351
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Greenhawt M. Environmental exposure to peanut and the risk of an allergic reaction. Ann Allergy Asthma Immunol 2018; 120:476-481.e3. [PMID: 29555352 DOI: 10.1016/j.anai.2018.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To review the evidence of the risk of environmental exposure to peanut to a peanut allergic individual. DATA SOURCES AND STUDY SELECTION A narrative review was performed using a PubMed search of relevant articles involving peanut environmental distribution, environmental peanut abatement, and public policy regarding peanut restriction. RESULTS Data from 4 studies have shown that peanut butter vapors and smeared peanut butter on skin do not cause systemic reactions, that peanut can be abated from hands and surfaces using appropriate cleaning agents, and that shelled peanut dust does not become airborne. Studies have recently confirmed dose of 1.5 mg of peanut protein would be generally tolerated by approximately 95% of the peanut-allergic population based on objective symptoms in challenge-based studies, affirming earlier research. Restrictive policies that focus on bans (or restricted presence in certain areas) of peanuts or peanut-containing products in environments such as schools or on commercial aircraft are not backed by evidence that such measures work, which may raise an uncomfortable clash between accommodations that lack any medical evidence of necessity and a desire to provide measures that comfort our patients. CONCLUSION There is little risk posed from non-oral exposure to peanut in the environment, from casual contact, proximity, or inhalation. If 5% of the population may tolerate a threshold of approximately 1.5 mg of peanut protein, this may help liberate behavior and situational-decision making regarding the necessity of certain avoidances and restrictions. Continued work is needed to dispel myths about the mechanisms of how peanut may induce an allergic reaction.
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Affiliation(s)
- Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Aurora, Colorado.
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352
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Greenhawt M, Chan ES, Fleischer DM, Hicks A, Wilson R, Shaker M, Venter C, Stukus D. Caregiver and expecting caregiver support for early peanut introduction guidelines. Ann Allergy Asthma Immunol 2018. [PMID: 29524559 DOI: 10.1016/j.anai.2018.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Recent guidelines recommend early peanut introduction (EPI) beginning around 4 to 6 months of age in infants with severe eczema and/or egg allergy and around 6 months for all other infants. Caregiver preferences for such practices are unknown. OBJECTIVE To determine levels of support for early allergenic solid food recommendations among new and expecting caregivers of infants at risk for peanut allergy. METHODS We explored preferences for EPI and in-office allergy risk assessment (IRA) through a nationally representative survey of expecting (n = 1,000) and new caregivers of infants younger than 1 year (n = 1,000). RESULTS Among a primarily female (99.7%), married (80.3%), and white (74.4%) sample, 29% had no or vague awareness of the new guidelines, 61% had no or minimal concern for their child developing food allergy, but 54% felt timing of food introduction has moderate to strong importance for developing food allergy. Only 31% expressed willingness for EPI before or around 6 months of age, with 40% reporting willingness to introduce peanut after 11 months of age, similar to tree nuts and seafood. However, 60% reported willingness to introduce egg before 8 months of age. A total of 51% and 56.8% were unwilling to allow IRA methods, such as skin testing and oral challenge, before 11 months of age, respectively. Odds of willingness to delay peanut introduction (odds ratio, 0.79; 95% confidence interval, 0.65-0.96) and undergo challenge (odds ratio, 0.67; 95% confidence interval, 0.54-0.82) after 6 months of age were lower among expecting caregivers. CONCLUSION Among new and expecting caregivers, there is poor current willingness and questionable support for early allergenic solid food recommendations, including IRA before introduction. Willingness was better among expecting vs current caregivers. These trends underscore a need for broader formal implementation planning to facilitate early allergen introduction and maximize its preventive benefits.
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Affiliation(s)
- Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Aurora, Colorado.
