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Izadi N, Rabinovitch N. Food-dependent exercise-induced anaphylaxis to soybean. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:303-304. [PMID: 29802905 DOI: 10.1016/j.jaip.2018.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/10/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Neema Izadi
- Division of Pediatric Allergy & Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colo.
| | - Nathan Rabinovitch
- Division of Pediatric Allergy & Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colo
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Abstract
OBJECTIVES The purpose of the present randomized controlled clinical trial was to compare the use of donkey milk-derived fortifier (DF) with commercial bovine milk-derived fortifier (BF) in very preterm or very-low-birth-weight newborns, in terms of feeding tolerance. METHODS This trial included 156 newborns born at <32 weeks of gestational age and/or with a birth weight ≤1500 g. Newborns were randomized 1:1 to receive enteral feeding with either a BF-arm, or a new, DF-arm for 21 days. The fortification protocol was the same for both study arms, and the 2 diets were designed to be isoproteic and isocaloric. Feeding tolerance was assessed by a standardized protocol. RESULTS The risk of feeding intolerance tended to be lower in DF-arm than in BF-arm, with a relative risk reduction of 0.63 (95% confidence interval: -0.29, +0.90). The mean number of episodes per newborn of feeding intolerance and feeding interruptions (any duration) were consistently lower in the DF-arm than in the BF-arm. Episodes of bilious gastric residuals and vomiting were significantly lower in the DF-arm. Time needed to reach full enteral feeding (150 mL · kg · day) and daily weight increase between the first day of exclusive enteral feeding (ie, without administering intravenous fluids) and discharge were similar in the BF- and DF-arms. CONCLUSIONS These results suggest that DF improve feeding tolerance when compared with standard bovine-derived fortifiers, with a similar auxological outcome.
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303
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Arasi S, Porcaro F, Cutrera R, Fiocchi AG. Severe Asthma and Allergy: A Pediatric Perspective. Front Pediatr 2019; 7:28. [PMID: 30805326 PMCID: PMC6378301 DOI: 10.3389/fped.2019.00028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
Abstract
Severe asthma in children is associated with significant morbidity and lung function decline. It represents a highly heterogeneous disorder with multiple clinical phenotypes. As its management is demanding, the social and economic burden are impressive. Several co-morbidities may contribute to worsen asthma control and complicate diagnostic and therapeutic management of severe asthmatic patients. Allergen sensitization and/or allergy symptoms may predict asthma onset and severity. A better framing of "allergen sensitization" and understanding of mechanisms underlying progression of atopic march could improve the management and the long-term outcomes of pediatric severe asthma. This review focuses on the current knowledge about interactions between severe asthma and allergies.
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Affiliation(s)
- Stefania Arasi
- Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
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304
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Nowak-Wegrzyn A, Greenhawt M. The importance of food allergy to the practicing clinician. Ann Allergy Asthma Immunol 2018; 120:227-228. [PMID: 29391200 DOI: 10.1016/j.anai.2018.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colorado
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305
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Li PH, Rutkowski K, Kennard L, Sellaturay P, Watts TJ, Haque R, Wagner A. Challenge-confirmed peanut allergy in older patients: Performance of skin tests, specific immunoglobulin E, and ara h 2. Ann Allergy Asthma Immunol 2018; 120:334-335. [PMID: 29508723 DOI: 10.1016/j.anai.2017.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/15/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Philip H Li
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Krzysztof Rutkowski
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Lucinda Kennard
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Priya Sellaturay
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Timothy J Watts
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rubaiyat Haque
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Annette Wagner
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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306
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Clark S, Boggs KM, Balekian DS, Hasegawa K, Vo P, Rowe BH, Camargo CA. Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis: 1999-2001 vs 2013-2015. Ann Allergy Asthma Immunol 2018; 120:419-423. [PMID: 29407420 DOI: 10.1016/j.anai.2018.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known. OBJECTIVE To describe temporal changes in ED concordance with guidelines for the management of SIIAs. METHODS We analyzed data from 2 multicenter retrospective studies of patients with stinging insect-related acute allergic reactions seen in 1 of 14 North American EDs during 2 periods: 1999 through 2001 and 2013 through 2015. Visits were identified similarly across studies (eg, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 989.5, 995.0, and 995.3). Anaphylaxis was defined as an acute allergic reaction with involvement of at least 2 organ systems or hypotension. We compared concordance between periods with 4 guideline recommendations: (1) treatment with epinephrine, (2) discharge prescription for epinephrine auto-injector, (3) referral to an allergist/immunologist, and (4) instructions to avoid the offending allergen. RESULTS We compared 182 patients with SIIA during 1999 to 2001 with 204 during 2013 to 2015. Any treatment with epinephrine (before arrival to the ED or in the ED) increased over time (30% vs 49%; P < .001). Prescriptions for epinephrine auto-injector at discharge increased significantly (34% vs 57%; P < .001), whereas documentation of referral to an allergist/immunologist decreased (28% vs 12%; P = .002), and instructions to avoid the offending allergen did not change (23% vs 24%; P = .94). Receipt of at least 3 guideline recommendations increased over time; however, the comparison was not statistically significant (10% vs 16%; P = .15). CONCLUSION During the nearly 15-year study interval, we observed increased ED concordance with epinephrine-related guideline recommendations for the management of SIIA. Reasons for the decrease in allergy/immunology referrals merit further study.
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Affiliation(s)
- Sunday Clark
- NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
| | | | - Diana S Balekian
- Massachusetts General Hospital, Boston, Massachusetts; Asthma and Allergy Affiliates, Salem, Massachusetts
| | | | - Phuong Vo
- Boston Medical Center, Boston, Massachusetts
| | - Brian H Rowe
- Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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307
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Leung ASY, Leung NYH, Wai CYY, Leung TF, Wong GWK. Allergen immunotherapy for food allergy from the Asian perspective: key challenges and opportunities. Expert Rev Clin Immunol 2018; 15:153-164. [PMID: 30488732 DOI: 10.1080/1744666x.2019.1554432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Prevalence of food allergy is rising in different regions of the world. Asia has not been spared from this epidemic, but epidemiological data have revealed a different pattern of food allergens in this continent. Allergen-specific immunotherapy (AIT) for food allergy, which has been revolutionary as the main focus of research in recent years, needs to be adapted for the different populations in Asia. Areas covered: Recent evidence shows increasing popularity and superiority of AIT over strict food avoidance as the cornerstone of food allergy management. Asia is a distinctive continent with specific food allergy triggers, in particular, seafood, and wheat. Peanut, on the contrary, is not a common food allergen in most parts of Asia. The common Asian food allergens, as well as the rapidly developing food-specific AIT in this region will be covered in this article. Expert commentary: Evidence on oral immunotherapy for wheat allergy and preclinical data on shellfish AIT are promising. Further work should be done on resolving cross-sensitization between environmental allergens with wheat and shellfish allergens, and a modified AIT approach to enhance the safety and effectiveness of food-specific immunotherapy.
