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How primary care providers can help prevent food allergies. Curr Opin Pediatr 2022; 34:430-437. [PMID: 35797492 DOI: 10.1097/mop.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW IgE-mediated food allergy rates have increased in recent decades, yet treatment options remain limited. Prevention strategies are thus essential. We will review recent research and consensus guidelines for food allergy prevention. RECENT FINDINGS Research has continued to support that early introduction of allergens via the gastrointestinal tract induces tolerance and prevents development of food allergy. In contrast, allergen sensitization may occur via transcutaneous allergen exposure. This is supported by research that shows a decreased risk of food allergy with aggressive treatment of atopic dermatitis. More recent research suggests that transcutaneous sensitization could also be facilitated by frequent emollient use in the absence of atopic dermatitis but definitive research is lacking. Murine models have shown a likely role of dysbiosis, or disruption of the body's normal healthy microbiome, in development of food allergy, yet human studies have yet to show a conclusive benefit of probiotics in the prevention of food allergy. SUMMARY Important approaches for food allergy prevention are: introduction of peanut and cooked egg at 4-6 months, early introduction of other allergenic foods, and early diagnosis and treatment of atopic dermatitis (because of a predisposition to food sensitization through the damaged skin barrier). More research is needed to clarify the role, if any, of emollient use and probiotics.
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Warren C, Bartell T, Nimmagadda SR, Bilaver LA, Koplin J, Gupta R. Socioeconomic Determinants of Food Allergy Burden-A clinical introduction. Ann Allergy Asthma Immunol 2022; 129:407-416. [PMID: 35914663 DOI: 10.1016/j.anai.2022.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This review characterizes what is currently known about how prevalence, severity, distribution, and management of food allergy (FA) differs across socioeconomic strata and provides guidance for practicing clinicians about how to improve equity in research participation, healthcare delivery, and patient outcomes through a deeper understanding of the socioeconomic determinants of FA. DATA SOURCES Epidemiological and biomedical literature published prior to April 2022. RESULTS Socioeconomic status (SES) is a complex concept that not only encompasses economic resources (e.g., income, wealth) but also a person's social, economic and political power and standing, each of which can impact health. However, in many studies of individuals and families with FA, assessment of SES has been limited and often a respondent's membership within a racial and ethnic group is utilized as a proxy for low SES. As a whole, findings from US-population-based studies indicate a consistent trend: those who self-identify as non-Hispanic Black, and to a lesser extent other subpopulations who identify as being of non-White race and ethnicity, experience a greater burden of food-allergic sensitization and disease including higher rates of emergency health care utilization and food-induced anaphylactic fatality as compared to those identifying as White. CONCLUSION Reports of FA management and outcomes highlight inequities among specific low SES populations in the US. Clinicians can and should act to reduce inequities by engaging more diverse populations in clinical research, equitably implementing FA risk screening and prevention, thoughtfully utilizing emerging technologies to ameliorate disparities based on SES in healthcare delivery and outcomes, and advocating for social change.
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Affiliation(s)
- Christopher Warren
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine and Center for Food Allergy and Asthma Research.
| | - Tami Bartell
- Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sai R Nimmagadda
- Northwestern University, Feinberg School of Medicine, Center for Food Allergy and Asthma Research; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, Division of Allergy and Immunology
| | - Lucy A Bilaver
- Northwestern University, Feinberg School of Medicine, Department of Pediatrics and Center for Food Allergy and Asthma Research
| | - Jennifer Koplin
- Murdoch Children's Research Institute Melbourne, Melbourne, Vic., Australia. Department of Paediatrics and School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Ruchi Gupta
- Center for Food Allergy & Asthma Research; Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago
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103
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Dantzer J, Wood RA. Can Peanut Allergy Prevention Be Translated to the Pediatric Population? JAMA 2022; 328:25-26. [PMID: 35788815 DOI: 10.1001/jama.2022.6263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer Dantzer
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Wood
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Díaz Martín JJ, Blesa Baviera L, Campoy Folgoso C, Espín Jaime B, Leis Trabazo MR, Mesa Del Castillo M, Martín Masot R, Martinez-Cañavate Burgos A, Martorell Aragones A, Molina Arias M, Roman Riechmann E, Saenz de Pipaón M, Valdesoiro Navarrete L. Consensus document on the primary prevention of cow's milk protein allergy in infants aged less than 7 days. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:59.e1-59.e7. [PMID: 35786539 DOI: 10.1016/j.anpede.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/13/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Cow's milk protein allergy (CMPA) is the most frequent food allergy in the first year of life. There is no clear consensus regarding its prevention. A recommendation to avoid CMP in the first week of life as a preventive measure in all infants, regardless of their atopic risk, has recently been published. The purpose of this document is to issue a recommendation on the use of extensively hydrolyzed CMP formulas in the first week of life for the primary prevention of CMPA. METHODS A group of experts was formed with members proposed by the Spanish Association of Pediatrics (AEP), the Spanish Society of Clinical Immunology and Allergology and Pediatric Asthma (SEICAAP), the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP) and the Spanish Society of Neonatology (SENEO). The group conducted a critical review of the evidence on the subject published in the last 10 years. RESULTS The search yielded 72 studies, of which 66 were rejected for not meeting the inclusion criteria. The final review included 6 documents: 3 clinical trials and 3 systematic reviews, 2 of them with meta-analysis. There was no evidence of a statistically significant reduction in the incidence of CMPA in the infants who received hypoallergenic formulae or exclusive breastfeeding. CONCLUSION Based on the current evidence, it is not possible to draw clear conclusions about the effect of avoiding CMP in the first week of life for prevention of CMPA. Although there are data that suggest a certain beneficial effect of avoiding CMPA in atopic risk infants, these results are not conclusive enough to extend the recommendation to the general population.
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Affiliation(s)
- Juan José Díaz Martín
- Sección de Gastroenterología y Nutrición Infantil, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Abstract
Food allergy is common and has increased in prevalence over time. Although there are many types of reactions to foods, immunoglobulin E (IgE) mediated food allergy is acute in onset and resolves quickly, and is reproducible in nature. Anaphylaxis is the most severe form of IgE-mediated food allergy and has a range of clinical manifestations. First-line food allergy diagnostic testing is sensitive but not specific and should only be done in the context of a convincing history of a reaction. Oral food challenge is the criterion standard in diagnosis but carries the risk of a reaction. The only therapy for anaphylaxis is immediate intramuscular epinephrine. Traditional management of food allergy consists of avoidance management, with strict avoidance, reading labels, and carrying an epinephrine autoinjector at all times. Although effective, accidental reactions do occur, and this management strategy has a profound impact on quality of life.
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Affiliation(s)
- Elissa M Abrams
- From the Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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Díaz Martín JJ, Blesa Baviera L, Campoy Folgoso C, Espín Jaime B, Leis Trabazo MR, Mesa del Castillo M, Martín Masot R, Martinez-Cañavate Burgos A, Martorell Aragones A, Molina Arias M, Roman Riechmann E, Saenz de Pipaón M, Valdesoiro Navarrete L. Documento de consenso en la prevención primaria de alergia a proteínas de leche de vaca en lactantes menores de 7 días de vida. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Upton JE. Efficacy, effectiveness and other patient-centered outcomes of oral immunotherapy. JOURNAL OF FOOD ALLERGY 2022; 4:28-33. [PMID: 39021849 PMCID: PMC11250439 DOI: 10.2500/jfa.2022.4.220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Oral immunotherapy (OIT) is the medically supervised ingestion of a food allergen. Understanding of the expected outcomes of OIT allow for risk-benefit assessments for patient-centered decisions. The efficacy of OIT to achieve desensitization in children has been confirmed in multiple meta-analyses, even with vastly disparate study populations and methodologies. Most children initiated on OIT will achieve the ability to eat more allergen before experiencing an allergic reaction than if they continue to avoid their allergen. This effect is diminished without regular ingestion. Previous meta-analyses showed increased allergic reactions on OIT versus avoidance or placebo due to the dosing itself; however, a recent meta-analysis showed that peanut OIT in children did not lead to an increase in allergic reactions. Analysis of emerging data suggests that OIT may reduce reactions to accidental exposures over time. Important patient-centered outcomes, including reaction avoidance or amelioration, and psychosocial impacts and/or quality of life, and studies of more demographically representative populations are also necessary.
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Affiliation(s)
- Julia E.M. Upton
- From the Division of Immunology and Allergy, The Hospital for Sick Children, Toronto, Ontario, Canada; and
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Relevance of Early Introduction of Cow’s Milk Proteins for Prevention of Cow’s Milk Allergy. Nutrients 2022; 14:nu14132659. [PMID: 35807839 PMCID: PMC9268691 DOI: 10.3390/nu14132659] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
Food allergy incidence has increased worldwide over the last 20 years. For prevention of food allergy, current guidelines do not recommend delaying the introduction of allergenic foods. Several groundbreaking studies, such as the Learning Early About Peanut Allergy study, showed that the relatively early introduction of this allergenic food between 4–6 months of age reduces the risk of peanut allergy. However, less is known about the introduction of cow’s milk, as many children already receive cow’s-milk-based formula much earlier in life. This can be regular cow’s milk formula with intact milk proteins or hydrolyzed formulas. Several recent studies have investigated the effects of early introduction of cow’s-milk-based formulas with intact milk proteins on the development of cow’s milk allergy while breastfeeding. These studies suggest that depending on the time of introduction and the duration of administration of cow’s milk, the risk of cow’s milk allergy can be reduced (early introduction) or increased (very early introduction followed by discontinuation). The aim of this narrative review is to summarize these studies and to discuss the impact of early introduction of intact cow’s milk protein—as well as hydrolyzed milk protein formulas—and the development of tolerance versus allergy towards cow’s milk proteins.