| | - Edmond S Chan
- BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Fleischer
- Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Aurora, Colorado
| | - Allison Hicks
- Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Aurora, Colorado
| | - Rachel Wilson
- Central Michigan University College of Medicine, Mt Pleasant, Michigan
| | - Marcus Shaker
- Dartmouth Hitchcock Clinic, Dartmouth University Medical Center, Hanover, New Hampshire
| | - Carina Venter
- Children's Hospital Colorado, University of Colorado School of Medicine, Section of Allergy and Immunology, Aurora, Colorado
| | - David Stukus
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
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353
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Should Younger Siblings of Peanut Allergic Children Be Screened for Peanut Allergy? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:414-418. [DOI: 10.1016/j.jaip.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 01/05/2023]
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354
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Rachid R, Keet CA. Current Status and Unanswered Questions for Food Allergy Treatments. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:377-382. [DOI: 10.1016/j.jaip.2017.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 01/19/2023]
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355
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Bird JA, Spergel JM, Jones SM, Rachid R, Assa'ad AH, Wang J, Leonard SA, Laubach SS, Kim EH, Vickery BP, Davis BP, Heimall J, Cianferoni A, MacGinnitie AJ, Crestani E, Burks AW. Efficacy and Safety of AR101 in Oral Immunotherapy for Peanut Allergy: Results of ARC001, a Randomized, Double-Blind, Placebo-Controlled Phase 2 Clinical Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:476-485.e3. [PMID: 29092786 DOI: 10.1016/j.jaip.2017.09.016] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/06/2017] [Accepted: 09/18/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Peanut oral immunotherapy, using a variety of approaches, has been previously shown to induce desensitization in peanut-allergic subjects, but no products have been approved for clinical use by regulatory agencies. OBJECTIVE We performed the first phase 2 multicentered study to assess the safety and efficacy of AR101, a novel oral biologic drug product. METHODS A randomized, double-blind, placebo-controlled trial was conducted at 8 US centers. Eligible subjects were 4 to 26 years old, sensitized to peanut, and had dose-limiting symptoms to ≤143 mg of peanut protein in a screening double-blind, placebo-controlled food challenge (DBPCFC). Subjects were randomized 1:1 to daily AR101 or placebo and gradually up-dosed from 0.5 to 300 mg/day. The primary endpoint was the proportion of subjects in each arm able to tolerate ≥443 mg (cumulative peanut protein) at exit DBPCFC with no or mild symptoms. RESULTS Fifty-five subjects (29 AR101, 26 placebo) were enrolled. In the intention-to-treat analysis, 23 of 29 (79%) and 18 of 29 (62%) AR101 subjects tolerated ≥443 mg and 1043 mg at exit DBPCFC, respectively, versus 5 of 26 (19%) and 0 of 26 (0%) placebo subjects (both P < .0001). Compared with placebo, AR101 significantly reduced symptom severity during exit DBPCFCs and modulated peanut-specific cellular and humoral immune responses. Gastrointestinal (GI) symptoms were the most common treatment-related adverse events (AEs) in both groups, with 6 AR101 subjects (21%) withdrawing, 4 of those due primarily to recurrent GI AEs. CONCLUSIONS In this study, AR101 demonstrated an acceptable safety profile and demonstrated clinical activity as a potential immunomodulatory treatment option in peanut-allergic children over the age of 4, adolescents, and young adults.
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Affiliation(s)
- J Andrew Bird
- Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Tex.
| | - Jonathan M Spergel
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Ark
| | - Rima Rachid
- Division of Allergy & Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Amal H Assa'ad
- Division of Allergy & Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Julie Wang
- Division of Allergy & Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie A Leonard
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego, Calif
| | - Susan S Laubach
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego, Calif; Allergy and Asthma Medical Group and Research Center, San Diego, Calif
| | - Edwin H Kim
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Brian P Vickery
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC; Department of Clinical Development, Aimmune Therapeutics, Brisbane, Calif
| | - Benjamin P Davis
- Division of Immunology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jennifer Heimall
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Antonella Cianferoni
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Andrew J MacGinnitie
- Division of Allergy & Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Elena Crestani
- Division of Allergy & Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
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356
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Greenhawt M. Editorial: With tree nut sensitization, take the current when it serves, or lose our ventures. Allergy 2018; 73:525-526. [PMID: 29319877 DOI: 10.1111/all.13383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M. Greenhawt
- Department of Pediatrics; Section of Allergy and Immunology; Children's Hospital Colorado; University of Colorado School of Medicine; Aurora CO USA
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357
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Egan M, Greenhawt M. Common questions in food allergy avoidance. Ann Allergy Asthma Immunol 2018; 120:263-271. [PMID: 29508713 DOI: 10.1016/j.anai.2017.09.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Maureen Egan
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, Colorado.