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Affiliation(s)
- Agnes Sze Yin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Nicki Yat Hin Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Christine Yee Yan Wai
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Ting Fan Leung
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
| | - Gary Wing Kin Wong
- a Department of Paediatrics , The Chinese University of Hong Kong, Prince of Wales Hospital Shatin , New Territories , Hong Kong
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308
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Li J, Li S, Huang L, Cui Y, She T, Bian Y, Li H. A light-initiated chemiluminescent assay for rapid quantitation of allergen-specific IgG 4 in clinical samples. Clin Chim Acta 2018; 489:83-88. [PMID: 30517849 DOI: 10.1016/j.cca.2018.11.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/06/2018] [Accepted: 11/30/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND An increase in allergen-specific IgG4 (sIgG4), which serves as a blocking antibody, is associated with acquisition of immune tolerance after immunotherapy. In this study, we developed a rapid, sensitive, and homogeneous immunoassay based on the light-initiated chemiluminescent assay (LICA) technology for quantifying allergen sIgG4 in serum samples. METHODS Allergen sIgG4 was measured in vitro by incubating the sample with biotinylated allergens and chemiluminescent beads coated with anti-human IgG4 antibody, followed by the addition of streptavidin-coated sensitizer beads. Multiple tests were performed to optimize the working conditions of the LICA and evaluate its performance. RESULTS We established the optimal concentration of biotinylated allergens (250 ng/mL), the optimal dilution range (1:8 for Gal d 1, Gal d 2 sIgG4 and 1:4 for Gal d 3, Gal d 4 sIgG4), and the optimal incubation time (20 min for Gal d 1, Gal d 2 sIgG4 and 40 min for Gal d 3, Gal d 4 sIgG4). The lower limit of quantification (LLOQ) was 0.261 ng/mL. The coefficient variation (CV) of the LICA was <10%. The assay was unaffected by general interfering substances at physiological concentrations. It exhibited excellent accuracy to detect allergen-sIgG4 in human serum. Additionally, we demonstrated that the levels of Gal d 1, Gal d 2, and Gal d 3-sIgG4 were significantly higher in the egg allergy group (p < .05), but no differences were found between the groups for Gal d 4-sIgG4. CONCLUSIONS The LICA demonstrated satisfactory performance and can be used for quantifying allergen sIgG4 in clinical practice.
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Affiliation(s)
- Junpu Li
- School of Medical Laboratory, Tianjin Medical University, 1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Shaoshen Li
- Academy of Traditional Chinese Medicine Affiliated Hospital, 354 Beima Road, Hongqiao District,Tianjin, China
| | - Lunhui Huang
- School of Medical Laboratory, Tianjin Medical University, 1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Yaqiong Cui
- School of Medical Laboratory, Tianjin Medical University, 1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Tiantian She
- School of Medical Laboratory, Tianjin Medical University, 1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Ying Bian
- School of Medical Laboratory, Tianjin Medical University, 1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Huiqiang Li
- School of Medical Laboratory, Tianjin Medical University, 1 Guangdong Road, Hexi District, Tianjin 300203, China.
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309
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Efron A, Zeldin Y, Gotesdyner L, Stauber T, Maoz Segal R, Binson I, Dinkin M, Dinkowitz L, Shahar D, Deutch M, Yaron M, Nevet A, Reshef A, Agmon-Levin N, Kenett RS, Kidon MI. A Structured Gradual Exposure Protocol to Baked and Heated Milk in the Treatment of Milk Allergy. J Pediatr 2018; 203:204-209.e2. [PMID: 30270168 DOI: 10.1016/j.jpeds.2018.07.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/17/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a structured gradual exposure protocol (SGEP) with extensively heated and baked milk in promoting allergy resolution in children with cow milk allergy (CMA). STUDY DESIGN In a case control study, children with CMA aged 1-4 years who were treated with SGEP including extensively heated and baked milk, were compared with children treated with strict avoidance. Data were collected from medical records and from validated telephone questionnaires. Data analysis was performed using a nonparametric Kaplan-Meier and proportional hazard Cox regression model, after evaluation of the adequacy of the case control matching. RESULTS There were 43 children with milk allergy-26 (62%) males with a mean age at intervention of 21 months (range, 12-47 months)-who were treated with SGEP and followed to a mean age of 40 months (range, 20-82 months). The median age at resolution of CMA was compared with a matched group of 67 children treated with strict avoidance at least until 4 years of age or followed until earlier resolution, with a mean age at follow-up of 71 months (range, 11-176 months). The median estimated age at CMA resolution in the SGEP group was 36 months (95% CI, 34.5-49.7) compared with 98 months (95% CI, 82.4-114.1) in controls (P < .001). At last follow-up, 86% of treated children were tolerant to unheated milk proteins vs 52% of controls (P = .003). CONCLUSION A structured protocol with extensively heated and baked milk seems to promote faster resolution of CMA.
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Affiliation(s)
- Adi Efron
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yuri Zeldin
- Clinical Allergy and Immunology, "Goldman" School of Medicine, Ben Gurion University, Beer Sheva, Israel; Clalit Health Services, Tel Aviv, Israel
| | - Leora Gotesdyner
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Stauber
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Ramit Maoz Segal
- Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Danit Shahar
- Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Michal Deutch
- Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Avner Reshef
- Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Nancy Agmon-Levin
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Ron S Kenett
- KPA Group and Institute for Drug Research, School of Pharmacy, Hebrew University, Jerusalem, Israel
| | - Mona I Kidon
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Clalit Health Services, Tel Aviv, Israel; Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
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310
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Gupta RS, Warren CM, Smith BM, Blumenstock JA, Jiang J, Davis MM, Nadeau KC. The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics 2018; 142:e20181235. [PMID: 30455345 PMCID: PMC6317772 DOI: 10.1542/peds.2018-1235] [Citation(s) in RCA: 450] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 12/12/2022] Open
Abstract
: media-1vid110.1542/5840360268001PEDS-VA_2018-1235Video Abstract BACKGROUND: Childhood food allergy (FA) is a life-threatening chronic condition that substantially impairs quality of life. This large, population-based survey estimates childhood FA prevalence and severity of all major allergenic foods. Detailed allergen-specific information was also collected regarding FA management and health care use. METHODS A survey was administered to US households between 2015 and 2016, obtaining parent-proxy responses for 38 408 children. Prevalence estimates were based on responses from NORC at the University of Chicago's nationally representative, probability-based AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models were used to evaluate FA predictors. RESULTS Overall, estimated current FA prevalence was 7.6% (95% confidence interval: 7.1%-8.1%) after excluding 4% of children whose parent-reported FA reaction history was inconsistent with immunoglobulin E-mediated FA. The most prevalent allergens were peanut (2.2%), milk (1.9%), shellfish (1.3%), and tree nut (1.2%). Among food-allergic children, 42.3% reported ≥1 severe FA and 39.9% reported multiple FA. Furthermore, 19.0% reported ≥1 FA-related emergency department visit in the previous year and 42.0% reported ≥1 lifetime FA-related emergency department visit, whereas 40.7% had a current epinephrine autoinjector prescription. Prevalence rates were higher among African American children and children with atopic comorbidities. CONCLUSIONS FA is a major public health concern, affecting ∼8% of US children. However, >11% of children were perceived as food-allergic, suggesting that the perceived disease burden may be greater than previously acknowledged.
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Affiliation(s)
- Ruchi S Gupta
- Departments of Pediatrics,
- Medicine, and
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Christopher M Warren
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Bridget M Smith
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Center for Innovation for Complex Chronic Healthcare, Edward J. Hines Jr Veterans Affairs Hospital, Hines, Illinois; and
| | - Jesse A Blumenstock
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jialing Jiang
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew M Davis
- Departments of Pediatrics
- Medicine, and
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Mary Ann & J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
- Medical Social Sciences and Preventive Medicine, and
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of Medicine, Stanford, California
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311
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Sindher S, Long AJ, Purington N, Chollet M, Slatkin S, Andorf S, Tupa D, Kumar D, Woch MA, O'Laughlin KL, Assaad A, Pongracic J, Spergel JM, Tam J, Tilles S, Wang J, Galli SJ, Nadeau KC, Chinthrajah RS. Analysis of a Large Standardized Food Challenge Data Set to Determine Predictors of Positive Outcome Across Multiple Allergens. Front Immunol 2018; 9:2689. [PMID: 30538699 PMCID: PMC6277531 DOI: 10.3389/fimmu.2018.02689] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Double-blind placebo-controlled food challenges (DBPCFCs) remain the gold standard for the diagnosis of food allergy; however, challenges require significant time and resources and place the patient at an increased risk for severe allergic adverse events. There have been continued efforts to identify alternative diagnostic methods to replace or minimize the need for oral food challenges (OFCs) in the diagnosis of food allergy. Methods: Data was extracted for all IRB-approved, Stanford-initiated clinical protocols involving standardized screening OFCs to a cumulative dose of 500 mg protein to any of 11 food allergens in participants with elevated skin prick test (SPT) and/or specific IgE (sIgE) values to the challenged food across 7 sites. Baseline population characteristics, biomarkers, and challenge outcomes were analyzed to develop diagnostic criteria predictive of positive OFCs across multiple allergens in our multi-allergic cohorts. Results: A total of 1247 OFCs completed by 427 participants were analyzed in this cohort. Eighty-five percent of all OFCs had positive challenges. A history of atopic dermatitis and multiple food allergies were significantly associated with a higher risk of positive OFCs. The majority of food-specific SPT, sIgE, and sIgE/total IgE (tIgE) thresholds calculated from cumulative tolerated dose (CTD)-dependent receiver operator curves (ROC) had high discrimination of OFC outcome (area under the curves > 0.75). Participants with values above the thresholds were more likely to have positive challenges. Conclusions: This is the first study, to our knowledge, to not only adjust for tolerated allergen dose in predicting OFC outcome, but to also use this method to establish biomarker thresholds. The presented findings suggest that readily obtainable biomarker values and patient demographics may be of use in the prediction of OFC outcome and food allergy. In the subset of patients with SPT or sIgE values above the thresholds, values appear highly predictive of a positive OFC and true food allergy. While these values are relatively high, they may serve as an appropriate substitute for food challenges in clinical and research settings.
