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Yin Leung AS, Tham EH, Samuel M, Munblit D, Chu DK, Dahdah L, Yamamoto-Hanada K, Trikamjee T, Warad V, van Niekerk A, Martinez S, Ellis A, Bielory L, Cuadros G, van Bever H, Wallace D, Tang M, Sublett J, Wong GWK. Quality and consistency of clinical practice guidelines on the prevention of food allergy and atopic dermatitis: Systematic review protocol. World Allergy Organ J 2022; 15:100679. [PMID: 36185546 PMCID: PMC9478906 DOI: 10.1016/j.waojou.2022.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/03/2022] [Accepted: 07/21/2022] [Indexed: 12/29/2022] Open
Abstract
Background and aims Allergy prevention strategies have gained significant traction as a means to attenuate the growing burden of allergic diseases over the past decade. As the evidence base for primary prevention of food allergy (FA) and atopic dermatitis (AD) is constantly advancing, clinical practice guideline (CPG) recommendations on interventions for FA and AD prevention vary in quality and consistency among professional organizations. We present a protocol for a systematic review of CPGs on primary prevention of FA and AD. Methods We will systematically review and appraise all CPGs addressing primary prevention of FA and AD and report our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases and manual website searches from January 2011 to March 2021 without language or geographical restrictions, and supplemented by author contact, will generate the list of potentially relevant CPGs to screen. Evaluation of the methodological quality, consistency, and global applicability of shortlisted CPGs will be performed by members of the Allergy Prevention Work Group of the World Allergy Organization (WAO) using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE-REX (Recommendations EXcellence). instruments. Guideline contents, consistency, and quality of the recommendations will be summarised in tabular and narrative formats. We aim to present consolidated recommendations from international guidelines of the highest methodological quality and applicability, as determined by AGREE II and AGREE-REX. Dissemination This systematic review will provide a succinct overview of the quality and consistency of recommendations across all existing CPGs for FA and AD prevention, as well as crucial perspectives on applicability of individual recommendations in different geographical contexts. Results from this systematic review will be reported in a peer-reviewed journal. It will also inform a position statement by WAO to provide a practical framework to guide the development of future guidelines for allergy prevention worldwide. Prospero registration number CRD42021265689.
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Key Words
- AD, Atopic dermatitis
- AGREE-II, Appraisal of Guidelines for Research and Evaluation - II
- AGREE-REX, Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX)
- Atopic dermatitis
- CPG, Clinical Practice Guideline
- Clinical practice guideline
- Eczema
- FA, Food allergy
- Food allergy
- ISAAC, International Study of Asthma and Allergies in Childhood
- LEAP, Learning Early About Peanut Allergy
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PROSPERO, Prospective Register of Systematic Reviews
- Primary prevention
- SR, Systematic review
- WAO, World Allergy Organization
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Affiliation(s)
- Agnes Sze Yin Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Miny Samuel
- Research Support Unit, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Daniel Munblit
- 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
| | - Derek K. Chu
- Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Lamia Dahdah
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Thulja Trikamjee
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Vijay Warad
- Sai Allergy Asthma Eye Hospital, Pune, India
| | - Andre van Niekerk
- Department of Paediatrics and Child Health, School of Medicine, University of Pretoria, South Africa
| | | | - Anne Ellis
- Department of Medicine, Queen's University, and the Division of Allergy and Immunology, Kingston General Hospital, Kingston, ON, Canada
| | - Leonard Bielory
- Department of Medicine, Allergy, Immunology and Ophthalmology, Hackensack Meridian School of Medicine, Springfield, NJ, USA,Center for Environmental Prediction Rutgers University, New Brunswick, NJ, USA,Kean University, Center for Aerobiology Research, New Jersey Center for Science, Technology and Mathematics, Union, NJ, USA
| | | | - Hugo van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Dana Wallace
- Nova Southeastern Allopathic Medical School, Fort Lauderdale, FL, USA
| | - Mimi Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Australia,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | - James Sublett
- Pediatric Allergy & Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Gary Wing Kin Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China,Corresponding author. Gary W.K. Wong, Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
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252
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Brishti A, Germundson-Hermanson DL, Smith NA, Kearney AE, Warda Y, Nagamoto-Combs K. Asymptomatic sensitization to a cow's milk protein induces sustained neuroinflammation and behavioral changes with chronic allergen exposure. FRONTIERS IN ALLERGY 2022; 3:870628. [PMID: 36157272 PMCID: PMC9490182 DOI: 10.3389/falgy.2022.870628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/22/2022] [Indexed: 12/04/2022] Open
Abstract
Mouse models of food allergy have contributed to our understanding of various aspects of the disease, including susceptibilities, symptom spectra, cellular mechanisms, and therapeutic approaches. Previously, we used a mouse model of non-anaphylactic cow's milk allergy (CMA) and investigated sex- and strain-dependent differences in immunological, neurological, and behavioral sequelae. We showed that male C57BL/6J mice sensitized to a bovine whey protein, β-lactoglobulin (BLG; Bos d 5), exhibited anxiety- and depression-like behavior upon acute allergen challenge. Systemic levels of BLG-specific immunoglobulins, cytokines and chemokines were also elevated in the sensitized mice. Furthermore, neuroinflammation and intestinal dysbiosis were evident as the possible causes of the altered behavior. To assess whether frequent allergen exposure influences CMA-associated pathologies over an extended period in this subclinical model, we placed BLG-sensitized mice on a whey protein (WP)-containing or whey-free control (CTL) diet for 3 months. As expected, allergen-specific IgE was significantly elevated in the plasma after completing the 5-week sensitization phase. However, the IgE levels declined in both diet groups after 3 months. In contrast, allergen-specific IgG1 stayed elevated in sensitized mice with the CTL diet, and the WP diet to a lesser extent. Interestingly, BLG-sensitized mice on the WP diet exhibited anxiety-like behavior and a trend toward spatial memory decline compared to the sham or the sensitized mice on the CTL diet. Moreover, increased immunoreactivities for GFAP and Iba1 and elevated levels of CXCL13 and CCL12, the chemokines involved in central leukocyte recruitment and other neurological diseases, were also observed in the brain. We demonstrated that sensitization to the whey protein, particularly with continuous allergen exposure, resulted in persistent neuroinflammation and associated behavioral changes despite lowered allergen-specific immunoglobulin levels. These results suggested that continuous consumption of the offending allergen may lead to adverse consequences in the brain even after desensitization.
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Affiliation(s)
- Afrina Brishti
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Danielle L. Germundson-Hermanson
- Clinical and Translational Science Graduate Program, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Nicholas A. Smith
- Clinical and Translational Science Graduate Program, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Angela E. Kearney
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Yassmine Warda
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
| | - Kumi Nagamoto-Combs
- Department of Biomedical Sciences, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, United States
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253
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Wood RA, Chinthrajah RS, Eggel A, Bottoli I, Gautier A, Woisetschlaeger M, Tassinari P, Altman P. The rationale for development of ligelizumab in food allergy. World Allergy Organ J 2022; 15:100690. [PMID: 36185545 PMCID: PMC9483652 DOI: 10.1016/j.waojou.2022.100690] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Food allergy (FA) is a growing healthcare problem worldwide and the rising prevalence in many countries can be attributed to lifestyle, environmental, and nutritional changes. Immunoglobulin E (IgE)-mediated FA is the most common form of FA affecting approximately 3%-10% of adults and 8% of children across the globe. Food allergen-induced immediate hypersensitivity reactions mediated by IgE and high-affinity IgE receptor (FcεRI) complexes on mast cells and basophils are a major hallmark of the disease. FA can affect several aspects of health-related quality of life and impose a substantial financial burden on patients and healthcare systems. Although currently there is one United States Food and Drug Administration (FDA) and European Medicines Agency (EMA)-approved treatment for peanut allergy (Palforzia), the main treatment approaches are based on allergen avoidance and symptom management. Thus, there is an urgent need for more effective and ideally disease-modifying strategies. Given the crucial role of IgE in FA, anti-IgE monoclonal antibodies are considered promising therapeutic agents. Talizumab was the first humanized anti-IgE antibody to demonstrate substantial protection against allergic reactions from accidental peanut exposure by substantially increasing the peanut reactivity threshold on oral food challenge. However, development of talizumab was discontinued and further trials were performed using omalizumab. In double-blind, Phase 2, placebo-controlled trials in patients with multi-FAs, sustained dosing with omalizumab, or omalizumab in combination with oral immunotherapy, enabled rapid desensitization to multiple trigger foods. In this review, we describe the development of ligelizumab (a derivative of talizumab), a next generation, humanized monoclonal anti-IgE antibody, its existing clinical evidence, and its potential in the management of FA. When compared with omalizumab, ligelizumab binds with ∼88-fold higher affinity for human IgE and recognizes a different epitope that substantially overlaps with the binding site of FcεRI. These properties translate into a high potency to block IgE/FcεRI signaling in both in vitro and in vivo studies. Given its efficient suppression of IgE levels, good safety and pharmacokinetic/pharmacodynamic profile, ligelizumab clearly warrants further studies for the potential management of FA.
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Affiliation(s)
- Robert A Wood
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Alexander Eggel
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | | | | | | | | | - Pablo Altman
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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254
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Abstract
OBJECTIVES Anaphylaxis is a serious allergic reaction that has the potential to be life-threatening if not recognized and managed rapidly. Several regional studies have shown increased incidence of anaphylaxis over the past decade. The objectives of this study were to determine rates of pediatric anaphylaxis in southeast Michigan between January 1, 2010, and December 31, 2019, and to describe the epidemiology of pediatric patients presenting to emergency centers in southeast Michigan with anaphylaxis. METHODS We performed a retrospective chart review of all pediatric patients aged 0 to 17 years presenting to 2 large emergency centers from 2010 to 2019 with a diagnosis of anaphylaxis using International Classification of Diseases , Ninth and Tenth Revision , Clinical Modification codes. Epidemiological and visit data, including length of stay, use of intravenous medication, and emergency severity index, were extracted and analyzed. Pediatric anaphylaxis rates were calculated based on detected anaphylaxis cases divided by total pediatric emergency department visits to the 2 emergency centers. A Poisson regression model was used to predict rates of anaphylaxis per 100,000 emergency department visits. RESULTS One thousand three hundred ninety-one pediatric visits for anaphylaxis were identified during a period between January 1, 2010, and December 31, 2019. There was a significant rate of increase in pediatric anaphylaxis cases over the 10-year study period at both suburban emergency centers, with an annual increase of 21% and 13%. There was no significant change in trends in demographic factors. Most anaphylaxis cases were young, White males with private insurance. Most children did not receive intravenous medications (77%). The median length of stay increased by 1.5 hours over the study period and 92% of patients were discharged home. CONCLUSIONS Pediatric emergency center visits and length of stay for anaphylaxis in southeast Michigan have markedly increased over the past 10 years.