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109
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Skjerven HO, Lie A, Vettukattil R, Rehbinder EM, LeBlanc M, Asarnoj A, Carlsen KH, Despriee ÅW, Färdig M, Gerdin SW, Granum B, Gudmundsdóttir HK, Haugen G, Hedlin G, Håland G, Jonassen CM, Landrø L, Mägi CAO, Olsen IC, Rudi K, Saunders CM, Skram MK, Staff AC, Söderhäll C, Tedner SG, Aadalen S, Aaneland H, Nordlund B, Lødrup Carlsen KC. Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial. Lancet 2022; 399:2398-2411. [PMID: 35753340 DOI: 10.1016/s0140-6736(22)00687-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 03/04/2022] [Accepted: 04/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary prevention of food allergy by early introduction of allergenic foods seems promising. We aimed to determine whether early food introduction or the application of regular skin emollients in infants from a general population reduced the risk of food allergy. METHODS This 2 × 2 factorial, cluster-randomised trial was done at Oslo University Hospital and Østfold Hospital Trust, Oslo, Norway, and Karolinska University Hospital, Stockholm, Sweden. Infants of women recruited antenatally at the routine 18-week ultrasound examination were cluster-randomised at birth to the following groups: (1) no intervention group; (2) the skin intervention group (skin emollients; bath additives and facial cream; from age 2 weeks to <9 months, both at least four times per week); (3) the food intervention group (early complementary feeding of peanut, cow's milk, wheat, and egg from age 3 months); or (4) combined intervention group (skin and food interventions). Participants were randomly assigned (1:1:1:1) using computer-generated randomisation based on clusters of 92 geographical areas and eight 3-month time blocks. Study personnel performing clinical assessments were masked to group allocation. The primary outcome was allergy to any interventional food at 36 months of age. The primary efficacy analysis was done by intention-to-treat analysis, which included all participants who were randomly assigned, apart from three individuals who withdrew their consent. This was a study performed within ORAACLE (the Oslo Research Group of Asthma and Allergy in Childhood; the Lung and Environment). This study is registered as ClinicalTrials.gov, NCT02449850. FINDINGS We recruited 2697 women with 2701 pregnancies, from whom 2397 newborn infants were enrolled between April 14, 2015, and April 11, 2017. Of these infants, 597 were randomly assigned to the no intervention group, 575 to the skin intervention group, 642 to the food intervention group, and 583 to the combined intervention group. One participant in each of the no intervention, food intervention, and skin intervention groups withdrew consent and were therefore not included in any analyses. Food allergy was diagnosed in 44 children; 14 (2·3%) of 596 infants in the non-intervention group, 17 (3·0%) of 574 infants in the skin intervention group, six (0·9%) of 641 infants in the food intervention group, and seven (1·2%) of 583 infants in the combined intervention group. Peanut allergy was diagnosed in 32 children, egg allergy in 12 children, and milk allergy in four children. None had allergy to wheat. Prevalence of food allergy was reduced in the food intervention group compared with the no food intervention group (risk difference -1·6% [95% CI -2·7 to -0·5]; odds ratio [OR] 0·4 [95% CI 0·2 to 0·8]), but not compared with the skin intervention group (0·4% [95% CI -0·6 to 1· 5%]; OR 1·3 [0·7 to 2·3]), with no significant interaction effect (p=1·0). Preventing food allergy in one child required early exposure to allergenic foods in 63 children. No serious adverse events were observed. INTERPRETATION Exposure to allergenic foods from 3 months of age reduced food allergy at 36 months in a general population. Our results support that early introduction of common allergenic foods is a safe and effective strategy to prevent food allergy. FUNDING Full funding sources listed at end of paper (see Acknowledgments).
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Affiliation(s)
- Håvard Ove Skjerven
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Anine Lie
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Riyas Vettukattil
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eva Maria Rehbinder
- Department of Dermatology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marissa LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Anna Asarnoj
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Kai-Håkon Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Åshild Wik Despriee
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; VID Specialized University, Oslo, Norway
| | - Martin Färdig
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sabina Wärnberg Gerdin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Berit Granum
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Hrefna Katrín Gudmundsdóttir
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guttorm Haugen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Geir Håland
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Christine Monceyron Jonassen
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway; Department of Pediatrics, Østfold Hospital Trust, Kalnes, Norway
| | - Linn Landrø
- Department of Dermatology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Caroline-Aleksi Olsson Mägi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Knut Rudi
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Carina Madelen Saunders
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marius Kurås Skram
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cilla Söderhäll
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra G Tedner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sigve Aadalen
- Department of Pediatrics, Østfold Hospital Trust, Kalnes, Norway
| | - Hilde Aaneland
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Björn Nordlund
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Karin C Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hydrolysierte Säuglingsnahrung für die Allergieprävention – wissenschaftliche Evidenz und Empfehlungen für die Praxis. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01529-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund
Laut S3-Leitlinie „Allergieprävention“ (Update 2021) soll bei nicht (voll) gestillten Säuglingen mit erhöhtem Allergierisiko geprüft werden, ob eine Säuglingsnahrung mit nachgewiesener allergiepräventiver Wirksamkeit verfügbar ist. Einige Hersteller bewerben ihre Produkte entsprechend.
Ziel der Arbeit
Der Artikel gibt einen Überblick über die wissenschaftliche Evidenz und internationale Empfehlungen zum Einsatz von hydrolysierter Säuglingsnahrung (sog. hypoallergene [HA-]Nahrung) zur Prävention von atopischen Erkrankungen.
Materialien und Methoden
In medizinischen Datenbanken wurde eine Literaturrecherche (Zeitraum: 2016–2021) zum Nutzen von hydrolysierten Säuglingsnahrungen für die Allergieprävention bei Risikokindern und zu entsprechenden internationalen Leitlinien durchgeführt. Auf dieser Basis wurden die aktuelle Empfehlung der deutschen S3-Leitlinie sowie die Produkte auf dem deutschen Markt eingeordnet.
Ergebnisse
Es gibt keine hinreichenden Belege für einen generellen allergiepräventiven Nutzen von Säuglingsnahrungen mit Proteinhydrolysat bei Säuglingen mit erhöhtem Allergierisiko. Die GINI-Interventionsstudie deutet darauf hin, dass eine der eingesetzten Hydrolysatnahrungen zur Prävention atopischer Dermatitis bei Risikokindern wirksam gewesen sein könnte. Die Ergebnisse können aber, auch angesichts methodischer Schwächen, nicht als alleinige Basis für eine allgemeine Empfehlung zur Verwendung von HA-Nahrung herangezogen werden. Internationale Fachgesellschaften sprechen sich seit einigen Jahren eher gegen eine solche Empfehlung aus.
Diskussion
Für die derzeit in Deutschland vermarkteten Säuglingsnahrungen auf Basis von partiell hydrolysiertem Protein fehlen Wirksamkeitsbelege. Sie können daher nicht zur Allergieprävention empfohlen werden.
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Vale SL, Roche I, Netting M, Said M, Joshi P, Clifford R, Campbell DE, Salter SM. Nip allergies in the Bub: a qualitative study for a public health approach to infant feeding for allergy prevention. Aust N Z J Public Health 2022; 46:438-443. [PMID: 35616393 DOI: 10.1111/1753-6405.13241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify a brand, key messages and resources to underpin a public health approach to food allergy prevention. METHODS A focus group design was used to explore perceptions and opinions of potential brands, infant feeding messages and resources for providing standardised food allergy prevention information. Focus groups were conducted in February 2018 using interview guides and were transcribed verbatim. A content analysis of the transcripts was undertaken using thematic analysis software. The University of Western Australia provided ethics approval: RA/4/20/4280. RESULTS Seven focus groups with 39 participants were conducted. Four slogans and styles of imagery were considered. 'Nip Allergies in the Bub' was the most favoured slogan and images of babies with food were most favoured. Participant feedback was sought regarding messages and supporting messages were considered important. Participants were consulted about useful resources and a website was identified. CONCLUSIONS Conducting focus groups assisted the selection of a brand, messages and resources to underpin a public health approach to implementing allergy prevention guidelines. IMPLICATIONS FOR PUBLIC HEALTH This is the first focus group research undertaken for food allergy prevention. Identification of a meaningful brand, key messages and resources will support a public health approach to implementing allergy prevention guidelines.
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Affiliation(s)
- Sandra L Vale
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia.,National Allergy Strategy, New South Wales.,Australasian Society of Clinical Immunology and Allergy, New South Wales
| | - Ingrid Roche
- National Allergy Strategy, New South Wales.,Perth Children's Hospital, Western Australia
| | - Merryn Netting
- National Allergy Strategy, New South Wales.,Women and Kids Theme, South Australian Health and Medical Research Institute, South Australia.,Department of Paediatrics, University of Adelaide, South Australia.,Nutrition Department, Women's and Children's Health Network, South Australia
| | - Maria Said
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia.,National Allergy Strategy, New South Wales.,Allergy & Anaphylaxis Australia, New South Wales
| | - Preeti Joshi
- National Allergy Strategy, New South Wales.,Australasian Society of Clinical Immunology and Allergy, New South Wales.,Department of Allergy and Immunology, The Children's Hospital at Westmead, New South Wales
| | - Rhonda Clifford
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia
| | - Dianne E Campbell
- Australasian Society of Clinical Immunology and Allergy, New South Wales.,Department of Allergy and Immunology, The Children's Hospital at Westmead, New South Wales.,Discipline of Child and Adolescent Health, The University of Sydney, New South Wales
| | - Sandra M Salter
- Faculty of Health and Medical Sciences, The University of Western Australia, Western Australia
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Bartnikas LM, Dupuis R, Wang J, Phipatanakul W. Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management. Ann Allergy Asthma Immunol 2022; 129:430-439. [PMID: 35568300 DOI: 10.1016/j.anai.2022.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Food allergy (FA) affects approximately 8% of children in the United States. Management comprises both preventing and treating allergic reactions, which poses unique challenges in the inner-city school setting. In this article, we review the epidemiology of FA in school-aged children and management challenges and opportunities specific to the inner-city population. DATA SOURCES A literature search of the PubMed database was performed to identify published literature on FA epidemiology, FA management, school policies, disparities, inner-city, race, ethnicity, and socioeconomic status. STUDY SELECTIONS Relevant articles on FA management best practices and challenges in schools, with a particular emphasis on inner-city schools and populations and socioeconomic, racial, and ethnic disparities, were reviewed in detail. RESULTS Disparities in FA prevalence, management, and treatment exist. Additional research is needed to better characterize these disparities and elucidate the mechanisms leading to them. There is a lack of evidence-based interventions for the prevention and treatment of food allergic reactions in schools and specifically in inner-city schools, in which a greater proportion of students may rely on school food. CONCLUSION There are opportunities for partnership among health care providers, schools, and communities to address unmet needs in FA management and disparities in the inner-city school setting.
