández Rivas Servicio de Alergia

2 Allergenic potential of foods to induce IgE responses to induce allergic reactions Clinical approach : Data from a cross-sectional study carried out in 12 allergy clinics across Europe within the EUfunded project Europrevall

3 WP 1.3. Prospective cross-sectional study 12 clinical centres across Europe New incidental cases P7: Montserrat Fernández-Rivas, HCSC, ES P6: Barbara Ballmer-Weber, UHZU, CH P17: Photini Papageorgiou, NKAU, GR P20: André Knulst, UMCU, NL P32: Marek L. Kowalski, MUL, PL P33: Suranjit Sereviratne, UMCU, UK P37: Todor A. Popov, MUS, BG P38: Martin Fuchs, FHB, CZ P39: Ruta Dubakiene, UV, LT P45: Riccardo Asero, IT P47: Frédéric de Blay, HUS, F P48: David Gislason, UHR, IS

4 Selection of patients AR to any food < 2 h Medical history SPT/ CAP 24 foods, 12 inhalants latex DBPCFC Priority 1 foods

5 Foods under study Priority 1 Milk Egg Fish Shrimp Peanut Hazelnut Celery Apple Peach Priority 2 Walnut Kiwi Soybean Sesame seed Wheat Mustard Priority 3 Tomato Carrot Banana Melon Sunflower seed Lentil Poppy seed Corn Buckwheat

6 Data on 24 foods on: Frequency of immediate adverse reactions in 1508 patients Frequency of IgE responses (SPT, CAP) Limitation: sensitivity of SPT and CAP Overestimation of clinically relevant allergy DBPCFC performed in ~ 9% patients (egg, milk, peanut, hazelnut, celery): positive outcome in 56% (41%-73%).

7 Frequency of reported reactions in 1508 patients hazelnut apple peanut walnut peach kiwi milk tomato egg carrot melon banana celery fish shrimp soybean sunflower seed sesame seed wheat mustard lentil poppy seed corn buckwheat

8 hazelnut apple peanut walnut shrimp fish celery banana melon peach carrot kiwi milk egg tomato all subjects

9 Frequency of reported reactions in 177 patients 3 y milk egg peanut fish hazelnut walnut tomato apple celery peach banana soybean lentil kiwi wheat poppy seed carrot sesame seed sunflower seed corn shrimp mustard melon buckwheat

10 peanut walnut hazelnut apple shrimp fish celery banana melon peach kiwi milk carrot egg tomato all subjects < 3 y

11 Frequency of reported reactions in 70 patients 7-10 y peanut egg hazelnut fish kiwi apple milk walnut peach carrot sesame seed soybean celery banana wheat poppy seed melon corn lentil shrimp tomato sunflower seed mustard buckwheat

12 hazelnut apple peanut walnut shrimp fish celery banana melon peach carrot kiwi milk egg tomato all subjects 7-10 y

13 hazelnut apple peanut walnut shrimp fish celery banana melon peach carrot kiwi milk egg tomato all subjects > 14 years (1261)

14 apple 72,5 67,5 banana 10 58,5 buckwheat 22,2 100 carrot 68,3 79,2 celery 58,6 67,3 corn 16,7 20 egg 42,2 48 fish 39,6 43,8 hazelnut 71,3 86 kiwi 15,9 55,6 lentil 14,3 33,3 melon milk 19 30,6 31,4 53,8 % (+) CAP % (+) SPT mustard 37,5 57,1 peach 22 83,8 peanut 53,8 64,4 poppy seed 30 41,9 sesame seed 43,1 52,9 shrimp 55,1 65,7 soybean 33,3 29,3 sunflower seed 50 56,7 tomato walnut wheat 23,4 39,9 41,1 49, ,4 SPT, m 39% CAP, m 56%

15 Geographical differences The 4 most common foods involved in AR (excluding small children) P06. Switzerland Apple Hazelnut Kiwi Walnut P07. Spain Peach Fish Kiwi Melon P17. Greece Walnut Fish Peach Peanut P20. Netherlands Apple Kiwi Walnut Hazelnut P32. Poland Walnut Hazelnut Apple Peanut P33. UK Peanut Hazelnut Apple Kiwi P37. Bulgaria Peanut Fish Peach Hazelnut P38. Czech Rep. Hazelnut Peanut Walnut Apple P39. Lithuania Hazelnut Apple Peanut Carrot P45. Italy Apple Peach Hazelnut Kiwi P46. France Apple Peach Hazelnut Walnut P48. Iceland Shrimp Kiwi Fish Peanut

16 Geographical differences CH GR IL milk egg fish shrimp peanut hazelnut celery apple peach

17 Geographical differences CH GR IL walnut kiwi soybean sesame seed wheat mustard

18 corn buckwheat poppy seed tomato carrot banana melon sunflower seed lentil Geographical differences CH GR IL

19 respiratory anaphylaxis %(+) CAP OAS skin digestive % (+) SPT freq AR Hazelnut CH (n= 118) GR (n= 18) IL (n=6)

20 anaphylaxis %(+) CAP OAS skin digestive respiratory % (+) SPT freq AR Apple CH (n=121) GR (n=9) IL (n=7)

21 Apple allergy NL A I E OAS CU Dig RC Dyspnea U AX Shock JACI 2006; 118:

22 OR for OAS: 2.85 ( ) OR for SR: 7.76 ( ) JACI 2006; 118:

23 Food Allergen content Fresh/processed Exposure (cut, inh, oral) Pattern exposure Quantity Individual Genetic factors Atopy GI tract Skin barrier Airway: BHR Age/sex Response to parasites Nutritional status Environment Airborne allergens Dietary habits Culinary habits Microbes/Parasites All these interactions determine the allergenic potential of a given food

24 although all foods are potentially allergenic