Vitamin D and Anaphylaxis

Anaphylaxis

Anaphylaxis is a very severe hypersensitivity to an allergen. Allergens are any substances that cause allergies. This condition affects many systems of the body at the same time.

• Skin: hives, itchiness, and flushing
• Respiratory: shortness of breath
• Gastrointestinal: abdominal pain, diarrhea, and vomiting
• Cardiovascular: coronary artery spasm and possible heart attack
• Nervous: drop in blood pressure, possible loss of bladder control, and anxiety

Anaphylaxis usually occurs suddenly and requires emergency treatment.

Risk factors

The most common causes of anaphylaxis are:

• Foods
• Venom from insect bites or stings
• Drugs
• Frequency of exposure to an allergen

Sunlight exposure and anaphylaxis risk

Several studies have identified links between severe allergies, seasons of birth, and vitamin D:

• One U.S. study identified regional differences in EpiPen prescriptions in 2004. (EpiPen [Day Pharmaceuticals, California] is an injection used to treat severe allergies.) The most EpiPen prescriptions were filled in the Northeast. The least number of prescriptions were filled in the Southwest. This variation may be related to summertime solar ultraviolet-B (UVB) doses. There is more UVB light in the Southwest and less in the Northeast.
• There was a significant increase in EpiPen prescription rates in Australia as latitudes increased. Higher latitudes are farther from the equator and have less sun.
• Evidence suggests that season of birth may be associated with food allergies. Therefore, vitamin D may support a developing immune system whether in early childhood, in utero, or both.

Vitamin D and Anaphylaxis

How vitamin D works

Vitamin D may help severe allergies because it:

• Reduces immunoglobulin E (IgE), a type of antibody: Higher IgE levels are associated with increased risk of anaphylaxis. As vitamin D levels increase in value from winter to summer, IgE levels drop.
• Reduces inflammation: Calcitriol is the hormonal version of vitamin D. It acts on the immune system and reduces inflammation when the body is fighting allergies.

Prevention

Vitamin D may lower the risk of food allergies and anaphylaxis while the baby is in utero, in early childhood, and later in life.

In Finland, maternal diet affected the risk of food allergies in children up to five years of age. Mothers who took more vitamin D (even low doses) during pregnancy had children with less sensitivity to food allergens.

Treatment

There are no reported studies indicating that vitamin D may be used to treat allergies or anaphylaxis. It seems unlikely that vitamin D would be helpful for anaphylaxis as this condition usually requires emergency treatment and vitamin D’s effects would take at least a day or two to appear.

References

1. Camargo, C. A., Jr. Clark, S. Kaplan, M. S. Lieberman, P. Wood, R. A. Regional differences in EpiPen prescriptions in the United States: the potential role of vitamin D. The Journal of allergy and clinical immunology. 2007 Jul; 120 (1): 131-6.
2. Fioletov, V. E. McArthur, L. J. Mathews, T. W. Marrett, L. Estimated ultraviolet exposure levels for a sufficient vitamin D status in North America. J Photochem Photobiol B. 2010 Aug 2; 100 (2): 57-66.
3. Griffin, M. D. Xing, N. Kumar, R. Vitamin D and its analogs as regulators of immune activation and antigen presentation. Annu Rev Nutr. 2003; 23117-45.
4. Hypponen, E. Berry, D. J. Wjst, M. Power, C. Serum 25-hydroxyvitamin D and IgE – a significant but nonlinear relationship. Allergy. 2009 Apr; 64 (4): 613-620.
5. Leffell, D. J. Brash, D. E. Sunlight and skin cancer. Sci Am. 1996 Jul; 275 (1): 52-3, 56-9.
6. Mullins, R. J. Clark, S. Camargo, C. A., Jr. Regional variation in epinephrine autoinjector prescriptions in Australia: more evidence for the vitamin D-anaphylaxis hypothesis. Ann Allergy Asthma Immunol. 2009 Dec; 103 (6): 488-95.
7. Mullins, R. J. Clark, S. Camargo, C. A., Jr. Regional variation in infant hypoallergenic formula prescriptions in Australia. Pediatr Allergy Immunol. 2010 Mar; 21 (2 Pt 2): e413-20.
8. Nwaru, B. I. Ahonen, S. Kaila, M. Erkkola, M. Haapala, A. M. Kronberg-Kippila, C. Veijola, R. Ilonen, J. Simell, O. Knip, M. Virtanen, S. M. Maternal diet during pregnancy and allergic sensitization in the offspring by 5 yrs of age: a prospective cohort study. Pediatr Allergy Immunol. 2010 Feb; 21 (1 Pt 1): 29-37.
9. Rudders, S. A. Banerji, A. Vassallo, M. F. Clark, S. Camargo, C. A., Jr. Trends in pediatric emergency department visits for food-induced anaphylaxis. J Allergy Clin Immunol. 2010 Aug; 126 (2): 385-8.
10. Rudders, S. A. Espinola, J. A. Camargo, C. A., Jr. North-south differences in US emergency department visits for acute allergic reactions. Ann Allergy Asthma Immunol. 2010 May; 104 (5): 413-6.
11. Vassallo, M. F. Banerji, A. Rudders, S. A. Clark, S. Camargo, C. A., Jr. Season of birth and food-induced anaphylaxis in Boston. Allergy. 2010 Nov; 65 (11): 1492-3.
12. Vassallo, M. F. Banerji, A. Rudders, S. A. Clark, S. Mullins, R. J. Camargo, C. A., Jr. Season of birth and food allergy in children. Ann Allergy Asthma Immunol. 2010 Apr; 104 (4): 307-13.
13. Vassallo, M. F. Camargo, C. A., Jr. Potential mechanisms for the hypothesized link between sunshine, vitamin D, and food allergy in children. J Allergy Clin Immunol. 2010 Aug; 126 (2): 217-22.