Table 4 Long-term management: trigger-specific prevention

Food-induced anaphylaxis [119–134]

Sustained clinical and immunological unresponsiveness to peanut was documented after up to 5 years of peanut oral immunotherapy. Responders had smaller skin test wheals and lower allergen-specific IgE levels at baseline and at the time of post-treatment peanut challenge, compared with non-responders [130].

Sustained clinical and immunological responsiveness to peanut has been documented after up to 3 years of peanut sublingual immunotherapy. Responders had a significant decrease in peanut-specific basophil activation and skin prick test titration with peanut, as compared with non-responders [131].

In selected high-risk infants with eczema, egg allergy, or both, who were aged 4–10 months (inclusive) at study entry, early introduction of peanut snacks (at least 6 grams weekly until age 60 months) prevented development of clinical reactivity to peanut [134].

Hymenoptera venom-induced anaphylaxis [135–139]

In 100 adults who completed venom immunotherapy and had live sting challenges to prove efficacy, post-challenge scores on the Vespid Allergy Quality of Life Questionnaire improved significantly, independent of age, sex, or severity of the initial anaphylaxis episode [138].

Drug/iatrogenic agent-induced anaphylaxis [140–148]

In a retrospective study of patients with a history of hypersensitivity reactions during anesthesia, comprehensive evaluation, including skin tests and measurement of basal tryptase levels, followed by development of a management plan, minimized risk of subsequent reactions even when a specific trigger such as an antibiotic, neuromuscular blocker, or latex was not identified [145].

Idiopathic anaphylaxis [149, 150]

In 20 % of 110 patients with idiopathic anaphylaxis (no identifiable trigger by history, skin tests, or allergen-specific IgE levels), the etiology of the episode was identified by using the ImmunoCAP ISAC 103 allergen array in addition to the ImmunoCAP 250 platform. Omega-5 gliadin and shrimp were the most frequently identified sensitizations among those not previously recognized [149].