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Affiliation(s)
- Paul M Patek
- From the Division of Pediatric Emergency Medicine, Beaumont Hospital, Royal Oak, MI
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255
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Dasanayaka BP, Wang H, Li Z, Yu M, Ahmed AMM, Zhang Z, Lin H, Wang X. Evaluating the effects of processing on antigenicity and immunochemical detectability of fish proteins by ELISA. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2022.104690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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256
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Probiotication of Nutritious Fruit and Vegetable Juices: An Alternative to Dairy-Based Probiotic Functional Products. Nutrients 2022; 14:nu14173457. [PMID: 36079714 PMCID: PMC9459872 DOI: 10.3390/nu14173457] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Fruits and vegetables are widely known to be rich in nutrients, antioxidants, vitamins, dietary fiber, minerals, and a bioactive molecule, making them an essential component of a balanced diet with multiple documented positive effects on human health. The probiotication of plant-based juices for the production of functional and nutraceutical food serves as a healthy alternative to dairy probiotics. They are cholesterol free, lack several dairy allergens, and also encourage ingestion for people with lactose intolerance. This review highlights valuable claims regarding the efficacy of different probiotic strains on various diseases. A comprehensive nutrition comparison and the preference of plant-based over dairy probiotic drinks is also discussed, supported with updated market trends of probiotic drinks (dairy and non-dairy based). An extensive compilation of current plant-based probiotic drinks that are available in markets around the world is listed as a reference. The fermentability of carbon sources by probiotic microorganisms is crucial in addressing the development of plant-based drinks. Therefore, the pathway involved in metabolism of sucrose, glucose, fructose, and galactose in fruit and vegetable juice was also underlined. Finally, the key factors in monitoring the quality of probiotic products such as total soluble solids, sugar consumption, titratable acidity, pH, and stability at low storage temperatures were outlined.
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257
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Scurlock AM, Brown E, Davis CM. Food insecurity in children and adults with food allergies. Ann Allergy Asthma Immunol 2022; 129:424-429. [PMID: 35987455 DOI: 10.1016/j.anai.2022.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Food allergy is a substantial public health concern associated with risk of severe or potentially life-threatening reactions and requiring life-altering changes in dietary habits. This increasingly prevalent health concern is associated with adverse medical, nutritional, psychosocial, and economic effects on the estimated 32 million affected individuals in the United States. Management of food allergy requires life-altering dietary modifications and constant vigilance to avoid implicated allergens to minimize the risk of anaphylaxis, which can lead to considerable anxiety and reduced quality of life. Specialized diets are expensive and often difficult to access, particularly for low-income and minority individuals with food allergy. The overlap of food insecurity with diet-treated illnesses further increases the burden on patients with food allergies and their families, with overall rates of food insecurity increasing substantially during the coronavirus disease 2019 pandemic. Universal screening to identify food insecure households and connect them with appropriate resources is a critical step in addressing unmet needs at the individual and family level. At the systems level, integrated advocacy approaches addressing the complex interplay between multiple societal issues such as poverty, systemic racism, wage inequality, housing insecurity, lack of transportation, and other social determinants of health are vital to ensure access to safe, healthy, nutritionally complete options for patients with food allergies and their families.
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Affiliation(s)
- Amy M Scurlock
- Department of Pediatrics, Arkansas Children's Hospital and Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | | | - Carla M Davis
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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258
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Anaphylaxis to SARS-CoV-2 Vaccines in the Setting of a Nationwide Passive Epidemiological Surveillance Program. J Clin Immunol 2022; 42:1593-1599. [PMID: 35976470 PMCID: PMC9382604 DOI: 10.1007/s10875-022-01350-1] [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: 05/11/2022] [Accepted: 08/12/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Information on anaphylaxis among recipients of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains scarce. OBJECTIVE To identify the observed incidence of anaphylaxis in recipients of different anti-SARS-CoV-2 vaccines. METHODS A nationwide observational study among recipients of 61,414,803 doses of seven different anti-SARS-CoV-2 vaccines, describing the incidence and characteristics of adult patients (age ≥ 18 years) who developed anaphylaxis as an adverse event following immunization (AEFI) against SARS-CoV-2 vaccines between December 24, 2020, and October 15, 2021, in Mexico. RESULTS Sixty-six patients developed anaphylaxis as an AEFI, for an overall observed incidence of 1.07 cases per 1,000,000 (95% CI 0.84-1.37) administered doses. Eighty-six percent of the patients were female, consistent with previous reports of AEFI to COVID-19 vaccines. mRNA-based vaccine recipients had the highest frequency of anaphylaxis, followed by adenovirus-vectored vaccines and inactivated virus recipients, with an observed incidence of 2.5, 0.7, and 0.2 cases per 1,000,000 doses administered, respectively. Only 46% of the patients received correct treatment with epinephrine as the first-line treatment through the appropriate route and dose. We detected one case of anaphylactic reaction-related death occurring 5 min following immunization with ChAdOx1 nCov-19 for a mortality rate of 1.5% among those who developed this AEFI. CONCLUSIONS In our population, anaphylactic reactions were infrequent. Our study provides further evidence supporting the security of these newly developed vaccines.
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259
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Messina M, Duncan A, Messina V, Lynch H, Kiel J, Erdman JW. The health effects of soy: A reference guide for health professionals. Front Nutr 2022; 9:970364. [PMID: 36034914 PMCID: PMC9410752 DOI: 10.3389/fnut.2022.970364] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Soy is a hotly debated and widely discussed topic in the field of nutrition. However, health practitioners may be ill-equipped to counsel clients and patients about the use of soyfoods because of the enormous, and often contradictory, amount of research that has been published over the past 30 years. As interest in plant-based diets increases, there will be increased pressure for practitioners to gain a working knowledge of this area. The purpose of this review is to provide concise literature summaries (400-500 words) along with a short perspective on the current state of knowledge of a wide range of topics related to soy, from the cholesterol-lowering effects of soy protein to the impact of isoflavones on breast cancer risk. In addition to the literature summaries, general background information on soyfoods, soy protein, and isoflavones is provided. This analysis can serve as a tool for health professionals to be used when discussing soyfoods with their clients and patients.
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Affiliation(s)
- Mark Messina
- Soy Nutrition Institute Global, Washington, DC, United States
| | - Alison Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Heidi Lynch
- Kinesiology Department, Point Loma Nazarene University, San Diego, CA, United States
| | - Jessica Kiel
- Scientific and Clinical Affairs, Medifast Inc., Baltimore, MD, United States
| | - John W. Erdman
- Division of Nutritional Sciences and Beckman Institute, Department of Food Science and Human Nutrition, University of Illinois at Urbana/Champaign, Urbana, IL, United States
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260
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Weimer DS, Demory Beckler M. Underlying Immune Mechanisms Involved in Cow’s Milk-Induced Hypersensitivity Reactions Manifesting as Atopic Dermatitis. Cureus 2022; 14:e27604. [PMID: 36059314 PMCID: PMC9433788 DOI: 10.7759/cureus.27604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Of the many symptoms associated with cow’s milk allergy (CMA), many populations face the burden of the appearance or worsening of atopic dermatitis (AD) when consuming milk products. Due to the prevalence and possible severity of symptoms, it is important to understand the underlying immune mechanisms involved in such reactions. Hypersensitivity reactions are exaggerated immune responses to often benign antigens, many times resulting in a cascade of pro-inflammatory processes. Of the four major types, type I and IV are of most relevance when considering atopic dermatitis worsened by cow’s milk. Considered a “true allergy,” type I (immediate) hypersensitivity reactions occur within hours after secondary exposure to an allergen and are primarily driven by antibodies and humoral immune responses. On the contrary, type IV (delayed) hypersensitivity reactions are driven by cell-mediated responses involving T-cell activation. Due to the array of symptoms induced by these complex reactions, it is imperative to diagnose early and treat appropriately. In this literature review, we aim to highlight the primary underlying immune contributors to hypersensitivity reactions, discuss AD as a manifestation of hypersensitivity reactions to cow’s milk, and consider current and future treatment options for combatting hypersensitivities manifesting as AD.
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261
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Shao H, Min F, Huang M, Wang Z, Bai T, Lin M, Li X, Chen H. Novel perspective on the regulation of food allergy by probiotic: The potential of its structural components. Crit Rev Food Sci Nutr 2022; 64:172-186. [PMID: 35912422 DOI: 10.1080/10408398.2022.2105304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Food allergy (FA) is a global public health issue with growing prevalence. Increasing evidence supports the strong correlation between intestinal microbiota dysbiosis and food allergies. Probiotic intervention as a microbiota-based therapy could alleviate FA effectively. In addition to improving the intestinal microbiota disturbance and affecting microbial metabolites to regulate immune system, immune responses induced by the recognition of pattern recognition receptors to probiotic components may also be one of the mechanisms of probiotics protecting against FA. In this review, it is highlighted in detail about the regulatory effects on the immune system and anti-allergic potential of probiotic components including the flagellin, pili, peptidoglycan, lipoteichoic acid, exopolysaccharides, surface (S)-layer proteins and DNA. Probiotic components could enhance the function of intestinal epithelial barrier as well as regulate the balance of cytokines and T helper (Th) 1/Th2/regulatory T cell (Treg) responses. These evidences suggest that probiotic components could be used as nutritional or therapeutic agents for maintaining immune homeostasis to prevent FA, which will contribute to providing new insights into the resolution of FA and better guidance for the development of probiotic products.
