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Bird JA, Lack G, Perry TT. Clinical management of food allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:1-11; quiz 12. [PMID: 25577612 DOI: 10.1016/j.jaip.2014.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/09/2014] [Accepted: 06/11/2014] [Indexed: 11/28/2022]
Abstract
Food allergies are commonly seen by the practitioner, and managing these patients is often challenging. Recent epidemiologic studies report that as many as 1 in 13 children in the United States may have a food allergy, which makes this an important disease process to appropriately diagnose and manage for primary care physicians and specialists alike. Having a understanding of the basic immunologic processes that underlie varying presentations of food-induced allergic diseases will guide the clinician in the initial workup. This review will cover the basic approach to understanding the immune response of an individual with food allergy after ingestion and will guide the clinician in applying appropriate testing modalities when needed by conducting food challenges if indicated and by educating the patient and his or her guardian to minimize the risk of accidental ingestion.
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Affiliation(s)
- J Andrew Bird
- Division of Allergy and Immunology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex.
| | - Gideon Lack
- Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom; Children's Allergy Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark; Department of Allergy and Immunology, Arkansas Children's Hospital, Little Rock, Ark
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Dang TD, Peters RL, Allen KJ. Debates in allergy medicine: baked egg and milk do not accelerate tolerance to egg and milk. World Allergy Organ J 2016; 9:2. [PMID: 26839629 PMCID: PMC4727327 DOI: 10.1186/s40413-015-0090-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/30/2015] [Indexed: 11/10/2022] Open
Abstract
There is emerging evidence that children with egg and cow's milk allergy who can tolerate these allergens cooked in baked goods are more likely to develop tolerance. As a result a hypothesis has arisen that exposure to egg and milk in baked goods may hasten tolerance development; however, it is unclear whether children who develop tolerance do so because they have ingested low levels of egg or milk in baked products. An alternative explanation for the improved prognosis in those who can tolerate food allergens in the baked form is that tolerance to egg and milk in baked goods is simply an indicator of a phenotype that is less likely to be persistent. We discuss the role that the baked egg or milk allergy phenotype plays on predicting tolerance development and suggest that it is the phenotype of the disease rather than exposure to altered allergens that is the strongest predictor of tolerance development.
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Affiliation(s)
- Thanh D Dang
- Centre of Food and Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia ; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Rachel L Peters
- Centre of Food and Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia ; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Katrina J Allen
- Centre of Food and Allergy Research, Murdoch Childrens Research Institute, Melbourne, Australia ; Department of Allergy and Clinical Immunology, The Royal Children's Hospital, Melbourne, Australia ; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia ; Department of Paediatrics, University of Melbourne, Parkville, Australia ; Institute of Inflammation and Repair, University of Manchester, Manchester, UK ; Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Australia
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53
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Reese I, Lange L. Allergie gegen Kuhmilch und Hühnerei: Was bietet die molekulare Allergiediagnostik? ALLERGO JOURNAL 2015. [DOI: 10.1007/s15007-015-0981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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54
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Effect of heat denaturation of egg white proteins ovalbumin and ovomucoid on CD4+ T cell cytokine production and human mast cell histamine production. J Funct Foods 2015. [DOI: 10.1016/j.jff.2015.06.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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55
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Nowak-Węgrzyn A, Albin S. Oral immunotherapy for food allergy: mechanisms and role in management. Clin Exp Allergy 2015; 45:368-83. [PMID: 25077670 DOI: 10.1111/cea.12382] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the emergence of food allergy as an important public health problem, it has become clear that there is an unmet need in regard to treatment. In particular, IgE-mediated food allergy that is associated with risk of fatal anaphylaxis has been the subject of multiple studies in the past decade. The growing body of evidence derived from multiple centres and various study designs indicates that for IgE-mediated food allergy, immunomodulation through food immunotherapy is possible; however, the extent of protection afforded by such treatment is highly variable. At this time, the capacity for food immunotherapy to restore permanent tolerance to food has not been demonstrated conclusively. This review will discuss these topics as they apply to the most important studies of food oral immunotherapy.
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Affiliation(s)
- A Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
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56
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Affiliation(s)
- M. C. Berin
- Pediatric Allergy and Immunology; Icahn School of Medicine at Mount Sinai; New York NY USA
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57
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58
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Kulis M, Wright BL, Jones SM, Burks AW. Diagnosis, management, and investigational therapies for food allergies. Gastroenterology 2015; 148:1132-42. [PMID: 25633563 PMCID: PMC4793977 DOI: 10.1053/j.gastro.2015.01.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 12/14/2022]
Abstract
Food allergies have increased in prevalence over the past 20 years, now becoming an important public health concern. Although there are no therapies currently available for routine clinical care, recent reports have indicated that immunotherapies targeting the mucosal immune system may be effective. Oral immunotherapy is conducted by administering small, increasing amounts of food allergen; it has shown promise for desensitizing individuals with peanut, egg, or milk allergies. Sublingual immunotherapy also desensitizes allergic patients to foods-2 major studies have examined the effects of sublingual immunotherapy in subjects with peanut allergies. We review the complex nature of IgE-mediated food allergies and the therapies being evaluated in clinical trials. We focus on the diagnosis and management of food allergies and investigational therapies.
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Affiliation(s)
- Mike Kulis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Benjamin L. Wright
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Stacie M. Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - A. Wesley Burks
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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59
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Netting M, Donato A, Makrides M, Gold M, Quinn P, Penttila I. Allergenicity of pasteurized whole raw Hen's egg compared with fresh whole raw Hen's egg. Pediatr Allergy Immunol 2015; 26:234-238. [PMID: 25720528 DOI: 10.1111/pai.12365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral food challenges for diagnosis and management of egg allergy using fresh egg are common; however, to limit the risk of foodborne infection, many allergy units use pasteurized raw egg. Pasteurization and drying processes have the potential to affect the structure of egg proteins in egg powder and thus the allergenicity when compared to fresh egg. Our aim was to compare the binding of serum IgE from egg-allergic children to in vitro digested and undigested pasteurized whole raw egg powder with unpasteurized fresh whole raw egg. METHODS Egg proteins from in vitro digested or undigested pasteurized whole raw egg powder, fresh whole egg, egg white and egg yolk were separated by SDS-PAGE, transferred onto nitrocellulose membrane and incubated overnight with pooled sera from egg-allergic children. RESULTS In both the raw egg samples and the pasteurized whole egg powder, protein bands corresponding to known molecular weights of the major egg allergens were present. Pasteurized whole raw egg powder was bound by serum IgE in a similar manner to unpasteurized whole raw egg and was unaffected by in vitro digestion. Serum IgE also bound egg yolk, indicating sensitization to both egg yolk and egg white proteins. CONCLUSIONS The main egg allergens are present in pasteurized whole raw egg powder, and serum IgE of egg-allergic children binds to them in a similar pattern to those in fresh whole raw egg. Pasteurized whole raw egg powder is a suitable substitute for raw egg in clinical practice for oral food challenges.
