Literature Review

1) Anaphylaxis to various protein antigens occurs relatively frequently in the United States. It is the most severe form of immediate allergic hypersensitivity. Foods are the most common triggers including peanut, egg, shellfish, tree nut and more. When the physical exam, the history and specific allergy testing fail to identify the etiology, then medicine calls the reaction: idiopathic anaphylaxis. In a new study in Frontiers in Allergy we see that synthetic food additives may be the issue. From the study: "SPT was positive for carmine-containing red food colorants, including a commercially available gel and a prepared cochineal extract. Control subjects tested negative. sIgE to carmine was equivocal. The patient was educated about allergen avoidance and has remained symptom-free following elimination of carmine from her diet, cosmetics, and medications." (Khalil et. al. 2025)

This case report is a window into the diverse array of possible triggers, many of which are not tested by allergists nationally. Avoidance of processed foods could be an avenue to anaphylaxis avoidance.

2) Distinct skin microbiomes noted on children with food allergy and asthma? Racial disparities are noted epidemiologically with regard to asthma, allergy, food allergy and atopic dermatitis/eczema as it relates to the diseases and the gut microbiomes. How does this reality play out in the microbiome of the skin? From a new study in the Journal Pediatric Allergy and Immunology we see the following: One possible explanation for these trends is that environmental exposures in modern society disrupt the composition and diversity of the human gut microbiome, contributing to food allergy and atopy development. This microbial imbalance can dysregulate immune function, predisposing individuals to allergic disease, an effect especially notable in black children, whose gut bacterial profiles differ significantly from white children with food allergies and often mirror those seen in asthma. Looking at the skin: "The skin acts as a key barrier to the external exposome, and epithelial function can be impacted by changes in skin microbiota which is heavily driven by environmental exposures. However, the relationship between the skin microbiome and atopic disease pathogenesis, as it relates to ethnic differences in FA outcomes, is unclear." (Fyolek et. al. 2025)

In the study, overall skin microbial alpha diversity was not different between black and white children. However, subgroup analysis paints a different picture. Urbanization has simplified environmental bacterial diversity, reducing microbial exposure essential to immune balance. Because soil contact strongly shapes the skin microbiota, limited greenspace and higher pollution in impoverished urban neighborhoods may contribute to the reduced presence of protective “gatekeeping” bacteria on the skin of black children. This depletion, affecting genera such as Actinobacteria and Coronybacteria, likely reflects greater exposure to urban materials and environmental hazards rather than socioeconomic index alone. The observed differences in skin microbiota and loss of commensal species in black children with food allergy, and its association with asthma, are concerning but potentially reversible. Emerging evidence suggests that restoring environmental microbial diversity could help rebalance the skin ecosystem. Continued research is essential to better understand and address these disparities.

At the end of the day, more outdoor play, avoidance of over cleansing the skin, avoidance of urban toxic materials, using active skin repair for pH balance of the atopic skin and more can help this atopic struggle while we wait for topical microbial alterations as skin probiotics are developed.

Dr. M

Khalil Front Allerg

Fyolek Ped Allerg Immun