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Affiliation(s)
- Huming Shao
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- School of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang University, Nanchang, Jiangxi, China
| | - Fangfang Min
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- School of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang University, Nanchang, Jiangxi, China
| | - Meijia Huang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- School of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang University, Nanchang, Jiangxi, China
| | - Zhongliang Wang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- School of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang University, Nanchang, Jiangxi, China
| | - Tianliang Bai
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- School of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang University, Nanchang, Jiangxi, China
| | - Min Lin
- Department of Dermatology, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China
| | - Xin Li
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- School of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang University, Nanchang, Jiangxi, China
| | - Hongbing Chen
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Food Allergy, Nanchang University, Nanchang, Jiangxi, China
- Sino-German Joint Research Institute, Nanchang University, Nanchang, Jiangxi, China
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262
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Bajzik V, DeBerg HA, Garabatos N, Rust BJ, Obrien KK, Nguyen QA, O’Rourke C, Smith A, Walker AH, Quinn C, Gersuk VH, Farrington M, Jeong D, Vickery BP, Adelman DC, Wambre E. Oral desensitization therapy for peanut allergy induces dynamic changes in peanut-specific immune responses. Allergy 2022; 77:2534-2548. [PMID: 35266148 PMCID: PMC9356972 DOI: 10.1111/all.15276] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The PALISADE study, an international, phase 3 trial of peanut oral immunotherapy (POIT) with AR101, resulted in desensitization in children and adolescents who were highly allergic to peanut. An improved understanding of the immune mechanism induced in response to food allergen immunotherapy would enable more informed and effective therapeutic strategies. Our main purpose was to examine the immunological changes in blood samples from a subset of peanut-allergic individuals undergoing oral desensitization immunotherapy with AR101. METHODS Blood samples obtained as part of enrollment screening and at multiple time points during PALISADE study were used to assess basophil and CD4+ T-cell reactivity to peanut. RESULTS The absence of clinical reactivity to the entry double-blinded placebo-controlled peanut challenge (DBPCFC) was accompanied by a significantly lower basophil sensitivity and T-cell reactivity to peanut compared with DBPCFC reactors. At baseline, peanut-reactive TH2A cells were observed in many but not all peanut-allergic patients and their level in peripheral blood correlates with T-cell reactivity to peanut and with serum peanut-specific IgE and IgG4 levels. POIT reshaped circulating peanut-reactive T-cell responses in a subset-dependent manner. Changes in basophil and T-cell responses to peanut closely paralleled clinical benefits to AR101 therapy and resemble responses in those with lower clinical sensitivity to peanut. However, no difference in peanut-reactive Treg cell frequency was observed between groups. CONCLUSION Oral desensitization therapy with AR101 leads to decreased basophil sensitivity to peanut and reshapes peanut-reactive T effector cell responses supporting its potential as an immunomodulatory therapy.
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Affiliation(s)
- Veronique Bajzik
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - Hannah A. DeBerg
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - Nahir Garabatos
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - Blake J. Rust
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | | | - Quynh-Anh Nguyen
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - Colin O’Rourke
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | | | - Alex H. Walker
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - Charlie Quinn
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - Vivian H. Gersuk
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | | | - David Jeong
- Virginia Mason Medical Center, Seattle, WA 98101
| | | | | | - Erik Wambre
- Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
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263
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Cook-Mills JM, Emmerson LN. Epithelial barrier regulation, antigen sampling, and food allergy. J Allergy Clin Immunol 2022; 150:493-502. [DOI: 10.1016/j.jaci.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
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264
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The natural substances with anti-allergic properties in food allergy. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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265
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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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266
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Lloyd M, Dunn Galvin A, Tang MLK. Measuring the Impact of Food Immunotherapy on Health-Related Quality of Life in Clinical Trials. FRONTIERS IN ALLERGY 2022; 3:941020. [PMID: 35910858 PMCID: PMC9326481 DOI: 10.3389/falgy.2022.941020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Food allergy is a common, and often lifelong, disorder with considerable negative impact on the quality of life of those affected and their families. While several promising immunotherapies for food allergy have either been approved or are in late-phase clinical trials based on demonstrated effectiveness at inducing desensitization, evidence of benefit in terms of improving patient-centered outcomes is inconsistent. Historically, health-related quality of life has not been prioritized as an endpoint in food immunotherapy trials and, even when included, findings have been undermined by methodological limitations of the measurement instruments used and issues with data interpretation. This review highlights the importance of measuring health-related quality of life as an endpoint in food immunotherapy trials and discusses the strengths and limitations of available evidence in this regard, with a focus on the appropriate use of assessment instruments and interpretation of findings. There remains much to learn regarding the impact of food immunotherapies on patient wellbeing, both during treatment and over the longer term. Our aim is to assist clinicians, researchers, policy makers and consumers in their interpretation of the existing literature, and to promote greater scientific rigor in the design and selection of outcome measurement frameworks for future studies evaluating the efficacy of immunotherapy treatments for food allergy.
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Affiliation(s)
- Melanie Lloyd
- Allergy Immunology Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Audrey Dunn Galvin
- School of Applied Psychology, Cork University Hospital, University College Cork, Cork, Ireland
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mimi L. K. Tang
- Allergy Immunology Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- *Correspondence: Mimi L. K. Tang
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267
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Rotella K, Oriel RC. Accidental Reactions to Foods: Frequency, Causes, and Severity. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:157-168. [PMID: 35855411 PMCID: PMC9282141 DOI: 10.1007/s40521-022-00314-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
Purpose of Review In this review, we present the epidemiology of food allergy and allergic reactions to foods using studies that have been published over the past decade. We review these allergic reactions — how they differ by food trigger, geographic region, demographic distribution, setting, and severity. Recent Findings The rising prevalence of food allergy and persistent accidental allergic reactions to foods in various settings remains a worldwide concern. Differences in global prevalence, food triggers for reactions, and severity of accidental reactions may be explained by diversity in diets and food labeling legislation. A number of studies are highlighted that describe the unique challenges and risk factors that contribute to accidental reactions in restaurants and schools, as well as the efforts that have been made to improve safety and outcomes in these settings. Summary Food allergy prevalence has demonstrated significant variations between regions and age groups. Despite best efforts by individuals, physicians, and legislative bodies to improve safety for food allergic individuals, accidental reactions to foods still occur and can result in fatalities.
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Affiliation(s)
- Karina Rotella
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY 10029 USA
| | - Roxanne C. Oriel
- Department of Pediatrics, Division of Allergy & Immunology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY 10029 USA
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268
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Vininski MS, Rajput S, Hobbs NJ, Dolence JJ. Understanding sex differences in the allergic immune response to food. AIMS ALLERGY AND IMMUNOLOGY 2022; 6:90-105. [PMID: 38314333 PMCID: PMC10836331 DOI: 10.3934/allergy.2022009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Food allergies are of great public health concern due to their rising prevalence. Our understanding of how the immune system reacts to food remains incomplete. Allergic responses vary between individuals with food allergies. This variability could be caused by genetic, environmental, hormonal, or metabolic factors that impact immune responses mounted against allergens found in foods. Peanut (PN) allergy is one of the most severe and persistent of food allergies, warranting examination into how sensitization occurs to drive IgE-mediated allergic reactions. In recent years, much has been learned about the mechanisms behind the initiation of IgE-mediated food allergies, but additional questions remain. One unresolved issue is whether sex hormones impact the development of food allergies. Sex differences are known to exist in other allergic diseases, so this poses the question about whether the same phenomenon is occurring in food allergies. Studies show that females exhibit a higher prevalence of atopic conditions, such as allergic asthma and eczema, relative to males. Discovering such sex differences in allergic diseases provide a basis for investigating the mechanisms of how hormones influence the development of IgE-mediated reactions to foods. Analysis of existing food allergy demographics found that they occur more frequently in male children and adult females, which is comparable to allergic asthma. This paper reviews existing allergic mechanisms, sensitization routes, as well as how sex hormones may play a role in how the immune system reacts to common food allergens such as PN.
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Affiliation(s)
| | | | - Nicholas J. Hobbs
- Department of Biology, University of Nebraska at Kearney, Kearney, NE, 68849
| | - Joseph J. Dolence
- Department of Biology, University of Nebraska at Kearney, Kearney, NE, 68849
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269
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Mishra M, Sarkar T, Choudhury T, Bansal N, Smaoui S, Rebezov M, Shariati MA, Lorenzo JM. Allergen30: Detecting Food Items with Possible Allergens Using Deep Learning-Based Computer Vision. FOOD ANAL METHOD 2022. [DOI: 10.1007/s12161-022-02353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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270
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Lama JK, Iijima K, Kobayashi T, Kita H. Blocking the inhibitory receptor programmed cell death 1 prevents allergic immune response and anaphylaxis in mice. J Allergy Clin Immunol 2022; 150:178-191.e9. [PMID: 35092762 PMCID: PMC9271539 DOI: 10.1016/j.jaci.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Food allergy and acute anaphylaxis can be life-threatening. While T follicular helper (Tfh) cells play a pivotal role in the allergic immune responses, the immunologic mechanisms that regulate the production of antibodies (Abs) that mediate anaphylaxis are not fully understood. OBJECTIVE The aim of this study was to investigate the role of the inhibitory receptor programmed cell death protein 1 (PD-1), which is highly expressed on Tfh cells, in allergic immune responses using an animal model of peanut allergy and anaphylaxis. METHODS Naive wild-type mice were exposed to peanut flour intranasally and then challenged with peanut extract to induce systemic anaphylaxis. The roles of PD-1 were examined by blocking Abs and using gene-deficient animals. A hapten model and passive cutaneous anaphylaxis were used to characterize allergen-specific Abs. RESULTS Treatment with anti-PD-1 enhanced development of Tfh cells and germinal center B cells in mice exposed to peanut flour. Nonetheless, anti-PD-1 or its ligand fully protected mice from developing anaphylaxis. Anti-PD-1 treatment or genetic deficiency of PD-1 in CD4+ T cells inhibited production of peanut-specific IgE and increased the levels of IgG. The passive cutaneous anaphylaxis showed that peanut-specific Abs generated in anti-PD-1-treated animals prevented, rather than provoked, anaphylaxis when transferred to naive animals. Anti-PD-1 promoted production of Abs with low affinity for an antigen in the hapten model. CONCLUSION Blockade of the pathway between PD-1 and its ligand is protective against allergic immune responses. The direct interaction between Tfh cells and B cells may play a pivotal role in controlling Ab quality and clinical manifestation of allergic diseases.