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Affiliation(s)
- Merryn Netting
- Women's and Children's Health Research Institute, North Adelaide, SA, Australia.,School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, SA, Australia
| | - Adaweyah Donato
- Women's and Children's Health Research Institute, North Adelaide, SA, Australia
| | - Maria Makrides
- Women's and Children's Health Research Institute, North Adelaide, SA, Australia.,School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, SA, Australia.,South Australian Health Medical Research Institute, Adelaide, SA, Australia
| | - Michael Gold
- School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, SA, Australia.,Department of Allergy and Immunology, Children's Youth and Women's Health Network, Adelaide, SA, Australia
| | - Patrick Quinn
- School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, SA, Australia.,Department of Allergy and Immunology, Children's Youth and Women's Health Network, Adelaide, SA, Australia
| | - Irmeli Penttila
- Women's and Children's Health Research Institute, North Adelaide, SA, Australia.,School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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60
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Food processing and allergenicity. Food Chem Toxicol 2015; 80:223-240. [PMID: 25778347 DOI: 10.1016/j.fct.2015.03.005] [Citation(s) in RCA: 301] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/06/2015] [Accepted: 03/08/2015] [Indexed: 11/22/2022]
Abstract
Food processing can have many beneficial effects. However, processing may also alter the allergenic properties of food proteins. A wide variety of processing methods is available and their use depends largely on the food to be processed. In this review the impact of processing (heat and non-heat treatment) on the allergenic potential of proteins, and on the antigenic (IgG-binding) and allergenic (IgE-binding) properties of proteins has been considered. A variety of allergenic foods (peanuts, tree nuts, cows' milk, hens' eggs, soy, wheat and mustard) have been reviewed. The overall conclusion drawn is that processing does not completely abolish the allergenic potential of allergens. Currently, only fermentation and hydrolysis may have potential to reduce allergenicity to such an extent that symptoms will not be elicited, while other methods might be promising but need more data. Literature on the effect of processing on allergenic potential and the ability to induce sensitisation is scarce. This is an important issue since processing may impact on the ability of proteins to cause the acquisition of allergic sensitisation, and the subject should be a focus of future research. Also, there remains a need to develop robust and integrated methods for the risk assessment of food allergenicity.
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61
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Abstract
This article provides a clinically focused review of food-induced anaphylaxis that includes epidemiology, risk factors, allergens, diagnosis, and management. Currently, there is no treatment for food allergy. Dietary avoidance and emergency preparedness are the cornerstones of management. Effective and safe therapies to reduce the risk of serious food-induced reactions are urgently needed, as are reliable biomarkers to predict severity.
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62
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Benhamou Senouf AH, Borres MP, Eigenmann PA. Native and denatured egg white protein IgE tests discriminate hen's egg allergic from egg-tolerant children. Pediatr Allergy Immunol 2015; 26:12-7. [PMID: 25443975 DOI: 10.1111/pai.12317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate diagnosis of egg allergy by IgE testing is challenged by a large number of atopic subjects sensitized, but clinically tolerant to eggs. In addition, discrimination between allergy to raw only, or raw and cooked egg allergy is important. In this study, we investigate the diagnostic performance of IgE tests to native and denatured egg proteins. METHODS According to food challenges and clinical tolerance, study subjects were randomized to the following groups: (Group A) sensitized but clinically tolerant to egg, (Group B) allergic to raw egg only, or (Group C) allergic to raw and cooked egg. Serum-specific IgE to native or reduced and oxidized egg white, ovomucoid, and ovalbumin were measured. RESULTS Increasing titers of specific IgE to the various proteins were found according to the degree of the egg allergy. Cut-off values for IgE testing to native egg could be determined to distinguish between raw egg allergic and egg-tolerant subjects (1.6 kU/l), as well as raw and cooked egg allergic and egg-tolerant subjects (4.1 kU/l). ROC curves analysis showed that native ovalbumin was the best test for the diagnosis of allergy to raw and cooked egg, and native ovomucoid was best to distinguish between allergy to raw only, and allergy to raw and cooked egg. Sequential testing improved the diagnosis, when in addition to IgE to native egg white, IgE to native ovalbumin was tested for the diagnosis of raw and cooked egg allergy, and IgE to native ovomucoid for the discrimination between allergy to raw only, or to raw and cooked eggs. CONCLUSION The diagnosis of egg allergy can be significantly improved using a panel of IgE tests to egg proteins in the native or denatured form. The accuracy can be improved using combined IgE testing.
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Affiliation(s)
- Avigael H Benhamou Senouf
- Department of Child and Adolescent, Pediatric Allergy Unit, University Hospitals, Geneva, Switzerland
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63
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Li Z, Luo Y, Jiang M. Effects of Heat Treatment on the Antigenicity and Allergenicity of Grass Carp Muscles. JOURNAL OF AQUATIC FOOD PRODUCT TECHNOLOGY 2015. [DOI: 10.1080/10498850.2013.851758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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64
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Jhon J, Lee KE, Kim MN, Hong JY, Kim MJ, Kim YH, Park HB, Han YK, Lee HS, Kim KW, Sohn MH, Park JW, Kim KE. Diagnostic utility of skin prick test to cooked egg in children with egg allergy. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.1.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jin Jhon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Eun Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Na Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yeon Hong
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Bin Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ki Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seon Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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65
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Sun N, Tekutyeva L, Wang S, Pu Q, Zhou C, Wang J, Che H. A modified weight-of-evidence approach to evaluate the allergenic potential of food proteins. Toxicol Res (Camb) 2015. [DOI: 10.1039/c4tx00211c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Schematic interpretation of a modified weight-of-evidence approach for evaluating the allergenic potential of food proteins.