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, Colorado
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358
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Miceli Sopo S, Monaco S, Bersani G, Romano A, Fantacci C. Proposal for management of the infant with suspected food protein-induced allergic proctocolitis. Pediatr Allergy Immunol 2018; 29:215-218. [PMID: 29197125 DOI: 10.1111/pai.12844] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stefano Miceli Sopo
- Allergy Unit, Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Serena Monaco
- Allergy Unit, Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Giulia Bersani
- Allergy Unit, Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Alberto Romano
- Allergy Unit, Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
| | - Claudia Fantacci
- Allergy Unit, Department of Pediatrics, Agostino Gemelli Hospital, Sacred Heart Catholic University, Rome, Italy
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359
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Elizur A, Appel MY, Nachshon L, Levy MB, Epstein-Rigbi N, Golobov K, Goldberg MR. NUT Co Reactivity - ACquiring Knowledge for Elimination Recommendations (NUT CRACKER) study. Allergy 2018; 73:593-601. [PMID: 29127694 DOI: 10.1111/all.13353] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ambiguities exist regarding the diagnosis of tree-nut allergy, necessitating either their elimination or the performance of oral food challenges (OFCs). OBJECTIVE To examine the coincidences of allergies among tree-nuts and improve diagnostic testing to minimize the need for OFC. METHODS Eighty-three patients prospectively evaluated for walnut, pecan, cashew, pistachio, hazelnut, and almond allergy. A history of previous reactions was obtained, and standardized skin prick tests (SPTs) using finely ground tree-nut solution and basophil activation tests (BAT) were performed. Patients underwent OFC for each tree-nut they eliminated and to which a reaction in the previous 2 years was not documented. RESULTS While most patients were sensitized to 5-6 tree-nuts, over 50% were allergic to only 1-2 tree-nuts. The highest rate of allergy in sensitized patients was observed for walnut (74.6%) and cashew (65.6%). The rate of co-allergy for most tree-nuts was <30%. Two-thirds of walnut- and cashew-allergic patients were also allergic to pecan and pistachio, respectively, while all pecan- and pistachio-allergic patients were allergic to walnut and cashew, respectively. Receiver-operating characteristic analysis for SPT and BAT was tree-nut dependent and yielded area under the curve (AUC) values ranging from 0.75 to 0.94. Knowledge of coincident allergies in these pairs along with the combination of SPT and BAT correctly distinguished allergic from tolerant patients for walnut (87%), pecan (66%), cashew (71%), and pistachio (79%). CONCLUSION The data presented here should assist in differentiating between allergic and tolerant patients, decrease the need for OFC, and allow for appropriate elimination recommendations.
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Affiliation(s)
- A. Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
- Department of Pediatrics; Sackler Faculty of Medicine; Tel Aviv University; Zerifin Israel
| | - M. Y. Appel
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - L. Nachshon
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. B. Levy
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - N. Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - K. Golobov
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
| | - M. R. Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology; Assaf-Harofeh Medical Center; Zerifin Israel
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360
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Ribeiro A, Moreira D, Costa C, Pinto Pais I. Food protein-induced enterocolitis syndrome: a challenging diagnosis. BMJ Case Rep 2018; 2018:bcr-2017-222822. [PMID: 29437805 DOI: 10.1136/bcr-2017-222822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity triggered by food proteins. It may present acutely, with repetitive vomiting, diarrhoea and lethargy leading to dehydration and eventually shock or insidiously with intermittent emesis, chronic diarrhoea or failure to thrive. We describe a paediatric male patient with recurrent sepsis-like episodes of fever, lethargy, ashen-grey skin colouration and vomiting followed by diarrhoea. These episodes were triggered by cow's milk formula and grains. Laboratory tests revealed leucocytosis, thrombocytosis, metabolic acidosis and elevated C reactive protein. After exclusion of other differential diagnoses, the diagnosis of FPIES was established on clinical improvement with withdrawal of the offending food and positive oral food challenge. FPIES diagnosis requires a high index of suspicion and is frequently delayed, which contributes to an increased morbidity. This is due to the wide spectrum of clinical presentations and due to the absence of specific diagnostic tests.
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Affiliation(s)
- Andreia Ribeiro
- Department of Paediatrics, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Diana Moreira
- Department of Paediatrics, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Cristina Costa
- Pediatric Gastroenterology, Centro Hospitalar Gaia Espinho, Vila Nova de Gaia, Portugal
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361
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D'Auria E, Mameli C, Piras C, Cococcioni L, Urbani A, Zuccotti GV, Roncada P. Precision medicine in cow's milk allergy: proteomics perspectives from allergens to patients. J Proteomics 2018; 188:173-180. [PMID: 29408543 DOI: 10.1016/j.jprot.2018.01.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/20/2018] [Accepted: 01/30/2018] [Indexed: 02/07/2023]
Abstract
Cow's milk allergy (CMA) is one of the most common food allergies, especially during childhood. CMA is an immunological mediated adverse reaction to one or more cow's milk proteins, which are normally harmless to a non-allergic individual, as the result of a failure of oral tolerance. To make a correct diagnosis of CMA and a proper treatment is critical in clinical practice. Application of proteomics along with new bio-informatics tools in the field of food allergy is one of the hot topics presented in recent years. In the present review, we focus on recent applications of proteomics to the field of cow's milk allergy, from allergens quantification to the diagnosis, treatment and prognosis. Furthermore, we also shed a light on potential future directions and developments, that are parts of personalized medicine but also of the One Health approach. SIGNIFICANCE The field of food allergies is becoming a milestone in public health. Food allergies, in fact, can cause life-threatening reactions and profoundly influence the quality of life. Precise, fast and reliable diagnosis of food allergies, and in particular milk allergies is essential to avoid severe allergic reactions and also to prevent dangerous and eventually unnecessary dietary restrictions; but this can be difficult also due to a complex interaction of genetic background, environment, and microbiota. In this sense, proteomics represents steps toward researching food and milk allergy integrated with the clinic to improve pathophysiology, diagnosis, therapy, and prognosis.
