About 60% of cases occur in breast-fed babies, the remainder in infants fed cow's milk or soy protein-based formulas. Patients can be taught to identify hidden food components in processed foods. (18), Food protein-induced allergic proctocolitis (FPIAP). 10%–30% of the world’s population suffers from seasonal allergies and asthma. Warren CM, Jhaveri S, Warrier MR, Smith B, Gupta RS. By collaborating with member societies, WAO provides direct educational outreach programs, symposia and lectureships to members in nearly 100 countries around the globe. Peanut allergy, once considered to be a life-long condition, can resolve in up to 30% of cases (50). J. However, research is ongoing and the future use of recombinant allergens (44), synthetic peptides (45),and epicutaneous therapy for desensitization in humans looks more promising (46). The Learning Early about Peanut (LEAP) study showed that early introduction of peanuts significantly decreased the frequency of peanut allergy among children at high risk, and modulated immune responses to peanuts (33). Ann Allergy Asthma Immunol. While valid in the studied populations, the value of such decision points cannot be universal (see table below). How many people have asthma? Pediatr Allergy Immunol. Review our cookies information for more details. Although it is not, strictly speaking, an allergic disease, at least one-third of infants and young children with atopic eczema have IgE-mediated food allergy. Publication on prevention of allergy and allergic asthma. Thalayasingam M, Lee BW. For example, functional genetic variants in the IL-12 receptor b1, Toll-like receptor 9, and thymic stromal lymphopoietin genes and even IL-4 gene polymorphism have been associated with an increased risk of food sensitization (6). Patients present with postprandial nausea and vomiting, abdominal pain, diarrhea (occasionally steatorrhea) and weight loss in adults and failure to thrive in young infants. Americans spent around $99 billion on their pets in 2020. 2015;136:952-61, 37. Grimshaw KE, Bryant T, Oliver EM, et al. According to all the current guidelines, an infant with at least one first-degree relative (parent or sibling) with a history of allergic disease’ (26, 27) in particular allergic rhinitis, asthma, eczema, or food allergy (28, 29) is at greater risk for developing food allergy. milk. Food allergy and the introduction of solid foods to infants: a consensus document. All of this is caused by the massive release of mediators from mast cells and basophils. Arerugi. This site uses cookies. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.Pediatrics. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. Hence, based on these findings, the National Institutes of Health (NIH) Guidelines for the Management and Prevention of Food Allergy subsequently recommended the introduction of peanut-containing foods to “high-risk” infants early in life (4-11 months) (34). Resolution of IgE-mediated fish allergy. This approach has reached the level of evidence to be included in the NIAID recommendations on food allergy prevention (30), but it has subsequently been questioned. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review  and meta-analysis. The IgE-mediated reactions are usually divided into immediate-onset reactions (arising up to 2 hours from the food ingestion) and immediate plus late-phase (in which the immediate onset symptoms are followed by prolonged or ongoing symptoms). Houben G, Burney P, Chan CH, Crevel R, Dubois A, et al. Togias A, Cooper SF, Acebal ML, et al. The negative predictive accuracy of a skin prick test weal of < 3mm greater than the negative control is high, usually > 95%, and is strong evidence that the food may be consumed without severe, immediate food-allergic reactions. 548,208.42. Boyce JA, Assa'ad A, Burks AW, et al. UNL web framework and quality assurance provided by the, Apply to the University of Nebraska–Lincoln, Give to the University of Nebraska–Lincoln, Institute of Agriculture and Natural Resources, Food Allergy Research and Resource Program, 11th Food Allergens Methodologies Workshop, General Information on Food Allergies & Sensitivities, FARRP Annual Reports and Board Meeting Minutes, College of Agricultural Sciences and Natural Resources. The only study using food challenges reports a prevalence of fish allergy of 0% - 0.3% and a prevalence of shellfish allergy ranging between 0% and 0.9%. Additional medicatioons  include H1 and H2 antihistamines, corticosteroids, and prostaglandin synthetase inhibitors