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Affiliation(s)
- Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts.
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Abrams EM, Watson W, Vander Leek TK, Atkinson A, Primeau MN, Francoeur MJ, McHenry M, Lavine E, Orkin J, Cummings C, Blair B, Chan ES. Dietary exposures and allergy prevention in high-risk infants. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:36. [PMID: 35501827 PMCID: PMC9063186 DOI: 10.1186/s13223-021-00638-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022]
Abstract
Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. Breastfeeding should be promoted and supported regardless of issues pertaining to food allergy prevention, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies. When cow's milk protein formula has been introduced in an infant's diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. For high-risk infants, there is compelling evidence that introducing allergenic foods early-at around 6 months, but not before 4 months of age-can prevent common food allergies, and allergies to peanut and egg in particular. Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. Pre-emptive in-office screening before introducing allergenic foods is not recommended. No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada.
| | - Wade Watson
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Timothy K Vander Leek
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Adelle Atkinson
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Marie-Noel Primeau
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Marie-Josee Francoeur
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Mary McHenry
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Elana Lavine
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Julia Orkin
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Carl Cummings
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Becky Blair
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
| | - Edmond S Chan
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, FE125-685 William Avenue, Winnipeg, MB, R2A 5L9, Canada
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114
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Winslow A, Keet CA. Preventing allergies through the skin. Ann Allergy Asthma Immunol 2022; 129:276-285. [PMID: 35470039 DOI: 10.1016/j.anai.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/17/2022] [Accepted: 04/07/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To inform readers of the current and forthcoming skin barrier interventions that have clinically relevant implications in the prevention of allergic sensitization and atopic diseases. DATA SOURCES Peer-reviewed journal articles indexed on PubMed and clinical trials referenced on clinicaltrials.gov were analyzed. STUDY SELECTIONS Literature searches from PubMed and clinicaltrials.gov were performed using combinations of the following search terms: prevention, allergy, atopy, skin, cutaneous, microbiome, microbiota, Staphylococcus aureus, atopic dermatitis, eczema, food allergy, and asthma. RESULTS The skin barrier represents an entry point for allergic sensitization and TH2-mediated allergic disorders. Results from clinical trials designed to improve microbiome complexity and reduce S aureus colonization, provide skin barrier enhancement, and deliver epicutaneous immunotherapy are summarized and discussed in the context of primary, secondary, and tertiary prevention of allergic disease. CONCLUSION The skin barrier is a promising target for prevention of allergic disease, though clinical trial results thus far have been mixed, at best.
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Affiliation(s)
- Andrew Winslow
- Division of Allergy and Immunology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Corinne Allison Keet
- Division of Allergy and Immunology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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115
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Skypala IJ, Taylor CF, Pallister A, Scadding GW. A Pilot Study to Evaluate the Dietary Intake of Adults Attending a Food Allergy Clinic, and Compare the Results Against the Final Diagnostic Outcome. FRONTIERS IN ALLERGY 2022; 2:765029. [PMID: 35387056 PMCID: PMC8974758 DOI: 10.3389/falgy.2021.765029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The impact of poor diet on growth and development in children with a food allergy is well-recognized and researched. Food allergy is an increasing problem in adults, as are food intolerances. Another issue is the rising number of individuals adopting a vegetarian or vegan lifestyle. Studies evaluating the diet of adolescents and adults with food allergy against controls suggest their dietary intakes are similar. We wished to evaluate all patients attending a food allergy clinic to determine whether there were dietary and nutritional differences between those with a food allergy or a food intolerance. Methods: All adults newly referred to a secondary care food allergy clinic in a UK hospital, in a 1-month period, were included in the study. Prior to their appointment, those who consented to take part had their height and weight documented and an assessment made of their habitual food intake. Their subsequent diagnosis was reviewed, and results for those with a confirmed diagnosis of food allergy were compared to those with a food intolerance or where the cause of symptoms was unknown. Results: Thirty subjects were recruited, with full results available for 29 subjects, 15 of whom (52%) were diagnosed with a new/existing food allergy (FA). For the whole cohort, dietary intake was sufficient for protein, and most vitamins and minerals, whereas energy, carbohydrate, unsaturated fat and fiber intakes were well-below the reference range. Those with a FA had lower intakes of iron, zinc and vitamin B12 compared to those with no FA. In addition, iron and energy intakes were depleted in those avoiding nuts, and wheat avoidance was linked to a lower intake of riboflavin. Conclusion: The results from this small exploratory study suggest that whilst the majority of nutrients in the diet are sufficient in adults presenting to the food allergy clinic, intakes of energy and fiber may be below the reference range. Those with a food allergy are more likely to have a reduced intake of iron, zinc and vitamin B12. As others have demonstrated, the exclusion of specific food groups can also affect nutritional intakes.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy and Clinical Immunology, Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Allergy and Clinical Immunology, Imperial College, London, United Kingdom
| | - Cecile F Taylor
- Department of Nutrition and Dietetics, Royal Free Hospital, London, United Kingdom
| | - Anthony Pallister
- Department of Nutrition and Dietetics, Kettering General Hospital, Kettering, United Kingdom
| | - Guy W Scadding
- Department of Allergy and Clinical Immunology, Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,Department of Allergy and Clinical Immunology, Imperial College, London, United Kingdom
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116
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Egg Allergy in Children and Weaning Diet. Nutrients 2022; 14:nu14081540. [PMID: 35458102 PMCID: PMC9025129 DOI: 10.3390/nu14081540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
Eggs are a fundamental food in the human diet, and together with cow’s milk, they are the most common food allergen. This work highlights the main nutritional characteristics of eggs to show how their absence from a child’s diet can constitute a serious deficiency. We then analyze the risk factors that facilitate the onset of egg allergy. The third part of the paper reports possible interventions to lower the appearance of food allergy that have been occurred in trials. The last part of the paper is a synthesis of this research study that has been taken from several of the latest guidelines or from position papers.
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117
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Venter C, Smith PK, Arshad H. Dietary strategies for the prevention of asthma in children. Curr Opin Allergy Clin Immunol 2022; 22:123-131. [PMID: 35197434 DOI: 10.1097/aci.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review summarizes information relating to dietary intake during pregnancy, lactation and early life that may prevent childhood asthma. This review also summarizes how future studies may be improved. RECENT FINDINGS Recent findings from observational studies suggest that eating according to certain dietary patterns during pregnancy, such as the dietary inflammatory index, Mediterranean diet and Maternal diet index, may reduce asthma and or wheeze in the child. Vitamin D supplementation with higher doses than recommended during pregnancy may be associated with reduced early transient childhood wheezing in the offspring. Higher levels of omega-3 fatty acids in breast milk may be protective against childhood asthma. Breastfeeding infants has been shown to offer many benefits to mother and child but a direct relationship between breastfeeding and the development of asthma has not been established. During childhood, infants and children may need to reduce their intake of advanced glycation end products, increase their food intake according to the traditional Mediterranean diet and increase the diversity of foods eaten. SUMMARY Current evidence provides limited suggestions regarding dietary changes for preventing early transient childhood wheezing. In order to harmonize methods for future data collection and reporting, it is important to harmonize relevant definitions and other important factors. The aim of the considerations described here is to enable a better comparison of future studies and provide better guidance to patients and families.
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Affiliation(s)
- Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, Denver, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter K Smith
- Griffith University Department of Clinical Medicine
- Qld Allergy Services, Southport, Queensland, Australia
| | - Hasan Arshad
- University of Southampton, Southampton
- The David Hide Asthma and Allergy Center, Isle of Wight, UK
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118
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Lang A, Kaur O, Devonshire A, Kaat AJ, Kumar R. Learning Early About Peanut worries: Evaluation of parental PROMIS-29 anxiety scores during early peanut introduction clinics. Ann Allergy Asthma Immunol 2022; 128:472-473. [PMID: 35124222 PMCID: PMC8977240 DOI: 10.1016/j.anai.2022.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Abigail Lang
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Opinderjit Kaur
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ashley Devonshire
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aaron J Kaat
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rajesh Kumar
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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119
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Alternatives to Cow’s Milk-Based Infant Formulas in the Prevention and Management of Cow’s Milk Allergy. Foods 2022; 11:foods11070926. [PMID: 35407012 PMCID: PMC8997926 DOI: 10.3390/foods11070926] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/27/2022] Open
Abstract
Cow’s milk-based infant formulas are the most common substitute to mother’s milk in infancy when breastfeeding is impossible or insufficient, as cow’s milk is a globally available source of mammalian proteins with high nutritional value. However, cow’s milk allergy (CMA) is the most prevalent type of food allergy among infants, affecting up to 3.8% of small children. Hypoallergenic infant formulas based on hydrolysed cow’s milk proteins are commercially available for the management of CMA. Yet, there is a growing demand for more options for infant feeding, both in general but especially for the prevention and management of CMA. Milk from other mammalian sources than the cow, such as goat, sheep, camel, donkey, and horse, has received some attention in the last decade due to the different protein composition profile and protein amino acid sequences, resulting in a potentially low cross-reactivity with cow’s milk proteins. Recently, proteins from plant sources, such as potato, lentil, chickpeas, quinoa, in addition to soy and rice, have gained increased interest due to their climate friendly and vegan status as well as potential lower allergenicity. In this review, we provide an overview of current and potential future infant formulas and their relevance in CMA prevention and management.
