Food Allergy and Anaphylaxis Professor Mimi Tang The Royal Children’s Hospital, Melbourne Murdoch Childrens Research Institute, Melbourne University of Melbourne, Australia Food Allergy and Anaphylaxis • Terminology • Epidemiology • Food Allergy • Anaphylaxis WAO Nomenclature: Allergic Disease • Reproducible reactions to foods = hypersensitivity – Objectively reproducible symptoms or signs initiated by exposure to a defined stimulus at a dose tolerated by normal persons – Any reproducible reaction to a food – Controversial terminology – not widely accepted, best to use the term ‘reproducible reaction to food’ WAO Nomenclature 2003 • Allergy – Reaction initiated by specific immunological mechanisms • Intolerance – Reaction initiated by NON-immunological mechanisms Food Hypersensitivity (All reproducible reactions) Food Allergy Food Intolerance Immunologically NON-Immunologically mediated mediated IgE Mixed IgE and NON-IgE NON-IgE mediated mediated mediated Anaphylaxis • ASCIA Anaphylaxis Working Party… “Generalised allergic reaction that involves respiratory or cardiovascular systems or both” • Most severe presentation of an IgE mediated allergic reaction • A life-threatening allergic reaction Anaphylaxis Sampson HA et al. Second symposium on the definition and management of anaphylaxis: Summary report - Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. J Allergy Clin Immunology 2006;117;391-7. Rising Prevalence of Immune Disorders Bach, NEJM 2002;347: 911-920 Rising Rates of Food Allergy Incidence of Food Allergy increased >10-fold from 1990-2004 Mullins R, Dear K, Tang MLK. J Allergy Clin Immunol 2009 Exponential Rise in Food Anaphylaxis +250% +230% +350% Liew WK, Williamson E, Tang MLK. J Allergy Clin Immunol 2009;123:434-42