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Affiliation(s)
- Enza D'Auria
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, Università degli Studi di Milano, Milano, Italy
| | - Chiara Mameli
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, Università degli Studi di Milano, Milano, Italy
| | - Cristian Piras
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, 20133 Milano, Italy
| | - Lucia Cococcioni
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, Università degli Studi di Milano, Milano, Italy
| | - Andrea Urbani
- Università Cattolica del Sacro Cuore, Policlinico Gemelli, Roma, Italy; Fondazione Santa Lucia, Roma, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Ospedale dei Bambini V. Buzzi, Università degli Studi di Milano, Milano, Italy
| | - Paola Roncada
- Istituto Sperimentale Italiano Lazzaro Spallanzani, 20133 Milano, Italy.
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362
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Photocleavage-based affinity purification of biomarkers from serum: Application to multiplex allergy testing. PLoS One 2018; 13:e0191987. [PMID: 29389948 PMCID: PMC5794080 DOI: 10.1371/journal.pone.0191987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/15/2018] [Indexed: 11/19/2022] Open
Abstract
Multiplex serological immunoassays, such as implemented on microarray or microsphere-based platforms, provide greater information content and higher throughput, while lowering the cost and blood volume required. These features are particularly attractive in pediatric food allergy testing to facilitate high throughput multi-allergen analysis from finger- or heel-stick collected blood. However, the miniaturization and microfluidics necessary for creating multiplex assays make them highly susceptible to the “matrix effect” caused by interference from non-target agents in serum and other biofluids. Such interference can result in lower sensitivity, specificity, reproducibility and quantitative accuracy. These problems have in large part prevented wide-spread implementation of multiplex immunoassays in clinical laboratories. We report the development of a novel method to eliminate the matrix effect by utilizing photocleavable capture antibodies to purify and concentrate blood-based biomarkers (a process termed PC-PURE) prior to detection in a multiplex immunoassay. To evaluate this approach, it was applied to blood-based allergy testing. Patient total IgE was purified and enriched using PC-PURE followed by multiplex microsphere-based detection of allergen-specific IgEs (termed the AllerBead assay). AllerBead was formatted to detect the eight most common pediatric food allergens: milk, soy, wheat, egg, peanuts, tree nuts, fin fish and shellfish, which account for >90% of all pediatric food allergies. 205 serum samples obtained from Boston Children’s Hospital were evaluated. When PC-PURE was employed with AllerBead, excellent agreement was obtained with the standard, non-multiplex, ImmunoCAP® assay (average sensitivity above published negative predictive cutoffs = 96% and average Pearson r = 0.90; average specificity = 97%). In contrast, poor ImmunoCAP®-correlation was observed when PC-PURE was not utilized (average sensitivity above published negative predictive cutoffs = 59% and average Pearson r = 0.61; average specificity = 97%). This approach should be adaptable to improve a wide range of multiplex immunoassays such as in cancer, infectious disease and autoimmune disease.
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363
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Robinson ML, Lanser BJ. The Role of Baked Egg and Milk in the Diets of Allergic Children. Immunol Allergy Clin North Am 2018; 38:65-76. [DOI: 10.1016/j.iac.2017.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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364
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Parrish CP, Kim EH, Bird JA. Interventional Therapies for the Treatment of Food Allergy. Immunol Allergy Clin North Am 2018; 38:77-88. [DOI: 10.1016/j.iac.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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365
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Bingemann TA, Sood P, Järvinen KM. Food Protein-Induced Enterocolitis Syndrome. Immunol Allergy Clin North Am 2018; 38:141-152. [DOI: 10.1016/j.iac.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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366
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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367
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Cook QS, Burks AW. Peptide and Recombinant Allergen Vaccines for Food Allergy. Clin Rev Allergy Immunol 2018; 55:162-171. [DOI: 10.1007/s12016-018-8673-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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368
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Lianto P, Han S, Li X, Ogutu FO, Zhang Y, Fan Z, Che H. Quail egg homogenate alleviates food allergy induced eosinophilic esophagitis like disease through modulating PAR-2 transduction pathway in peanut sensitized mice. Sci Rep 2018; 8:1049. [PMID: 29348584 PMCID: PMC5773610 DOI: 10.1038/s41598-018-19309-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/27/2017] [Indexed: 01/07/2023] Open
Abstract
The present pharmacotherapy for eosinophilic esophagitis (EoE) fundamentally depend on inhaled corticosteroids. Despite the fact that oral intake of topical steroids can be successful in restricting EoE-related inflammation, there are concerns with respect to the long term utilization of steroids, especially in kids. In the current research, we assess the effect of quail egg, which is reportedly a known serine protease inhibitor, on symptomatology and immune responses in a peanut-sensitized mouse model of food allergy induced EoE. Daily oral treatment with quail egg attenuated mice symptomatology and immune response. Treatment with quail egg inhibited antigen-prompted increments in mouse tryptase and eosinophil cationic protein (ECP) in serum and eosinophil in inflamed tissues like oesophagus, lung, and digestive system. Quail egg treatment resulted in decreased antibody specific IgE and IgG1 and a variety of inflammatory genes that were abnormally expressed in EoE. Other effects included increased IL-10, decreased PAR-2 activation and NF-kB p65 in inflamed tissues. Our results suggest that quail egg treatment may have therapeutic potential in attenuating the symptoms of food allergy induced EoE like disease through regulating PAR-2 downstream pathway by blocking the activation of the transcription factor NF-kB p65 activity.