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120
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Kalayci O, Miligkos M, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Le Souef P, Nieto A, Phipatanakul W, Pitrez PM, Xepapadaki P, Jiu-Yao W, Papadopoulos NG. The role of environmental allergen control in the management of asthma. World Allergy Organ J 2022; 15:100634. [PMID: 35341023 PMCID: PMC8917313 DOI: 10.1016/j.waojou.2022.100634] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/08/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.
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121
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Miceli Sopo S, Sinatti D, Mastellone F, Bersani G, Gelsomino M. Comment on Halken et al. Pediatr Allergy Immunol 2022; 33. [PMID: 35338728 DOI: 10.1111/pai.13735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Stefano Miceli Sopo
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Dario Sinatti
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Francesco Mastellone
- Post-Graduate School of Pediatrics, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Giulia Bersani
- Pediatric Allergy Unit, Pediatrics Section, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
| | - Mariannita Gelsomino
- Post-Graduate School of Pediatrics, Department of Life Sciences and Public Health, Policlinico Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, Rome, Italy
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122
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Barni S, Caimmi D, Chiera F, Comberiati P, Mastrorilli C, Pelosi U, Paravati F, Marseglia GL, Arasi S. Phenotypes and Endotypes of Peach Allergy: What Is New? Nutrients 2022; 14:998. [PMID: 35267973 PMCID: PMC8912752 DOI: 10.3390/nu14050998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Peach allergy is emerging as a common type of fresh-fruit allergy in Europe, especially in the Mediterranean area. The clinical manifestations of peach allergy tend to have a peculiar geographical distribution and can range from mild oral symptoms to anaphylaxis, depending on the allergic sensitization profile. The peach allergen Pru p 7, also known as peamaclein, has recently been identified as a marker of peach allergy severity and as being responsible for peculiar clinical features in areas with high exposure to cypress pollen. This review addresses the latest findings on molecular allergens for the diagnosis of peach allergy, the clinical phenotypes and endotypes of peach allergy in adults and children, and management strategies, including immunotherapy, for peach allergy.
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Affiliation(s)
- Simona Barni
- Allergic Unit, Department of Pediatric, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France;
- IDESP, UMR A11–INSERM, Université de Montpellier, 34093 Montpellier, France
| | - Fernanda Chiera
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Carla Mastrorilli
- Department of Pediatrics, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy;
| | - Umberto Pelosi
- Pediatric Unit, Santa Barbara Hospital, 09016 Iglesias, Italy;
| | - Francesco Paravati
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Gian Luigi Marseglia
- Department of Pediatrics, University of Pavia, San Matteo Foundation IRCCS Policlinico, 27100 Pavia, Italy;
| | - Stefania Arasi
- Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
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123
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Quake AZ, Liu TA, D’Souza R, Jackson KG, Woch M, Tetteh A, Sampath V, Nadeau KC, Sindher S, Chinthrajah RS, Cao S. Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study. Nutrients 2022; 14:nu14040737. [PMID: 35215387 PMCID: PMC8879339 DOI: 10.3390/nu14040737] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/09/2023] Open
Abstract
The incidence and prevalence of food allergy (FA) is increasing. While several studies have established the safety and efficacy of early introduction of single allergens in infants for the prevention of FA, the exact dose, frequency, and number of allergens that can be safely introduced to infants, particularly in those at high or low risk of atopy, are still unclear. This 1-year pilot study evaluated the safety of the early introduction of single foods (milk, egg, or peanut) vs. two foods (milk/egg, egg/peanut, milk/peanut) vs. multiple foods (milk/egg/peanut/cashew/almond/shrimp/walnut/wheat/salmon/hazelnut at low, medium, or high doses) vs. no early introduction in 180 infants between 4-6 months of age. At the end of the study, they were evaluated for plasma biomarkers associated with food reactivity via standardized blood tests. Two to four years after the start of the study, participants were evaluated by standardized food challenges. The serving sizes for the single, double, and low dose mixtures were 300 mg total protein per day. The serving sizes for the medium and high dose mixtures were 900 mg and 3000 mg total protein, respectively. Equal parts of each protein were used for double or mixture foods. All infants were breastfed until at least six months of age. The results demonstrate that infants at either high or low risk for atopy were able to tolerate the early introduction of multiple allergenic foods with no increases in any safety issues, including eczema, FA, or food protein induced enterocolitis. The mixtures of foods at either low, medium, or high doses demonstrated trends for improvement in food challenge reactivity and plasma biomarkers compared to single and double food introductions. The results of this study suggest that the early introduction of foods, particularly simultaneous mixtures of many allergenic foods, may be safe and efficacious for preventing FA and can occur safely. These results need to be confirmed by larger randomized controlled studies.
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124
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Suleyman A, Tamay Z, Güler N. Risk Factors for the Development of IgE-Mediated Food Allergy in Preschool Children with Asthma. J Trop Pediatr 2022; 68:6533389. [PMID: 35188210 DOI: 10.1093/tropej/fmac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Food allergy is a component of the atopic march and may have effects on asthma. This study aimed to evaluate the risk factors for confirmed immunoglobulin E-mediated food allergies and their impact on the clinical picture in preschool children with asthma. METHODS Clinical history and allergic assessment results were obtained from medical records and analyzed retrospectively. Preschool children with asthma were included in the study and the characteristics of food allergy and asthma were evaluated. The patients were grouped as those with food allergy (Group I, n = 60) and those without (Group II, n = 98). RESULTS In patients with food allergy and asthma, the number of episodes requiring systemic steroids in the last year (p = 0.002), atopic dermatitis (p = 0.001), parental atopic disease (p = 0.009) and aeroallergen sensitivity rates (p < 0.001) was higher than patients without food allergies. The use of medium or high doses of inhaled steroids to achieve asthma control was more frequent in patients with food allergies (p = 0.014). Parental history of atopic disease [p = 0.007, odds ratio (OR): 3.27, 95% confidence interval (CI) 1.37-7.77)], atopic dermatitis (p = 0.017, OR: 2.80, 95% CI: 1.19-6.57), starting complementary food after 6 months (p = 0.004, OR: 3.9, 95% CI: 1.5-10.0) and having aeroallergen sensitivity (p < 0.001, OR: 6.01, 95% CI: 2.21-16.29) were identified as significant risk factors for food allergy. CONCLUSION Asthmatic preschool children with food allergies are more likely to have a parental atopic disease, atopic dermatitis, aeroallergen sensitivity and starting complementary food after 6 months. These patients experience more asthma attacks and need higher doses of steroids.
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Affiliation(s)
- Ayse Suleyman
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tamay
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nermin Güler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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125
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Abrams EM, Greenhawt M, Shaker M, Alqurashi W. Separating Fact from Fiction in the Diagnosis and Management of Food Allergy. J Pediatr 2022; 241:221-228. [PMID: 34678246 DOI: 10.1016/j.jpeds.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Canada.
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon; Geisel School of Medicine at Dartmouth, Hanover
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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126
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Brough HA, Lanser BJ, Sindher SB, Teng JMC, Leung DYM, Venter C, Chan SM, Santos AF, Bahnson HT, Guttman‐Yassky E, Gupta RS, Lack G, Ciaccio CE, Sampath V, Nadeau KC, Nagler CR. Early intervention and prevention of allergic diseases. Allergy 2022; 77:416-441. [PMID: 34255344 DOI: 10.1111/all.15006] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022]
Abstract
Food allergy (FA) is now one of the most common chronic diseases of childhood often lasting throughout life and leading to significant worldwide healthcare burden. The precise mechanisms responsible for the development of this inflammatory condition are largely unknown; however, a multifactorial aetiology involving both environmental and genetic contributions is well accepted. A precise understanding of the pathogenesis of FA is an essential first step to developing comprehensive prevention strategies that could mitigate this epidemic. As it is frequently preceded by atopic dermatitis and can be prevented by early antigen introduction, the development of FA is likely facilitated by the improper initial presentation of antigen to the developing immune system. Primary oral exposure of antigens allowing for presentation via a well-developed mucosal immune system, rather than through a disrupted skin epidermal barrier, is essential to prevent FA. In this review, we present the data supporting the necessity of (1) an intact epidermal barrier to prevent epicutaneous antigen presentation, (2) the presence of specific commensal bacteria to maintain an intact mucosal immune system and (3) maternal/infant diet diversity, including vitamins and minerals, and appropriately timed allergenic food introduction to prevent FA.
