الفهرس 
FOOD INTOLERANCE, SENSITIZATION AND ALLERGYOnly 14 pages are availabe for public view
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Abstract
Food allergy (FA) is a serious growing problem that increased in the past 2 decades, particularly in the pediatric age group impacting 2% to 10% of pediatric patients and mounting to approximately 3 million children. Hence FA prevention constitutes an important goal in pediatric practice because there is no current cure. Wheat and strawberry are common food allergens in children. They were incriminated in several clinical presentations. We were stimulated to evaluate the prevalence of IgE mediated wheat and strawberry sensitization and allergy in allergic pediatric population, and their possible impact on different allergic manifestations. Tools of assessment included detailed clinical history, detection of specific IgE sensitization for wheat using skin prick test (SPT), and for strawberry using prick-prick test (PPT), followed by oral elimination/challenge test (OCT) to confirm allergy in sensitized patients.
This study included 256 allergic children following up in the Pediatric Allergy, Immunology and Rheumatology Unit of Ain Shams University Children’s hospital, in the period from September 2018 to September 2019. Their ages ranged between 1-15 years; 117 (45.7%) of them were females and 139 (54.3%) were males.
Allergic diagnoses in the studied group were: Bronchial asthma in 38.3%, allergic rhinitis in 10.9%, atopic dermatitis in 20.7%, food allergy in 3.9% and combined allergies in 26.2%. The median (IQR) age at diagnosis of allergic disease was 3 (2 – 4.5) years. Wheat allergy was suspected in 3/256 patients according to history. Wheat sensitization proved by SPT was found in 9.4% of patients, and OCT had proved wheat allergy in only 1 patient (0.4%).
Wheat sensitization was more elicited in patients with atopic dermatitis (33.3% of sensitized patients). Strawberry allergy was suspected by history in 7 patients however, sensitization was detected by PPT in 7.8% of patients and confirmed allergy through OCT was proved in 2% of the studied children.
Strawberry sensitization was more elicited in patients with food allergy and atopic dermatitis. Common sensitization to wheat and strawberry was detected in 2.3% of the patients. Neither wheat nor strawberry sensitization were correlated to age of onset of allergy, type of allergic manifestations, severity of symptoms, control of illness, serum level of total Ig-E or absolute eosinophil count. However, wheat and strawberry sensitization were positively correlated to each other.
To our knowledge, this is the first study concerned about studying the relation between wheat and strawberry sensitization. Furthermore, both strawberry and wheat related allergic manifestations are commonly claimed in our country, and they are included broadly in the Mediterranean food. It was reported that different fruit processing conditions may induce alteration of immune-reactive epitopes on allergenic proteins, destroying existing epitopes on a protein and generating new ones (formation of neoallergens).
Wheat and strawberry sensitization and allergy were not as common as they were thought among allergic children. Wheat sensitization was positively correlated to strawberry sensitization however; they did not affect the onset, severity or control of allergic manifestations in the studied children. A prospective cohort study will provide a better understanding of the age at development of WA and that at tolerance acquisition.
RECOMMENDATIONS
1- Wider scale studies are needed to be designed from all the Allergy Centers in Egypt to settle an epidemiological registry for wheat and strawberry sensitization and allergy in atopic and non-atopic Egyptian children.
2- Longitudinal studies are needed to detect the age of presentation of wheat and strawberry allergy and also the age of tolerance development.
3- Database registry for allergic reactions in all hospitals is needed, with referring to the culprit trigger, the Allergy Center that the patient was advised to visit, and the final diagnosis of allergy trigger(s).
4- Antenatal and postnatal counseling for atopic families in order to regulate weaning strategy and orient them about the possible early allergic manifestations.