Department of Allergy and Clinical Immunology, Imperial College, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Front Immunol. 2019 Apr 3;10:673. doi: 10.3389/fimmu.2019.00673. eCollection 2019.
Food anaphylaxis is on the increase, with those who have an allergy to peanuts, tree nuts, milk, and seafood at the highest risk of developing such a reaction. However, the diet in many societies is increasingly varied, much of the food consumed is prepared outside the home, and meals are often composed of many different ingredients. Anaphylaxis may occur to a composite food, and it may be unclear whether the reaction is due to contamination or to a culprit allergen present in an added ingredient. Composite foods can contain many allergic proteins present in small amounts, which do not always have to be labeled, unless they feature in European or US labeling regulations. These "hidden" allergens include mustard, celery, spices, lupine, pea, natural food colourings, and preservatives, but can occasionally include allergenic material from contaminants such as cereal mites. Hidden allergens can provoke severe reactions to seemingly unconnected foods which might then lead to a diagnosis of idiopathic anaphylaxis. The same problem can arise with two well-known types of food allergy; wheat-dependant exercise induced anaphylaxis and allergy to non-specific Lipid Transfer Protein allergens, both of which might only manifest when linked to a cofactor such as exercise. Many of these risk factors for food anaphylaxis have a common link; the public's engagement with popular concepts of health and fitness. This includes the development of a food and exercise culture involving the promotion and marketing of foods for their health-giving properties i.e., meat substitutes, wheat substitutes, supplements and alternative, or "natural" remedies for common ailments. Some of these foods have been reported as the cause of severe allergic reactions, but because they are often viewed as benign unlikely causes of severe allergic reactions, could be considered to be hidden allergens. The best resource to elicit the likelihood of a hidden allergen provoking an allergic reaction is to take a detailed history of the allergic reaction, presence of co-factors, foods suspected, type of food and where it was consumed. A good knowledge of commonly used ingredients, and list of potential hidden allergen suspects are essential tools for the food allergy detective.
食物过敏反应呈上升趋势，花生、树坚果、牛奶和海鲜过敏者患此类过敏反应的风险最高。然而，许多社会的饮食日益多样化，许多人食用的食物是在家以外准备的，而且每餐通常由许多不同的食材组成。过敏反应可能发生在复合食品中，而且可能不清楚反应是由于污染还是由于添加成分中存在的罪魁祸首过敏原引起的。复合食品可能含有许多以少量存在的过敏原蛋白，这些蛋白不一定必须贴上标签，除非它们符合欧洲或美国的标签法规。这些“隐藏”的过敏原包括芥末、芹菜、香料、羽扇豆、豌豆、天然食用色素和防腐剂，但偶尔也可能包括来自如谷物螨等污染物的过敏原物质。隐藏的过敏原可能会引起看似无关的食物严重反应，从而导致特发性过敏反应的诊断。这一问题也可能出现在两种常见类型的食物过敏中，即小麦依赖运动诱导的过敏反应和对非特异性脂质转移蛋白过敏，这两种过敏反应只有在与运动等协同因子相关联时才会表现出来。食物过敏反应的许多这些风险因素有一个共同的联系，即公众对健康和健身的流行概念的参与。这包括发展一种食物和运动文化，涉及推广和营销具有健康属性的食物，例如肉类替代品、小麦替代品、补品和替代物，或用于治疗常见疾病的“天然”疗法。这些食物中的一些已被报道为严重过敏反应的原因，但由于它们通常被视为不太可能引起严重过敏反应的良性原因，因此可能被视为隐藏的过敏原。引出隐藏过敏原引起过敏反应的可能性的最佳资源是详细了解过敏反应的历史、协同因子的存在、可疑食物、食物类型以及食物的食用地点。了解常用成分以及潜在隐藏过敏原嫌疑者的清单是食物过敏侦探的必备工具。