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Affiliation(s)
- Helen A. Brough
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
| | - Bruce Joshua Lanser
- Division of Pediatric Allergy‐Immunology Department of Pediatrics National Jewish Health Denver CO USA
| | - Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
- Division of Allergy, Immunology and Rheumatology Department of Medicine Stanford University Stanford CA USA
| | - Joyce M. C. Teng
- Department of Dermatology Lucile Packard Children's Hospital at the Stanford University School of Medicine Palo Alto CA USA
| | - Donald Y. M. Leung
- Division of Pediatric Allergy‐Immunology Department of Pediatrics National Jewish Health Denver CO USA
| | - Carina Venter
- Section of Allergy & Immunology School of Medicine University of Colorado DenverChildren's Hospital Colorado Aurora CO USA
| | - Susan M. Chan
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
| | - Alexandra F. Santos
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Henry T. Bahnson
- Benaroya Research Institute and Immune Tolerance Network Seattle WA USA
| | - Emma Guttman‐Yassky
- Department of Dermatology and the Immunology Institute Icahn School of Medicine at Mount Sinai New York NY USA
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| | - Ruchi S. Gupta
- Center for Food Allergy and Asthma Research Northwestern University Feinberg School of Medicine Chicago IL USA
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA
| | - Gideon Lack
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
| | | | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
- Division of Allergy, Immunology and Rheumatology Department of Medicine Stanford University Stanford CA USA
| | - Cathryn R. Nagler
- Department of Pathology and Pritzker School of Molecular Engineering University of Chicago Chicago IL USA
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Keet CA, Berin MC. The year in food allergy. J Allergy Clin Immunol 2022; 149:867-873. [PMID: 35031274 DOI: 10.1016/j.jaci.2021.12.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022]
Abstract
Research into food allergy continues to rapidly evolve, accompanying and driving real changes in the clinical approach to these diseases. The past year has seen the rollout of the first treatment approved for active management of food allergy, more data on alternative methods of treatment, the continued evolution of strategies for prevention of food allergy, a renewed interest in phenotyping food allergy subtypes, and, importantly, key new insights into the pathophysiology of food allergy. We expect that in the coming years, the therapies that are in preclinical or early clinical evaluation now will make their way to the clinic, finally allowing the possibility of safe and effective treatments for food allergy.
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Affiliation(s)
- Corinne A Keet
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC.
| | - M Cecilia Berin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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128
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Abrams EM, Sicherer SH. Tree nut introduction in a peanut-allergic child: To eat, to screen, or to avoid? Pediatr Allergy Immunol 2022; 33:e13669. [PMID: 34553798 DOI: 10.1111/pai.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
There is no defined standard of care around tree nut introduction in a peanut-allergic child, and the role of screening prior to tree nut introduction is controversial. There is some evidence that peanut-allergic children are at increased risk of tree nut allergy, with approximately 23-68% of children with co-existent peanut/tree nut allergy. In some studies, it has been shown that tree nut allergy in children has the potential to be a severe allergy. However, this appears to be age-specific as infant anaphylaxis in general tends to be milder, and there has been no fatality reported on the first ingestion of an allergen in infancy. Familial hesitancy has been identified as a possible condition for undertaking screening tests prior to allergen introduction. Indeed, there has been limited evidence that caregiver hesitancy may exist in peanut-allergic families with tree nut introduction. However, pre-emptive screening has the potential to overdiagnose tree nut allergy and delay introduction (which could paradoxically increase risk). As a result, the decision is best made in the context of shared decision-making and patient preference-sensitive care.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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129
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Zhang D, Zheng J. The Burden of Childhood Asthma by Age Group, 1990-2019: A Systematic Analysis of Global Burden of Disease 2019 Data. Front Pediatr 2022; 10:823399. [PMID: 35252064 PMCID: PMC8888872 DOI: 10.3389/fped.2022.823399] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Asthma is a common respiratory disease in children. We aimed to update information about the incidence and mortality and disability-adjusted life years (DALYs) of childhood asthma and provide evidence-based recommendations for childhood asthma prevention. METHODS Data were obtained from the Global Burden of Disease (GBD) study, which was conducted from 1990 to 2019 in 204 countries. First, we estimated incidence, mortality and DALY rates of childhood asthma using a Bayesian meta-regression model. Second, we analyzed the relationship between the sociodemographic index (SDI) and DALYs in different age groups. Third, we studied changes in trends of the age-standardized DALY rate between 1990 and 2019 based on age group, SDI, and risk factors. RESULTS Globally, the number of deaths due to childhood asthma and the incidence and DALY rates were 12.9 thousand (95% UI 10.6 to 15.7), 22 million (95% UI 15 to 31), and 5.1 million (95% UI 3.4 to 7.5) in 2019, decreasing by 65.1% (95% UI 47.6 to 72.4), 5.3% (95% UI 2.6 to 8.8) and 30% (95% UI 18 to 41) from those in 1990, respectively. With the exception of high-SDI regions, the age-standardized DALY rate in all age groups in all SDI regions declined. In 2019, the age-standardized DALY rate in 1- to 4-year-old individuals was highest in low-SDI regions and that of 5- to 19-year-old individuals was highest in high-SDI regions. In contrast to low-SDI regions, individuals in high-SDI regions had a higher risk of DALYs due to asthma, except in those aged 1 to 4 years. A high body mass index (BMI) was a stronger risk factor than occupational asthmagens for childhood asthma. CONCLUSION Our findings provide insight into asthma prevention and treatment through the identification of key factors related to childhood asthma. Based on the data available, different risk factors according to age group and region/country suggest different prevention strategies, which is key for preventing childhood asthma.
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Affiliation(s)
- Daoqi Zhang
- Department of Internal Medicine Teaching and Research Section, Xuancheng Vocational and Technical College, Xuancheng, China
| | - Jinxin Zheng
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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130
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Issa C, Hobeika M, Khairallah W, Al-Jawaldeh A, Batal M. Timing and types of fluids and foods first introduced in a representative sample of toddlers attending day care programs across Lebanon: Are parents following international recommendations? J Pediatr Nurs 2022; 62:e45-e53. [PMID: 34266717 DOI: 10.1016/j.pedn.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current WHO's recommendation for optimal infant feeding advises exclusive breastfeeding for 6 months. After this initial period, infants should receive nutritionally adequate and safe complementary food starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond. PURPOSE This study examined the timing and types of fluids and foods first introduced in a representative sample of toddlers (n = 1051) from 79 daycares across Lebanon. Questionnaires were self-administered to parents of toddlers (12-36 months) with a participation rate of 67%. RESULTS Results showed that more than half of toddlers (55.7%) were introduced to infant formula within their first month of life. Around two-thirds received water as the first type of additional fluid (62.5%) with a mean age of 3.86 ± 2.15 months and fruits or cooked vegetables (69.7%) as the first types of food introduced with a mean age of 5.73 ± 1.56 months. Unfortunately, two-third (67.3%) were not breastfed after solid food introduction. PRACTICE IMPLICATIONS Our data on current suboptimal feeding practices in Lebanon shows the need to reinforce BF and CF practices recommendations and guidelines at the community, social and health system levels. CONCLUSIONS In the absence of specific recommendations and with the poor involvement of the various stakeholders, it was noted that more than half of the parents were not following the WHO recommendation concerning unnecessary fluid supplementation of infants and were introducing food before the recommended age of 6 months; moreover, only a minority of mothers continued breastfeeding after introducing food to their infants.
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Affiliation(s)
- Carine Issa
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon; INSPECT-LB, Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Maria Hobeika
- Nutrition Department, Faculty of Public Health II, Lebanese University, Fanar, Lebanon
| | | | - Ayoub Al-Jawaldeh
- Department of Nutrition Sciences, University of Vienna, UZA2 Althantstrasse 14, 1090 Vienna, Austria
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, University of Montreal, Canada; Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal (CReSP), Canada
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131
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Huffaker MF. The Prevention of Milk Allergy and the Risks of Stopping Too Soon. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:180-181. [PMID: 35000732 DOI: 10.1016/j.jaip.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Michelle F Huffaker
- Immune Tolerance Network, University of California San Francisco, San Francisco, Calif, and Allergy and Asthma Medical Group of the Bay Area, Walnut Creek, Calif.
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132
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Lee BR, Jung HI, Kim SK, Kwon M, Kim H, Jung M, Kyung Y, Kim BE, Choi SJ, Oh SY, Baek SY, Kim S, Bae J, Ahn K, Kim J. Dietary Diversity during Early Infancy Increases Microbial Diversity and Prevents Egg Allergy in High-Risk Infants. Immune Netw 2022; 22:e17. [PMID: 35573149 PMCID: PMC9066009 DOI: 10.4110/in.2022.22.e17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Bo Ra Lee
- Department of Pediatrics, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu 11749, Korea
| | - Hye-In Jung
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Korea
| | - Su Kyung Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul 06351, Korea
| | - Mijeong Kwon
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul 06351, Korea
| | - Hyunmi Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul 06351, Korea
| | - Minyoung Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan 49267, Korea
| | - Yechan Kyung
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Byung Eui Kim
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul 06351, Korea
- Department of Pediatrics, National Jewish Health, Denver, CO 80206, USA
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sun-Young Baek
- Center for Biomedical Statistics, Samsung Medical Center, Seoul 06351, Korea
| | - Seonwoo Kim
- Center for Biomedical Statistics, Samsung Medical Center, Seoul 06351, Korea
| | - Jaewoong Bae
- R&D Institute, BioEleven Co., Ltd., Seoul 06142, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul 06351, Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul 06351, Korea
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133
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Commins SP. Allergen Sold Separately? All Early Allergen Introduction Foods Are Not Equivalent. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:159-160. [PMID: 35000730 DOI: 10.1016/j.jaip.2021.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Scott P Commins
- Division of Allergy, Immunology, and Rheumatology, University of North Carolina School of Medicine, Chapel Hill, NC.
