This review highlights some of the research advances in
anaphylaxis, and
hypersensitivity reactions to foods, drugs, and insects and in allergic
skin disease that were reported in the Journal in 2008. Key epidemiologic observations include a rise in
anaphylaxis in a population-based study and lower rates of
peanut allergy in Israel, where infants consume peanut early compared with the United Kingdom, where dietary introduction is generally delayed. Advances in
food allergy diagnosis include
IgE epitope mapping that discloses the likelihood and severity of
allergy; studies correlating likelihood of clinical reactivity on the basis of food-specific
IgE to sesame, peanut, milk, and tree nuts; and an observation that a low baseline
angiotensin-converting enzyme level may be associated with having pharyngeal
edema during a reaction. Molecular, immunologic, and genetic studies are discerning pathways that are key in development of
food allergy, identifying new modalities to interrupt mast cell degranulation, and elucidating risks associated with
penicillin allergy. Regarding treatment, clinical studies show a majority of children with milk and
egg allergy tolerate these
proteins in modest amounts when they are extensively heated in baked goods, and studies show promise for oral
immunotherapy to treat
milk allergy and sublingual immunotherapy for honey
bee venom hypersensitivity. The importance of skin barrier dysfunction has continued to be highlighted in the pathophysiology of
atopic dermatitis (AD). Research has also continued to identify immunologic defects that contribute to the propensity of patients with AD to develop viral and
bacterial infection. New therapeutic approaches to AD,
urticaria, and
angioedema have been reported including use of probiotics, biologics,
vitamin D, and skin barrier creams.