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Wednesday 24 April 2019
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Expert view: Who is at risk of severe allergic reactions?

Allergies are a major ongoing problem, especially in Western countries. Currently, it is estimated that about a quarter of the world's population suffers from some type of allergy, mainly due to allergic rhinitis or allergic bronchial asthma.
 
However, the most dangerous reactions (anaphylaxis) usually occur through allergic reactions to foods, drugs and Hymenoptera (for example, wasps, bees, ants, etc) bites.
 
The Big Eight
Food allergies typically occur in childhood, but can persist, or even first occur, in adulthood. The foods most frequently responsible for allergic reactions are the ‘big eight’, namely: milk, eggs, fish, shellfish, soy, wheat, peanut and walnuts. Not all food allergies cause serious reactions; in fact, the intensity of the reaction depends on many factors, such as the sensitivity of the subject, the amount of ingested food, if it was raw, cooked or processed industrially (cooking and industrial processing can reduce the risk as they destroy certain types of allergens), and the health status of subject, including concomitant diseases and therapies.
 
Drug allergies
Allergic reactions to drugs are rarer, and occur more typically in adulthood. In these cases, reactions can be mild or more severe reactions. The most implicated drugs are antibiotics (especially the penicillin family) and non-steroidal anti-inflammatories. Subjects having had a previous adverse reaction to drugs (even if not severe) or even a suspected reaction should advise their clinician, who will advise on the proper diagnostic route to confirm or rule out the diagnosis and, if necessary, identify the drugs that patient can use safely.
 
Insect bites and allergies
Allergies to Hymenoptera bites mainly occur in adulthood; most at risk for these reactions are beekeepers, followed by all those who, for reasons related to work, hobbies or lifestyle can easily be stung by Hymenoptera. People who have presented a systemic reaction (shortness of breath, feeling lightheaded/syncope, intestinal symptoms, hives, etc) after a bee, wasp or hornet sting, or an extended local reaction (redness and swelling in a 10cm radius of site of the sting) are to be considered at risk of a severe reaction in case of future stings and should undergo an allergological diagnostic workup.
 
In subjects at a high risk of serious allergic reactions, the physician will prescribe emergency therapy with an ephineprine auto-injector, which should be carried by the patient at all times.