Pulse May 2019 issue - Page 21

Supported by an educational grant by Thermo Fisher Scientific consumption of certain foods such as apricot, lentil, peach and tomato have been suggested to confer an elevated risk in susceptible patients. 21 Appropriate advice should be given to the patient regarding foods they might need to avoid, and their symptoms should be carefully considered; those deemed at risk of anaphylaxis may require prescription of an adrenaline autoinjector. 10,20 Accurate diagnosis will support this process. Though there is little published evidence on the psychological impact of PFS specifically, the presence of anxiety and depression in people that have a food allergy is well documented, particularly in paediatric patients. 22,23 This is contributed to by the day-to-day impact of food avoidance measures and the more general fear of systemic reactions. 22 Effective management of these concerns requires an accurate diagnosis. 24 How many people does PFS actually affect? PFS affects about 2% of the UK population 14 , meaning there are approximately 1.3 million people in the UK with PFS 25 . Table 1. Cross-reactive food proteins Allergen Birch pollen Timothy grass pollen Fruits Apple, pear, cherry, peach, plum, apricot, kiwi Tomato, melon Vegetable Potato, carrot, celery Legumes Peanut, soybean Nuts Hazelnut, almond, walnut Cereals 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1.3m people with PFS 2 % of the UK Wheat, barley, rye, oat References Diagnosing PFS in primary care If a patient with allergic rhinitis presents with symptoms consistent with PFS, accurate identification of specific sensitivities may help to determine appropriate management and the requirement for secondary care referral. Further, it is widely accepted that allergies negatively impact a patient’s quality of life, and it is important that this is not underestimated; accurate diagnosis and advice can be life changing. 24,26 To support diagnosis, NICE recommends skin prick and/or serum-specific IgE (sIgE) testing 14 ; however, in the UK, skin prick testing generally requires escalation to secondary care 27 . SIgE blood tests are readily available and easy to use in primary care; 1 ml of blood can provide a diagnosis for up to ten allergens and could prevent premature hospital admission. Consider the patient’s history and presenting symptoms to decide whether it is prudent to perform diagnostics, and check which tests are available to you. Peanut, soybean 12. 13. 14. Price A, Ramachandran S, Smith G, Stevenson ML, Pomeranz MK, Cohen DE. Oral Allergy Syndrome (Pollen- Food Allergy Syndrome). Dermatitis. 2015;26(2):78–88. https://journals.lww.com/dermatitis/Fulltext/2015/03000/ Oral_Allergy_Syndrome__Pollen_Food_Allergy.4.aspx (last accessed 16 April 2019) Incorvaia C, Riario-Sforza GG. Allergy testing in the diagnosis of asthma. The Lancet Respiratory Medicine. 2015;3(5):PE16. https://www.thelancet.com/journals/lanres/article/PIIS2213- 2600(15)00089-2/fulltext (last accessed 16 April 2019) Janeway CA Jr, Travers P, Walport M, et al. Immunobiology: The Immune System in Health and Disease. 5th edition. New York: Garland Science; 2001. Effector mechanisms in allergic reactions. https://www.ncbi.nlm.nih.gov/books/NBK27112/ (last accessed 16 April 2019) Bantz SK, Zhu Z, Zheng T. The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma. J Clin Cell Immunol. 2014;5(2):202. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4240310/ (last accessed 16 April 2019) Scadding, GK, Kariyawasam, HH, Scadding, G, et al. 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Vieths S, Scheurer S, Ballmer-Weber B. Current Understanding of Cross-Reactivity of Food Allergens and Pollen. Annals of the New York Academy of Sciences. 2002;964:47-68. https://nyaspubs.onlinelibrary.wiley.com/ doi/full/10.1111/j.1749-6632.2002.tb04132.x (last accessed 16 April 2019) 18. Eriksson NE, Formgren H, Svenonius E. Food hypersensitivity in patients with pollen allergy. Allergy. 1982;37(6):437–43. https://www.ncbi.nlm.nih.gov/pubmed/7137538 (last accessed 16 April 2019) 19. Webber CM, England RW. Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge. Annals of Allergy, Asthma & Immunology. 2010;104(2):101–108. https://www. sciencedirect.com/science/article/pii/S1081120609000088 (last accessed 16 April 2019) 20. Katelaris CH. Should patients with pollen fruit syndrome be prescribed an automatic epinephrine injector? 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