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Affiliation(s)
- Na Sun
- College of Food Science and Nutritional Engineering
- China Agricultural University
- Beijing
- China
| | - Liudmila Tekutyeva
- Department of Commodity Science and Examination of Goods
- School of Business and Public Administration
- Far Eastern Federal University
- 8 Suhanova St. Vladivostok
- Russia
| | - Shiping Wang
- College of Food Science and Nutritional Engineering
- China Agricultural University
- Beijing
- China
| | - Qiankun Pu
- College of Food Science and Nutritional Engineering
- China Agricultural University
- Beijing
- China
| | - Cui Zhou
- College of Food Science and Nutritional Engineering
- China Agricultural University
- Beijing
- China
| | - Jing Wang
- College of Food Science and Nutritional Engineering
- China Agricultural University
- Beijing
- China
| | - Huilian Che
- College of Food Science and Nutritional Engineering
- China Agricultural University
- Beijing
- China
- The Supervision
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66
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Lechevalier V, Musikaphun N, Gillard A, Pasco M, Guérin-Dubiard C, Husson F, Nau F. Effects of dry heating on the progression of in vitro digestion of egg white proteins: contribution of multifactorial data analysis. Food Funct 2015; 6:1578-90. [DOI: 10.1039/c4fo01156b] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In vitrodigestion of egg white powders: multiple factor analysis to follow the dry-heating effect.
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Affiliation(s)
- Valerie Lechevalier
- Agrocampus Ouest
- F-35042 Rennes
- France
- Institut National de la Recherche Agronomique (INRA)
- F-35042 Rennes
| | - Nuttinee Musikaphun
- Agrocampus Ouest
- F-35042 Rennes
- France
- Institut National de la Recherche Agronomique (INRA)
- F-35042 Rennes
| | - Angelique Gillard
- Agrocampus Ouest
- F-35042 Rennes
- France
- Institut National de la Recherche Agronomique (INRA)
- F-35042 Rennes
| | - Maryvonne Pasco
- Agrocampus Ouest
- F-35042 Rennes
- France
- Institut National de la Recherche Agronomique (INRA)
- F-35042 Rennes
| | - Catherine Guérin-Dubiard
- Agrocampus Ouest
- F-35042 Rennes
- France
- Institut National de la Recherche Agronomique (INRA)
- F-35042 Rennes
| | - Francois Husson
- Agrocampus Ouest
- Applied Mathematics Department
- F-35042 Rennes
- France
| | - Francoise Nau
- Agrocampus Ouest
- F-35042 Rennes
- France
- Institut National de la Recherche Agronomique (INRA)
- F-35042 Rennes
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67
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IgE-Mediated Food Allergy. Mucosal Immunol 2015. [DOI: 10.1016/b978-0-12-415847-4.00084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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68
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Bloom KA, Huang FR, Bencharitiwong R, Bardina L, Ross A, Sampson HA, Nowak-Węgrzyn A. Effect of heat treatment on milk and egg proteins allergenicity. Pediatr Allergy Immunol 2014; 25:740-6. [PMID: 25251921 DOI: 10.1111/pai.12283] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heating destroys many conformational epitopes and reduces allergenicity of some foods. IgE-epitope binding has been shown to be different among patients who outgrew their cow's milk or hen's egg allergy and those who did not. A significant proportion of milk- or egg-allergic children are tolerant to these foods in their baked forms. We sought to explore the effects of heating on milk and egg proteins and to evaluate for differences in immunolabeling among children with regard to reactivity to heated milk or egg. METHODS Sera from participants in clinical dietary intervention trials were utilized. Milk and egg samples were variably heated and prepared (at times within a wheat matrix). Sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis (PAGE), protein transfer, and Western blot were completed. RESULTS Sera from 20 milk-allergic and 24 egg-allergic children were utilized. Gel electrophoresis showed strongly staining casein bands that persisted for up to 60 min of heating. In contrast, β-lactoglobulin and α-lactalbumin bands became progressively weaker with increasing heating times, with no detectable β-lactoglobulin after 15-20 min of heating. The ovalbumin band became progressively weaker, whereas ovomucoid remained stable after 25 min of heating. Immunolabeling revealed that all heated milk-reactive children possessed IgE antibodies that bound the casein fraction regardless of heating time. Presence of wheat during heating resulted in decreased IgE antibody binding to milk and egg white proteins. CONCLUSION Heating has a different effect on whey and caseins in cow's milk and ovalbumin and ovomucoid in hen's egg white. The effect of heat on protein allergenicity is affected by the temperature and duration, along with the presence of wheat.
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Affiliation(s)
- Katherine A Bloom
- Division of Allergy/Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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69
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Turner PJ, Kumar K, Fox AT. Skin testing with raw egg does not predict tolerance to baked egg in egg-allergic children. Pediatr Allergy Immunol 2014; 25:657-61. [PMID: 25298203 DOI: 10.1111/pai.12291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most children with egg allergy tolerate egg in baked foods, such as cake, but tolerance cannot be predicted with conventional allergy testing. We hypothesized that the skin prick test (SPT) wheal to unprocessed raw egg might predict tolerance of baked egg at formal oral food challenge (OFC). METHODS We conducted a retrospective chart review to assess the utility of SPT wheal to egg extract (EE), raw egg (RE), and the ratio of EE:RE in predicting outcome of baked-egg OFC in children presenting to our tertiary referral centers with a physician diagnosis of egg allergy and following complete egg avoidance in their diet, between 2009 and 2013. OFC were performed following a standardized protocol using baked egg in cake, to a total dose equivalent to 3g egg protein. RESULTS Data were analyzed from 186 completed challenges: OFC was positive in 64 (34%) children and negative in 122 (66%). Six children experienced anaphylaxis at OFC. Children tolerant to baked egg were more likely to have a lower SPT to egg extract/raw egg and EE:RE (median 0.56) than their allergic counterparts (0.70, p < 0.05). However, ROC curve analysis demonstrated poor predictivity of challenge outcome, with AUC for SPT to egg extract, raw egg and EE:ER equal to 0.71, 0.63 and 0.60, respectively. CONCLUSION EE:RE was not helpful in predicting outcome of baked-egg OFC. Indeed, SPT to egg extract was slightly better at predicting outcome than either SPT to raw egg or EE:RE. Unfortunately, tolerance to baked egg can only be predicted from previous history or through controlled exposure.