These drugs are only symptomatic, do not modify the natural course of the disease, and sometimes have unacceptable side effects. World Allergy Organ J. Although the pathogenic mechanisms of the APT have not been fully elucidated, a positive APT can predict a late phase reaction following oral food challenge. Du Toit G, Roberts G, Sayre PH, et al; LEAP Study Team. The classification of allergic and hypersensitivity diseases was established by the European Academy of Allergy and Clinical Immunology (EAACI) and the World Allergy Organization (WAO) in 2004 (1). Patients may also present with food refusal, dysphagia, food impaction or abdominal pain. FPIAP is a benign transient condition, typically starting in the first few months of life with bloody stools in well-appearing infants. These proteins are ubiquitous in pollens, plants, fruits and food. The epidemiology of milk allergy in US children. However, it is not possible to establish a half-life for a diagnosis of peanut allergy and tree nuts should still be considered as lifelong allergies. Peters RL, Allen KJ, Dharmage SC,et al. N Engl J Med. *Taiwan FDA released a revised regulation of food allergen labeling on 08-21-2018 to include 11 allergen substances and will come into force 7-1-2020. Adverse Reactions to Foods Committee, American College of Allergy, Asthma and Immunology. The Big 8 was based on comparative prevalence data at the time it was established (see following section), but 2 decades ago when that occurred, the available data were extremely limited. J Allergy Clin Immunol. Another important vegan food market statistic reveals that there was a growth of 11% in the plant-based food sector as of April 2019. A positive APT may detect clinically relevant late phase eczematous or GI reactions in infants and children (24). Kokkonen J, Tikkanen S, Savilahti R: Residual intestinal disease after milk allergy in infancy. **Voluntary labeling recommended for Abalone, Mackerel, Squid, Salmon, Salmon Roe, Almond, Cashew, Matsutake Mushroom, Sesame, Soybean, Yam, Apple, Banana, Kiwifruit, Orange, Peach, Beef, Chicken, Gelatin, Pork. 22. The definitions and concepts of allergic and hypersensitivity conditions beyond the allergy community have often created misunderstanding (2). 48. These food allergies are defined as non–IgE-mediated or mixed IgE- and non–IgE-mediated. J Allergy Clin Immunol 2017;139:189-20. 2009;58:524-36, 24. Chem Immunol Allergy 2015;101:152-61, 13. DBPCFC is difficult to organize in many clinical situations, and can be replaced by open challenges in many situations (when there is a minimal risk of false interpretations due to subjective factors). SPTs may also remain positive after the development of tolerance to the specific food. From the patient’s perspective, avoidance means meeting obstacles unshared by their non-allergic peers, thereby curtailing their quality of life. 2 The body’s immune response can be severe and life threatening, such as anaphylaxis. Food or exercise alone will not cause this reaction. The foods to which an individual is allergic should be avoided, as therapeutic intervention (tertiary prevention) in patients with food allergy. Curr Allergy Asthma Rep. 2016;16:47, 15. Garcia-Ara MC, Boyano-Martinez MT, Diaz-Pena JM, Martin-Munoz MF, Martin-Esteban M. Cow's milk-specific immunoglobulin E levels as predictors of clinical reactivity in the follow-up of the cow's milk allergy infants. According to all the current guidelines, an infant with at least one first-degree relative (parent or sibling) with a history of allergic disease’ (26, 27) in particular allergic rhinitis, asthma, eczema, or food allergy (28, 29) is at greater risk for developing food allergy. Muraro A, Halken S, Arshad SH, et al; EAACI Food Allergy and Anaphylaxis Guidelines Group. Online pet food sales rose by 77% during the March, 2020 Coronavirus lockdown. 30.4% of food allergic children have multiple food allergies 2; Of food allergic children, peanut is the most prevalent allergen, followed by milk and then shellfish 2; In 2012, 5.6% or 4.1 million children reported food allergies in the past 12 months. SUMMARY 1.1. Pediatr Allergy Immunol 2016 May;27 Suppl 23:1-250, 16. International consensus guidelines have been developed for FPIES. Peanuts, tree nuts, seeds and seafood are the major triggers for life long allergies. Clin Exp Allergy 2004;34:866-70. The immune system response to a food allergy ranges from mild rashes to abdominal pain to a life-threatening complication called anaphylactic shock. Allergy 2014, 69:559–70, 3. Clin Transl Allergy. Food protein –induced enterocolitis syndrome (FPIES), Primarily affects infants. Even today, there is an imperfect understanding because generating accurate prevalence data on food allergy is quite challenging. However, no study has evaluated the natural history of fish allergy in infants and fish should also be regarded as causing persistent allergies. