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Food-induced anaphylaxis: mast cells as modulators of anaphylactic severity

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Abstract

A food-induced anaphylactic reaction can occur within seconds to a few hours following exposure to the causal food allergen and often affects multiple organ systems including gastrointestinal, cutaneous, respiratory, and cardiovascular. A conundrum in the allergy field is that consumption of the same allergen can cause reactions of vastly different severity in separate individuals; one patient may experience a mild non-life-threatening reaction characterized by pruritis of lips or urticaria whereas another may experience a life-threatening reaction that involves respiratory and cardiovascular compromise leading to loss of consciousness and sometimes death. While there are tests available to determine the predictive risk value of a positive food challenge test or clinical reactivity, there is currently no reliable method to distinguish between individuals who are at risk of mild non-life-threatening versus life-threatening reaction. Recent research has significantly advanced our understanding of the involvement of immune pathways in the effector phase of food-induced anaphylaxis; a void remains regarding our understanding of the contribution of these pathways to severity of disease. In this review, we discuss mild non-life-threatening versus life-threatening food-induced anaphylaxis and factors (co-morbidities and immune activation) that predispose individuals to more severe disease. Furthermore, we summarize recent advancements in our understanding of the involvement of underlying immune pathways in systemic and food-induced anaphylaxis in mouse systems and discuss how these pathways may contribute to more severe disease phenotype.

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Acknowledgments

The authors would like to thank Drs. Pablo Abonia, Amal Asaad, and Marc Rothenberg for helpful discussions and Shawna Hottinger for editorial assistance. This work was supported in part by NIH R01AI073553-01 (S.P.H), NIH P30DK078392 (R.S), and a VA Merit Award (F.D.F). The authors have no conflicting financial interests.

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Authors and Affiliations

  1. Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Simon P. Hogan & Yui Hsi Wang

  2. Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Richard Strait

  3. Department of Medicine, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA

    Fred D. Finkelman

  4. Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Fred D. Finkelman

  5. Division of Molecular and Cellular Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Fred D. Finkelman

  6. Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML7028, Cincinnati, OH, 45229, USA

    Simon P. Hogan

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  1. Simon P. Hogan
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  2. Yui Hsi Wang
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  3. Richard Strait
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  4. Fred D. Finkelman
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Correspondence to Simon P. Hogan.

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This article is published as part of the Special Issue on Food Allergy [34:6]

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Hogan, S.P., Wang, Y.H., Strait, R. et al. Food-induced anaphylaxis: mast cells as modulators of anaphylactic severity. Semin Immunopathol 34, 643–653 (2012). https://doi.org/10.1007/s00281-012-0320-1

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