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Affiliation(s)
- Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew J Long
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States
| | - Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Madeleine Chollet
- Department of Medicine, School of Medicine, Stanford, CA, United States
| | - Sara Slatkin
- Department of Medicine, School of Medicine, Stanford, CA, United States
| | - Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Dana Tupa
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Divya Kumar
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Margaret A Woch
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Katherine L O'Laughlin
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Amal Assaad
- Division of Allergy and Immunology, Cincinnati Children's Medical Center, Cincinnati, OH, United States
| | - Jacqueline Pongracic
- Division of Allergy and Immunology, The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Tam
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Stephen Tilles
- ASTHMA Inc. Clinical Research Center, Northwest Asthma and Allergy Center, University of Washington, Seattle, WA, United States
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
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312
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Vickery BP, Vereda A, Casale TB, Beyer K, du Toit G, Hourihane JO, Jones SM, Shreffler WG, Marcantonio A, Zawadzki R, Sher L, Carr WW, Fineman S, Greos L, Rachid R, Ibáñez MD, Tilles S, Assa’ad AH, Nilsson C, Rupp N, Welch MJ, Sussman G, Chinthrajah S, Blumchen K, Sher E, Spergel JM, Leickly FE, Zielen S, Wang J, Sanders GM, Wood RA, Cheema A, Bindslev-Jensen C, Leonard S, Kachru R, Johnston DT, Hampel FC, Kim EH, Anagnostou A, Pongracic JA, Ben-Shoshan M, Sharma HP, Stillerman A, Windom HH, Yang WH, Muraro A, Zubeldia JM, Sharma V, Dorsey MJ, Chong HJ, Ohayon J, Bird JA, Carr TF, Siri D, Fernández-Rivas M, Jeong DK, Fleischer DM, Lieberman JA, Dubois AEJ, Tsoumani M, Ciaccio CE, Portnoy JM, Mansfield LE, Fritz SB, Lanser BJ, Matz J, Oude Elberink HNG, Varshney P, Dilly SG, Adelman DC, Burks AW. AR101 Oral Immunotherapy for Peanut Allergy. N Engl J Med 2018; 379:1991-2001. [PMID: 30449234 DOI: 10.1056/nejmoa1812856] [Citation(s) in RCA: 460] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peanut allergy, for which there are no approved treatment options, affects patients who are at risk for unpredictable and occasionally life-threatening allergic reactions. METHODS In a phase 3 trial, we screened participants 4 to 55 years of age with peanut allergy for allergic dose-limiting symptoms at a challenge dose of 100 mg or less of peanut protein (approximately one third of a peanut kernel) in a double-blind, placebo-controlled food challenge. Participants with an allergic response were randomly assigned, in a 3:1 ratio, to receive AR101 (a peanut-derived investigational biologic oral immunotherapy drug) or placebo in an escalating-dose program. Participants who completed the regimen (i.e., received 300 mg per day of the maintenance regimen for approximately 24 weeks) underwent a double-blind, placebo-controlled food challenge at trial exit. The primary efficacy end point was the proportion of participants 4 to 17 years of age who could ingest a challenge dose of 600 mg or more, without dose-limiting symptoms. RESULTS Of the 551 participants who received AR101 or placebo, 496 were 4 to 17 years of age; of these, 250 of 372 participants (67.2%) who received active treatment, as compared with 5 of 124 participants (4.0%) who received placebo, were able to ingest a dose of 600 mg or more of peanut protein, without dose-limiting symptoms, at the exit food challenge (difference, 63.2 percentage points; 95% confidence interval, 53.0 to 73.3; P<0.001). During the exit food challenge, the maximum severity of symptoms was moderate in 25% of the participants in the active-drug group and 59% of those in the placebo group and severe in 5% and 11%, respectively. Adverse events during the intervention period affected more than 95% of the participants 4 to 17 years of age. A total of 34.7% of the participants in the active-drug group had mild events, as compared with 50.0% of those in the placebo group; 59.7% and 44.4% of the participants, respectively, had events that were graded as moderate, and 4.3% and 0.8%, respectively, had events that were graded as severe. Efficacy was not shown in the participants 18 years of age or older. CONCLUSIONS In this phase 3 trial of oral immunotherapy in children and adolescents who were highly allergic to peanut, treatment with AR101 resulted in higher doses of peanut protein that could be ingested without dose-limiting symptoms and in lower symptom severity during peanut exposure at the exit food challenge than placebo. (Funded by Aimmune Therapeutics; PALISADE ClinicalTrials.gov number, NCT02635776 .).
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313
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The Health and Economic Outcomes of Peanut Allergy Management Practices. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:2073-2080. [DOI: 10.1016/j.jaip.2018.04.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/16/2018] [Accepted: 04/21/2018] [Indexed: 11/17/2022]
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314
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Miceli Sopo S, Bersani G, Fantacci C, Romano A, Monaco S. Diagnostic criteria for acute food protein-induced enterocolitis syndrome. Is the work in progress? Allergol Immunopathol (Madr) 2018; 46:607-611. [PMID: 29456036 DOI: 10.1016/j.aller.2017.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 11/15/2022]
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES.
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Affiliation(s)
- S Miceli Sopo
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy.
| | - G Bersani
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - C Fantacci
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - A Romano
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - S Monaco
- Allergy Unit, Department of Paediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
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315
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Nowak-Węgrzyn A, Wood RA, Nadeau KC, Pongracic JA, Henning AK, Lindblad RW, Beyer K, Sampson HA. Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy. J Allergy Clin Immunol 2018; 143:651-661.e9. [PMID: 30389226 DOI: 10.1016/j.jaci.2018.08.041] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Wheat is a common food allergen that can cause anaphylaxis. OBJECTIVE We sought to determine the efficacy and safety of vital wheat gluten (VWG) oral immunotherapy (OIT). METHODS After baseline double-blind, placebo-controlled food challenge (DBPCFC), 46 patients with wheat allergy (median age, 8.7 years; range, 4.2-22.3 years) were randomized 1:1 to low-dose VWG OIT or placebo, with biweekly escalation to 1445 mg of wheat protein (WP). After a year 1 DBPCFC, active subjects continued low-dose VWG OIT for another year and underwent a year 2 DBPCFC and, if passed, a subsequent off-therapy DBPCFC. Placebo-treated subjects crossed over to high-dose VWG OIT (maximum, 2748 mg of WP). RESULTS The median baseline successfully consumed dose (SCD) was 43 mg of WP in both groups. At year 1, 12 (52.2%) of 23 low-dose VWG OIT-treated and 0 (0%) of 23 placebo-treated subjects achieved the primary end point of an SCD of 4443 mg of WP or greater (P < .0001); median SCDs were 4443 and 143 mg, respectively. At year 2, 7 (30.4%) of 23 low-dose VWG OIT-treated subjects were desensitized to an SCD of 7443 mg of WP; 3 (13%) achieved sustained unresponsiveness 8 to 10 weeks off therapy. Among placebo-treated subjects who crossed over to high-dose VWG OIT, 12 (57.1%) of 21 were desensitized after 1 year (median SCD, 7443 mg of WP; nonsignificant vs low-dose VWG OIT). At year 1, skin prick test responses and wheat- and omega-5 gliadin-specific IgE levels did not differ between groups; the low-dose VWG OIT median specific IgG4 level was greater than placebo (wheat, P = .0005; omega-5 gliadin, P = .0001). Year 1 SCDs correlated with wheat-specific (rho = 0.55, P = .0003) and omega-5 gliadin-specific (rho = 0.51, P = .001) IgG4 levels in all subjects. Among 7822 low-dose VWG OIT doses in year 1, 15.4% were associated with adverse reactions: 0.04% were severe, and 0.08% subjects received epinephrine. Among 7921 placebo doses, 5.8% were associated with adverse reactions; none were severe. CONCLUSIONS Low- and high-dose VWG OIT induced desensitization in about one half of the subjects after 1 year of treatment. Two years of low-dose VWG OIT resulted in 30% desensitization, and 13% had sustained unresponsiveness.