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Affiliation(s)
- P J Turner
- Section of Paediatrics and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
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70
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Effect of high pressure homogenisation on microbial inactivation, protein structure and functionality of egg white. Food Res Int 2014. [DOI: 10.1016/j.foodres.2014.04.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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71
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Cell-based immunological assay: complementary applications in evaluating the allergenicity of foods with FAO/WHO guidelines. Food Res Int 2014. [DOI: 10.1016/j.foodres.2014.04.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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72
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Turner PJ, Mehr S, Sayers R, Wong M, Shamji MH, Campbell DE, Mills ENC. Loss of allergenic proteins during boiling explains tolerance to boiled peanut in peanut allergy. J Allergy Clin Immunol 2014; 134:751-3. [PMID: 25065723 DOI: 10.1016/j.jaci.2014.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/05/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Paul J Turner
- Section of Paediatrics (Allergy and Infectious Diseases) and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Division of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
| | - Sam Mehr
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, Australia
| | - Rebekah Sayers
- Institute of Inflammation and Repair, Manchester Institute of Biotechnology, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Melanie Wong
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, Australia
| | - Mohamed H Shamji
- Section of Allergy and Clinical Immunology, National Heart and Lung Institute and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Dianne E Campbell
- Division of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia; Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, Australia
| | - E N Clare Mills
- Institute of Inflammation and Repair, Manchester Institute of Biotechnology, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
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73
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Plundrich NJ, Kulis M, White BL, Grace MH, Guo R, Burks AW, Davis JP, Lila MA. Novel strategy to create hypoallergenic peanut protein-polyphenol edible matrices for oral immunotherapy. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2014; 62:7010-21. [PMID: 24758688 DOI: 10.1021/jf405773b] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Peanut allergy is an IgE-mediated hypersensitivity. Upon peanut consumption by an allergic individual, epitopes on peanut proteins bind and cross-link peanut-specific IgE on mast cell and basophil surfaces triggering the cells to release inflammatory mediators responsible for allergic reactions. Polyphenolic phytochemicals have high affinity to bind proteins and form soluble and insoluble complexes with unique functionality. This study investigated the allergenicity of polyphenol-fortified peanut matrices prepared by complexing various polyphenol-rich plant juices and extracts with peanut flour. Polyphenol-fortified peanut matrices reduced IgE binding to one or more peanut allergens (Ara h 1, Ara h 2, Ara h 3, and Ara h 6). Attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) suggested changes in secondary protein structure. Peanut protein-cranberry polyphenol fortified matrices triggered significantly less basophil degranulation than unmodified flour in an ex vivo assay using human blood and less mast cell degranulation when used to orally challenge peanut-allergic mice. Polyphenol fortification of peanut flour resulted in a hypoallergenic matrix with reduced IgE binding and degranulation capacity, likely due to changes in protein secondary structure or masking of epitopes, suggesting potential applications for oral immunotherapy.
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Affiliation(s)
- Nathalie J Plundrich
- Plants for Human Health Institute, Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University , North Carolina Research Campus, Kannapolis, North Carolina 28081, United States
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74
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Robison RG, Makhija MM, Pongracic JA. IgE-Mediated Food Allergy: Current Management. CURRENT PEDIATRICS REPORTS 2014. [DOI: 10.1007/s40124-014-0046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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75
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Oral immunotherapy for food allergy, ready for prime time? Heated egg and milk. Curr Allergy Asthma Rep 2014; 14:436. [PMID: 24671644 DOI: 10.1007/s11882-014-0436-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cow's milk and hen's egg allergies are two of the most common food allergies that affect children, with an estimated prevalence of 2-3 % each. Persistence of food allergy into late teen years and adulthood is being increasingly recognized, possibly due to strict avoidance practices. Heating has been known to alter food allergenicity, and the majority of milk- and egg-allergic patients tolerate heated forms of those foods. Heated milk and heated egg have been increasingly studied as oral immunotherapy (OIT) for treatment of milk and egg allergy. While heated milk and heated egg have been shown to be safe in selected milk- and egg-allergic cohorts, larger studies are needed to predict which patients are optimal candidates for this strategy and to further clarify whether ingestion of heated milk or heated egg truly accelerates the onset of clinical tolerance to unheated forms of these foods.
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Oyoshi MK, Oettgen HC, Chatila TA, Geha RS, Bryce PJ. Food allergy: Insights into etiology, prevention, and treatment provided by murine models. J Allergy Clin Immunol 2014; 133:309-17. [PMID: 24636470 DOI: 10.1016/j.jaci.2013.12.1045] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 12/15/2022]
Abstract
Food allergy is a rapidly growing public health concern because of its increasing prevalence and life-threatening potential. Animal models of food allergy have emerged as a tool for identifying mechanisms involved in the development of sensitization to normally harmless food allergens, as well as delineating the critical immune components of the effector phase of allergic reactions to food. However, the role animal models might play in understanding human diseases remains contentious. This review summarizes how animal models have provided insights into the etiology of human food allergy, experimental corroboration for epidemiologic findings that might facilitate prevention strategies, and validation for the utility of new therapies for food allergy. Improved understanding of food allergy from the study of animal models together with human studies is likely to contribute to the development of novel strategies to prevent and treat food allergy.
