![]() ![]() It is clear some foods are more likely to provoke anaphylaxis from the numerous publications reporting anaphylaxis data in large cohorts of patients. surmised that anaphylaxis outcome and severity cannot be determined by the eliciting dose, (amount/kilogram body weight) and that sensitivity and severity need to be considered separately by distinguishing between the amount and “dose,” which will differ significantly between young children and adults ( 2). showed clearly that the amount of allergen which provokes a reaction in a food challenge does not predict the severity of the reaction or the likelihood of anaphylaxis ( 1). Many foods have the potential to provoke an allergic reaction, depending on the individual susceptibility, the threshold dose required to elicit an allergic reaction and the type of allergens present within the food. A good knowledge of commonly used ingredients, and list of potential hidden allergen suspects are essential tools for the food allergy detective. 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. 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. ![]() 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. Many of these risk factors for food anaphylaxis have a common link the public's engagement with popular concepts of health and fitness. 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. ![]() Hidden allergens can provoke severe reactions to seemingly unconnected foods which might then lead to a diagnosis of idiopathic anaphylaxis. 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. 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. 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. 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.
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