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Affiliation(s)
- Anna Nowak-Węgrzyn
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY
| | - Robert A Wood
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kari C Nadeau
- Division of Allergy and Immunology, Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Jacqueline A Pongracic
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | | | - Kirsten Beyer
- Charité Universitätsmedizin Berlin, Department of Pediatric Pneumology and Immunology, Berlin, Germany
| | - Hugh A Sampson
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY.
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316
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Abstract
PURPOSE OF REVIEW This review incorporates findings from studies of oral food challenges (OFC) over the last decade and highlights the latest innovations and understanding of the procedure. RECENT FINDINGS PRACTALL guidelines are widely used in OFC research, but there is still no international consensus on the OFC protocol in clinical practice. Guidelines for performing OFC in clinical practice have been updated to include oral food challenges for infants. There have been advances in predictive models for outcomes and severity of reaction during OFC that take into account multiple clinical data as well as newer laboratory modalities. Low-dose OFC and eliciting threshold dose determination are being examined for additional diagnostic and therapeutic use in the management of food allergy. Quality-of-life considerations have also been reviewed, as well as post-OFC assessment and care. The OFC remains an important diagnostic tool in the management of food allergy and in clinical research. Advances in the field should improve safety and broaden the clinical applications of this essential procedure.
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317
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318
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Abstract
Although eosinophilic esophagitis (EoE) has been described in the literature for a substantial period, its recognition as a disease entity on the global stage is still relatively new. It has become a major diagnosis of consideration by medical providers when both adult and pediatric patients present with dysphagia, food impaction, and gastroesophageal reflux-like symptoms. In addition to the clinical work of specialists such as allergy-immunologists and gastroenterologists, the evolution of research organizations and advocacy groups focused on EoE have greatly assisted in bringing attention to, and raising awareness about, this disease. As a result of their efforts, diagnosis and treatment guidelines have been developed, and medical providers now have a specific ICD code for EoE. This represents a new model for the interaction of patients and medical provider, where patients not only advocate for their disorder, but also drive physician education and a patient-centered research agenda and its funding. It should be noted, though, that these organizations and advocacy groups are mainly located in North America and Europe, and as a result, EoE has largely been associated with the Caucasian demographic. However, it has been described in Asia, the Middle East, Latin America, and Africa. Physicians from these areas have increased awareness and understanding in the medical and research communities in their countries through case reports and the establishment and analysis of potential patient cohorts. At this time, the prevalence of EoE in these regions is comparably lower, but this may be due to less recognition and understanding of EoE, as well as medical efforts being directed towards more ubiquitous disease processes, such as infectious diseases. With the support and ongoing work of researchers, patients, and their family members, understanding and recognition of EoE as a clinically significant disease entity will continue to grow.
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319
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Durrani SR, Mukkada VA, Guilbert TW. Eosinophilic Esophagitis: an Important Comorbid Condition of Asthma? Clin Rev Allergy Immunol 2018; 55:56-64. [PMID: 29455359 DOI: 10.1007/s12016-018-8670-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Eosinophilic esophagitis and asthma are frequently found as comorbid conditions in children and adults along with other manifestations of atopic diathesis. These two conditions have similar T helper 2 responses-driven pathophysiology and share common management strategies such as using systemic corticosteroids and targeted anti-cytokine biologic therapies. Review of the literature finds that asthma is often a comorbid condition in eosinophilic esophagitis in both children and adults; however, the EoE-asthma relationship remains poorly characterized mechanistically and clinically. EoE and asthma commonly share several comorbid conditions such as allergic rhinitis and gastroesophageal reflux disease; therefore, addressing these comorbid conditions has the potential to improve and/or maintain control in both diseases. Similar to asthma, patients with EoE frequently demonstrate elevations in serum markers of atopy, including serum IgE levels, peripheral eosinophil counts, and T helper 2-related cytokines. Gastroesophageal reflux disease is thought to affect asthma through microaspirations, airway hyperresponsiveness, and increased vagal tone. The understanding of the relationship between gastroesophageal reflux and EoE is still evolving but seems to be bidirectional and interactive. In terms of treatment, similar classes of medications have been used in both EoE and asthma. In both children and adults, EoE remission can be achieved by food trigger avoidance and use of corticosteroids and biologic therapies. Asthma control is mostly achieved through inhaled corticosteroids, and long but biologic therapies are increasingly used in severe subsets of the disease. Significant clinical and mechanistic work needs to be accomplished to better understand the relationship between asthma, EoE, and their interaction with other allergic diseases. Understanding whether shared mechanisms exist can lead to the development of new diagnostic and therapeutic strategies. The following review examines the existing literature regarding prevalence, common comorbidities, and potential therapeutic approach and identifies gaps in knowledge and future directions.
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Affiliation(s)
- Sandy R Durrani
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Vincent A Mukkada
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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320
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Dong X, Zhong N, Fang Y, Cai Q, Lu M, Lu Q. MicroRNA 27b-3p Modulates SYK in Pediatric Asthma Induced by Dust Mites. Front Pediatr 2018; 6:301. [PMID: 30406061 PMCID: PMC6204538 DOI: 10.3389/fped.2018.00301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 09/25/2018] [Indexed: 01/09/2023] Open
Abstract
The PI3K-AKT pathway is known to regulate cytokines in dust mite-induced pediatric asthma. However, the underlying molecular steps involved are not clear. In order to clarify further the molecular steps, this study investigated the expression of certain genes and the involvement of miRNAs in the PI3K-AKT pathway, which might affect the resultant cytokine-secretion. in-vivo and in-vitro ELISA, qRT-PCR and microarrays analyses were used in this study. A down-expression of miRNA-27b-3p in dust mite induced asthma group (group D) was found by microarray analysis. This was confirmed by qRT-PCR that found the miRNA-27b-3p transcripts that regulated the expression of SYK and EGFR were also significantly decreased (p < 0.01) in group D. The transcript levels of the SYK and PI3K genes were higher, while those of EGFR were lower in the former group. Meanwhile, we found significant differences in plasma concentrations of some cytokines between the dust mite-induced asthma subjects and the healthy controls. On the other hand, this correlated with the finding that the transcripts of SYK and its downstream PI3K were decreased in HBE transfected with miRNA-27b-3p, but were increased in HBE transfected with the inhibitor in vitro. Our results indicate that the differential expression of the miRNAs in dust mite-induced pediatric asthma may regulate their target gene SYK and may have an impact on the PI3K-AKT pathway associated with the production of cytokines. These findings should add new insight into the pathogenesis of pediatric asthma.