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Affiliation(s)
- Michiko K Oyoshi
- Division of Immunology, Boston Children's Hospital and the Departments of Pediatrics, Harvard Medical School, Boston, Mass.
| | - Hans C Oettgen
- Division of Immunology, Boston Children's Hospital and the Departments of Pediatrics, Harvard Medical School, Boston, Mass
| | - Talal A Chatila
- Division of Immunology, Boston Children's Hospital and the Departments of Pediatrics, Harvard Medical School, Boston, Mass
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital and the Departments of Pediatrics, Harvard Medical School, Boston, Mass
| | - Paul J Bryce
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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77
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Jiménez-Saiz R, Benedé S, Molina E, López-Expósito I. Effect of Processing Technologies on the Allergenicity of Food Products. Crit Rev Food Sci Nutr 2014; 55:1902-17. [DOI: 10.1080/10408398.2012.736435] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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78
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Abstract
Food allergies are increasing in prevalence at a higher rate than can be explained by genetic factors, suggesting a role for as yet unidentified environmental factors. In this review, we summarize the state of knowledge about the healthy immune response to antigens in the diet and the basis of immune deviation that results in immunoglobulin E (IgE) sensitization and allergic reactivity to foods. The intestinal epithelium forms the interface between the external environment and the mucosal immune system, and emerging data suggest that the interaction between intestinal epithelial cells and mucosal dendritic cells is of particular importance in determining the outcome of immune responses to dietary antigens. Exposure to food allergens through non-oral routes, in particular through the skin, is increasingly recognized as a potentially important factor in the increasing rate of food allergy. There are many open questions on the role of environmental factors, such as dietary factors and microbiota, in the development of food allergy, but data suggest that both have an important modulatory effect on the mucosal immune system. Finally, we discuss recent developments in our understanding of immune mechanisms of clinical manifestations of food allergy. New experimental tools, particularly in the field of genomics and the microbiome, are likely to shed light on factors responsible for the growing clinical problem of food allergy.
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Affiliation(s)
- M Cecilia Berin
- Pediatric Allergy and Immunology, Box 1198, One Gustave L. Levy Place, New York, NY 10029, USA.
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79
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Benedé S, López-Fandiño R, Reche M, Molina E, López-Expósito I. Influence of the carbohydrate moieties on the immunoreactivity and digestibility of the egg allergen ovomucoid. PLoS One 2013; 8:e80810. [PMID: 24244718 PMCID: PMC3828280 DOI: 10.1371/journal.pone.0080810] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/07/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ovomucoid (OM) has two carbohydrate chains on each of the first and second domains and one in the third. The contribution of the covalently bound carbohydrate chains to the overall OM allergenicity is controversial. Another aspect directly related with the immunological properties of OM that has not been studied in depth is the importance of the carbohydrate chains on its digestibility. OBJECTIVE The aim of the study was to assess the involvement of the carbohydrate moieties of OM in its digestibility and allergenic properties. METHODS IgE-binding and basophil activation by glycosylated and enzymatically deglycosylated OM (dOM) were compared using blood from egg-allergic patients. The peptides obtained after digestion using a physiologically relevant model were identified by RP-HPLC-MS/MS and the IgE-binding of the resulting fragments was evaluated by DOT-Blot. RESULTS No structural changes were observed after deglycosylation of OM. 80% of the patients showed lower IgE binding to dOM as compared with OM and, in some patients, IgE reactivity could not be inhibited by pre-incubation with dOM. A subtle reduction in the percentage of activated basophils was observed when incubated with dOM as compared to OM. Following simulated digestion, dOM was more extensively degraded than OM, particularly during the gastric phase and both, OM and dOM, yielded, after the duodenal phase, immunoreactive fragments that were totally or partially coincident with previously described epitopes. CONCLUSION & CLINICAL RELEVANCE this work demonstrated an enhanced IgE reactivity towards carbohydrate containing OM in some egg-allergic patients that could be attributed to cross-sensitization or sensitization to the glycosylated components. The carbohydrate chains contributed to an increased resistance to proteolysis, and thus, to its allergenic potency. Evaluation of the products of digestion of OM and dOM revealed the presence of high-frequency IgE-binding epitopes that could remain linked by disulphide bonds.
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Affiliation(s)
- Sara Benedé
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rosina López-Fandiño
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marta Reche
- Servicio de Alergia, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Elena Molina
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Iván López-Expósito
- Departamento de Bioactividad y Análisis de Alimentos, Instituto de Investigación en Ciencias de la Alimentación, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
- * E-mail:
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80
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Food allergen selective thermal processing regimens may change oral tolerance in infancy. Allergol Immunopathol (Madr) 2013; 41:407-17. [PMID: 23253679 DOI: 10.1016/j.aller.2012.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 08/03/2012] [Indexed: 12/20/2022]
Abstract
Food allergy can be considered a failure in the induction of oral tolerance. Recently, great interest has been focused on understanding the mechanisms and the contributing factors of oral tolerance development, hoping for new definitive interventions in the prevention and treatment of food allergy. Given that food processing may modify the properties and the nature of dietary proteins, several food processing methods could affect the allergenicity of these proteins and consequently may favour oral tolerance induction to food allergic children. Indeed, effective thermal food processing regimens of altering food proteins to reduce allergenicity have been recently reported in the literature. This article is mainly focused on the effect of selective thermal processing regimens on the main infant allergenic foods, with a potential clinical relevance on their allergenicity and therefore on oral tolerance induction. In the light of recent findings, the acquisition of tolerance in younger age and consequently the ability of young children to "outgrow" food allergy could be achieved through the application of selective thermal processing regimens on certain allergenic foods. Therefore, the ability of processed foods to circumvent clinical disease and at the same time to have an impact on the immune system and facilitate tolerance induction could be invaluable as a component of a successful therapeutic strategy. The opening in the new avenues of research in the use of processed foods in clinical practice for the amelioration of the impact on the quality of life of patients and possibly in food allergy prevention is warranted.