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Affiliation(s)
- Jyoti K. Lama
- Department of Immunology, Mayo Clinic Rochester, Rochester, MN 55905 and Mayo Clinic Arizona, Scottsdale, AZ 85259,Immunology Program, Mayo Graduate School of Biomedical Sciences, Rochester, MN 55905 and Scottsdale, AZ 85259
| | - Koji Iijima
- Division of Allergy, Asthma and Clinical Immunology and Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259
| | - Takao Kobayashi
- Division of Allergy, Asthma and Clinical Immunology and Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259
| | - Hirohito Kita
- Department of Immunology, Mayo Clinic Rochester, Rochester, MN 55905 and Mayo Clinic Arizona, Scottsdale, AZ 85259,Division of Allergy, Asthma and Clinical Immunology and Department of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259
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271
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Albuhairi S, Rachid R. The use of adjunctive therapies during oral immunotherapy: A focus on biologics. JOURNAL OF FOOD ALLERGY 2022; 4:65-70. [PMID: 39021843 PMCID: PMC11250515 DOI: 10.2500/jfa.2022.4.220019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Oral immunotherapy (OIT), thus far, is the most evaluated therapeutic approach for food allergy. However, OIT is not known to lead to a cure, and it carries a risk for allergic reactions. Adjunct therapies to OIT are currently being investigated to evaluate their effect on safety and outcome. Of these therapies, omalizumab is the most evaluated biologic. There is mounting evidence that omalizumab is effective in inducing rapid desensitization of OIT in both single-food and multiallergen OIT, while diminishing the rate of adverse reactions. Evaluation of other adjunct biologics, such as dupilumab and bacterial therapy, is underway.
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Affiliation(s)
- Sultan Albuhairi
- From the Allergy and Immunology Section, Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Rima Rachid
- Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts; and
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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272
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Phadke NA, Wickner P, Wang L, Zhou L, Mort E, Bates DW, Seguin C, Fu X, Blumenthal KG. Allergy Safety Events in Health Care: Development and Application of a Classification Schema Based on Retrospective Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1844-1855.e3. [PMID: 35398557 PMCID: PMC9371622 DOI: 10.1016/j.jaip.2022.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/10/2022] [Accepted: 03/27/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Allergy safety requires understanding the operational processes that expose patients to their known allergens, including how and when such processes fail. OBJECTIVE To improve health care safety for patients with allergies, we developed and assessed an allergy safety event classification schema to describe failures resulting in allergy-related safety events. METHODS Using keyword searches followed by expert manual review of 299,031 voluntarily-filed safety event reports at 2 large academic medical centers, we identified and classified allergy-related safety events from 5 years of safety reports. We used driver diagrams to elucidate root causes for commonly observed allergy safety events in health care settings. RESULTS From 299,031 safety reports, 1922 (0.6%) were extracted with keywords and 744 (0.2%) were manually confirmed as allergy-related safety events. Safety failures were due to incomplete/inaccurate electronic health record documentation (n = 375, 50.4%), human factors (n = 175, 23.5%), allergy alert limitation and/or malfunction (n = 127, 17.1%), data exchange and interoperability failures (n = 92, 12.4%), and electronic health record system default options (n = 30, 4.0%). Safety failures resulted in known allergen exposures to drugs (n = 537), including heparin (n = 27) and topical anesthetics such as lidocaine (n = 8); latex (n = 114); food allergens (n = 73); and adhesive (n = 23). CONCLUSIONS We identified 744 allergy-related safety events to inform a novel safety failure classification schema as an important step toward a safer health care environment for patients with allergies. Improved systems are required to address safety issues with certain food and drug allergens.
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Affiliation(s)
- Neelam A Phadke
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Mass.
| | - Paige Wickner
- Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Liqin Wang
- Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, Mass
| | - Li Zhou
- Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, Mass
| | - Elizabeth Mort
- Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - David W Bates
- Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, Mass; Harvard T.H. Chan School of Public Health, Boston, Mass
| | | | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; The Mongan Institute, Massachusetts General Hospital, Boston, Mass
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, Mass; The Mongan Institute, Massachusetts General Hospital, Boston, Mass
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273
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Vander Does A, Ju T, Yosipovitch G. When Foods Cause Itch: Clinical Characteristics, Pathophysiology, and Recommendations for Food-Induced Skin and Mucosal Pruritus. Dermatitis 2022; Publish Ahead of Print:01206501-990000000-00036. [PMID: 35839419 DOI: 10.1097/der.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in dermatology on food-induced pruritus. In addition, itch severity is rarely mentioned. Food can induce pruritus through either ingestion or direct contact with skin or mucosal membranes. The most common type of itch provoked by food is acute urticaria, often through the classical immunoglobulin E (IgE)-mediated pathway. Other mechanisms include non-IgE-mediated, mixed (IgE-mediated and non-IgE-mediated), T-cell-mediated, and nonimmune reactions. For patients presenting with urticaria, generalized pruritus, oral pruritus, or dermatitis, a thorough history is warranted, and possible food associations should be considered and assessed. Although any food seems to have the potential to elicit an immune response, certain foods are especially immunogenic. Treatment includes avoidance of the trigger and symptom management. Careful consideration should be used as to avoid unnecessarily restrictive elimination diets.
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Affiliation(s)
- Ashley Vander Does
- From the Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, FL
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274
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Gao H, Jorgensen R, Raghunath R, Ng PKW, Gangur V. An Adjuvant-Free Mouse Model Using Skin Sensitization Without Tape-Stripping Followed by Oral Elicitation of Anaphylaxis: A Novel Pre-Clinical Tool for Testing Intrinsic Wheat Allergenicity. FRONTIERS IN ALLERGY 2022; 3:926576. [PMID: 36238931 PMCID: PMC9552944 DOI: 10.3389/falgy.2022.926576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022] Open
Abstract
Wheat is a major food allergen per the regulatory bodies of various nations. Hypersensitivity reactions to wheat have been steadily increasing for reasons that are not completely understood. Wheat-allergy models typically use adjuvants to induce sensitization to wheat proteins followed by an intraperitoneal challenge to elicit anaphylaxis. Although these models are very useful, they lack the ability to reveal the intrinsic allergenicity potential of wheat. To improve the mouse model of wheat allergy, we tested the hypothesis that repeated skin application of salt-soluble protein extract (SSPE) from durum wheat will clinically sensitize the mice to oral anaphylaxis to SSPE. Balb/c mice were bred and maintained on a plant-protein-free diet and used in the experiments. Adult female mice were exposed to SSPE once a week for 9 weeks via a solution on intact skin. Sensitization was measured by SSPE-specific IgE (sIgE) antibody and total IgE (tIgE) levels. Oral anaphylaxis was quantified by hypothermic shock response (HSR), and mucosal mast cell response (MMCR) was quantified by measuring MMCP-1 after oral challenge. Using single mouse data, correlation analyses were performed to determine the relationship among the allergenicity readouts. Spleen cytokines were quantified using a protein microarray method. Our results show that (i) repeated skin exposures to SSPE elicited robust increases in the sIgE and tIgE levels; (ii) skin exposure to SSPE was sufficient to sensitize mice for oral anaphylaxis and MMCR; (iii) both HSR and MMCR showed a strong correlation with each other, as well as with sIgE, and a modest correlation with tIgE levels; (iv) selected Th2/Th17/Th1 cytokines were elevated in skin-sensitized mice; and (v) oral allergen-challenged mice showed selective elevation of IL-6 and a panel of chemokines compared to saline-challenged mice. Together, we report the development and characterization of a novel adjuvant-free wheat-allergy mouse model that uses skin sensitization without tape-stripping followed by oral elicitation of anaphylaxis. Furthermore, validation of quantifiable wheat allergenicity readouts makes this model particularly suitable as a pre-clinical testing tool to assess the intrinsic sensitization/oral-anaphylaxis elicitation potential of novel wheat proteins (e.g., processed wheat) and to develop hypo/non-allergenic wheat products.
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Affiliation(s)
- Haoran Gao
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Rick Jorgensen
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Rajsri Raghunath
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Perry K. W. Ng
- Cereal Science Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Venu Gangur
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
- *Correspondence: Venu Gangur
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275
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Jorgensen R, Raghunath R, Gao H, Olson E, Ng PKW, Gangur V. A Mouse-Based Method to Monitor Wheat Allergens in Novel Wheat Lines and Varieties Created by Crossbreeding: Proof-of-Concept Using Durum and A. tauschii Wheats. Int J Mol Sci 2022; 23:ijms23126505. [PMID: 35742949 PMCID: PMC9224339 DOI: 10.3390/ijms23126505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022] Open
Abstract
Wheat allergies are potentially life-threatening because of the high risk of anaphylaxis. Wheats belong to four genotypes represented in thousands of lines and varieties. Monitoring changes to wheat allergens is critical to prevent inadvertent ntroduction of hyper-allergenic varieties via breeding. However, validated methods for this purpose are unavailable at present. As a proof-of-concept study, we tested the hypothesis that salt-soluble wheat allergens in our mouse model will be identical to those reported for humans. Groups of Balb/cJ mice were rendered allergic to durum wheat salt-soluble protein extract (SSPE). Using blood from allergic mice, a mini hyper-IgE plasma bank was created and used in optimizing an IgE Western blotting (IEWB) to identify IgE binding allergens. The LC-MS/MS was used to sequence the allergenic bands. An ancient Aegilops tauschii wheat was grown in our greenhouse and extracted SSPE. Using the optimized IEWB method followed by sequencing, the cross-reacting allergens in A. tauschii wheat were identified. Database analysis showed all but 2 of the durum wheat allergens and all A. tauschii wheat allergens identified in this model had been reported as human allergens. Thus, this model may be used to identify and monitor potential changes to salt-soluble wheat allergens caused by breeding.
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Affiliation(s)
- Rick Jorgensen
- Food Allergy & Immunology Laboratory, Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (R.J.); (R.R.); (H.G.)
| | - Rajsri Raghunath
- Food Allergy & Immunology Laboratory, Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (R.J.); (R.R.); (H.G.)
| | - Haoran Gao
- Food Allergy & Immunology Laboratory, Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (R.J.); (R.R.); (H.G.)
| | - Eric Olson
- Wheat Breeding & Genetics Laboratory, Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824, USA;
| | - Perry K. W. Ng
- Cereal Science Laboratory, Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI 48824, USA;
| | - Venu Gangur
- Food Allergy & Immunology Laboratory, Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (R.J.); (R.R.); (H.G.)