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134
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Simmonds L, Brownbill AL, Zee A, Netting MJ. Health-related marketing messages on product labels of commercial infant and toddler food packaging in Australia: a cross-sectional audit. BMJ Paediatr Open 2021. [PMCID: PMC8672004 DOI: 10.1136/bmjpo-2021-001241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundProper nutrition in early childhood is essential to ensure optimal growth and development. Use of ‘better-for-you’ features on food packaging position products as healthier for children. This study aims to systematically explore the use of better-for-you labelling on infant and toddler food packaging.MethodsA cross-sectional audit of health and nutrition claims, text and images used as ‘better-for-you’ features present on infant and toddler food packaging. Data on infant and toddler food packaging were collected from five large grocery stores in Adelaide, Australia in 2019. The content of 282 unique commercial products (n=215 infant foods, n=67 toddler foods) were analysed for explicit and implicit features positioning them as better-for-you, including health and nutrition claims as well as text and images representing ‘natural.’ResultsAt least one feature of better-for-you positioning was identified on all food packaging coded. All products had characteristics coded as ‘natural’. Almost one-fifth (17%) of the products included statements in addition to mandatory allergen labelling that their products were ‘free from’ certain allergens, or gluten. One-third of the labels had statements related to enhancing development of taste, oro-motor skills and other aspects of childhood development. Of the fruit and vegetable-based infant foods displaying a sugar statement suggesting a low sugar content, 85% were sweetened with fruit puree.ConclusionsThe use of better-for-you features on infant and toddler food packaging is common and pervasive. Allergen-free and developmental claims are being used to position infant and toddler foods as better-for-you. Regulation of toddler food products separately from adult food is required, as is tighter regulation of the appropriate use of sugar and fruit puree statements on infant and toddler food packaging.
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Affiliation(s)
- Lucy Simmonds
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Aimee L Brownbill
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Foundation for Alcohol Research and Education, Canberra, Canberra, Australia
- School of Medicine; School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anthea Zee
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Merryn J Netting
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine; School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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135
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Sampath V, Abrams EM, Adlou B, Akdis C, Akdis M, Brough HA, Chan S, Chatchatee P, Chinthrajah RS, Cocco RR, Deschildre A, Eigenmann P, Galvan C, Gupta R, Hossny E, Koplin JJ, Lack G, Levin M, Shek LP, Makela M, Mendoza-Hernandez D, Muraro A, Papadopoulous NG, Pawankar R, Perrett KP, Roberts G, Sackesen C, Sampson H, Tang MLK, Togias A, Venter C, Warren CM, Wheatley LM, Wong GWK, Beyer K, Nadeau KC, Renz H. Food allergy across the globe. J Allergy Clin Immunol 2021; 148:1347-1364. [PMID: 34872649 DOI: 10.1016/j.jaci.2021.10.018] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023]
Abstract
The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the need for better strategies for prevention, diagnosis, and therapy. In the last few decades, we have made great strides in understanding the causes and mechanisms underlying FAs, prompting guideline updates. Earlier guidelines recommended avoidance of common food allergens during pregnancy and lactation and delaying the introduction of allergenic foods in children aged between 1 and 3 years. Recent guidelines for allergy prevention recommend consumption of a healthy and diverse diet without eliminating or increasing the consumption of allergenic foods during pregnancy or breast-feeding. Early introduction of allergenic foods is recommended by most guidelines for allergy prevention after a period of exclusive breast-feedng (6 months [World Health Organization] or 4 months [European Academy of Allergy and Clinical Immunology]). New diagnostics for FA have been developed with varied availability of these tests in different countries. Finally, the first oral immunotherapy drug for FA was approved by the US Food and Drug Administration and European Medicines Agency in 2020. In this review, we will address the global prevalence of FA, our current understanding of the causes of FA, and the latest guidelines for preventing, diagnosing, and treating FA. We will also discuss similarities and differences between FA guidelines.
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Affiliation(s)
- Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif
| | - Elissa M Abrams
- Department of Paediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Department of Paediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Bahman Adlou
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service and Evelina Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Susan Chan
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service and Evelina Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Pantipa Chatchatee
- Pediatric Allergy and Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif
| | | | - Antoine Deschildre
- CHU Lille, University of Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France
| | - Philippe Eigenmann
- University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Cesar Galvan
- National Institute of Children Health, National Reference Center of Allergy, Asthma and Immunology, Lima, Peru; International Clinic, B&D Health Clinic, Lima, Peru
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service and Evelina Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa; inVIVO Planetary Health Group of the Worldwide Universities Network
| | - Lynette P Shek
- Department of Paediatrics, National University of Singapore, Singapore, Singapore
| | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Antonella Muraro
- Food Allergy Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Nikolaos G Papadopoulous
- Allergy Department, National and Kapodistrian University of Athens, Athens, Greece; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Graham Roberts
- Clinical and Experimental Sciences & Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Hospital, Southampton, United Kingdom; David Hide Asthma and Allergy Research Centre, St Mary' Hospital, Isle of Wight, United Kingdom
| | - Cansin Sackesen
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Hugh Sampson
- The Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Carina Venter
- Pediatric Allergy and Immunology, University of Colorado/Childrens Hospital Colorado, Boulder, Colo
| | - Christopher Michael Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Lisa M Wheatley
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Gary W K Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif.
| | - Harald Renz
- Institute of Laboratory Medicine, Philipps University Marburg, Member of the German Center for Lung Research (DZL), Member of Universities Giessen and Marburg Lung Center, Marburg, Germany; Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia
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Shaker M, Mauger D. Applying the Clinical Literature to a Science of Uncertainty and an Art of Probability. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:4233-4234. [PMID: 34893186 DOI: 10.1016/j.jaip.2021.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - David Mauger
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University, State College, Pa
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137
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Rangkakulnuwat P, Lao-Araya M. The prevalence and temporal trends of food allergy among preschool children in Northern Thailand between 2010 and 2019. World Allergy Organ J 2021; 14:100593. [PMID: 34721755 PMCID: PMC8521453 DOI: 10.1016/j.waojou.2021.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Although recent studies suggest that the prevalence of food allergy (FA) has not changed, the data from developing countries are limited. This study aimed to investigate time trends in the prevalence of FA among preschool children in 2010 and 2019 in Northern Thailand. Methods Two cross-sectional studies were performed, 9 years apart (2010 and 2019), using the same methods, in children aged 3–7 years living in Chiang Mai, Thailand. Parent-reporting questionnaire surveys were conducted. Families with children reporting FA were invited to undergo further investigations with skin prick testing, serum specific IgE, and oral food challenge (OFC). The prevalence of parent-reported FA, food sensitization, and OFC-confirmed FA were compared between the 2 periods. Results A total of 1013 out of 1146 questionnaires (452/546 in 2010 and 561/600 in 2019) were returned. The response rate was 88.4%. The prevalence of parent-reported food allergy in 2019 was significantly lower than that in 2010 (5.5% vs 9.3%; p = 0.02). However, there was no significant change in the prevalence of OFC-confirmed FA (0.9% vs 1.1%; p = 0.75). Three leading causative foods of parent-reported FA were cow's milk, shrimp, and eggs. Shrimp was still the most common OFC-confirmed food allergen. Atopic dermatitis was the most significantly parent reported factor associated with FA. Conclusion The overall prevalence of FA among preschool children in Northern Thailand had not increased during the past decade. There was no significant difference in the prevalence of OFC-confirmed FA between 2010 and 2019.
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Affiliation(s)
- Pisuttikan Rangkakulnuwat
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,School of Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Mongkol Lao-Araya
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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138
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Skypala I, Bauer M, DunnGalvin A, Venter C. The Challenges of Managing Multiple Food Allergies and Consequent Food Aversions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:35-44. [PMID: 34757065 DOI: 10.1016/j.jaip.2021.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/15/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
The allergic march can often result in children with one food allergy phenotype developing other allergic manifestations as they grow older. In this grand round, we describe the case of a child with a diagnosis of eosinophilic esophagitis at an early age, who subsequently developed IgE-mediated allergy to milk and egg. Because of the onset of allergic rhinitis, an additional complication of the teenage years was the development of pollen food syndrome, which further affected the already complex dietary management. These multiple allergies had a consequent effect on nutritional status and provoked considerable psychosocial issues, which greatly affected the patient's relationship with food. This case illustrates that for complex patients, a cohesive approach and shared decision-making are essential for diagnosis and management. Working with the patient and also the whole family, and considering how best to support them, necessitates a flexible approach. Regular follow-up is important to address changing psychosocial and dietary needs and monitor the resolution of allergies and response to pharmacotherapy. Complex patients need the input of a comprehensive multidisciplinary team, with good access to dietetic and psychological support, to optimize quality of life for these individuals and their families.