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Affiliation(s)
- Xiaoyan Dong
- Department of Pulmonary, Shanghai Children's Hospital, Shanghai, China
- Shanghai Institute of Medical Genetics, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Nanbert Zhong
- Shanghai Children's Hospital, Shanghai, China
- Department of Human Genetics, Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
- Chinese Alliance of Translational Medicine for Maternal and Children's Health, Beijing, China
- Peking University Center of Medical Genetics, Peking University Health Science Centre, Beijing, China
| | - Yudan Fang
- Shanghai Institute of Medical Genetics, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Qin Cai
- Shanghai Institute of Medical Genetics, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Min Lu
- Department of Pulmonary, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
| | - Quan Lu
- Department of Pulmonary, Shanghai Children's Hospital, Shanghai, China
- Shanghai Children's Hospital, Shanghai, China
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321
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De Jong NW. Epicutaneous immunotherapy: the next step for food allergy desensitization. Expert Rev Clin Immunol 2018; 14:977-978. [PMID: 30295101 DOI: 10.1080/1744666x.2018.1528873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nicolette W De Jong
- a Section Allergology & Clinical Immunology , ErasmusMC, Internal Medicine , CA Rotterdam , the Netherlands
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322
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Dantzer JA, Wood RA. The impact of tree nut oral food challenges on quality of life and acute reactions in nut allergic patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:698-700.e1. [PMID: 30312806 DOI: 10.1016/j.jaip.2018.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Jennifer A Dantzer
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert A Wood
- Division of Allergy & Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
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323
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Lupin: An emerging food allergen in the United States. Ann Allergy Asthma Immunol 2018; 122:8-10. [PMID: 30292799 DOI: 10.1016/j.anai.2018.09.467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/10/2018] [Accepted: 09/28/2018] [Indexed: 01/10/2023]
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324
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Abstract
PURPOSE OF REVIEW To familiarize the reader with the concept of precision medicine in food allergy by dealing with the current biomarkers for the diagnosis, prognosis, and management of the disease. RECENT FINDINGS Many efforts have been devoted in order to characterize reliable biomarkers able to identify specific phenotypes and endotypes in food allergy. Specific IgE (sIgE), sIgE/total IgE ratios, and T cell assays are just a few candidates that have been investigated over time. With the advent of omics sciences, a new era is commencing. A better understanding of pathogenesis of food allergy and mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient. In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the identification of proper biomarkers for a personalized treatment tailored on the specific patient's profile.
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Affiliation(s)
- Antonella Muraro
- Department of Woman and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
| | - Stefania Arasi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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325
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326
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Remes S, Kulmala P. The interplay between risk and preventive factors explains why some children develop allergies to certain foods and others show tolerance. Acta Paediatr 2018; 107:1677-1683. [PMID: 29751365 DOI: 10.1111/apa.14391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/26/2018] [Accepted: 05/03/2018] [Indexed: 01/02/2023]
Abstract
AIM A number of studies have clarified the tolerance mechanisms and risk factors for food allergies. Our aim was to explore food allergy symptoms by target organs, together with the risk factors and how to prevent food allergies and induce tolerance. METHODS We carried out a thorough review of studies on paediatric food allergies published in the last decade. RESULTS Food allergy symptoms may affect the skin, nasal and oral mucosa, conjunctivae, gastrointestinal tract or, in severe cases, the respiratory tract and cardiovascular organs. Immunoglobulin E (IgE)-mediated symptoms appear rapidly after exposure to the offending allergen, whereas non-IgE-mediated symptoms are typically delayed. The immunological processes involved in non-IgE-mediated allergic reactions are poorly understood, but T-cell activation is probably involved. There are several factors that influence the food sensitisation process: genetic predisposition, disruption of oral tolerance development, impaired skin barriers in atopic eczema and the influence of microbiomes. CONCLUSION The symptoms and intensity of reactions vary considerably with regard to food allergies, and these depend on the individual's concomitant immunological and regulatory mechanisms. There is strong evidence that dietary diversity is important for children, even when they come from families with high allergy risks.
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Affiliation(s)
- Sami Remes
- Department of Paediatrics; Kuopio University Hospital; Kuopio Finland
| | - Petri Kulmala
- PEDEGO Research Unit and Medical Research Center (MRC) Oulu; University of Oulu; Oulu University Hospital; Oulu Finland
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327
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Purington N, Chinthrajah RS, Long A, Sindher S, Andorf S, O'Laughlin K, Woch MA, Scheiber A, Assa'ad A, Pongracic J, Spergel JM, Tam J, Tilles S, Wang J, Galli SJ, Desai M, Nadeau KC. Eliciting Dose and Safety Outcomes From a Large Dataset of Standardized Multiple Food Challenges. Front Immunol 2018; 9:2057. [PMID: 30298065 PMCID: PMC6160556 DOI: 10.3389/fimmu.2018.02057] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/21/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Food allergy prevalence has continued to rise over the past decade. While studies have reported threshold doses for multiple foods, large-scale multi-food allergen studies are lacking. Our goal was to identify threshold dose distributions and predictors of severe reactions during blinded oral food challenges (OFCs) in multi-food allergic patients. Methods: A retrospective chart review was performed on all Stanford-initiated clinical protocols involving standardized screening OFCs to any of 11 food allergens at 7 sites. Interval-censoring survival analysis was used to calculate eliciting dose (ED) curves for each food. Changes in severity and ED were also analyzed among participants who had repeated challenges to the same food. Results: Of 428 participants, 410 (96%) had at least one positive challenge (1445 standardized OFCs with 1054 total positive challenges). Participants undergoing peanut challenges had the highest ED50 (29.9 mg), while those challenged with egg or pistachio had the lowest (7.07 or 1.7 mg, respectively). The most common adverse event was skin related (54%), followed by gastrointestinal (GI) events (33%). A history of asthma was associated with a significantly higher risk of a severe reaction (hazard ratio [HR]: 2.37, 95% confidence interval [CI]: 1.36, 4.13). Higher values of allergen-specific IgE (sIgE) and sIgE to total IgE ratio (sIgEr) were also associated with higher risk of a severe reaction (1.49 [1.19, 1.85] and 1.84 [1.30, 2.59], respectively). Participants undergoing cashew, peanut, pecan, sesame, and walnut challenges had more severe reactions as ED increased. In participants who underwent repeat challenges, the ED did not change (p = 0.66), but reactions were more severe (p = 0.02). Conclusions: Participants with a history of asthma, high sIgEr, and/or high values of sIgE were found to be at higher risk for severe reactions during food challenges. These findings may help to optimize food challenge dosing schemes in multi-food allergic, atopic patients, specifically at lower doses where the majority of reactions occur. Trials Registration Number: ClinicalTrials. gov number NCT03539692; https://clinicaltrials.gov/ct2/show/NCT03539692.
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Affiliation(s)
- Natasha Purington
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pharmacy, Lucile Packard Children's Hospital Stanford, CA, United States
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Sandra Andorf
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Katherine O'Laughlin
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Margaret A Woch
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexandra Scheiber
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Medical Center, Cincinnati, OH, United States
| | - Jacqueline Pongracic
- Division of Allergy and Immunology, The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Tam
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Stephen Tilles
- ASTHMA Inc. Clinical Research Center, Northwest Asthma and Allergy Center, University of Washington, Seattle, WA, United States
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Stephen J Galli
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Manisha Desai
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States.,Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, United States
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
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328
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Pham MN, Bunyavanich S. Prenatal Diet and the Development of Childhood Allergic Diseases: Food for Thought. Curr Allergy Asthma Rep 2018; 18:58. [PMID: 30229317 DOI: 10.1007/s11882-018-0811-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The development of allergic disease is shaped by genetics and the environment, including diet. Many studies suggest a role for maternal diet during pregnancy. In this article, we discuss potential mechanisms by which specific nutrients, particular foods, and dietary patterns may influence allergic disease development and review studies examining the relationship between prenatal diet and the risk of childhood allergy. RECENT FINDINGS The combination of in utero exposures and genetic predisposition may contribute to the development of allergic disease by altering immune and organ development. Inflammation predominates in the first and third trimesters whereas the second trimester is characterized by anti-inflammatory and Th2 immune responses. Maternal dietary exposures during pregnancy may interact with inherited genetic risk factors influence immune system development. There are varied results regarding the impact of maternal prenatal diet on the development of childhood allergies. Well-designed randomized controlled studies are needed to clarify this area.