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Affiliation(s)
- Priscilia Lianto
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, P.R. China
| | - Shiwen Han
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, P.R. China
| | - Xinrui Li
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, P.R. China
| | - Fredrick Onyango Ogutu
- Food Technology Division of Kenya Industrial Research and Development Institute, South C - Popo Rd., Off Mombasa Rd., 30650-00100, Nairobi, Kenya
| | - Yani Zhang
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, P.R. China
| | - Zhuoyan Fan
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, P.R. China
| | - Huilian Che
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, P.R. China.
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369
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Novel immunotherapy and treatment modality for severe food allergies. Curr Opin Allergy Clin Immunol 2018; 17:212-219. [PMID: 28362675 DOI: 10.1097/aci.0000000000000365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In recent years, many studies on oral immunotherapy (OIT) have been conducted; however, few have focused on severe food allergies. The purpose of this review was to assess the efficacy and safety of oral immunotherapies for patients with severe food allergy. RECENT FINDINGS We reviewed multiple immunotherapy reports published within a few years or reports focusing on severe food allergies. We also investigated recent studies on OIT and novel food allergy management. SUMMARY Immunotherapies targeting low-dose antigen exposure and oral food challenges using low-dose target volumes may be safer than conventional OIT. It is necessary to consider which immunotherapy regimen is appropriate based on allergy severity of the patient.
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370
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Coscia A, Bertino E, Tonetto P, Peila C, Cresi F, Arslanoglu S, Moro GE, Spada E, Milani S, Giribaldi M, Antoniazzi S, Conti A, Cavallarin L. Nutritional adequacy of a novel human milk fortifier from donkey milk in feeding preterm infants: study protocol of a randomized controlled clinical trial. Nutr J 2018; 17:6. [PMID: 29316931 PMCID: PMC5761142 DOI: 10.1186/s12937-017-0308-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 12/15/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fortification of human milk is a standard practice for feeding very low birth weight infants. However, preterm infants often still experience suboptimal growth and feeding intolerance. New fortification strategies and different commercially available fortifiers have been developed. Commercially available fortifiers are constituted by a blend of ingredients from different sources, including plant oils and bovine milk proteins, thus presenting remarkable differences in the quality of macronutrients with respect to human milk. Based on the consideration that donkey milk has been suggested as a valid alternative for children allergic to cow's milk proteins, due to its biochemical similarity to human milk, we hypothesized that donkey milk could be a suitable ingredient for developing an innovative human milk fortifier. The aim of the study is to evaluate feeding tolerance, growth and clinical short and long-term outcomes in a population of preterm infants fed with a novel multi-component fortifier and a protein concentrate derived from donkey milk, in comparison to an analogous population fed with traditional fortifier and protein supplement containing bovine milk proteins. METHODS The study has been designed as a randomized, controlled, single-blind clinical trial. Infants born <1500 g and <32 weeks of gestational age were randomized to receive for 21 days either a combination of control bovine milk-based multicomponent fortifier and protein supplement, or a combination of a novel multicomponent fortifier and protein supplement derived from donkey milk. The fortification protocol followed is the same for the two groups, and the two diets were designed to be isoproteic and isocaloric. Weight, length and head circumference are measured; feeding tolerance is assessed by a standardized protocol. The occurrence of sepsis, necrotizing enterocolitis and adverse effects are monitored. DISCUSSION This is the first clinical study investigating the use of a human milk fortifier derived from donkey milk for the nutrition of preterm infants. If donkey milk derived products will be shown to improve the feeding tolerance or either of the clinical, metabolic, neurological or auxological outcomes of preterm infants, it would be an absolute innovation in the field of feeding practices for preterm infants. TRIAL REGISTRATION ISRCTN - ISRCTN70022881 .
