Witchaya Srisuwatchari

Background: Rapid drug desensitization (RDD) enables the safe reintroduction of chemotherapeutic agents in patients with hypersensitivity reactions (HSRs). However, some patients experience breakthrough reactions (BTRs) during desensitization, and research on factors associated with BTRs is limited in pediatric patients. Methods: We conducted an ambispective observational cross‐sectional study in Bangkok, Thailand. Patients ≤18‐year‐old who experienced immediate HSRs (within 1–6 h) to chemotherapeutic agents and underwent RDD following evaluation by allergists between January 2010 and April 2025 were included. Results: A total of 182 RDDs were performed in 38 children (median age of 5.3 years). The majority were diagnosed with acute leukemia (47.4%), and the most common causative agents for HSRs were E. coli ‐Asparaginase (26.9%), vincristine (24.7%), and methotrexate (13.7%). Asparaginase, vincristine, cyclophosphamide, carboplatin/oxaliplatin, and doxorubicin were commonly associated with Type I HSRs, while methotrexate, cyclosporin A and etoposide were linked to Type I HSRs as well as infusion‐related reactions (IRRs) or cytokine‐release reactions (CRRs). Twenty‐nine BTRs occurred during RDD (15.9%), most of which were mild (72.4%). Independent risk factors for BTRs included E. coli ‐Asparaginase desensitization (adjusted OR 3.87 [1.45, 10.39], p = .007), and a higher initial starting dose (ratio ≤1:10,000) (adjusted OR 3.51 [1.02, 12.18], p = .048). Conversely, later cycles of desensitization reduced the risk of BTRs (adjusted OR 0.47 [0.31, 0.72], p < .001). Conclusion: RDDs for chemotherapeutic agents effectively enable safe treatment continuation in most children with immediate HSRs, including type I HSR, CRR, and mixed reactions. In our study, E. coli ‐Asparaginase, a higher initial starting dose, and an early desensitization cycle were identified as having potential risk factors associated with BTRs. image

This review examines the evolving global landscape of food‐induced anaphylaxis (FIA), revealing critical epidemiological shifts that challenge traditional allergen management paradigms. As the leading cause of anaphylaxis worldwide, FIA demonstrates striking geographic, age‐specific, and temporal patterns that reflect broader changes in dietary practices, environmental exposures, and food production systems. Emerging trends reveal novel allergen sources that evade current regulatory frameworks, including non‐priority legumes, edible insects and galacto‐oligosaccharides with distinct cross‐reactivity patterns and the expanding prevalence of buckwheat, tree nut and seeds anaphylaxis. Complex syndromes such as lipid transfer protein syndrome, tick‐borne α‐Gal syndrome and food‐dependent exercise‐induced anaphylaxis represent diagnostic challenges requiring heightened clinical suspicion. Critical knowledge gaps remain in certain regions where limited surveillance, inadequate adrenaline access, and uncharacterized regional allergens create substantial management disparities. The review emphasizes urgent needs for comprehensive global surveillance networks, precision diagnostic tools for atypical presentations, expanded allergen labeling policies encompassing novel proteins, and equity‐centered interventions addressing geographic disparities in emergency treatment access. image

Food-dependent exercise-induced allergic reactions (FDEIA) represent a distinct clinical phenomenon where symptoms arise during exercise following the consumption of specific trigger foods, with the most severe manifestation being anaphylaxis—a condition distinct from typical exercise-induced or food-induced anaphylaxis. In FDEIA, patients can either exercise or tolerate specific foods separately without experiencing any allergic reactions. Diagnosis relies on patient history and provocation testing, requiring rigorous implementation within a supervised hospital environment. Positive symptoms and clinical signs during testing confirm FDEIA, while negative outcomes do not preclude its presence. Exercise stands as the primary trigger, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol. The utilization of various protocols for food cofactor challenges to confirm FDEIA yields differing diagnostic outcomes. We highlight the updated concept of food cofactor challenges, incorporating protocols reported in the literature, and summarize current recommendations and comprehensive management approaches for FDEIA patients.

The number of children presenting with IgE-mediated wheat reactions to academic medical centers in Thailand continues to increase. Improved knowledge about the clinical characteristic of wheat allergy is urgently needed to better understand the risk factors and to improve proper treatment in this patient population. A cross-sectional study using questionnaire review of children who presented with IgE-mediated wheat allergy during 2001 to 2015 was performed. Patients were divided into the wheat anaphylaxis (WA) or the only skin symptoms (SO) group. One hundred children were enrolled. Fifty-one and 49 patients were allocated to the WA and SO group, respectively. The median age was 40.5 months (range: 6-200), and the median age of onset was 7 months (range: 3-96). The vast majrity (90%) developed their first reaction after their first ingestion of wheat. Atopic dermatitis (AD) was found to be the only significant difference between groups and found more commonly in SO than in WA (59.2% vs. 35.3%, p = 0.02). Median mean wheal diameter (MWD) of skin prick test (SPT) and median sIgE level to wheat were higher in WA than in SO (8 vs. 3 mm, p < 0.001; and, 33.3 vs. 3.6 kUA/l, p < 0.001). Children with wheat allergy presented very early in life. AD was found in approximately half of the patients, and more commonly in SO. Median MWD of SPT and sIgE level to wheat were significantly higher in WA. These data will aid in further planning for a larger survey and intervention study in wheat allergy.

A skin prick test (SPT) and food challenge test (OFC) are useful in identification of food sensitization and food allergy. To evaluate food allergen sensitization by SPT and food allergy by OFC in allergic Thai patients METHODS: SPTs for common food allergens were performed on allergic patients at Siriraj Hospital, Bangkok, Thailand, from 2011 to 2015. An OFC was performed in positive food SPT patients with informed consent. SPTs to food were positive in 539 (20%) out of 2,678 allergic patients (73.8% were < 10 years old). Crab was the most common sensitized food in each year of the study period. In patients aged < 1 year, the most common sensitized foods were egg white (23.8%) and wheat (22.2%), while shrimp was for patients aged > 10 years (25%). A positive OFC was found in 29 (26.1%) out of the 111 OFCs performed (9.1% in patients with asthma, 28.6% in allergic rhinitis and 26.3% in food allergy). Positive OFCs were found for 60% of the crab, 35.7% of the egg yolk, and 31% of the cow's milk OFCs. Compared to OFC, SPT showed high specificity (71%-100%) but low sensitivity (0%-40%). The percentage of sensitization to egg white, egg yolk, wheat, soy, and peanut significantly increased (p < 0.05) from 2011 to 2015. The sensitization to egg white, egg yolk, wheat, soy, and peanut significantly increased and crab was the most common sensitized food. Food allergy in patients with allergic rhinitis was as common as in patients diagnosed food allergy.