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. 45. On the other hand, it should be acknowledged that efforts are underway to improve this understanding.15 A rigorous estimate of the prevalence of food allergy would need to involve several cri… Host factors such as lactase deficiency, which are associated with lactose intolerance, or idiosyncratic responses may be responsible for other non-allergic reactions to foods. b) Positivity to in vivo and/or in vitro tests to prove underlying mechanism and etiology. Schoemaker AA, Sprikkelman AB, Grimshaw KE, et al. World Allergy Organ J. Based on IMF data. Pertussis. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics. Arerugi. Sampson HA. Source: World Bank. Pediatr Allergy Immunol.2001;12 (suppl 14): 91 –96, 42. Specific IgE levels display a variable diagnostic accuracy according to the nature of the allergen, the studied population, the specific brand of the test. Similar legislation is in effect in the US, where the 2006 Food Allergen Labeling and Consumer Protection Act provides that all food products require an ingredient statement. In atopic dermatitis, also a frequent symptom of food allergy, immediate reactions can be followed by late cutaneous reactions. 3; In 2015, 4.2 million children in the US have food allergies. 6; General Allergy. 2014;7:10, 40. Alessandro Fiocchi, MD and Vincenzo Fierro, MD About 50% of anaphylaxis reactions are due to food allergy. 25. It is implicated in Eosinophilic Esophagitis, Eosinophilic gastritis and gastroenteritis, food protein-induced enterocolitis syndrome, and allergic proctocolitis. Fiocchi A, Terracciano L Bouygue GR, Veglia F, Sarratud T, Martelli A, Restani P. Incremental prognostic factors associated with cow's milk allergy outcomes in infant and child referrals: the Milan Cow's Milk Allergy Cohort study. Greer FR, Sicherer SH, Burks AW et al; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. J Pediatr Gastroenterol Nutr 2001; 32: 156-61. Allergic rhinoconjunctivitis and asthma can occur following food challenge testing, but respiratory symptoms from food allergy in the absence of skin or gastrointestinal manifestations are rare. In chronic forms, it presents as emesis, diarrhea, poor growth, and, in severe cases, with starvation and lethargy. In acute forms, or after re-administration of restricted foods, it may determine emesis, diarrhea, and hypotension, starting two hours following ingestion. Those with the highest IgE levels, with the most serious clinical manifestations (anaphylaxis and asthma), and with the wider co-sensitizations are less likely to overgrowth their food allergy. Such reactions are due to cross-reactive allergens as pathogenesis related (PR),  profilins, or lipid transfer proteins (LTP). Allergy. Atopy patch testing for foods: a review of the literature. While most food allergies arise in childhood, at least 15 percent of patients with food allergies are first diagnosed in adulthood. 2015 Dec 14;8:37, 6. Toxic reactions to food can occur in any patient, if a sufficient amount of the food is ingested; they are due to toxins in the food, e.g., to histamine in scombroid fish or bacterial toxins in food. The first proposed recommendation for a large-scale prevention of food allergy has been the use of hypoallergenic (HA) formulae in case of breastfeeding failure. J Allergy Clin Imunnol 2004, 113:832–6, 2. Discover all statistics and data on Health and wellness food trends in Europe now on statista.com! Xie J, Lotoski LC, Chooniedass R, et al. Eosinophilic Esophagitis. Try our corporate solution for free! 4. 52. Allergies in Adults Food Allergies. The exact cause of these disorders remains unknown although both IgE-mediated and T-cell-mediated reactions have been implicated. J Allergy Clin Immunol. A series of adverse reactions to foods do not involve an immune response and are not considered food allergies (4). It must strike a precautionary equilibrium between the demands of prohibitive measures against allergy care and quality of life. DBPCFC should be performed in specialist centers with close supervision. These conditions are characterized by infiltration of eosinophils in the mucosal, muscular and/or serosal layers of the stomach or small intestines. 