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81
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Jiménez-Saiz R, Benedé S, Miralles B, López-Expósito I, Molina E, López-Fandiño R. Immunological behavior of in vitro digested egg-white lysozyme. Mol Nutr Food Res 2013; 58:614-24. [DOI: 10.1002/mnfr.201300442] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/29/2013] [Accepted: 08/06/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Rodrigo Jiménez-Saiz
- Instituto de Investigación en Ciencias de la Alimentación (CIAL), CSIC-UAM; Madrid Spain
| | - Sara Benedé
- Instituto de Investigación en Ciencias de la Alimentación (CIAL), CSIC-UAM; Madrid Spain
| | - Beatriz Miralles
- Instituto de Investigación en Ciencias de la Alimentación (CIAL), CSIC-UAM; Madrid Spain
| | - Iván López-Expósito
- Instituto de Investigación en Ciencias de la Alimentación (CIAL), CSIC-UAM; Madrid Spain
| | - Elena Molina
- Instituto de Investigación en Ciencias de la Alimentación (CIAL), CSIC-UAM; Madrid Spain
| | - Rosina López-Fandiño
- Instituto de Investigación en Ciencias de la Alimentación (CIAL), CSIC-UAM; Madrid Spain
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82
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Radosavljevic J, Nordlund E, Mihajlovic L, Krstic M, Bohn T, Buchert J, Velickovic TC, Smit J. Sensitizing potential of enzymatically cross-linked peanut proteins in a mouse model of peanut allergy. Mol Nutr Food Res 2013; 58:635-46. [DOI: 10.1002/mnfr.201300403] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Luka Mihajlovic
- University of Belgrade; Faculty of Chemistry; Belgrade Serbia
| | - Maja Krstic
- University of Belgrade; Faculty of Chemistry; Belgrade Serbia
| | - Torsten Bohn
- Centre de Recherche Public - Gabriel Lippmann; Belvaux Luxembourg
| | | | | | - Joost Smit
- Institute for Risk Assessment Sciences; Utrecht University; Utrecht The Netherlands
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83
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Watanabe H, Toda M, Sekido H, Wellner A, Fujii T, Henle T, Hachimura S, Nakajima-Adachi H. Heat treatment of egg white controls allergic symptoms and induces oral tolerance to ovalbumin in a murine model of food allergy. Mol Nutr Food Res 2013; 58:394-404. [DOI: 10.1002/mnfr.201300205] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/14/2013] [Accepted: 06/18/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Hiroko Watanabe
- Chemistry Division; Kanagawa Prefectural Institute of Public Health; Chigasaki Japan
| | - Masako Toda
- Junior Research Group 1 Experimental Allergology; Paul-Ehrlich-Institut; Langen Germany
| | - Haruko Sekido
- Chemistry Division; Kanagawa Prefectural Institute of Public Health; Chigasaki Japan
| | - Anne Wellner
- Institute of Food Chemistry; Technische Universitaet Dresden; Dresden Germany
| | - Tomoyuki Fujii
- Graduate School of Agricultural Science; Tohoku University; Sendai Japan
| | - Thomas Henle
- Institute of Food Chemistry; Technische Universitaet Dresden; Dresden Germany
| | - Satoshi Hachimura
- Research Center for Food Safety; Graduate School of Agricultural and Life Sciences; University of Tokyo; Tokyo Japan
| | - Haruyo Nakajima-Adachi
- Research Center for Food Safety; Graduate School of Agricultural and Life Sciences; University of Tokyo; Tokyo Japan
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84
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Turner PJ, Mehr S, Joshi P, Tan J, Wong M, Kakakios A, Campbell DE. Safety of food challenges to extensively heated egg in egg-allergic children: a prospective cohort study. Pediatr Allergy Immunol 2013; 24:450-5. [PMID: 23773122 DOI: 10.1111/pai.12093] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many children with IgE-mediated allergy to egg can tolerate egg in baked foods. However, the clinical characteristics and severity of reactions of egg-allergic children who react to baked egg at open food challenge (OFC) are not well defined. METHODS Children presenting to our tertiary referral clinic with a diagnosis of egg allergy and following complete egg avoidance in their diet were offered OFC to baked egg. Challenges were performed with incremental dosages to a total of one baked muffin containing 1/6 egg (equivalent to 1 g egg protein) following a standardized protocol. Data were collected prospectively from 2009-2012. RESULTS Open food challenge to baked egg were carried out on 236 egg-allergic children who had been strictly avoiding egg in their diet. A total of 150 children (64%) passed and successfully incorporated baked egg into their diet. Eighty-six children (36%) reacted to their challenge. Of these, 12 (14%) experienced anaphylaxis (according to WAO criteria), including four to <100 mg extensively heated egg protein. Intramuscular adrenaline was administered to 5 of the 12 children, one of whom required a second dose due to persistent hypotension. Skin prick testing, asthma, or prior egg anaphylaxis were not predictive of challenge outcome. CONCLUSION The majority of children with IgE-mediated allergy to egg were able to tolerate 1 g of baked egg protein, but the outcome of OFC remained unpredictable, and 14% of children who failed OFC reacted with anaphylaxis. We recommend that OFC to baked egg should take place under medical supervision.
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Affiliation(s)
- Paul J Turner
- Department of Paediatric Allergy, Imperial College London, London, UK.
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85
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Heating does not decrease immunogenicity of goat's and ewe's milk. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:418-21. [DOI: 10.1016/j.jaip.2013.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 03/24/2013] [Accepted: 04/24/2013] [Indexed: 11/18/2022]
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86
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Villafana L, Terrados S, Ibrahim A, De la Hoz B, Berges-Gimeno P. Oral tolerance induction with heated egg in childrena and adolescents. Clin Transl Allergy 2013. [PMCID: PMC3723922 DOI: 10.1186/2045-7022-3-s3-p12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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87
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Azarnia S, Boye JI, Mongeon V, Sabik H. Detection of ovalbumin in egg white, whole egg and incurred pasta using LC–ESI-MS/MS and ELISA. Food Res Int 2013. [DOI: 10.1016/j.foodres.2013.02.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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88
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Kulis M, Wesley Burks A. Oral immunotherapy for food allergy: clinical and preclinical studies. Adv Drug Deliv Rev 2013; 65:774-81. [PMID: 23099276 DOI: 10.1016/j.addr.2012.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 09/25/2012] [Accepted: 10/17/2012] [Indexed: 11/24/2022]
Abstract
Food allergies affect approximately 5% of the U.S. population and have increased in the last decade. In recent years, oral immunotherapy (OIT) has been tested in clinical trials for peanut, milk, and egg allergies in young children. OIT appears to be fairly well tolerated by most subjects and leads to desensitization with a greatly increased threshold of allergen required to induce reactions. Further approaches being investigated in preclinical studies in mouse models indicate the potential for using adjuvants, such as TLR9 agonists in combination with OIT; peptide OIT; and non-allergen specific applications such as herbal formulations. Further questions about OIT remain, including the optimal dosing and length of treatment; whether tolerance can be developed; and the exact cellular mechanisms resulting in protection following OIT. With many clinical trials underway across the United States and other countries, and a growing pipeline of preclinical research with translational potential, there is great hope for a widely applicable food allergy treatment.
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89
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Netting M, Makrides M, Gold M, Quinn P, Penttila I. Heated allergens and induction of tolerance in food allergic children. Nutrients 2013; 5:2028-46. [PMID: 23739144 PMCID: PMC3725491 DOI: 10.3390/nu5062028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 01/25/2023] Open
Abstract
Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow's milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow's milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow's milk and egg allergy.