- Correspondence: ; Tel.: +1-517-353-3330
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276
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Takano T, Hirose M, Yamasaki Y, Hara M, Okada T, Kunishima H. Investigation of the incidence of immunisation stress-related response following COVID-19 vaccination in healthcare workers. J Infect Chemother 2022; 28:735-740. [PMID: 35190259 PMCID: PMC8825314 DOI: 10.1016/j.jiac.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/06/2022] [Accepted: 02/04/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Safe vaccination worldwide is critical to end the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate adverse reactions to vaccination using a web-based questionnaire and examine the risk factors for the occurrence of immunisation stress-related response (ISRR). METHODS We conducted a questionnaire survey using Google Form® among the employees of St. Marianna University Hospital who had received the COVID-19 vaccine between April 2021 and May 2021, 1 week after the first and second vaccinations. We developed and used a questionnaire to identify individuals with ISRR according to the World Health Organization diagnostic criteria. A generalised linear mixed model was constructed with ISRR onset as the dependent variable, subjects as the random factor, and each parameter as a fixed factor. A multivariate model was constructed using the forced imputation method with factors that were significant in the univariate analysis. RESULTS We enrolled 2,073 and 1,856 respondents in the first and second questionnaire surveys, respectively. Fifty-five and 33 ISRR cases were identified in the first and second vaccinations, respectively. In the univariate analysis, strong pre-vaccination anxiety (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.30-4.12, p = 0·004) and history of allergy (OR, 1.6; 95% CI, 1.14-2.24, p = 0·007) were significant risk factors. Multivariate analysis also showed that strong pre-vaccination anxiety (OR, 2.1; 95% CI, 1.15-3.80, p = 0.016) and history of allergy (OR, 1.5; 95% CI, 1.09-2.15, p = 0.014) were significant risk factors. CONCLUSIONS Confirmation of allergy prior to vaccination and subsequent action are essential for addressing ISRR.
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Affiliation(s)
- Tomonori Takano
- Department of Infectious Disease, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masanori Hirose
- Division of General Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yukitaka Yamasaki
- Department of Infectious Disease, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masatoshi Hara
- Division of Cardiology and Health Service Centre, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomoyuki Okada
- Department of Otolaryngology and Health Service Centre, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Disease, St. Marianna University School of Medicine, Kanagawa, Japan.
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277
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Emerging approaches in the diagnosis and therapy in shellfish allergy. Curr Opin Allergy Clin Immunol 2022; 22:202-212. [DOI: 10.1097/aci.0000000000000827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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278
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Labrosse R, Graham F, Caubet JC. Recent advances in the diagnosis and management of tree nut and seed allergy. Curr Opin Allergy Clin Immunol 2022; 22:194-201. [DOI: 10.1097/aci.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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279
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Sehgal S, Gupta RS, Wlodarski M, Bilaver LA, Wehbe FH, Spergel JM, Wang J, Ciaccio CE, Makhija M, Starren JB. Development of Food Allergy Data Dictionary: Toward a Food Allergy Data Commons. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1614-1621.e1. [PMID: 35259539 DOI: 10.1016/j.jaip.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Food allergy (FA) data lacks a common base of terminology and hinders data exchange among institutions. OBJECTIVE To examine the current FA concept coverage by clinical terminologies and to develop and evaluate a Food Allergy Data Dictionary (FADD). METHODS Allergy/immunology templates and patient intake forms from 4 academic medical centers with expertise in FA were systematically reviewed, and in-depth discussions with a panel of FA experts were conducted to identify important FA clinical concepts and data elements. The candidate ontology was iteratively refined through a series of virtual meetings. The concepts were mapped to existing clinical terminologies manually with the ATHENA vocabulary browser. Finally, the revised dictionary document was vetted with experts across 22 academic FA centers and 3 industry partners. RESULTS A consensus version 1.0 FADD was finalized in November 2020. The FADD v1.0 contained 936 discrete FA concepts that were grouped into 14 categories. The categories included both FA-specific concepts, such as foods triggering reactions, and general health care categories, such as medications. Although many FA concepts are included in existing clinical terminologies, some critical concepts are missing. CONCLUSIONS The FADD provides a pragmatic tool that can enable improved structured coding of FA data for both research and clinical uses, as well as lay the foundation for the development of standardized FA structured data entry forms.
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Affiliation(s)
- Shruti Sehgal
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ruchi S Gupta
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; The Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
| | - Mark Wlodarski
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lucy A Bilaver
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Firas H Wehbe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Julie Wang
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christina E Ciaccio
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, Ill
| | - Melanie Makhija
- Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Justin B Starren
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Sindher SB, Kumar D, Cao S, Purington N, Long A, Sampath V, Zedeck SS, Woch MA, Garcia‐Lloret M, Chinthrajah RS. Phase 2, randomized multi oral immunotherapy with omalizumab 'real life' study. Allergy 2022; 77:1873-1884. [PMID: 35014049 DOI: 10.1111/all.15217] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) is frequently discontinued due to adverse events (AEs) and current data suggests that lowering OIT doses can minimize severity and frequency of AEs. However, the minimum daily dose that can enable desensitization and induce immune responses in multi-food OIT (mOIT) is unknown. METHODS Participants aged 2-25 years with multi-food allergies were pretreated with fixed-dose omalizumab (150 mg, 3 doses, every 4 weeks), and randomized 1:1 to receive mOIT to a total maintenance dose of either 300 or 1200 mg total protein, (total dose includes at least two and up to a max of five allergens) and then transitioned to real-food protein equivalents after 18 weeks of treatment. The primary endpoint was the proportion of subjects with increases in IgG4/IgE ratio of at least 2 allergens by ≥25% from baseline after 18 weeks of therapy. The primary efficacy and safety analyses were done in the intention-to-treat population. RESULTS Sixty participants were enrolled across two sites. Seventy percent of participants in both arms showed changes in sIgG4/sIgE ratio in at least 2 allergens with no difference between the treatment groups (OR [95% CI] = 1.00 [0.29, 3.49]). Overall, there were no differences in AEs between the 300 and 1200 mg groups (19% vs. 17%, p = .69), respectively. CONCLUSIONS Our data suggest that plasma marker changes are induced early, even at a total protein dose of 300 mg inclusive of multiple allergens when mOIT is combined with fixed-dose omalizumab. Identification of optimal mOIT dosing with adjunct omalizumab is needed for the long-term success of OIT. TRIAL REGISTRATION ClinicalTrials.gov (NCT03181009).
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Affiliation(s)
- Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Divya Kumar
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Quantitative Sciences Unit Stanford University Stanford California USA
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
| | - Stacey S. Zedeck
- University of California Los Angeles California USA
- Department of Pediatrics Division of Immunology Allergy, and Rheumatology Los Angeles California USA
| | - Margaret A. Woch
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
| | - Maria Garcia‐Lloret
- University of California Los Angeles California USA
- Department of Pediatrics Division of Immunology Allergy, and Rheumatology Los Angeles California USA
| | - Rebecca Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford California USA
- Division of Pulmonary and Critical Care Medicine Stanford University Stanford California USA
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O'Rourke E, Tang H, Chin A, Long A, Sindher S, Chinthrajah RS. Current insights: a systemic review of therapeutic options for peanut allergy. Curr Opin Allergy Clin Immunol 2022; 22:188-193. [PMID: 35660711 PMCID: PMC9178908 DOI: 10.1097/aci.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW With increasing prevalence of peanut allergy (PA) globally and the greater risk of potential reactions occurring due to the leading role of nuts in food products, PA has become a significant public health concern over the past decade, affecting up to 5 million of the US adult population. This review details updates and advances in prevalence, diagnosis, and immunotherapies that have occurred over the past year. RECENT FINDINGS Therapeutic and diagnostic advances remain at the forefront of research and have continued to push the food allergy (FA) field forward to provide a promising role in the detection and treatment of PA. The FA field has researched significant advances in peanut immunotherapy, biomarker diagnosis, and quality of life (QoL) improvement. SUMMARY Given the burden and consequences for individuals with PA, these advances delivered in clinical practice can significantly improve the QoL of individuals with PA and their caregivers. Ongoing studies will continue to investigate long-term outcome measures of desensitisation and effective management plans tailored to the families' needs.
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Affiliation(s)
- Eimear O'Rourke
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
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282
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Jiang X, Mu H, Hsieh YHP, Rao Q. Isolation and Characterization of Chicken Serum Albumin (Hen Egg Alpha-Livetin, Gal d 5). Foods 2022; 11:foods11111637. [PMID: 35681387 PMCID: PMC9180759 DOI: 10.3390/foods11111637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Chicken serum albumin, i.e., hen egg alpha-livetin, is a recognized food allergen in chicken meat and hen eggs. Currently, there is no immunoassay available for its detection from food matrices. The characterization of chicken serum albumin-specific antibodies and the extraction of the target protein are essential for immunoassay development. One monoclonal antibody (mAb), 3H4, was used in this study due to its selectivity to a linear epitope on avian serum albumin. To study the extraction of chicken serum albumin, phosphate-buffered saline (PBS) with two additives, i.e., sodium dodecyl sulfate (SDS) and dithiothreitol (DTT), was used for its extraction from chicken blood plasma and hen egg yolk. SDS and DTT improved the chicken serum albumin’s recovery and enhanced chicken serum albumin’s immunodetection. In addition, chicken serum albumin retained the best solubility and immunoreactivity after heat treatment in a neutral condition. It experienced degradation and aggregation in acidic and alkaline conditions, respectively. Overall, PBS containing 0.1% SDS and 1 mM DTT (pH 7.2) was a better extraction buffer for chicken serum albumin. However, the complexity of the food matrix and elevated temperature could reduce its solubility and immunoreactivity.
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Affiliation(s)
- Xingyi Jiang
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA; (X.J.); (Y.-H.P.H.)
| | - Han Mu
- Novavax, Inc., Gaithersburg, MD 20878, USA;
| | - Yun-Hwa Peggy Hsieh
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA; (X.J.); (Y.-H.P.H.)
| | - Qinchun Rao
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA; (X.J.); (Y.-H.P.H.)