2006;97:10-20, 33. Dang TD, Peters RL, Allen KJ. When autocomplete results are available use up and down arrows to review and enter to select. 2016;9:10, 36. Prince BT, Mandel MJ, Nadeau K, Singh AM. The prevalence of food allergies has risen worldwide during the past few decades, becoming a significant global health concern. J Allergy Clin Immunol. Food allergens may be triggers for some acute exacerbations (20). have been reported (52). Ann Allergy Asthma Immunol. It is generally accepted that food allergy affects approximately 2.5% of the general population, but the spread of prevalence data is wide, ranging from 1% to 10%. The PDF file should be printed on 8"x14" (legal) paper. 2010;126(6 Suppl):S1-58, 29. Food allergies are a growing food safety and public health concern that affect an estimated 8% of children in the United States. Immunological approaches to the treatment of food allergy. Komata T, Shukuya A, Imai T, Tachimoto H, Ebisawa M.  Single blind food challenge using dried food powder --2nd Report. The symptoms of IgE-mediated, non-IgE–mediated, and mixed IgE- and non–IgE-mediated food allergy are presented in Table 13. Peanuts and nut products are added to thicken and flavor sauces. 2017 Feb 3 [Epub ahead of print], 19. Severe reactions can result in most or all symptoms associated with anaphylaxis. Find an indicator: (or browse indicators) News. CO2 emissions (kt) 2014. WebMD gives you a quick rundown of some of the most important allergy and asthma statistics. Many children who contract pertussis have coughing spells that last four to eight weeks. Acute urticaria and angioedema are the most frequent manifestation of food allergy. WAO Journal 2010; 3:57-61, 20. Furuta  GT, Katzka DA. Probiotics for the prevention of allergy: A systematic review and meta-analysis of randomized controlled trials. Allergol Immunopathol (Madr). Component Resolved Diagnosis (CRD) elucidated the link between a severe allergy to pollen and the increase of oral allergy syndrome (OAS), exercise induced asthma and anaphylaxis when eating certain foods. World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Vitamin D. World Allergy Organ J. Dreborg S. Debates in allergy medicine: food intolerance does not exist. Rarely, dietary protein proctitis shows mild hypoalbuminaemia and peripheral eosinophilia. Mixed IgE and non-IgE mediated reaction are conditions associated with food allergy involving both IgE- and non-IgE-mediated mechanisms (3). World Development Indicators. The symptoms of the allergic reaction may range from mild to severe. **Voluntary labeling recommended for Abalone, Mackerel, Squid, Salmon, Salmon Roe, Almond, Cashew, Matsutake Mushroom, Sesame, Soybean, Yam, Apple, Banana, Kiwifruit, Orange, Peach, Beef, Chicken, Gelatin, Pork. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ. Fish allergy seems more frequent in Asia (12) than in Western countries (13). Other factors, such as sIgE antibody level and age at diagnosis, have also been associated with prognosis of food allergy, although these associations are not invariably consistent across studies (47, 48, 49). Ninety per cent of patients experience skin (urticaria, angioedema) plus respiratory symptoms such as asthma, rhinitis or conjunctivitis; in 30% of the cases, they also develop gastrointestinal symptoms or hypotension, and shock and cardiac arrhythmias may occur. The World Allergy Organization (WAO)/McMaster Working Group Guidelines for Allergic Disease Prevention (GLAD-P) has also published GRADE recommendations on the use of probiotics and prebiotics for allergy prevention based on current available evidence. 2016 Jan 26;6:1, 9. World Statistics Understand the world. Where avoidance of the implicated food may result in nutritional deficiency, dietary supplementation is necessary3. Ann Allergy Asthma Immunol 2013;110:370-4, 17. For this reason, decision points have been proposed. Source: FAO. The prevalence of peanut allergy among children in the United Kingdom, North America, and Australia has been reported doubled in 10 years and is approximately 1.8%, 1.4%, and 3.0% respectively. Non-IgE-mediated reactions, which are poorly defined both clinically and scientifically, are believed to be generally T-cell-mediated. In the future, the elucidation of the gene-environment interactions will be crucial for understanding the food allergy pathogenesis. Natural history of peanut allergy and predictors of resolution in the first 4 years of life: A population-based assessment. When respiratory symptoms occur following food challenge, both early- and late-phase IgE-mediated mechanisms are probably involved. A form of anaphylaxis associated to food is the exercise-induced food-dependent anaphylaxis, occurring, generally, 2-4 hours after ingestion of a food to which the individual is allergic. There is a relationship between symptom severity after ingestion and the likelihood of outgrowing the problem; the more severe the reaction, the less likely that the food allergy will be outgrown. 