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Affiliation(s)
- Isabel Skypala
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Allergy & Clinical Immunology, Imperial College London, London, United Kingdom.
| | - Maureen Bauer
- Children's Hospital Colorado Section of Pediatric Allergy and Immunology, University of Colorado School of Medicine, Denver, Colo
| | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Carina Venter
- Children's Hospital Colorado Section of Pediatric Allergy and Immunology, University of Colorado School of Medicine, Denver, Colo
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139
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Venter C, Pickett K, Starling A, Maslin K, Smith PK, Palumbo MP, O'Mahony L, Ben Abdallah M, Dabelea D. Advanced glycation end product intake during pregnancy and offspring allergy outcomes: A Prospective cohort study. Clin Exp Allergy 2021; 51:1459-1470. [PMID: 34610188 DOI: 10.1111/cea.14027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/24/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Associations have been shown between concurrent assessment of dietary intake of advanced glycation end products (AGEs) and childhood allergic outcomes. We examined the association between maternal AGEs intake and development of offspring asthma, wheeze, atopic dermatitis, allergic rhinitis and food allergies, and sought to determine whether the intake of AGEs was associated with cord sera cytokines/chemokines. METHODS Pregnant women ≥16 years were recruited in the Healthy Start study, a prospective pre-birth cohort from Colorado (N = 1410). The analysis included 962 dyads with adequate diet (≥2 recalls) and allergy outcome details. AGEs intake was estimated for each mother by matching intakes reported using 24-h dietary recalls during pregnancy to a reference database of commonly consumed foods' AGEs values. Child diagnoses of asthma and allergies up to 8 years were obtained from electronic medical records. Cord sera cytokines and chemokines were analysed in a subset (N = 462) of children. RESULTS The median [IQR] AGEs intake for the overall sample was 11,919 kU/day [8293, 16,573]. Unadjusted analysis showed a positive association between maternal AGEs intake in pregnancy and rhinitis up to 8 years of age (HR = 1.03; 95% CI: 1.01, 1.06), but the association was attenuated and no longer significant in adjusted models (HR = 1.01; 95% CI: 0.98, 1.04). Both adjusted and unadjusted models showed no associations between AGEs intake in pregnancy and any of the other outcomes (p > .05). There were no significant associations between any cytokine or chemokine measured and AGEs intake or any of the outcomes studied (p > .05). CONCLUSION The study showed that maternal AGEs intake was not associated with offspring asthma and allergy outcomes. AGEs exposure during pregnancy may not have the same impact on child development as postnatal exposure.
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Affiliation(s)
- Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Kaci Pickett
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Anne Starling
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
| | | | - Pete K Smith
- Qld Allergy Services, Southport, Queensland, Australia.,Department of Clinical Medicine, Griffith University, Southport, Queensland, Australia
| | - Michaela P Palumbo
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Miriam Ben Abdallah
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA.,Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
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Childs CE, Munblit D, Ulfman L, Gómez-Gallego C, Lehtoranta L, Recker T, Salminen S, Tiemessen M, Collado MC. Potential Biomarkers, Risk Factors and their Associations with IgE-mediated Food Allergy in Early Life: A Narrative Review. Adv Nutr 2021; 13:S2161-8313(22)00081-3. [PMID: 34596662 PMCID: PMC8970818 DOI: 10.1093/advances/nmab122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Food allergy affects the quality of life of millions of people worldwide and presents a significant psychological and financial burden for both national and international public health. In the past few decades, the prevalence of allergic disease has been on the rise worldwide. Identified risk factors for food allergy include family history, mode of delivery, variations in infant feeding practices, prior diagnosis of other atopic diseases such as eczema, and social economic status. Identifying reliable biomarkers which predict the risk of developing food allergy in early life would be valuable in both preventing morbidity and mortality and by making current interventions available at the earliest opportunity. There is also the potential to identify new therapeutic targets. This narrative review provides details on the genetic, epigenetic, dietary and microbiome influences upon the development of food allergy and synthesizes the currently available data indicating potential biomarkers. While there is a large body of research evidence available within each field of potential risk factors, there are very limited number of studies which span multiple methodological fields, for example including immunology, microbiome, genetic/epigenetic factors and dietary assessment. We recommend that further collaborative research with detailed cohort phenotyping is required to identify biomarkers, and whether these vary between at-risk populations and the wider population. The low incidence of oral food challenge confirmed food allergy in the general population, and the complexities of designing nutritional intervention studies will provide challenges for researchers to address in generating high quality, reliable and reproducible research findings. STATEMENT OF SIGNIFICANCE Food allergy affects the quality of life of millions of people worldwide and presents a significant psychological and financial burden for both national and international public health. Identifying reliable biomarkers which predict the risk of developing food allergy would be valuable in both preventing morbidity and mortality and by making current interventions available at the earliest opportunity. This review provides details on the genetic, epigenetic, dietary and microbiome influences upon the development of food allergy. This helps in identifying reliable biomarkers to predict the risk of developing food allergy, which could be valuable in both preventing morbidity and mortality and by making interventions available at the earliest opportunity.
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Affiliation(s)
- Caroline E Childs
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom,Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel Munblit
- Imperial College London, London, United Kingdom,Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Carlos Gómez-Gallego
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Chua GT, Chan ES, Soller L, Cook VE, Vander Leek TK, Mak R. Home-Based Peanut Oral Immunotherapy for Low-Risk Peanut-Allergic Preschoolers During the COVID-19 Pandemic and Beyond. FRONTIERS IN ALLERGY 2021; 2:725165. [PMID: 35387028 PMCID: PMC8974914 DOI: 10.3389/falgy.2021.725165] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to the deprioritization of non-emergency services, such as oral food challenges and the initiation of oral immunotherapy (OIT) for food-allergic children. Recent studies have suggested that home-based peanut OIT could be a safe and effective option for low-risk peanut-allergic children. In the period between September 1, 2020, and January 31, 2021, nine preschoolers with a history of mild allergic reactions to peanut underwent home-based peanut OIT. Eight of them (88.9%) completed the build-up phase at home in 11–28 weeks, tolerating a daily maintenance dose of 320 mg peanut protein. During the build-up, six patients (75.0%) reported urticaria, three (33.3%) reported gastrointestinal tract symptoms, and one (14.3%) reported oral pruritis. None of the patients developed anaphylaxis, required epinephrine, or attended emergency services related to OIT. One or two virtual follow-up visits were completed per patient during the build-up phase. Our case series shows that home-based OIT could be offered to the low-risk preschoolers during the COVID-19 pandemic when non-emergency services are limited and could be considered beyond the pandemic, especially for the families living in the rural or remote areas that may otherwise be unable to access OIT.
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Affiliation(s)
- Gilbert T. Chua
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong, SAR China
- *Correspondence: Gilbert T. Chua
| | - Edmond S. Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Victoria E. Cook
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Community Allergy Clinic, Victoria, BC, Canada
| | - Timothy K. Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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142
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Krawiec M, Fisher HR, Du Toit G, Bahnson HT, Lack G. Overview of oral tolerance induction for prevention of food allergy-Where are we now? Allergy 2021; 76:2684-2698. [PMID: 33539570 DOI: 10.1111/all.14758] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 01/10/2023]
Abstract
Oral tolerance induction through early introduction of allergenic food has proven effective in randomized controlled trials. This new approach to weaning has been incorporated into many national and international infants' feeding guidelines. However, there are questions that require further discussion, such as, which foods should be introduced early, should the intervention be targeted to infants at high-risk or to the general population, and what is the ideal timing for early food introduction. This review examines the extent to which recent trials address these critical questions and highlights areas where further research is required.
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Affiliation(s)
- Marta Krawiec
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
| | - Helen R. Fisher
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
| | - George Du Toit
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Henry T. Bahnson
- Benaroya Research Institute and the Immune Tolerance Network Seattle USA
| | - Gideon Lack
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
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143
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Cox AL, Shah A, Groetch M, Sicherer SH. Allergic reactions in infants using commercial early allergen introduction products. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3517-3520.e1. [PMID: 34022446 DOI: 10.1016/j.jaip.2021.04.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Amanda L Cox
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Ami Shah
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marion Groetch
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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144
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DiGiacomo DV, Herbert L, Jacobs M, Ramos A, Robbins KA. Maternal dietary allergen restriction while breast-feeding: Pediatric resident knowledge and practices. JOURNAL OF FOOD ALLERGY 2021; 3:50-55. [PMID: 39022398 PMCID: PMC11250550 DOI: 10.2500/jfa.2021.3.210008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Background An adequate understanding of the relationship between breast-feeding practices and infant food allergy is essential for clinicians. Although there is evidence of an education gap in general breast-feeding concepts, little is known about the pediatric trainee knowledge and practice with regard to breast-feeding, maternal diet, and potential allergy outcomes. Objective To assess pediatric residents' knowledge, describe practices, and evaluate a module designed to provide evidence-based education about breast-feeding, food allergy, and food avoidance to inform future resources on the topic of breast-feeding and allergic outcomes. Methods Pediatric residents completed a survey to assess the knowledge and comfort with regard to maternal dietary restriction, breast-feeding, and infant food allergy. Residents then viewed an online educational module about evidence-based breast-feeding and infant food allergy guidelines, and, after 1 month, completed the online questionnaire again. Results Among respondents (N = 68), only 8% and 5%, felt knowledgeable and comfortable with current maternal diet during breast-feeding and infant food allergy recommendations, respectively. Eighty-seven percent had not received formal training on the topic, and a large percentage relied on mentor teaching (49%) or anecdotal evidence (19%) as opposed to available guidelines (32%) for guidance. Most respondents (61-93%) correctly answered questions with regard to guidelines on primary and secondary food allergy prevention in relation to maternal diet. The upper-level residents answered more questions correctly about allergic proctocolitis compared with the interns (p < 0.05); no differences were noted for other topics. The majority (63%) did not believe that a mother's nutritional status could be adversely affected by dietary allergen restriction. A review of the pre- and posttest scores showed the educational module had little impact on knowledge. Conclusion Pediatric residents reported low comfort and perceived that they had little knowledge about maternal diet and infant food allergy, yet their actual performance suggested the opposite. Those who completed the educational module did not demonstrate knowledge improvement, which highlighted the need for the development of robust educational resources.