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Affiliation(s)
- Alessandra Coscia
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Enrico Bertino
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Paola Tonetto
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Chiara Peila
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Francesco Cresi
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Sertac Arslanoglu
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy
| | - Guido E Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy
| | - Elena Spada
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Silvano Milani
- Unit of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics (CREA), Strada delle cacce 73, 10135 Turin, Italy
| | - Sara Antoniazzi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
| | - Amedeo Conti
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
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371
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Fiocchi A, Schunemann H, Ansotegui I, Assa’ad A, Bahna S, Canani RB, Bozzola M, Dahdah L, Dupont C, Ebisawa M, Galli E, Li H, Kamenwa R, Lack G, Martelli A, Pawankar R, Said M, Sánchez-Borges M, Sampson H, Shamir R, Spergel J, Terracciano L, Vandenplas Y, Venter C, Waserman S, Wong G, Brozek J. The global impact of the DRACMA guidelines cow's milk allergy clinical practice. World Allergy Organ J 2018; 11:2. [PMID: 29308116 PMCID: PMC5753480 DOI: 10.1186/s40413-017-0179-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The 2010 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow's milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment. OBJECTIVES & METHODS Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and international level. We describe some economic consequences of their application. RESULTS DRACMA are the most cited CMA guidelines, and the second cited guidelines on food allergy. Many subsequent guidelines took stock of DRACMA's metanalyses adapting recommendations to the local context. Some of these chose not to consider OFC as an absolute requirement for the diagnosis of CMA. Studies on their implementation show that in this case, the treatment costs may increase and there is a risk of overdiagnosis. Interestingly, we observed a reduction in the cost of alternative formulas following the publication of the DRACMA guidelines. CONCLUSIONS DRACMA reconciled international differences in the diagnosis and management of CMA. They promoted a cultural debate, improved clinician's knowledge of CMA, improved the quality of diagnosis and care, reduced inappropriate practices, fostered the efficient use of resources, empowered patients, and influenced some public policies. The accruing evidence on diagnosis and treatment of CMA necessitates their update in the near future.
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Affiliation(s)
- Alessandro Fiocchi
- Division of Allergy, Department of Pediatrics, Pediatric Hospital Bambino Gesù, Piazza Sant’Onofrio, Vatican City, Rome Italy
| | - Holger Schunemann
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
| | - Ignacio Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Carretera Leioa-Unbe 33 bis, 48950 Erandio - Bilbao, Spain
| | - Amal Assa’ad
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Sami Bahna
- Pediatrics & Medicine, Allergy & Immunology, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Roberto Berni Canani
- Department of Translational Medical Science, European Laboratory for Investigation of Food Induced Diseases and CEINGE Advanced Biotechnology, University of Naples Federico II, Naples, Italy
| | - Martin Bozzola
- Department of Pediatrics, British Hospital, Perdriel 74, CABA, Buenos Aires, Argentina
| | - Lamia Dahdah
- Division of Allergy, Department of Pediatrics, Pediatric Hospital Bambino Gesù, Piazza Sant’Onofrio, Vatican City, Rome Italy
| | - Christophe Dupont
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Hôpital Necker Enfants Malades, Paris, France
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Elena Galli
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy
| | - Haiqi Li
- Pediatric Division, Department of Primary Child Care, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Rose Kamenwa
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Gideon Lack
- King’s College London, Asthma-UK Centre in Allergic Mechanisms of Asthma, Department of Paediatric Allergy, St Thomas’ Hospital, London, UK
| | | | - Ruby Pawankar
- Department of Otolaryngology, Nippon Medical School, 1-1-5 Sendagi, Tokyo, 113 Japan
| | - Maria Said
- Allergy & Anaphylaxis Australia (A&AA) organisation, Sydney, Australia
| | - Mario Sánchez-Borges
- Department of Allergy and Clinical Immunology Centro Médico-Docente La Trinidad Caracas, Caracas, Venezuela
| | - Hugh Sampson
- Department of Pediatrics, Jaffe Food Allergy Institute, New York, USA
- Icahn School of Medicine at Mount Sinai, Box 1089, New York, USA
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jonathan 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 USA
| | - Luigi Terracciano
- National Pediatric Healthcare System, Board member of the Italian Pediatric Respiratory Society, ATS, Milan, Italy
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carina Venter
- Section of Allergy & Immunology, University of Colorado Denver School of Medicine | Children’s Hospital Colorado, Aurora, CO USA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON Canada
| | - Gary Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Jan Brozek
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N 3Z5 Canada
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Abstract
Food allergies manifest in a variety of clinical conditions within the gastrointestinal tract, skin and lungs, with the most dramatic and sometimes fatal manifestation being anaphylactic shock. Major progress has been made in basic, translational and clinical research, leading to a better understanding of the underlying immunological mechanisms that lead to the breakdown of clinical and immunological tolerance against food antigens, which can result in either immunoglobulin E (IgE)-mediated reactions or non-IgE-mediated reactions. Lifestyle factors, dietary habits and maternal-neonatal interactions play a pivotal part in triggering the onset of food allergies, including qualitative and quantitative composition of the microbiota. These factors seem to have the greatest influence early in life, an observation that has led to the generation of hypotheses to explain the food allergy epidemic, including the dual-allergen exposure hypothesis. These hypotheses have fuelled research in preventive strategies that seek to establish desensitization to allergens and/or tolerance to allergens in affected individuals. Allergen-nonspecific therapeutic strategies have also been investigated in a number of clinical trials, which will eventually improve the treatment options for patients with food allergy.