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Affiliation(s)
- Merryn Netting
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
| | - Maria Makrides
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
| | - Michael Gold
- Children’s Youth and Women’s Health Network, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.G.); (P.Q.)
| | - Patrick Quinn
- Children’s Youth and Women’s Health Network, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.G.); (P.Q.)
| | - Irmeli Penttila
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
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90
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Tey D, Dharmage SC, Robinson MN, Allen KJ, Gurrin LC, Tang MLK. Frequent baked egg ingestion was not associated with change in rate of decline in egg skin prick test in children with challenge confirmed egg allergy. Clin Exp Allergy 2013. [PMID: 23181794 DOI: 10.1111/j.1365-2222.2012.04061.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is controversial whether egg-allergic children should strictly avoid all forms of egg, or if regular ingestion of baked egg will either delay or hasten the resolution of egg allergy. OBJECTIVE This is the first study to examine the relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size in egg-allergic children. METHODOLOGY This was a retrospective clinical cohort study. All children with challenge-proven egg allergy who attended the Royal Children's Hospital Allergy Department 1996-2005 and had at least two egg skin prick tests performed in this period were included (n = 125). Frequency of baked egg ingestion was assessed by telephone questionnaire as follows: (a) frequent (> once per week), (b) regular (> once every 3 months, up to ≤ once per week) or (c) strict avoidance (≤ once every 3 months). The relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size was examined by multiple linear regression, adjusting for potential confounders. RESULTS Mean rate of decline in egg skin prick test size in all children was 0.7 mm/year (95% CI 0.5-1.0 mm/year). There was no evidence (P = 0.57) that the rate of decline in egg skin prick test size differed between children who undertook frequent ingestion (n = 21, mean 0.4 mm/year, 95% CI -0.3-1.2 mm/year), regular ingestion (n = 37, mean 0.9 mm/year, 95% CI 0.4-1.4 mm/year) or strict avoidance (n = 67, mean 0.7 mm/year, 95% CI 0.4-1.1 mm/year) of baked egg. CONCLUSIONS Compared with strict dietary avoidance, frequent consumption of baked egg was not associated with a different rate of decline in egg skin prick test size in egg-allergic children. CLINICAL RELEVANCE Given that dietary restrictions can adversely impact on the family, it is reasonable to consider liberalizing baked egg in the diet of egg-allergic children.
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Affiliation(s)
- D Tey
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
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91
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Food allergy: an enigmatic epidemic. Trends Immunol 2013; 34:390-7. [PMID: 23648309 DOI: 10.1016/j.it.2013.04.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/05/2013] [Accepted: 04/05/2013] [Indexed: 01/17/2023]
Abstract
Food allergy is a common disease that is rapidly increasing in prevalence for reasons that remain unknown. Current research efforts are focused on understanding the immune basis of food allergy, identifying environmental factors that may contribute to its rising prevalence, and developing immunotherapeutic approaches to establish immune tolerance to foods. Technological advances such as peptide microarray and MHC class II tetramers have begun to provide a comprehensive profile of the immune response to foods. The burgeoning field of mucosal immunology has provided intriguing clues to the role of the diet and the microbiota as risk factors in the development of food allergy. The purpose of this review is to highlight significant gaps in our knowledge that need answers to stem the progression of this disorder that is reaching epidemic proportions.
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92
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Badina L, Matarazzo L, Longo G, Barbi E. Could slightly cooked egg be a suitable medium for oral immunotherapy in persistent hen's egg allergy? Allergol Immunopathol (Madr) 2013; 41:141-2. [PMID: 23395518 DOI: 10.1016/j.aller.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 11/26/2022]
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93
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Steele L, Mayer L, Berin MC. Mucosal immunology of tolerance and allergy in the gastrointestinal tract. Immunol Res 2013; 54:75-82. [PMID: 22447352 DOI: 10.1007/s12026-012-8308-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The mucosal immune system typically exists in a state of active tolerance to food antigens and commensal bacteria. Tolerance to food proteins is induced in part by dendritic cells residing in the intestinal mucosa and implemented by regulatory T cells. Food allergy occurs when immune tolerance is disrupted and a sensitizing immune response characterized by food-specific IgE production occurs instead. Experimental food allergy in mice requires use of adjuvant or exploitation of alternate routes of sensitization to induce allergic sensitization, and can aid in understanding the mechanisms of sensitization to food allergens and the pathophysiology of gastrointestinal manifestations of food allergy. Recent work in the understanding of mucosal immunology of tolerance and allergy in the gastrointestinal tract will be discussed.
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Affiliation(s)
- Lauren Steele
- Mount Sinai School of Medicine, Immunology Institute, New York, NY 10029, USA
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Roth-Walter F, Starkl P, Zuberbier T, Hummel K, Nöbauer K, Razzazi-Fazeli E, Brunner R, Pali-Schöll I, Kinkel J, Felix F, Jensen-Jarolim E, Kinaciyan T. Glutathione exposes sequential IgE-epitopes in ovomucoid relevant in persistent egg allergy. Mol Nutr Food Res 2013; 57:536-44. [PMID: 23349099 DOI: 10.1002/mnfr.201200612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 10/30/2012] [Accepted: 11/13/2012] [Indexed: 11/06/2022]
Abstract
SCOPE Patients with persistent egg allergy have more immunoglobulin E (IgE) against sequential than conformational epitopes of ovomucoid (OVO). Here, we aimed to identify compounds capable to render sequential epitopes in egg. METHODS AND RESULTS Glutathione was used for in vitro reduction of OVO and circular dichroism analyses were performed. Glutathione reduced OVO in a concentration-dependent manner. Egg white was analyzed for reduced proteins with a thiol probe and by MALDI-TOF/TOF. In unprocessed total egg white, several reduced proteins were detected by the thiol probe, among them reduced ovalbumin could be confirmed with MS analyses. Egg-allergics or sensitized controls were tested serologically (n = 19) for IgE against native and reduced OVO and in skin prick tests (n = 9). More patients had IgE against reduced than native OVO in Western blots. In skin prick test, five out of seven persistent egg-allergics and none of the controls reacted with reduced OVO. CONCLUSION Reduced egg proteins are present in natural egg white. Glutathione, which is present in egg and furthermore is used as texture-improving additive in processed food, is capable of reducing OVO. Patients with persistent egg allergy reacted rather to reduce the native OVO. Hence, our data indicate that reduction is a novel natural and processing-associated principle, which contributes to the allergenicity of food.
