Le allergie alimentari multiple Giampaolo Ricci Università di Bologna

Allergie alimentari multiple Definizione -epidemiologia Quadri clinici Quali rischi Problemi nutrizionali

The natural history of cow's milk protein allergy/intolerance. Høst A1, Jacobsen HP, Halken S, Holmenlund D. Associated adverse reactions to other foods, especially egg, soy, peanut and citrus develop in about 41-54% Eur J Clin Nutr. 1995 Sep;49 Suppl 1:S13-8.

……almost 50% non IgE mediated CMA react to soy …….

Nella real life pediatrica 78% hanno allergie alimentari multiple (3,4/persona)

Allergie alimentari multiple Definizione -epidemiologia Quadri clinici Quali rischi Problemi nutrizionali

Clinical features of food protein-induced enterocolitis syndrome Chronic Acute Signs and symptoms Intermittent, chronic vomiting Chronic, watery diarrhea with blood/mucus Lethargy Pallor Dehydration Abdominal distension Weight loss Failure to thrive Repetitive vomiting every 10 to 15 minutes, onset one to three hours after ingestion (>90%) Diarrhea, onset approximately five hours after ingestion (<50%) Lethargy (70%) Pallor (70%) Hypotension (15%) Hypothermia (25%)

15% poly food sensitization at 12 months

11% poly food sensitization at 24 months 18% poly food sensitization during the first 2 years of life

Early-life SPT to common food allergens can provide valuable information in predicting the risk of sensibilization and food allergy into adolescence in individuals at high risk Altough a small proportion of children may develop late-onset food sensitization, it is unlikely to be clinically relevant.

‘HealthNuts’, a population-based, longitudinal food allergy study in Melbourne, 5276 infants aged 11–15 months were recruited through 131 council-run immunization sessions from September 2007 to August 2011.

Diversi fenotipi/endotipi Class 1: No allergic disease (70%). The no allergic disease.The estimated prevalence of an episode of wheeze was 17%. Class 2: Non-food-sensitized eczema (16%). late-onset (≥ 4 months) eczema (60%), prevalence of wheeze was 24%. Class 3: Single egg allergy (9%). Half the infants had eczema (27% early-onset and 23% late-onset ) and 15% had wheeze. Class 4: Multiple food allergies (predominantly peanut) (3%). Approximately half (56%) were also allergic to egg, the prevalence of eczema was 72%, with early-onset eczema being more common (42%), whilst 23% had a history of wheezing. Class 5: Multiple food allergies (predominantly egg) (2%). egg ( prevalence 91%), sesame (50%) and peanut (39%). Early-onset eczema had the highest prevalence (58%), and an additional 31% were estimated to have reported late-onset eczema. The estimated prevalence of the history of wheeze was 14%.

POLLEN FOOD SYNDROME Patients are sensitized to pollen allergenic molecules highly cross-reacting with their homologues in the offending foods OAS can also be the clinical expression of primary sensitization to genuine and/or cross-reacting food allergens and it is frequently the first symptom of an allergic reaction in cases followed by systemic symptoms

POLLEN FOOD SYNDROME ( endotypes) MONO-PANALLERGEN MULTI-PANALLERGEN NO PANALLERGEN Bet v 1 Pru p 3 Phl p 12 Mastrorilli C et al, Allergy 2016

Allergie alimentari multiple Definizione -epidemiologia Quadri clinici Quali rischi Problemi nutrizionali

Aumenta il rischio di severità della allergia alimentare

Aumenta il rischio di comorbidità allergiche

Aumenta il rischio di asma

Aumenta il rischio di asma

Individuals with increased diversity of IgE against multiple components or epitopes may be more likely to experience severe reactions, but such diagnostic tools are not routinely available.

Allergie alimentari multiple Definizione -epidemiologia Quadri clinici Quali rischi Problemi nutrizionali

Speranze ?

Le allergie alimentari multiple: sintesi finale Condizione frequente Quadri clinici molto diversi con età di esordio differente Patogenesi IgE e non IgE-mediata Si associano ad una maggiore severità clinica Attenti ai problemi nutrizionali

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