2017 Jan 6. Resuscitation facilities and overnight admission can be necessary in severe cases. 2015; 8:4, 30. For an optimal clarification: Based on these definitions, a correct diagnosis of allergic disease must adhere to the following conditions: a) Compatible clinical history; and ***GSO includes the countries of Saudi Arabia, UAE, Kuwait, Bahrain, Oman, Qatar, and Yemen. Allen KJ, Turner PJ, Pawankar R, Taylor S, Sicherer S, Lack G, Rosario N, Ebisawa M, Wong G, Mills EN, Beyer K, Fiocchi A, Sampson HA. While sometimes these, and other presumed food allergic reactions, are defined “food intolerances”, this term should not be used to define an allergic reaction (5). 2016; 26;9:2. 49. Debates in allergy medicine: baked egg and milk  do not accelerate tolerance to egg and milk. Persistent protective effect of heat killed E. coli producing “engineered,” recombinant peanut proteins in a murine model of peanut allergy. 2014;69:590-601, 28. Boyce JA, Assa'ad A, Burks AW, et al. We rely upon and are appreciative of user input. (21), Allergic eosinophilic gastritis or gastroenteritis. 2012;40:195-7. Yepes-Nuñez JJ, Fiocchi A, Pawankar R, Cuello-Garcia CA, Zhang Y, Morgano GP, Ahn K, Al-Hammadi S, Agarwal A, Gandhi S, Beyer K, Burks W, Canonica GW, Ebisawa M, Kamenwa R, Lee BW, Li H, Prescott S, Riva JJ, Rosenwasser L, Sampson H, Spigler M, Terracciano L, Vereda A, Waserman S, Schünemann HJ, Brożek JL. World Allergy Week 2020 . To disclose hidden food allergens, food labelling is an issue of relevance to food allergic consumers of processed or pre-packaged foods. Addendum guidelines for the prevention of peanut allergy in the United States. In fact, the labeling regulations do not prescribe the indication of potential contaminants, but many manufacturers are now indicating, “may contain” as a warning of potential contaminations during food preparation (39). Environmental influences and genetic factors of the host underlie the immunopathogenesis of food allergy and its manifestations. Patients experiencing food allergies and their caregivers are heavily burdened personally, socially, emotionally, and financially. Report of the NIAID-sponsored expert panel. They are milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish. Report by Steve Wearne, Director of Policy . FARRP welcomes any suggestions for additions or corrections (send to [email protected]). 1 That’s 1 in 13 children, or about 2 students per classroom. In the future, the GLAD-P guidelines may be expanded as more data from rigorously designed, adequately powered and well-executed trials become available. 3% of infants have a milk allergy. One of the most often asked parents’ questions is “How long will my child’s food allergy last?”   Given the present impossibility to modify the natural history of food allergy, the answer must take into account a series of factors. The rise in allergies in recent decades has been particularly noticeable in the West. Avoidance measures need to be tailored to the individual’s life and disease requirements must take account o  the needs of growth, the prevention of anaphylaxis and, of the benefits expected of allergen avoidance itself. Sicherer SH, Muñoz-Furlong A, Sampson HA. © 2021 World Allergy Organization. “Tolerance” in “desensitized” children disappears if the allergen is not ingested every day in therapeutic doses. Allergy Asthma Proc 2014;35:435-43. Symptoms caused by immediate sensitivity in the gastrointestinal tract typically develop within minutes to 2 hours of ingesting the offending food. Kattan J. iCAALL - International Collaboration in Asthma, Allergy and Immunology, Basophil, Eosinophil & Mast Cell Disorders in Allergic Disease. (31) Earlier guidelines on allergy prevention recommended delayed exposure to solid foods, avoidance of allergenic foods, and did not include interventions aimed at promoting the infants’ immune tolerance (32). When the symptoms are severe, it is known as anaphylaxis. Boonyaviwat O, Pacharn P, Jirapongsananuruk O, Vichyanond P, Visitsunthorn N. Role of atopy patch test for diagnosis of food allergy-related gastrointestinal symptoms in children. The varied factors include differing criteria for making food allergy diagnosis, study methodologies, geographic variation, ages, and dietary exposures to name a few. 2012;7(10):e45377, 7. A recent systematic review concluded that oral immunotherapy is no longer experimental, but is ready for practical application (42). Globally. Recommendations on other interventional measures, such as vitamin D supplementation, in allergy prevention are negative (37). 