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Affiliation(s)
- Franziska Roth-Walter
- Comparative Medicine, Messerli Research Institute, University of Veterinary Medicine Vienna, Vienna, Medical University of Vienna and University of Vienna, Austria
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95
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Liu X, Feng BS, Kong X, Xu H, Li X, Yang PC, Liu Z. Food-Cooking Processes Modulate Allergenic Properties of Hens Egg White Proteins. Int Arch Allergy Immunol 2013; 160:134-42. [DOI: 10.1159/000339396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/09/2012] [Indexed: 12/22/2022] Open
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96
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Jones SM, Burks AW. The changing CARE for patients with food allergy. J Allergy Clin Immunol 2013; 131:3-11; quiz 12-3. [DOI: 10.1016/j.jaci.2012.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/09/2012] [Accepted: 11/09/2012] [Indexed: 11/17/2022]
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97
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Stanic-Vucinic D, Stojadinovic M, Atanaskovic-Markovic M, Ognjenovic J, Grönlund H, van Hage M, Lantto R, Sancho AI, Velickovic TC. Structural changes and allergenic properties of β-lactoglobulin upon exposure to high-intensity ultrasound. Mol Nutr Food Res 2012; 56:1894-905. [DOI: 10.1002/mnfr.201200179] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 07/19/2012] [Accepted: 08/16/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Dragana Stanic-Vucinic
- Faculty of Chemistry; Department of Biochemistry; University of Belgrade; Belgrade; Serbia
| | - Marija Stojadinovic
- Faculty of Chemistry; Department of Biochemistry; University of Belgrade; Belgrade; Serbia
| | | | - Jana Ognjenovic
- Faculty of Chemistry; Department of Biochemistry; University of Belgrade; Belgrade; Serbia
| | - Hans Grönlund
- Clinical Immunology and Allergy Unit; Department of Medicine; Karolinska Institute, Karolinska University Hospital; Stockholm; Sweden
| | - Marianne van Hage
- Clinical Immunology and Allergy Unit; Department of Medicine; Karolinska Institute, Karolinska University Hospital; Stockholm; Sweden
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98
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Abstract
PURPOSE OF REVIEW The introduction of extensively heated milk and egg protein into the diet has been explored in recent years. RECENT FINDINGS Studies have suggested that a large subset of children who react to unheated milk or egg can tolerate extensively heated forms of these foods. Immunologic changes induced by a diet containing baked milk and egg are similar to changes that have been observed during oral immunotherapy trials. The baked milk and egg diet appears to accelerate the development of regular milk and egg tolerance when compared with strict avoidance. SUMMARY An oral challenge to extensively heated milk and egg into milk and egg allergic children's diets should be considered when appropriate. Oral food challenges are the most reliable means of establishing a diagnosis and should be undertaken under physician supervision.
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99
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Berin MC. Mucosal antibodies in the regulation of tolerance and allergy to foods. Semin Immunopathol 2012; 34:633-42. [PMID: 22777546 DOI: 10.1007/s00281-012-0325-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 06/20/2012] [Indexed: 01/01/2023]
Abstract
The intestinal mucosa is densely packed with antibody-secreting B cells, the majority of which produce IgA. Mucosal antibodies have traditionally been thought of as neutralizing antibodies that exclude antigens, but they also function in antigen sampling, allowing for selective transcytosis of antigens from the intestinal lumen. IgE-mediated antigen uptake can facilitate the development of allergic reactions to foods, but emerging evidence indicates that IgG-mediated antigen uptake may also play an important role in the development of immune tolerance to foods, particularly in the neonate. This review will focus on the role of intestinal immunoglobulins in the development of clinical tolerance and allergy to food antigens.
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Affiliation(s)
- M Cecilia Berin
- Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
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100
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Chen TK, Lee JH, Yu HH, Yang YH, Wang LC, Lin YT, Chiang BL. Association between human IL-10 gene polymorphisms and serum IL-10 level in patients with food allergy. J Formos Med Assoc 2012; 111:686-92. [PMID: 23265747 DOI: 10.1016/j.jfma.2011.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 08/23/2011] [Accepted: 11/01/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/PURPOSE Single nucleotide polymorphisms (SNPs) of the interleukin-10 (IL-10) gene are associated with allergic diseases in different populations. This study aimed to determine the distribution of two SNPs at -1082A/G and -592A/C (rs1800896 and rs1800872, respectively) in the IL-10 gene promoter of Taiwanese food allergy (FA) patients, and also to compare the serum IL-10 levels between patients with (FA) and controls. METHODS Thirty-seven patients with FA and 52 controls were enrolled, and their peripheral blood was collected for IL-10 SNP genotyping and the corresponding serum IL-10 level of each genotype. RESULTS The thirty-seven FA patients had positive food-specific IgE (≥ 0.75kU/L) to more than one food, and the most frequent allergens wereshrimp and crab (56.8% and 35.1%, respectively). The genotype distributions in the FA patients compared to the control group were AA and AG at -1082A/G (86.5% and 13.5% vs. 86.6% and 13.4%, respectively), and AA, AC, and CC at -592A/C (45.9%, 43.3% and 10.8% vs. 38.5%, 48.1% and 13.4%, respectively). Serum IL-10 levels were significantly lower in the FA group than in the control group (p=0.0187), and the IL-10 level of -592A/C of genotype AA was significantly lower than that of the other genotypes (AC+CC) (p=0.007). Patients with AA/AA haplotype homozygotes (10 of 24) had significantly lower serum IL-10 levels than those with other haplotypes. CONCLUSIONS The two SNPs at -1082A/G and -592A/C of IL-10 were associated with FA in our Taiwanese population, and FA patients with the genotype AA/AA haplotype homozygotes had lower serum IL-10 levels. This suggests that IL-10 might play a critical role in the pathogenesis of FA. We suggest that it may be practicable to evaluate the serum IL-10 levels of FA patients and to predict the possibility of FA if genotypes and haplotypes are checked regularly.
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Affiliation(s)
- Tuo-Kang Chen
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, ROC
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