- Correspondence: ; Tel.: +1-850-644-1829
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283
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Xie Q, Xue W. IgE-Mediated food allergy: Current diagnostic modalities and novel biomarkers with robust potential. Crit Rev Food Sci Nutr 2022; 63:10148-10172. [PMID: 35587740 DOI: 10.1080/10408398.2022.2075312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Food allergy (FA) is a serious public health issue afflicting millions of people globally, with an estimated prevalence ranging from 1-10%. Management of FA is challenging due to overly restrictive diets and the lack of diagnostic approaches with high accuracy and prediction. Although measurement of serum-specific antibodies combined with patient medical history and skin prick test is a useful diagnostic tool, it is still an imprecise predictor of clinical reactivity with a high false-positive rate. The double-blind placebo-controlled food challenge represents the gold standard for FA diagnosis; however, it requires large healthcare and involves the risk of acute onset of allergic reactions. Improvement in our understanding of the molecular mechanism underlying allergic disease pathology, development of omics-based methods, and advances in bioinformatics have boosted the generation of a number of robust diagnostic biomarkers of FA. In this review, we discuss how traditional diagnostic modalities guide appropriate diagnosis and management of FA in clinical practice, as well as uncover the potential of the latest biomarkers for the diagnosis, monitoring, and prediction of FA. We also raise perspectives for precise and targeted medical intervention to fill the gap in the diagnosis of FA.
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Affiliation(s)
- Qiang Xie
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, P.R. China
| | - Wentong Xue
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, P.R. China
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284
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Peters RL, Guarnieri I, Tang MLK, Lowe AJ, Dharmage SC, Perrett KP, Gurrin LC, Koplin JJ. The natural history of peanut and egg allergy in children up to age 6 years in the HealthNuts population-based longitudinal study. J Allergy Clin Immunol 2022; 150:657-665.e13. [PMID: 35597613 DOI: 10.1016/j.jaci.2022.04.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prospectively collected data on the natural history of food allergy are lacking. OBJECTIVE We examined the natural history of egg and peanut allergy in children from age 1 to 6 years and assessed whether a skin prick test (SPT) result or other clinical factors at diagnosis are associated with the persistence or resolution of food allergy in early childhood. METHODS The HealthNuts cohort consists of 5276 children who were recruited at age 1 year and have been followed prospectively. Children with food allergy at age 1 year (peanut [n = 156] or raw egg [n = 471] allergy ) and children who developed new sensitizations or food reactions after age 1 year were assessed for food sensitization and allergy (confirmed by oral food challenge when indicated) at the 6-year follow-up. RESULTS New-onset food allergy developed by age 6 years was more common for peanut (0.7% [95% CI = 0.5%-1.1%]) than egg (0.09% [95% CI = 0.03%-0.3%]). Egg allergy resolved more commonly (89% [95% CI = 85%-92%]) than peanut allergy (29% [95% CI = 22%-38%]) by age 6 years. The overall weighted prevalence of peanut allergy at age 6 years was 3.1% (95% CI = 2.6-3.7%) and that of egg allergy was 1.2% (95% = CI 0.9%-1.6%). The factors at age 1 year associated with persistence of peanut allergy were peanut SPT result of 8 mm or larger (odds ratio [OR] = 2.35 [95% CI 1.08-5.12]), sensitization to tree nuts (adjusted OR [aOR] = 2.51 [95% CI = 1.00-6.35]), and early-onset severe eczema (aOR = 3.23, [95% CI 1.17-8.88]). Factors at age 1 associated with persistence of egg allergy at age 6 were egg SPT result of 4 mm or larger (OR = 2.98 [95% CI 1.35-6.36]), other (peanut and/or sesame) food sensitizations (aOR = 2.80 [95% CI = 1.11-7.03]), baked egg allergy (aOR = 7.41 [95% CI = 2.16-25.3]), and early-onset severe eczema (aOR = 3.77 [95% CI = 1.35-10.52]). CONCLUSION Most egg allergy and nearly one-third of peanut allergy resolves naturally by age 6 years. The prevalence of peanut allergy at age 6 years was similar to that observed at age 1 year, largely owing to new-onset food peanut allergy after age 1 year. Infants with early-onset eczema, larger SPT wheals, or multiple food sensitizations and/or allergies were less likely to acquire tolerance to either peanut or egg.
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Affiliation(s)
- Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia.
| | - Imma Guarnieri
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Adrian J Lowe
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Shyamali C Dharmage
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Lyle C Gurrin
- Murdoch Children's Research Institute, Parkville, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
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285
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Farag MA, Khalifa I, Gamal M, Bakry IA. The chemical composition, production technology, authentication, and QC analysis of dried milk. Int Dairy J 2022. [DOI: 10.1016/j.idairyj.2022.105407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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286
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Breach MR, Dye CN, Galan A, Lenz KM. Prenatal allergic inflammation in rats programs the developmental trajectory of dendritic spine patterning in brain regions associated with cognitive and social behavior. Brain Behav Immun 2022; 102:279-291. [PMID: 35245680 PMCID: PMC9070022 DOI: 10.1016/j.bbi.2022.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/04/2022] [Accepted: 02/26/2022] [Indexed: 12/01/2022] Open
Abstract
Allergic inflammation during pregnancy increases risk for a diagnosis of neurodevelopmental disorders such as Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) in the offspring. Previously, we found a model of such inflammation, allergy-induced maternal immune activation (MIA), produced symptoms analogous to those associated with neurodevelopmental disorders in rats, including reduced juvenile play behavior, hyperactivity, and cognitive inflexibility. These behaviors were preceded by perinatal changes in microglia colonization and phenotype in multiple relevant brain regions. Given the role that microglia play in synaptic patterning as well as evidence for altered synaptic architecture in neurodevelopmental disorders, we investigated whether allergic MIA altered the dynamics of dendritic spine patterning throughout key regions of the rat forebrain across neurodevelopment. Adult virgin female rats were sensitized to the allergen, ovalbumin, with alum adjuvant, bred, and allergically challenged on gestational day 15. Brain tissue was collected from male and female offspring on postnatal days (P) 5, 15, 30, and 100-120 and processed for Golgi-Cox staining. Mean dendritic spine density was calculated for neurons in brain regions associated with cognition and social behavior, including the medial prefrontal cortex (mPFC), basal ganglia, septum, nucleus accumbens (NAc), and amygdala. Allergic MIA reduced dendritic spine density in the neonatal (P5) and juvenile (P15) mPFC, but these mPFC spine deficits were normalized by P30. Allergic inflammation reduced spine density in the septum of juvenile (P30) rats, with an interaction suggesting increased density in males and reduced density in females. MIA-induced reductions in spine density were also found in the female basal ganglia at P15, as well as in the NAc at P30. Conversely, MIA-induced increases were found in the NAc in adulthood. While amygdala dendritic spine density was generally unaffected throughout development, MIA reduced density in both medial and basolateral subregions in adult offspring. Correlational analyses revealed disruption to amygdala-related networks in the neonatal animals and cortico-striatal related networks in juvenile and adult animals in a sex-specific manner. Collectively, these data suggest that communication within and between these cognitive and social brain regions may be altered dynamically throughout development after prenatal exposure to allergic inflammation. They also provide a basis for future intervention studies targeted at rescuing spine and behavior changes via immunomodulatory treatments.
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Affiliation(s)
- Michaela R. Breach
- Neuroscience Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Courtney N. Dye
- Neuroscience Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Anabel Galan
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Kathryn M. Lenz
- Department of Psychology, The Ohio State University, Columbus, OH, USA,Department of Neuroscience, The Ohio State University, Columbus, OH, USA,Institute for Behavioral Medicine Research, The Ohio State University, Columbus, OH, USA
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287
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Blázquez-García M, Arévalo B, Serafín V, Benedé S, Mata L, Galán-Malo P, Segura-Gil I, Pérez MD, Pingarrón JM, Campuzano S. Ultrasensitive detection of soy traces by immunosensing of glycinin and β-conglycinin at disposable electrochemical platforms. Talanta 2022; 241:123226. [DOI: 10.1016/j.talanta.2022.123226] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
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288
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Jones CJ, Paudyal P, West RM, Mansur AH, Jay N, Makwana N, Baker S, Krishna MT. Burden of allergic disease among ethnic minority groups in high-income countries. Clin Exp Allergy 2022; 52:604-615. [PMID: 35306712 PMCID: PMC9324921 DOI: 10.1111/cea.14131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/19/2022]
Abstract
The COVID‐19 pandemic raised acute awareness regarding inequities and inequalities and poor clinical outcomes amongst ethnic minority groups. Studies carried out in North America, the UK and Australia have shown a relatively high burden of asthma and allergies amongst ethnic minority groups. The precise reasons underpinning the high disease burden are not well understood, but it is likely that this involves complex gene–environment interaction, behavioural and cultural elements. Poor clinical outcomes have been related to multiple factors including access to health care, engagement with healthcare professionals and concordance with advice which are affected by deprivation, literacy, cultural norms and health beliefs. It is unclear at present if allergic conditions are intrinsically more severe amongst patients from ethnic minority groups. Most evidence shaping our understanding of disease pathogenesis and clinical management is biased towards data generated from white population resident in high‐income countries. In conjunction with standards of care, it is prudent that a multi‐pronged approach towards provision of composite, culturally tailored, supportive interventions targeting demographic variables at the individual level is needed, but this requires further research and validation. In this narrative review, we provide an overview of epidemiology, sensitization patterns, poor clinical outcomes and possible factors underpinning these observations and highlight priority areas for research.
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Affiliation(s)
- Christina J Jones
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Priyamvada Paudyal
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, Brighton, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adel H Mansur
- Birmingham Regional Severe Asthma Service, University Hospitals Birmingham NHS Foundation Trust, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Nicola Jay
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Nick Makwana
- Department of Child Health, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Mamidipudi T Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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289
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Landers JJ, Janczak KW, Shakya AK, Zarnitsyn V, Patel SR, Baker JR, Gill HS, O'Konek JJ. Targeted allergen-specific immunotherapy within the skin improves allergen delivery to induce desensitization to peanut. Immunotherapy 2022; 14:539-552. [PMID: 35196877 PMCID: PMC9043875 DOI: 10.2217/imt-2021-0206] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: Epicutaneous immunotherapy (EPIT) with peanut has been demonstrated to be safe but efficacy may be limited by allergen uptake through the skin barrier. To enhance allergen uptake into the skin, the authors used peanut-coated microneedles and compared them with EPIT in a peanut allergy mouse model. Methods: Sensitized mice were treated with peanut-coated microneedles or peanut-EPIT and then challenged with peanut to determine protection. Results: Treatment with peanut-coated microneedles was safe and showed enhanced desensitization to peanut compared with peanut-EPIT administered via a similar schedule. Protection was associated with reduced Th2 immune responses and mast cell accumulation in the intestine. Conclusion: Peanut-coated microneedles have the potential to present a safe method of improving allergen delivery for cutaneous immunotherapy.