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Affiliation(s)
- Michele N Pham
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Box 1498, New York, NY, 10029, USA
| | - Supinda Bunyavanich
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Box 1498, New York, NY, 10029, USA.
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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329
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Connors L, O'Keefe A, Rosenfield L, Kim H. Non-IgE-mediated food hypersensitivity. Allergy Asthma Clin Immunol 2018; 14:56. [PMID: 30275846 PMCID: PMC6157279 DOI: 10.1186/s13223-018-0285-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Non-immunoglobulin E (IgE)-mediated food hypersensitivity includes a spectrum of disorders that predominantly affect the gastrointestinal tract. This review will focus on the following more common non-IgE-mediated food hypersensitivity syndromes: food protein-induced enterocolitis syndrome (FPIES), allergic proctocolitis (AP), food protein-induced enteropathy (FPE) and celiac disease. FPIES, AP and FPE typically present in infancy and are most commonly triggered by cow’s milk protein or soy. The usual presenting features are profuse emesis and dehydration in FPIES; blood-streaked and mucousy stools in AP; and protracted diarrhea with malabsorption in FPE. Since there are no confirmatory noninvasive diagnostic tests for most of these disorders, the diagnosis is based on a convincing history and resolution of symptoms with food avoidance. The mainstay of management for FPIES, AP and FPE is avoidance of the suspected inciting food, with periodic oral food challenges to assess for resolution, which generally occurs in the first few years of life. Celiac disease is an immune-mediated injury caused by the ingestion of gluten that leads to villous atrophy in the small intestine in genetically susceptible individuals. Serologic tests and small intestinal biopsy are required to confirm the diagnosis of celiac disease, and management requires life-long adherence to a strict gluten-free diet.
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Affiliation(s)
| | | | - Lana Rosenfield
- 3University of Manitoba, Winnipeg, MB Canada.,5McMaster University, Hamilton, ON Canada
| | - Harold Kim
- 4Western University, London, ON Canada.,5McMaster University, Hamilton, ON Canada
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330
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Koppelman SJ, Smits M, Tomassen M, de Jong GAH, Baumert J, Taylor SL, Witkamp R, Veldman RJ, Pieters R, Wichers H. Release of Major Peanut Allergens from Their Matrix under Various pH and Simulated Saliva Conditions-Ara h2 and Ara h6 Are Readily Bio-Accessible. Nutrients 2018; 10:E1281. [PMID: 30208580 PMCID: PMC6165493 DOI: 10.3390/nu10091281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/28/2018] [Accepted: 08/31/2018] [Indexed: 01/24/2023] Open
Abstract
The oral mucosa is the first immune tissue that encounters allergens upon ingestion of food. We hypothesized that the bio-accessibility of allergens at this stage may be a key determinant for sensitization. Light roasted peanut flour was suspended at various pH in buffers mimicking saliva. Protein concentrations and allergens profiles were determined in the supernatants. Peanut protein solubility was poor in the pH range between 3 and 6, while at a low pH (1.5) and at moderately high pHs (>8), it increased. In the pH range of saliva, between 6.5 and 8.5, the allergens Ara h2 and Ara h6 were readily released, whereas Ara h1 and Ara h3 were poorly released. Increasing the pH from 6.5 to 8.5 slightly increased the release of Ara h1 and Ara h3, but the recovery remained low (approximately 20%) compared to that of Ara h2 and Ara h6 (approximately 100% and 65%, respectively). This remarkable difference in the extraction kinetics suggests that Ara h2 and Ara h6 are the first allergens an individual is exposed to upon ingestion of peanut-containing food. We conclude that the peanut allergens Ara h2 and Ara h6 are quickly bio-accessible in the mouth, potentially explaining their extraordinary allergenicity.
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Affiliation(s)
- Stef J Koppelman
- Food Allergy Research and Resource Program, Department of Food Science & Technology, University of Nebraska, 279 Food Innovation Center, Lincoln, NE 68588-6207, USA.
| | - Mieke Smits
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands.
| | - Monic Tomassen
- Food & Biobased Research, Wageningen University and Research, Bornse Weilanden 9, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | | | - Joe Baumert
- Food Allergy Research and Resource Program, Department of Food Science & Technology, University of Nebraska, 279 Food Innovation Center, Lincoln, NE 68588-6207, USA.
| | - Steve L Taylor
- Food Allergy Research and Resource Program, Department of Food Science & Technology, University of Nebraska, 279 Food Innovation Center, Lincoln, NE 68588-6207, USA.
| | - Renger Witkamp
- Department of Human Nutrition, Wageningen University and Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands.
| | - Robert Jan Veldman
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands.
| | - Raymond Pieters
- Research Group Innovative Testing in Life Sciences and Chemistry, University of Applied Sciences, Heidelberglaan 7, 3584 CS Utrecht, The Netherlands.
- Institute for Risk Assessment Sciences, Faculty of Veterinary Medicines, Utrecht University, Yalelaan 1, 3584 CL, Utrecht, The Netherlands.
| | - Harry Wichers
- Food & Biobased Research, Wageningen University and Research, Bornse Weilanden 9, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
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331
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Tapke DE, Scherzer R, Grayson MH. Unnecessary food allergy testing by primary care providers: Ethical implications for the specialist. Ann Allergy Asthma Immunol 2018; 121:668-672. [PMID: 30009878 DOI: 10.1016/j.anai.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- David E Tapke
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, Ohio
| | - Rebecca Scherzer
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, Ohio
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, Ohio.
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332
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Miceli Sopo S, Fantacci C, Bersani G, Romano A, Liotti L, Monaco S. Is food protein induced enterocolitis syndrome only a non IgE-mediated food allergy? Allergol Immunopathol (Madr) 2018; 46:499-502. [PMID: 29472022 DOI: 10.1016/j.aller.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
Food protein induced enterocolitis syndrome (FPIES) is classified as non-IgE-mediated or cell-mediated food allergy, although there is an atypical phenotype so defined for the presence of specific IgEs. All diagnostic criteria for FPIES include the absence of skin or respiratory symptoms of IgE-mediated type. We present four cases that suggest that specific IgEs may have a pathogenic role, resulting in the existence of different FPIES phenotypes. This could be important from a diagnostic and therapeutic point of view.
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333
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Du YJ, Nowak-Węgrzyn A, Vadas P. FPIES in adults. Ann Allergy Asthma Immunol 2018; 121:736-738. [PMID: 30121366 DOI: 10.1016/j.anai.2018.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/22/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Yue Jennifer Du
- Keenan Research Summer Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anna Nowak-Węgrzyn
- Elliott and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine, New York, New York
| | - Peter Vadas
- Division of Allergy and Clinical Immunology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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334
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Arasi S, Caminiti L, Crisafulli G, Pajno GB. A general strategy for de novo immunotherapy design: the active treatment of food allergy. Expert Rev Clin Immunol 2018; 14:665-671. [PMID: 29984605 DOI: 10.1080/1744666x.2018.1498784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION IgE-mediated food allergy (FA) has been emerging as a public health priority. It is a potentially life-threatening condition with negative impact on the quality of life of patients and their family and its prevalence is increasing in westernized countries in the recent two decades. The current standard approach to FA consists of the strict avoidance of the triggering food. However, an elimination diet may be difficult and frustrating, above all for those foods (e.g. milk and egg) that are pivotal in the common diet. Oral immunotherapy (OIT) may increase the amount of food that the patient can intake without reaction and reduce the risk of potential life-threatening allergic reactions. It is currently considered the most promising treatment for FA. However, many gaps are still unsolved. Areas covered: The aim of this review is to shed light on the current evidence and the main needs in OIT in order to stimulate the development of longitudinal, prospective, and well-designed studies with the final goal of a 'precision medicine.' Expert commentary: Clinical trials for OIT conducted so far are extremely heterogeneous. The aim in the near future is to identify the most suitable candidates to OIT and algorithms for treatments tailored on well-characterized subpopulations of patients.