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373
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Koksal BT, Barıs Z, Ozcay F, Yilmaz Ozbek O. Single and multiple food allergies in infants with proctocolitis. Allergol Immunopathol (Madr) 2018; 46:3-8. [PMID: 28739021 DOI: 10.1016/j.aller.2017.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/18/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Food protein-induced allergic proctocolitis is a frequent cause of rectal bleeding in infants. Characteristics of infants with multiple food allergies have not been defined. OBJECTIVE This study aimed to identify characteristics of infants with proctocolitis and compare infants with single and multiple food allergies. METHODS A total of 132 infants with proctocolitis were evaluated retrospectively. All of the infants were diagnosed by a paediatric allergist and/or a paediatric gastroenterologist according to guidelines. Clinical features of the infants, as well as results of a complete blood count, skin prick test, specific immunoglobulin E, and stool examinations or colonoscopy were recorded. RESULTS Cow's milk (97.7%) was the most common allergen, followed by egg (22%). Forty-five (34.1%) infants had allergies to more than one food. Infants with multiple food allergies had a higher eosinophil count (613±631.2 vs. 375±291.9) and a higher frequency of positive specific IgE and/or positive skin prick test results than that of patients with a single food allergy. Most of the patients whose symptoms persisted after two years of age had multiple food allergies. CONCLUSIONS There is no difference in clinical presentations between infants with single and multiple food allergies. However, infants with multiple food allergies have a high blood total eosinophil count and are more likely to have a positive skin prick test and/or positive specific IgE results.
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Affiliation(s)
- B T Koksal
- Department of Pediatrics, Division of Pediatric Allergy, Baskent University Faculty of Medicine, Ankara, Turkey.
| | - Z Barıs
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baskent University Faculty of Medicine, Ankara, Turkey
| | - F Ozcay
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baskent University Faculty of Medicine, Ankara, Turkey
| | - O Yilmaz Ozbek
- Department of Pediatrics, Division of Pediatric Allergy, Baskent University Faculty of Medicine, Ankara, Turkey
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374
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Godwin B, Liacouras C, Mehta V, Eisenberg J, Agawu A, Brown-Whitehorn T, Ruffner MA, Verma R, Cianferoni A, Spergel JM, Muir AB. A Review of Tertiary Referrals for Management of Pediatric Esophageal Eosinophilia. Front Pediatr 2018; 6:173. [PMID: 29974044 PMCID: PMC6019483 DOI: 10.3389/fped.2018.00173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/29/2018] [Indexed: 01/07/2023] Open
Abstract
Background: Eosinophilic esophagitis is a chronic, immune-mediated disease characterized by symptoms of esophageal dysfunction and ≥15 eosinophils/high-powered field (eos/hpf). Proton pump inhibitor responsive esophageal eosinophilia (1) is an entity of esophageal eosinophilia that responds to PPI therapy and is thought to be clinically and histologically similar to EoE. Current guidelines suggest therapy with PPI prior to endoscopy and use of PPI as first line for esophageal eosinophilia. In order to gain a better understanding of community practice patterns and to try differentiate between these two entities, we sought to evaluate the clinical presentations, treatment and final diagnoses of patients presenting to our institution for second opinions of esophageal eosinophilia. Methods: A search of our electronic medical record yielded a list of patients presenting for a second opinion of esophageal eosinophilia. Charts were reviewed for clinical information. Results: A total of 187 charts were included. Patients ranged from 1-19 years old with 75% being male and 74% being Caucasian. Of the patients who had documentation of their medications at the time of initial endoscopy, 70% were not on any PPI prior to their endoscopy, and 94% were on <2 mg/kg/day. Of the 19 patients who had full response to PPI therapy and were diagnosed with PPI-REE, close to half had previously been treated with diet, steroids, or both. Patients with final diagnosis of EoE had significantly higher eos/hpf on initial endoscopy compared to those with diagnosis of PPI-REE (51.9 ± 30.6 v. 35.8 ± 16.4. p = 0.027), as well as higher likelihood of having IgE-mediated food allergy (79 v. 47%, p = 0.003). Conclusions: Diagnostic and therapeutic algorithms are needed for esophageal eosinophilia to prevent misdiagnosis and unnecessary procedures and therapies.
