D2.319 - A clinical case of polysensitization and multiple allergies in a 1.5-year-old child

Polysensitivity and clinical manifestations of multiple allergies are no longer uncommon. The clinical case under consideration presents potential dietary challenges. A 1.5-year-old child with clinical manifestations of anaphylaxis to egg white, rhinoconjunctivitis in cats and birch blossoms and a history of atopic dermatitis was found to have food sensitization to almost all obligate allergens, according to the results of an extended ALEX-300 study.

During the diagnostic process, in addition to confirming an allergy to egg white (with clear symptoms of anaphylaxis), high levels of class 3-4 antibodies to other food groups were randomly detected: milk, nuts, soy, legumes, cereals, and fish. Among other things, storage proteins (2S Albumin,11S Globulin), LTP, Parvalbumin, and Omega-5-Gliadin, which induce severe allergic reactions, were also detected. It is important to note that not all identified foods had been introduced into the child's diet; many of them had never been tried before (nuts, legumes, fish).

High sensitization to epidermal allergens (Lipocalin, Uteroglobin, Serum Albumin) was also detected, as well as tree pollen with PR-10 cross-sensitization to a number of foods.

The objectives of this case study are:

(a) to differentiate between safe and potentially dangerous asymptomatic sensitizations;

(b) to reduce the risk of severe allergic reactions and prevent the breakdown of immunological tolerance to sensitized foods.

Conclusions: asymptomatic sensitization to previously introduced foods does not require restrictive measures. It is recommended to continue them in the diet, despite high antibody levels. Identified sensitization to foods with PR-10 cross-sensitization molecules also does not require dietary intervention. Products containing molecules with a high risk of anaphylaxis, such as storage proteins, LTP, and Parvalbumin, had not previously been introduced into the diet orally. This suggests a transcutaneous route of sensitization through the skin, leading to manifestations of atopic dermatitis. Consequently, the risk of developing clinically significant allergies with oral administration is further increased.