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Affiliation(s)
- Stefania Arasi
- a Department of Pediatrics- Allergy Unit , University of Messina , Messina , Italy.,b SIAF- Schweizerischers Institut für Allergie- und Asthmaforschung , Davos , Switzerland.,c Pediatric Allergy Unit , Bambino Gesù Children's Hospital, IRCCS , Rome , Italy
| | - Lucia Caminiti
- a Department of Pediatrics- Allergy Unit , University of Messina , Messina , Italy
| | - Giuseppe Crisafulli
- a Department of Pediatrics- Allergy Unit , University of Messina , Messina , Italy
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335
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Virkud YV, Wang J, Shreffler WG. Enhancing the Safety and Efficacy of Food Allergy Immunotherapy: a Review of Adjunctive Therapies. Clin Rev Allergy Immunol 2018; 55:172-189. [DOI: 10.1007/s12016-018-8694-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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336
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Li J, Fulton RB, O'Connell R, Jang HS, Fernando SL. Specific-IgE to galactose-α-1,3-galactose (alpha-gal) has limited utility in diagnosing meat allergy in a tick-endemic population. Ann Allergy Asthma Immunol 2018; 121:509-511. [PMID: 29966704 DOI: 10.1016/j.anai.2018.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jamma Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.
| | - Richard B Fulton
- Immunorheumatology Laboratory, NSW Health Pathology, Sydney, Australia
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337
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Greenhawt M, Fleischer DM, Spergel JM. Is It Time for a Randomized Trial on Early Introduction of Milk? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 4:489-90. [PMID: 27157938 DOI: 10.1016/j.jaip.2016.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Matthew Greenhawt
- Section of Allergy, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colo
| | - David M Fleischer
- Section of Allergy, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colo
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa.
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338
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Abstract
The management of food allergies requires the cooperation of the food allergic person, physician, family, and social contacts. For children, school management of food allergies is a key component of the overall approach. Recognition of the signs and symptoms of allergic reactions and preparation to administer the appropriate treatment of mild and severe symptoms in the event of accidental exposure is necessary. Avoidance of food allergens is facilitated by label reading and dietary guidance is extremely important to minimize nutritional deficiencies. Medications and vaccines with food-derived excipients generally do not need to be avoided because, in most cases, they contain little food protein.
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339
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Hammond C, Lieberman JA. Unproven Diagnostic Tests for Food Allergy. Immunol Allergy Clin North Am 2018; 38:153-163. [PMID: 29132671 DOI: 10.1016/j.iac.2017.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The gold standard for diagnosis of immunoglobulin E (IgE)-mediated food allergy remains the oral food challenge, with serum IgE testing and skin prick testing serving as acceptable alternatives. However, the increase in prevalence of food allergy (both physician diagnosed and patient suspected) has led patients to pursue a variety of other alternative diagnostic procedures for suspected food allergy, which are reviewed in this article. These procedures (IgG testing, electrodermal testing, cytotoxic testing, provocation/neutralization, and applied kinesiology) have largely been unproven and may lead to unnecessary elimination diets.
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Affiliation(s)
- Catherine Hammond
- Department of Pediatrics, The University of Tennessee Health Science Center, 51 North Dunlap, Suite 400, Memphis, TN 38105, USA
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, 51 North Dunlap, Suite 400, Memphis, TN 38105, USA.
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340
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Gonzales-González VA, Díaz AM, Fernández K, Rivera MF. Prevalence of food allergens sensitization and food allergies in a group of allergic Honduran children. Allergy Asthma Clin Immunol 2018; 14:23. [PMID: 29946340 PMCID: PMC6004676 DOI: 10.1186/s13223-018-0245-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/28/2018] [Indexed: 12/03/2022] Open
Abstract
Background Food allergy is a public health problem that has increased in the last decade. Despite the increasing rates in children, quality data on the burden of these diseases is lacking particularly in developing countries. Honduras has no studies in pediatric patients. Objectives The objective of this research was to identify the most common sensitization patterns to food through epicutaneous skin testing and food allergy rates in children and their correlation with common allergic diseases in a group of patients from Hospital of Pediatrics Maria. Methods Cross-sectional retrospective, descriptive study in which records and database of all allergic patients in the immunology outpatient clinic from Hospital of Pediatrics Maria were reviewed between the periods of January 2015 through June 2016. Results A total of 365 children were analyzed, the age of participants were in the range from 1 to 18 years, with an average of 9.8 years. Sensitization to food allergens were found in 23, and 58.3% were poly-sensitized. The most common food allergens that patients were sensitized to: milk 9.0%, eggs 6.9%, peanut 4.9% and pork meat 4.4%. Food allergy was confirmed via oral food challenged in 9.3% of the patients. The most frequent food allergies found were: cow’s milk allergy 6%, hen’s egg allergy 5.2% and wheat allergy 1.9%. Conclusions Milk and egg were the most common a food allergens found in the population studied. Most of the patients were found to be poly-sensitized. The frequent food allergies confirmed via oral food challenge were cow’s milk allergy, hen’s egg allergy and wheat allergy.
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Affiliation(s)
| | - Adolfo Martin Díaz
- Division of Pediatric Allergy and Immunology, Hospital María de Especialidades Pediátricas, Tegucigalpa, Francisco Morazán, Honduras
| | - Karla Fernández
- Division of Pediatric Allergy and Immunology, Hospital María de Especialidades Pediátricas, Tegucigalpa, Francisco Morazán, Honduras
| | - María Félix Rivera
- 3Division of Epidemiology, Facultad de Ciencias Medicas, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Francisco Morazán, Honduras
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341
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Pecora V, Valluzzi RL, Mennini M, Fierro V, Dahdah L. Debates in Allergy Medicine: Does oral immunotherapy shorten the duration of milk and egg allergy? The pro argument. World Allergy Organ J 2018; 11:11. [PMID: 29977438 PMCID: PMC6003149 DOI: 10.1186/s40413-018-0191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/27/2018] [Indexed: 01/08/2023] Open
Abstract
The development of oral tolerance or food allergy is an active process, related to dynamic interactions between host immune cells, microbiome, dietary factors, and food allergens. Oral tolerance is the default immune response in the gut. A food allergy occurs when this process fails and a pathologic Th2 response is activated. Oral food immunotherapy (OIT) aims to restore immune tolerance in food-allergic individuals. The stimulation of Tregs production seems to represent a crucial step in inducing long-term tolerance, but other mechanisms (e.g., the suppression of mast cell and basophil reactivity, changes in allergen-specific cells with regulatory markers) are involved. Several studies reported the efficacy of OIT in terms of "sustained unresponsiveness" (SU), an operational definition of immune tolerance. In successfully treated subjects, the ability to pass an oral food challenge 2 to 8 weeks after stopping the food allergen exposure seems to be conditioned by the treatment starting age, frequency, amount or type of food consumed, and by the duration of the maintenance phase. Based on the available data, the percentage of milk- and egg-allergic subjects achieving sustained unresponsiveness after an OIT ranges from 21% to 58,3%. A comprehensive understanding of mechanisms underlying the induction of oral tolerance with OIT, or natural tolerance to food allergens in healthy individuals, could potentially lead to advances in development of better treatment options for food allergic patients.
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Affiliation(s)
- Valentina Pecora
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Rocco Luigi Valluzzi
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Maurizio Mennini
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Vincenzo Fierro
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Lamia Dahdah
- Division of Allergy, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
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342
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Abstract
PURPOSE OF REVIEW This review aims to provide an update of recent advances in the epidemiology, clinical features and diagnosis, and management of food-induced anaphylaxis (FIA). RECENT FINDINGS Food allergy prevalence and FIA rates continue to rise, but FIA fatalities are stable. Basophil and mast cell activation tests promise more accurate identification of food triggers. Oral, sublingual, and epicutaneous immunotherapy can desensitize a significant portion of subjects. Epinephrine use for FIA remains sub-optimal. As the burden of food allergy continues to increase, it appears that the corresponding increase in research focused on this epidemic is beginning to bear fruit. The stable number of FIA fatalities in the face of an ongoing epidemic indicates lives have already been saved. The emergence of new diagnostic tests and interventional therapies may transform the management of FIA in the coming years.