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Affiliation(s)
- Jeffrey J Landers
- Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Katarzyna W Janczak
- Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | | | - James R Baker
- Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Harvinder Singh Gill
- Department of Chemical Engineering, Texas Tech University, Lubbock, TX 79409, USA
| | - Jessica J O'Konek
- Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI 48109, USA
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290
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Lang A, Balmert LC, Weiss M, Pongracic JA, Singh AM. Real world use of peanut component testing among children in the Chicago metropolitan area. Allergy Asthma Proc 2022; 43:226-233. [PMID: 35524355 DOI: 10.2500/aap.2022.43.220021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Peanut component tests (PCT) have become important in the evaluation of peanut allergy. There remains a paucity of research across the United States in investigating the utility of PCT in clinical practice in conjunction with current standards of care. Objective: The primary aims were to evaluate the performance and sensitization patterns of PCT in clinical practice when first available at our institution. Methods: We performed a retrospective chart review of 184 children with PCT and oral food challenge (OFC) results between 2012 and 2017. Simple logistic regression models assessed the associations between PCT and OFC outcomes. Receiver operator characteristic curves were constructed, and a predicted probability curve was derived for Ara h2. Results: The median (interquartile range [IQR]) age at OFC was 4 years (2-7 years), and 111 patients (60%) were boys. Ara h 2 was the most commonly sensitized PCT. Sixty-one patients (33%) reacted at OFC. Ara h 2 specific immunoglobulin E (sIgE) ≥ 0.35 kUA/L was associated with increased odds of reacting at OFC (odds ratio 5.91 95% confidence interval, 2.93-11.89; p < 0.001); however, 19 patients (37%) positive for Ara h 2 did not react. Ara h 2 sIgE of 0.49 kUA/L and 4.58 kUA/L were associated with 50% and 90% probability, respectively, of reacting at OFC. Among those sensitized only to Ara h 8 or 9 (n = 21), 86% had no reaction. There was no statistically significant association with polysensitization to Ara h 1, 2, and 3, and peanut OFC outcome. Conclusion: Although the Ara h 2 sIgE value was associated with clinical reactivity, a significant proportion of the patients sensitized to Ara h 2 tolerated peanut. OFC remains an important tool in the evaluation of peanut allergy.
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Affiliation(s)
- Abigail Lang
- From the Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lauren C Balmert
- Division of Biostatistics, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Mitchell Weiss
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jacqueline A Pongracic
- From the Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anne Marie Singh
- From the Division of Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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291
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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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292
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Spolidoro GCI, Azzolino D, Cesari M, Agostoni C. Diet Diversity Through the Life-Course as an Opportunity Toward Food Allergy Prevention. FRONTIERS IN ALLERGY 2022; 2:711945. [PMID: 35386992 PMCID: PMC8974677 DOI: 10.3389/falgy.2021.711945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
The prevalence of food allergies (FA) is increasing worldwide. Generally, the onset of allergies, including FA, begins in early childhood and may persist and/or develop through the life-course. Even though epidemiological studies have focused mainly on children, allergies can also occur for the first-time during adulthood. Within the prolongation of life, it is expected that allergies will be encountered more often even in older people. Recent findings suggest that an early exposure to diverse food antigens may promote the development of immune tolerance. Accordingly, diet diversity during the first year of life or even earlier may have a positive impact on the prevention of allergies. The anti-inflammatory properties of some dietary nutrients may positively contribute to a tolerogenic immune environment too. Diet diversity is associated with a more favorable microbiome, and increasing evidence suggests a promising role of gut microbiota manipulation in inducing immune tolerance. Unjustified avoidance of allergenic foods may expose to intakes of some nutrients below recommended levels through the life-course, even more in cases of self-diagnosis and treatment of presumed forms of food intolerance. Nutritional strategies including the early exposure to a variety of food antigens are a promising area of research for preventive purposes through the life-course possibly extending positive outcomes to older stages. The aim of this paper is to highlight the role of diet diversity in preventing the development of FA starting in early life, as well as to provide an overview of the main strategies to prevent related nutritional issues throughout the life-course.
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Affiliation(s)
- Giulia C I Spolidoro
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Domenico Azzolino
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Matteo Cesari
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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293
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Is oral food challenge useful to avoid complete elimination in Japanese patients diagnosed with or suspected of having IgE-dependent hen's egg allergy? A systematic review. Allergol Int 2022; 71:221-229. [PMID: 34663557 DOI: 10.1016/j.alit.2021.09.005] [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: 05/07/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND IgE-mediated egg allergy is a common food allergy worldwide. Patients with egg allergy are known to easily achieve tolerance compared to other allergens such as nuts. Oral food challenge (OFC) is often performed on patients diagnosed with or suspected of having IgE-mediated food allergy, but whether hen's egg OFC is useful in IgE-dependent egg allergy patients to avoid complete elimination remains unknown. METHODS We identified articles in which OFCs were performed in Japanese patients diagnosed with or suspected of having IgE-mediated egg allergy. We evaluated whether the OFCs were useful to avoid the complete elimination of eggs by assessing the following: (1) the number of patients who could avoid complete elimination; (2) the number of patients who experienced serious adverse events (SAEs); or (3) adverse events (AEs); (4) improvement in quality of life (QOL); and (5) immunological changes. RESULTS Fifty-nine articles were selected in the study; all the references were case series or case studies in which OFC was compared to pre-challenge conditions. The overall negative ratio against egg OFC was 62.7%, but an additional 71.9% of OFC-positive patients could take eggs when expanded to partial elimination. Of the 4182 cases, 1146 showed AEs in the OFC, and two cases reached an SAE. Two reports showed an improvement in QOL and immunological changes, although the evidence was weak. CONCLUSIONS OFCs against eggs may be useful to avoid complete elimination, but medical professionals should proceed with the test safely and carefully.
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294
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The US population-level burden of cow's milk allergy. World Allergy Organ J 2022; 15:100644. [PMID: 35539895 PMCID: PMC9046619 DOI: 10.1016/j.waojou.2022.100644] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cow's milk is a food allergen of public health importance both in the United States and globally. Its natural history and epidemiology have been most studied among infants and young children, but the public health burden it places on adults and older pediatric populations remains unclear. This study comprehensively characterizes the US population-level burden of cow's milk allergy (CMA), including its prevalence, severity, health care utilization, psychosocial impact, natural history, and other associated factors-including ability to tolerate extensively heated milk products-within a large, nationally-representative survey sample of US households. Methods A cross-sectional survey was administered via web and telephone. Population level inference was based on data collected from participants recruited from National Opinion Research Center (NORC) at the University of Chicago's probability-based AmeriSpeak panel. Established dual-sample complex survey calibration methods were used to augment this sample with additional participants recruited through Survey Sampling International to increase the precision of the resulting estimates. In total, surveys were administered to a nationally representative sample of 51 819 US households from October 1, 2015, through September 31, 2016. Self-report responses from 40 453 adults and parent-proxy report for 38 408 children were analyzed. Results Analyzing survey responses from 78 851 individuals, an estimated 4.7% (95% CI, 4.4%-4.9%) of the US population reported current CMA, whereas 1.9% (95% CI, 1.8%-2.1%) met symptom-report criteria for convincing IgE-mediated allergy. An estimated 0.9% (95% CI, 0.8%-1.0%) had CMA that met convincing symptom-report criteria and was physician diagnosed. Female and White respondents were more likely to report outgrowing CMA relative to males and those reporting other races and ethnicities. Individuals with CMA who reported tolerance to baked milk products were less likely to report severe reaction histories (33.5% vs 42.7%; p = .03), a lifetime history of food allergy-related emergency department visits (43.4% vs. 55.8%; p = .005), and treating a milk-allergic reaction with epinephrine (10.6 vs. 18.9%; p = .003). These individuals also exhibited less psychosocial burden on the validated Food Allergy Independent Measure (FAIM) than their counterparts with CMA who were allergic to baked forms of milk. Conclusion These data indicate a discrepancy in reported rates of allergy to cow's milk among the US general population ranging from approximately 1 in 20 with reported CMA to fewer than 1 in 50 with physician-confirmed CMA. However, they suggest a substantial population-level burden of CMA, including substantial healthcare utilization, psychosocial burden and nutritional impacts-particularly among the approximately 30% of individuals with CMA who cannot tolerate baked forms of milk.
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295
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Juel-Berg N, Larsen LF, Küchen N, Norgil I, Hansen KS, Poulsen LK. Patterns of Clinical Reactivity in a Danish Cohort of Tree Nut Allergic Children, Adolescents, and Young Adults. FRONTIERS IN ALLERGY 2022; 3:824660. [PMID: 35958942 PMCID: PMC9361471 DOI: 10.3389/falgy.2022.824660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tree nut allergy is associated with severe reactions and poly-sensitization to other nuts and peanuts often occurs. There are regional differences in sensitization profiles that result in differences in clinical presentation. Denmark is located in a birch pollen endemic area, which could influence the allergy patterns due to pollen cross-sensitization. Objective This study aimed to investigate patterns of sensitization and clinical reactivity to tree nuts and peanuts and threshold levels for oral food challenges (OFCs) in a Danish cohort of tree nut allergic children, adolescents, and young adults. Methods Forty tree nut allergic subjects were assessed for clinical reactivity to six nuts, i.e., hazelnut, walnut, pistachio, cashew, almond, and peanut, by OFCs or convincing medical history of an immediate allergic reaction or tolerance. Clinical presentation and allergen-specific immunoglobulin E (sIgE) levels together with eliciting dose and rescue medication in OFCs were furthermore assessed. Results Allergy to two or more tree nuts was observed in most cases. Hazelnut-walnut dual allergy was common but not exclusively observed as concomitant allergies. Allergy to cashew was coincided in all but one of the assessed subjects with pistachio allergy. Half of all assessed subjects were allergic to peanuts. Oral symptoms followed by a skin reaction were the most common symptomatology that lead to OFC cessation and subjects often presented with symptoms from two or more organ systems. OFC threshold levels were within the same range, but cashew was distinguished from other nuts by causing allergic symptoms at the lowest dose. Clinical reactivity and the allergy patterns were to some extent reflected by sIgE levels and by correlations in sIgE between the nuts. Conclusions In this Northern European cohort, subjects with clinically relevant tree nut allergy were generally allergic to two or more tree nuts and close to half of them also to peanuts. There were two distinct and independent allergic phenotypes; the majority of hazelnut allergic subjects were also allergic to walnut, and all but one subject with cashew allergy were dual allergic to pistachio. These findings are consistent with a strong sIgE correlation between hazelnut and walnut and a close to total sIgE correlation between cashew and pistachio.
