Molecular profiling of pediatric food allergy: Sensitisation patterns and psychosocial burden

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Created On: 06/11/2026

Pediatric food allergy is associated with severe allergic reactions, psychosocial distress, and challenges in emergency management.

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Key take away

Bulgarian children with suspected food allergy exhibit prominent tree nut sensitisation and age-related differences in allergen profiles, while families face considerable psychosocial challenges amid limited access to epinephrine auto-injectors.

Background

Pediatric food allergy is associated with severe allergic reactions, psychosocial distress, and challenges in emergency management. This study examined molecular sensitisation profiles in Bulgarian children with suspected food allergies and assessed the impact on caregiver quality of life (QoL) in a setting where epinephrine auto-injectors were unavailable.

Method

The study included 1,163 pediatric patients who underwent molecular allergy testing using the Allergy Explorer 2 (ALEX2) multiplex platform. A sensitisation threshold greater than 0.10 kUA/L was applied to assess allergen profiles and co-sensitisation patterns. Additionally, 90 caregivers completed structured questionnaires evaluating the impact of food allergy on family QoL.

Result

Tree nut sensitisation predominated: Tree nut allergens showed the highest sensitisation prevalence, with prominent responses to Ana o 3, Pis v 1, Jug r 1, Cor a 9, and Cor a 14.
Sensitisation profiles varied with age: Younger children more frequently exhibited sensitisation to stable storage proteins, whereas older children showed more pathogenesis-related class 10 (PR-10)-associated cross-reactive profiles.
Co-sensitisation clustered across related allergens: Strong correlations were identified between cashew and pistachio, walnut and hazelnut, as well as among mammalian milk and fish allergens.
Family burden extended beyond allergic symptoms: Caregiver questionnaires revealed fear of anaphylaxis, persistent vigilance against accidental exposure, and restrictions on daily activities.
Emergency preparedness remained a key concern: Caregivers reported challenges related to inadequate preparedness for severe allergic reactions in a setting without access to epinephrine auto-injectors.

Conclusion

The study identified prominent tree nut sensitisation patterns, age-related differences in molecular profiles, and co-sensitisation across related allergen groups in Bulgarian children with suspected food allergy. Caregiver responses also highlighted considerable psychosocial burden and concerns regarding emergency preparedness. These findings underscore the potential value of molecular allergy assessment alongside improved emergency planning and family support.

Source:

Allergies

Link:

https://www.mdpi.com/2313-5786/6/3/31

Article:

Food Allergy Without a Safety Net—Molecular Sensitisation Patterns and Family Quality of Life Among Bulgarian Children in a Setting Without Epinephrine Auto-Injectors