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Affiliation(s)
- Christopher P Parrish
- Department of Pediatrics and Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390-9063, USA.
| | - Heidi Kim
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
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343
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Allergic Rhinitis and Other Atopic Diseases in Children With Attention Deficit Hyperactivity Disorder. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0164-6] [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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344
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Pecora V, Mennini M, Calandrelli V, Patriarca G, Valluzzi R, Fierro V. How to actively treat food allergy. Curr Opin Allergy Clin Immunol 2018; 18:248-257. [DOI: 10.1097/aci.0000000000000450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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345
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Reddy K, Kearns M, Alvarez-Arango S, Carrillo-Martin I, Cuervo-Pardo N, Cuervo-Pardo L, Dimov V, Lang DM, Lopez-Alvarez S, Schroer B, Mohan K, Dula M, Zheng S, Kozinetz C, Gonzalez-Estrada A. YouTube and food allergy: An appraisal of the educational quality of information. Pediatr Allergy Immunol 2018. [PMID: 29512839 DOI: 10.1111/pai.12885] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Food allergy affects an estimated 8% of children and 3% of adults in the United States. Food-allergic individuals increasingly use the web for medical information. We sought to determine the educational quality of food allergy YouTube videos. METHODS We performed a YouTube search using keywords "food allergy" and "food allergies". The 300 most viewed videos were included and analyzed for characteristics, source, and content. Source was further classified as healthcare provider, alternative medicine provider, patient, company, media, and professional society. A scoring system (FA-DQS) was created to evaluate quality (-10 to +34 points). Negative points were assigned for misleading information. Eight reviewers scored each video independently. RESULTS Three hundred videos were analyzed, with a median of 6351.50 views, 19 likes, and 1 dislike. More video presenters were female (54.3%). The most common type of video source was alternative medicine provider (26.3%). Alternative treatments included the following: water fast, juicing, Ayurveda, apple cider, yoga, visualization, and sea moss. Controversial diagnostics included kinesiology, IgG testing, and pulse test. Almost half of the videos depicted a non-IgE-mediated reaction (49.0%).Videos by professional societies had the highest FA-DQS (7.27). Scores for videos by professional societies were significantly different from other sources (P < .001). There was a high degree of agreement among reviewers (ICC = 0.820; P < .001). CONCLUSION YouTube videos on food allergy frequently recommend controversial diagnostics and commonly depict non-IgE-mediated reactions. There is a need for high-quality, evidence-based, educational videos on food allergy.
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Affiliation(s)
- Keerthi Reddy
- Department of Pediatrics, East Tennessee State University, Johnson City, TN, USA
| | - Mary Kearns
- Department of Pediatrics, East Tennessee State University, Johnson City, TN, USA
| | | | | | | | - Lyda Cuervo-Pardo
- Division of Allergy and Immunology, Northwestern University, Chicago, IL, USA
| | - Ves Dimov
- Allergy and Immunology, Cleveland Clinic Florida, Ft Lauderdale, FL, USA
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Brian Schroer
- Department of Pediatric Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, OH, USA
| | - Kaushik Mohan
- Business Analytics & Supply Chain Management, University of Tennessee, Knoxville, TN, USA
| | - Mark Dula
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Simin Zheng
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Claudia Kozinetz
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN, USA
| | - Alexei Gonzalez-Estrada
- Department of Allergy and Clinical Immunology, East Tennessee State University, Johnson City, TN, USA
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346
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Duffey H, Egan M. Development of food protein-induced enterocolitis syndrome (FPIES) to egg after immunoglobulin E-mediated egg allergy. Ann Allergy Asthma Immunol 2018; 121:379-380. [PMID: 29859249 DOI: 10.1016/j.anai.2018.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/07/2018] [Accepted: 05/23/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Hannah Duffey
- Section of Pediatric Allergy and Immunology Department of Pediatrics Children's Hospital of Colorado Aurora, Colorado.
| | - Maureen Egan
- Section of Pediatric Allergy and Immunology Department of Pediatrics Children's Hospital of Colorado Aurora, Colorado
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347
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Waibel K, Lee R, Coop C, Mendoza Y, White K. Food allergy guidance in the United States military: A work group report from the American Academy of Allergy, Asthma & Immunology's Military Allergy and Immunology Assembly. J Allergy Clin Immunol 2018; 142:54-59. [PMID: 29777733 DOI: 10.1016/j.jaci.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
A diagnosis of food allergy adversely affects one's ability to join or remain in the military. Inadequate knowledge or misconceptions of current military-specific standards regarding food allergy and how these apply to enlistment, induction, and retention in the US military can lead potentially to inaccurate counseling because each military service has specific regulations that affect the evaluation and decision-making process. Recognizing this knowledge gap, the American Academy of Allergy, Asthma & Immunology's Military Allergy and Immunology Assembly established a work group that reviewed and summarized all aspects of military instructions, policies, and regulations regarding IgE-mediated food allergy. A flowchart was developed outlining each step of the military entry process for an applicant with a history of food allergy. Furthermore, summary tables were made to provide improved "fluency" regarding each service's medical regulations, whereas key considerations were outlined for the allergist who is evaluating a subject who is seeking military entry or retention. Both civilian and military allergists play an essential role in the evaluation, counseling, and management of patients with a food allergy history. Understanding the service-specific language and regulations regarding food allergy will improve the allergist's awareness, counseling, and management of these individuals.
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Affiliation(s)
- Kirk Waibel
- Allergy Service, Division of Medicine, Landstuhl Regional Medical Center, Landstuhl, Germany.
| | - Rachel Lee
- Division of Allergy & Immunology, Department of Internal Medicine, Naval Medical Center, San Diego, Calif
| | - Christopher Coop
- Department of Allergy and Immunology, Wilford Hall Ambulatory Surgical Center, San Antonio, Tex
| | - Yun Mendoza
- Allergy Service, Division of Medicine, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Kevin White
- Allergy and Immunization Clinic, 48th Medical Group, Lakenheath, United Kingdom
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Oland AA, Booster GD, Bender BG. Integrated behavioral health care for management of stress in allergic diseases. Ann Allergy Asthma Immunol 2018; 121:31-36. [PMID: 29751088 DOI: 10.1016/j.anai.2018.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This article reviews current findings regarding the management of stress in allergic disease. DATA SOURCES The authors use articles and books published between 1995 and 2017. Approximately 85% of sources used were published in the last 10 years, and 60% were published in the last 5 years. Most of the sources are peer-reviewed articles. STUDY SELECTIONS Articles that focused on allergic diseases such as allergic rhinitis, food allergies, urticaria, and allergic asthma were included. Articles in which whether the underlying disorder was allergic in nature (for example, nonspecified asthma) were not included. Preference was given to articles published within the past five years. RESULTS Patients with allergic diseases, particularly those with chronic or co-occurring allergic diseases, often experience stress and, in turn, this experience of stress can exacerbate disease presentation. High rates of treatment nonadherence in patients with allergic disease also can increase disease burden and stress. Research supports the benefit of behavioral health interventions for patients with allergic disease. Interventions with multidisciplinary teams, which include behavioral health, as well as interventions at the school, workplace, and community level, are recommended. CONCLUSION Medical providers working with patients with allergic disease need to address patients' experience of stress and nonadherence to treatment recommendations. This could be done through routine screening and referrals to behavioral health or, ideally, through incorporation of a behavioral health provider within a multidisciplinary patient team.
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Affiliation(s)
- Alyssa A Oland
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Genery D Booster
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Bruce G Bender
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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Barni S, Sarti L, Mori F, Muscas G, Belli F, Pucci N, Novembre E. Tolerability and palatability of donkey's milk in children with cow's milk allergy. Pediatr Allergy Immunol 2018; 29:329-331. [PMID: 29392769 DOI: 10.1111/pai.12871] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Barni
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Giada Muscas
- Nutrition Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Fina Belli
- Nutrition Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Neri Pucci
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elio Novembre
- Allergy Unit, Department of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
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