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Affiliation(s)
- Nanna Juel-Berg
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lau Fabricius Larsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
| | - Niels Küchen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Ida Norgil
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Kirsten Skamstrup Hansen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Lars K. Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- *Correspondence: Lars K. Poulsen
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296
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Abstract
INTRODUCTION As the prevalence of food allergies (FA) increases worldwide, our understanding of its pathophysiology and risk factors is markedly expanding. In the past decades, an increasing number of genes have been linked to FA. Identification of such genes may help in predicting the genetic risk for FA development, age of onset, clinical manifestation, causative allergen(s), and possibly the optimal treatment strategies. Furthermore, identification of these genetic factors can help to understand the complex interactions between genes and the environment in predisposition to FA. AREAS COVERED We outline the recent important progress in determining genetic variants and disease-associated genes in IgE-mediated FA. We focused on the monogenic inborn errors of immunity (IEI) where FA is one of the clinical manifestations, emphasizing the genes and gene variants which were linked to FA with some of the most robust evidence. EXPERT OPINION Genetics play a significant role, either directly or along with environmental factors, in the development of FA. Since FA is a multifactorial disease, it is expected that multiple genes and genetic loci contribute to the risk for its development. Identification of the involved genes should contribute to the area of FA regarding pathogenesis, prediction, recognition, prognosis, prevention, and possibly therapeutic interventions.
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Affiliation(s)
- Yesim Demirdag
- Division of Basic and Clinical Immunology, Department of Medicine University of California, Irvine, CA
| | - Sami Bahna
- Division of Basic and Clinical Immunology, Department of Medicine University of California, Irvine, CA
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297
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Tedner SG, Asarnoj A, Thulin H, Westman M, Konradsen JR, Nilsson C. Food allergy and hypersensitivity reactions in children and adults-A review. J Intern Med 2022; 291:283-302. [PMID: 34875122 DOI: 10.1111/joim.13422] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Adverse reactions after food intake are commonly reported and a cause of concern and anxiety that can lead to a very strict diet. The severity of the reaction can vary depending on the type of food and mechanism, and it is not always easy to disentangle different hypersensitivity diagnoses, which sometimes can exist simultaneously. After a carefully taken medical history, hypersensitivity to food can often be ruled out or suspected. The most common type of allergic reaction is immunoglobulin E (IgE)-mediated food allergy (prevalence 5-10%). Symptoms vary from mild itching, stomach pain, and rash to severe anaphylaxis. The definition of IgE-mediated food allergy is allergic symptoms combined with specific IgE-antibodies, and therefore only IgE-antibodies to suspected allergens should be analyzed. Nowadays, methods of molecular allergology can help with the diagnostic process. The most common allergens are milk and egg in infants, peanut and tree nuts in children, and fish and shellfish in adults. In young children, milk/egg allergy has a good chance to remit, making it important to follow up and reintroduce the food when possible. Other diseases triggered by food are non-IgE-mediated food allergy, for example, eosinophilic esophagitis, celiac disease, food protein-induced enterocolitis syndrome, and hypersensitivity to milk and biogenic amines. Some of the food hypersensitivities dominate in childhood, others are more common in adults. Interesting studies are ongoing regarding the possibilities of treating food hypersensitivity, such as through oral immunotherapy. The purpose of this review was to provide an overview of the most common types of food hypersensitivity reactions.
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Affiliation(s)
- Sandra G Tedner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Asarnoj
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Thulin
- Allergy and Lung Department, Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Marit Westman
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Asthma and Allergy Clinic S:t Göran, Stockholm, Sweden
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Nilsson
- Allergy and Lung Department, Sachs' Children and Youth Hospital, Stockholm, Sweden.,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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298
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Fernandez‐Rivas M, Vereda A, Vickery BP, Sharma V, Nilsson C, Muraro A, Hourihane JO, DunnGalvin A, Toit G, Blumchen K, Beyer K, Smith A, Ryan R, Adelman DC, Jones SM. Open-label follow-on study evaluating the efficacy, safety, and quality of life with extended daily oral immunotherapy in children with peanut allergy. Allergy 2022; 77:991-1003. [PMID: 34320250 PMCID: PMC9293305 DOI: 10.1111/all.15027] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/09/2021] [Indexed: 12/22/2022]
Abstract
Background The benefit of daily administration of Peanut (Arachis hypogaea) Allergen Powder‐dnfp (PTAH)—formerly AR101—has been established in clinical trials, but limited data past the first year of treatment are available. This longitudinal analysis aimed to explore the impact of continued PTAH therapeutic maintenance dosing (300 mg/day) on efficacy, safety/tolerability, and food allergy‐related quality of life. Methods We present a subset analysis of PALISADE‐ARC004 participants (aged 4–17 years) who received 300 mg PTAH daily for a total of ~1.5 (Group A, n = 110) or ~2 years (Group B, n = 32). Safety assessments included monitoring the incidence of adverse events (AEs), accidental exposures to food allergens, and adrenaline use. Efficacy was assessed by double‐blind, placebo‐controlled food challenge (DBPCFC); skin prick testing; peanut‐specific antibody assays; and Food Allergy Quality of Life Questionnaire (FAQLQ) and Food Allergy Independent Measure (FAIM) scores. Results Continued maintenance with PTAH increased participants’ ability to tolerate peanut protein: 48.1% of completers in Group A (n = 50/104) and 80.8% in Group B (n = 21/26) tolerated 2000 mg peanut protein at exit DBPCFC without dose‐limiting symptoms. Immune biomarkers showed a pattern consistent with treatment‐induced desensitization. Among PTAH‐continuing participants, the overall and treatment‐related exposure‐adjusted AE rate decreased throughout the intervention period in both groups. Clinically meaningful improvements in FAQLQ and FAIM scores over time suggest a potential link between increased desensitization as determined by the DBPCFC and improved quality of life. Conclusions These results demonstrate that daily PTAH treatment for peanut allergy beyond 1 year leads to an improved safety/tolerability profile and continued clinical and immunological response.
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Affiliation(s)
| | | | | | - Vibha Sharma
- Department of Paediatric Allergy and Immunology Royal Manchester Children's Hospital Manchester UK
| | - Caroline Nilsson
- Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sachs’ Children and Youth Hospital Stockholm Sweden
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region Department of Woman and Child Health Padua University Hospital Padua Italy
| | - Jonathan O'B. Hourihane
- Paediatrics and Child Health Royal College of Surgeons in Ireland Dublin Ireland
- Infant Centre and Pediatrics and Child Health University College Cork, and HRB Clinical Research Facility‐Cork Cork Ireland
| | - Audrey DunnGalvin
- Infant Centre and Pediatrics and Child Health University College Cork, and HRB Clinical Research Facility‐Cork Cork Ireland
- Department of Pediatrics and Pediatric Infectious Diseases Sechenov University Moscow Russia
| | - George Toit
- Guy's and St. Thomas’ NHS Foundation Trust London UK
| | - Katharina Blumchen
- Division of Allergology, Pneumology and Cystic Fibrosis Department of Children and Adolescent Medicine Goethe University Frankfurt Frankfurt Germany
| | - Kirsten Beyer
- Division of Pulmonology, Immunology and Critical Care Medicine Department of Pediatrics Charité Universtãtsmedizin Berlin Berlin Germany
| | - Alex Smith
- Aimmune Therapeutics Brisbane California USA
| | | | - Daniel C. Adelman
- Aimmune Therapeutics Brisbane California USA
- Department of Medicine University of California San Francisco San Francisco California USA
| | - Stacie M. Jones
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital Little Rock Arkansas USA
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299
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Trends in Food Allergy Research, Regulations and Patient Care. NUTRITION TODAY 2022; 57:64-69. [PMID: 35369380 PMCID: PMC8946589 DOI: 10.1097/nt.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review provides an overview of food allergies, their impact on affected individuals and caregivers, regulatory activities, and current research efforts to improve allergen management and patient care. Food allergies have been reported to affect up to 32 million Americans, including approximately 6 million children. The Centers for Disease Control and Prevention reported that food allergies in children have clearly increased by 50% between 1997 and 2011. Recent years have seen significant advances in the understanding of responses to food allergens such as the development of response thresholds that hold promise for developing more informative labels on food packaging. Staying current on advances in food allergy research will allow healthcare and nutrition practitioners to provide evidence-based guidance to individuals they serve.
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300
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Amnuaycheewa P, Niemann L, Goodman RE, Baumert JL, Taylor SL. Challenges in Gluten Analysis: A Comparison of Four Commercial Sandwich ELISA Kits. Foods 2022; 11:706. [PMID: 35267339 PMCID: PMC8909647 DOI: 10.3390/foods11050706] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023] Open
Abstract
Gluten is composed of prolamin and glutelin proteins from several related grains. Because these proteins are not present in identical ratios in the various grains and because they have some differences in sequence, the ability to accurately quantify the overall amount of gluten in various food matrices to support gluten-free labeling is difficult. Four sandwich ELISAs (the R-Biopharm AG R5 RIDASCREEN®, the Neogen Veratox® R5, the Romer Labs AgraQuant® G12, and the Morinaga Wheat kits) were evaluated for their performance to quantify gluten concentrations in various foods and ingredients. The Morinaga and AgraQuant® G12 tests yielded results comparable to the two R5 kits for most, but not for certain, foods. The results obtained with the Morinaga kit were lower when compared to the other kits for analyzing powders of buckwheat and several grass-based products. All four kits were capable of detecting multiple gluten-containing grain sources including wheat, rye, barley, semolina, triticale, spelt, emmer, einkorn, Kamut™, and club wheat. Users of the ELISA kits should verify the performance in their hands, with matrices that are typical for their specific uses. The variation in results for some food matrices between test methods could result in trade disputes or regulatory disagreements.
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Affiliation(s)
- Plaimein Amnuaycheewa
- Department of Agro-Industrial, Food, and Environmental Technology, King Mongkut’s University of Technology North Bangkok (KMUTNB), Bangkok 10800, Thailand;
| | - Lynn Niemann
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
| | - Richard E. Goodman
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
| | - Joseph L. Baumert
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
| | - Steve L. Taylor
- Food Allergy Research and Resource Program (FARRP), Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68588-6207, USA; (L.N.); (R.E.G.); (J.L.B.)
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