2016;116:334-8. . Since the COVID-19 virus outbreak in December 2019, the disease has spread to almost 100 countries around the globe with the World Health Organization declaring it a public health emergency. J Allergy Clin Immunol 2004;114:387-91. In the last years, the experience with oral immunotherapy has made this a common, accepted treatment in some countries. Prevalence of seafood allergy in the United States determined by a random telephone survey. Food Chem Toxicol 2016;89:8-18, 39. This very rare syndrome, affecting infants and young children, is characterized by recurrent episodes of pneumonia associated with pulmonary infiltrates, haemosiderosis, gastrointestinal blood loss, iron deficiency, anaemia, failure to thrive. Precautionary labelling of foods for allergen content: are we ready for a global framework? Often tolerance is not acquired suddenly, but there is a gradual increase of the doses tolerated at challenge. Based on UN World Prospects, 2019 rev. Raw whole egg and egg yolk. Food allergies and other types of food hypersensitivities affect millions of Americans and their families. Pediatric Clinics of North America. 1. There are even more fun stats and facts you should know about your little friends, so keep reading! 2016;352:i974, 32. The guideline panel suggested using probiotics in pregnant and breastfeeding women whose children and infants are at high risk for developing allergy29. Probiotics have been shown by numerous studies to be effective in allergy prevention, particularly in reducing allergic eczema at a rate of 9 fewer cases per 100 pregnant women (risk ratio [RR] 0.72), 16 fewer cases per 100 breastfeeding women (RR 0.58), and 5 fewer cases per 100 infants (RR 0.82). The World Allergy Organization is proud to announce that World Allergy Week 2020 will occur 28 June - 4 July 2020 and will focus on the theme of "Allergy care does not stop with COVID-19." In other countries, hidden allergens can be exempt from specific labeling, and thus be inadvertently consumed by food allergic individuals. Burks AW, Tang M, Sicherer S, et al. World Allergy Organ J. Accurate determination of the prevalence is still one of the major problems with food allergy, considering that many factors influence the reported prevalence of food allergy. The natural history of food allergy also depends on the specific food sensitization, with children allergic to milk and egg displaying a better prognosis than those allergic to peanuts, tree nuts and fish(14). The health-care system is also considerably affected. Food-induced pulmonary haemosiderosis (Heiner's Syndrome). Typical food allergies are IgE-mediated, but several reactions involve different immunologic mechanisms. GLAD-P provides no recommendation at this time on prebiotic use in pregnant and breastfeeding women, owing to the lack of evidence from experimental and observational studies. The World Allergy Organisation (WAO) estimate of allergy prevalence of the whole population by country ranges between 10 - 40% (Pawankar R, et al, 2013); More than 150 million Europeans suffer from chronic allergic diseases and the current prediction is that by 2025 half of the entire EU population will be affected (EAACI, 2016); In the UK Allergy. Fiocchi A, Pawankar R, Cuello-Garcia C, et al. Komata T, Shukuya A, Imai T, Tachimoto H, Ebisawa M.  Single blind food challenge using dried food powder--1st report. Epinephrine is the only medication that is effective for the treatment of anaphylaxis. The in vitro diagnostics can help to identify cross-reactive allergens between pollen and foods, or foods and latex. Allergy. Higher levels of specific IgE for food allergens may better correlate with clinical reactivity as evidenced by challenge testing. There are three broad groups of immune reactions: IgE-mediated, non-IgE-mediated and mixed. Demoly P, Tanno LK, Akdis CA, Lau S, et al.
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