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Affiliation(s)
- Daniel V DiGiacomo
- From the Division of Allergy and Immunology, Children's National Health System, Washington, D.C., and
- Division of Pediatrics, George Washington University School of Medicine, Washington, D.C
| | - Linda Herbert
- From the Division of Allergy and Immunology, Children's National Health System, Washington, D.C., and
- Division of Pediatrics, George Washington University School of Medicine, Washington, D.C
| | - Marni Jacobs
- From the Division of Allergy and Immunology, Children's National Health System, Washington, D.C., and
| | - Ashley Ramos
- From the Division of Allergy and Immunology, Children's National Health System, Washington, D.C., and
| | - Karen A Robbins
- From the Division of Allergy and Immunology, Children's National Health System, Washington, D.C., and
- Division of Pediatrics, George Washington University School of Medicine, Washington, D.C
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145
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Brar KK. Food Allergy Evaluation for Dermatologic Disorders. Immunol Allergy Clin North Am 2021; 41:517-526. [PMID: 34225904 DOI: 10.1016/j.iac.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Food allergy evaluation for dermatologic disorders is warranted when Type 1 allergy is suspected, and includes skin prick testing (SPT) or measurement of specific immunoglobulin E (IgE) levels. The utility of these tests for identifying triggers is improved with clinical correlation, especially for contact urticaria, and protein contact dermatitis, which are mixed mechanism diseases. In atopic dermatitis (AD), patients are at risk for development of food allergy, and screening with SPT or IgE may be considered in severe AD, especially to guide early food introduction. Management of food-related AD exacerbations should focus on modifications in skincare before evaluating for allergy.
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Affiliation(s)
- Kanwaljit K Brar
- Fink Pediatric Ambulatory Care Center 160 East 32nd St, 3rd floor New York, NY 10016, USA; Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, 160 East 32nd Street, L3, New York, NY 10016, USA.
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146
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Abrams EM, Shaker M, Greenhawt M, Mack DP. International Peanut Allergy Prevention, 6 Years After the Learning Early About Peanut Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:71-77. [PMID: 34311123 DOI: 10.1016/j.jaip.2021.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/26/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
Six years ago, the Learning Early About Peanut (LEAP) trial findings helped fundamentally shift the paradigm of peanut allergy prevention. Although the results of LEAP are well accepted, policy-makers, caregivers, and clinicians struggle with how best to implement and apply the study's key findings in clinical practice. Differences in guidelines highlight issues related to peanut allergy prevention implementation, including caregiver acceptability, cost, fidelity, feasibility, appropriateness, and adoption. The goals of this rostrum are to review how the LEAP study has informed international peanut allergy prevention policy, as well as to review the strengths and ongoing controversies in peanut allergy prevention implementation.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Dartmouth, Hanover, NH
| | - Matthew Greenhawt
- Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Halton Pediatric Allergy, Burlington, Ontario, Canada
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Chiale F, Maggiora E, Aceti A, Liotto N, Coscia A, Peila C, Baldassarre ME, Bertino E, Cresi F. Complementary Feeding: Recommendations for the Introduction of Allergenic Foods and Gluten in the Preterm Infant. Nutrients 2021; 13:2477. [PMID: 34371985 PMCID: PMC8308791 DOI: 10.3390/nu13072477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this systematic review is to analyze the available literature on the introduction of allergenic foods and gluten among preterm infants. METHODS A systematic review of published studies concerning the introduction of gluten and allergenic foods in preterm infants was performed on PubMed and on the Cochrane Library. RESULTS Of the 174 PubMed results, 15 papers were considered suitable for the review. A total of 83 records were identified through the Cochrane Library search; eight papers were included in the review. Additional papers were identified from the reference lists of included studies. A secondary search was conducted on the same databases to find recommendations and advice regarding healthy full-term infants that could be translated to preterm infants. Therefore, 59 additional papers were included in the review. CONCLUSIONS Current guidelines for the introduction of solid food cannot be directly transposed to preterm infants. Further research is needed to provide evidence-based guidelines regarding weaning in preterm infants. To date, we can suggest that in preterm infants allergenic foods and gluten may be introduced when complementary feeding is started, any time after 4 months of corrected age, avoiding delayed introduction and irrespective of infants' relative risk of developing allergy. Avoiding large amounts of gluten during the first few weeks after gluten introduction and during infancy is advised, despite limited evidence to support this recommendation.
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Affiliation(s)
- Federica Chiale
- Neonatal Pathology and Neonatal Intensive Care Unit, Sant’Anna Hospital, City of Health and Science University Hospital of Turin, University of Turin, 10126 Turin, Italy; (F.C.); (A.C.); (C.P.); (E.B.); (F.C.)
| | - Elena Maggiora
- Neonatal Pathology and Neonatal Intensive Care Unit, Sant’Anna Hospital, City of Health and Science University Hospital of Turin, University of Turin, 10126 Turin, Italy; (F.C.); (A.C.); (C.P.); (E.B.); (F.C.)
| | - Arianna Aceti
- Neonatal Intensive Care Unit, AOU Bologna, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
| | - Nadia Liotto
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, 20122 Milan, Italy;
| | - Alessandra Coscia
- Neonatal Pathology and Neonatal Intensive Care Unit, Sant’Anna Hospital, City of Health and Science University Hospital of Turin, University of Turin, 10126 Turin, Italy; (F.C.); (A.C.); (C.P.); (E.B.); (F.C.)
| | - Chiara Peila
- Neonatal Pathology and Neonatal Intensive Care Unit, Sant’Anna Hospital, City of Health and Science University Hospital of Turin, University of Turin, 10126 Turin, Italy; (F.C.); (A.C.); (C.P.); (E.B.); (F.C.)
| | | | - Enrico Bertino
- Neonatal Pathology and Neonatal Intensive Care Unit, Sant’Anna Hospital, City of Health and Science University Hospital of Turin, University of Turin, 10126 Turin, Italy; (F.C.); (A.C.); (C.P.); (E.B.); (F.C.)
| | - Francesco Cresi
- Neonatal Pathology and Neonatal Intensive Care Unit, Sant’Anna Hospital, City of Health and Science University Hospital of Turin, University of Turin, 10126 Turin, Italy; (F.C.); (A.C.); (C.P.); (E.B.); (F.C.)
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148
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Early Introduction of Food Allergens and Risk of Developing Food Allergy. Nutrients 2021; 13:nu13072318. [PMID: 34371828 PMCID: PMC8308770 DOI: 10.3390/nu13072318] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/27/2022] Open
Abstract
There is increasing evidence that early introduction of allergenic foods may decrease the risk of developing IgE-mediated food allergy. Patterns of food introduction before the 2015 publication of the Learning Early about Peanut Allergy (LEAP) trial are not well-studied, but are important as a baseline for evaluating subsequent changes in infant feeding practices and potentially food allergy. We performed a retrospective longitudinal study using data from a multicenter cohort of infants hospitalized with bronchiolitis between 2011–2014. The primary outcomes were IgE-mediated egg or peanut allergy by age 3 years. Of 770 participants included in the analysis, 635 (82%) introduced egg, and 221 (27%) introduced peanut by age 12 months per parent report. Four participants had likely egg allergy, and eight participants had likely peanut allergy by age 3 years. Regular infant egg consumption was associated with less egg allergy. The association was suggestive for infant peanut consumption with zero peanut allergy cases. Overall, our results suggest that early introduction of peanut was uncommon before 2015. Although limited by the small number of allergy cases, our results suggest that early introduction of egg and peanut are associated with a decreased risk of developing food allergy, and support recent changes in practice guidelines.
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Abrams EM, Greenhawt M, Alqurashi W, Singer AG, Shaker M. The Revenge of Unintended Consequences of Anaphylaxis-Risk Overdiagnosis: How Far We Have Come and How Far We Have to Go. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3911-3917. [PMID: 34147680 DOI: 10.1016/j.jaip.2021.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
Overdiagnosis of anaphylaxis risk is an underappreciated aspect of anaphylaxis prevention. Whereas the benefits of anaphylaxis-risk prevention are well known, potential harms resulting from preemptive approaches to mitigate anaphylaxis-risk are not insignificant. Still, great progress has been made in recent years to avoid the unintended consequences of anaphylaxis-risk overdiagnosis. Reflection on recent advances in the use of diagnostic testing, as well as the application of diagnostic labels, provides an important perspective to understand how far the specialty of allergy and immunology has come in improving the lives of patients and families. Examples of recent paradigm shifts in anaphylaxis-risk management include approaches to peanut allergy prevention without screening, deferral of corticosteroids to prevent biphasic anaphylaxis reactions, reevaluation of reflex use of emergency medical services for resolved community anaphylaxis, and an approach to penicillin allergy delabeling with direct oral challenge. Routine medical practices to decrease anaphylaxis risk can have lifelong impacts for patients-beyond just preventing anaphylaxis. As our understanding of these trade-offs evolves, it becomes necessary to weigh both the benefits and the harms of past management approaches. Because medicine remains a science of uncertainty and an art of probability, a critical approach to risk mitigation remains necessary to find the often-elusive balance in anaphylaxis prevention.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Marcus Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH.
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150
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Kubala SA, Mohyi PM, Sokol K, Frischmeyer-Guerrerio P. Challenge of food allergy testing and avoidance in children with atopic dermatitis. BMJ Case Rep 2021; 14:14/6/e243141. [PMID: 34088695 PMCID: PMC8183214 DOI: 10.1136/bcr-2021-243141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Atopic dermatitis (AD) is a common presenting complaint by children and their caretakers to their primary care providers. On testing, children with AD frequently exhibit positive food-specific IgE levels in the absence of immediate allergic reactions. Misinterpretation of these false positive tests can lead to unnecessary food avoidance, which can have tremendous psychosocial, economic and nutritional consequences and, in some cases, facilitate the development of an immediate hypersensitivity to the food. We present a child with persistent AD who underwent broad testing that led to unnecessary food avoidance resulting in Vitamin D deficiency, growth failure and the development of an IgE-mediated food allergy. This case underscores the need for caution by primary care clinicians in using food avoidance diets as a treatment for AD and the importance of limiting allergy testing to foods only when the clinical history indicates an immediate hypersensitivity reaction.
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Affiliation(s)
- Stephanie Ann Kubala
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Paula Mariam Mohyi
- Internal Medicine, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
| | - Kristin Sokol
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
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