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Affiliation(s)
- Bridget Godwin
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Chris Liacouras
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Vijay Mehta
- Pediatrics, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Joshua Eisenberg
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Atu Agawu
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Terri Brown-Whitehorn
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Melanie A Ruffner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ritu Verma
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Antonella Cianferoni
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jonathan M Spergel
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Amanda B Muir
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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375
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Feuille E, Nowak-Wegrzyn A. Allergen-Specific Immunotherapies for Food Allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:189-206. [PMID: 29676066 PMCID: PMC5911438 DOI: 10.4168/aair.2018.10.3.189] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
With rising prevalence of food allergy (FA), allergen-specific immunotherapy (AIT) for FA has become an active area of research in recent years. In AIT, incrementally increasing doses of inciting allergen are given with the goal to increase tolerance, initially through desensitization, which relies on regular exposure to allergen. With prolonged therapy in some subjects, AIT may induce sustained unresponsiveness, in which tolerance is retained after a period of allergen avoidance. Methods of AIT currently under study in humans include oral, sublingual, epicutaneous, and subcutaneous delivery of modified allergenic protein, as well as via DNA-based vaccines encoding allergen with lysosomal-associated membrane protein I. The balance of safety and efficacy varies by type of AIT, as well as by targeted allergen. Age, degree of sensitization, and other comorbidities may affect this balance within an individual patient. More recently, AIT with modified proteins or combined with immunomodulatory therapies has shown promise in making AIT safer and/or more effective. Though methods of AIT are neither currently advised by experts (oral immunotherapy [OIT]) nor widely available, AIT is likely to become a part of recommended management of FA in the coming years. Here, we review and compare methods of AIT currently under study in humans to prepare the practitioner for an exciting new phase in the care of food allergic patients in which improved tolerance to inciting foods will be a real possibility.
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Affiliation(s)
- Elizabeth Feuille
- Division of Pediatric Pulmonology, Allergy, and Immunology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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376
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Dinakar C, Shroba J, Portnoy JM. The transforming power of proximity food challenges. Ann Allergy Asthma Immunol 2017; 117:135-7. [PMID: 27499540 DOI: 10.1016/j.anai.2016.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Chitra Dinakar
- Division of Allergy/Immunology, Children's Mercy Hospitals, Kansas City, Missouri.
| | - Jodi Shroba
- Division of Allergy/Immunology, Children's Mercy Hospitals, Kansas City, Missouri
| | - Jay M Portnoy
- Division of Allergy/Immunology, Children's Mercy Hospitals, Kansas City, Missouri
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377
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Otani IM, Nadeau KC. Biologic Therapies for Immunoglobulin E-mediated Food Allergy and Eosinophilic Esophagitis. Immunol Allergy Clin North Am 2017; 37:369-396. [PMID: 28366483 DOI: 10.1016/j.iac.2017.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Immunoglobulin (Ig) E-mediated food allergy and eosinophilic esophagitis (EoE) are chronic, allergen-mediated disorders characterized by an aberrant TH2 immune response. The development and investigation of biologics for the treatment of IgE-mediated food allergy and eosinophilic esophagitis have provided further insight into the pathophysiology and management of these disorders. This article provides an overview of biologic therapies that are being investigated or have potential as treatments for IgE-mediated food allergy and eosinophilic esophagitis. Identification of EoE phenotypes that are responsive to biologics and investigation of biologics combined with other therapies may help elucidate a role for biologics in EoE.
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Affiliation(s)
- Iris M Otani
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA.
| | - Kari C Nadeau
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
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378
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Saidova A, Hershkop AM, Ponce M, Eiwegger T. Allergen-Specific T Cells in IgE-Mediated Food Allergy. Arch Immunol Ther Exp (Warsz) 2017; 66:161-170. [DOI: 10.1007/s00005-017-0501-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022]
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379
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Wang J, Bingemann T, Russell AF, Young MC, Sicherer SH. The Allergist's Role in Anaphylaxis and Food Allergy Management in the School and Childcare Setting. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:427-435. [PMID: 29258790 DOI: 10.1016/j.jaip.2017.11.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 12/28/2022]
Abstract
Anaphylaxis and food allergy management in childcare facilities and schools are growing challenges. An increasing number of children experience severe allergic reactions on school grounds as evidenced by reports of epinephrine use. Data also suggest that the prevalence of food allergy may be increasing, with a large percentage of school-aged children at risk for anaphylaxis. Moreover, anaphylaxis may occur for the first time in a previously undiagnosed child at school or childcare setting, suggesting that general preparedness is essential. Management includes strategies for minimizing the risk of reactions and allergen exposures as well as readiness to recognize and treat allergic reactions of any severity. The primary objective of this report is to offer health care providers an overview of relevant evidence, resources, and expert opinion to assist with developing interprofessional collaborative counsel on school food allergy management and anaphylaxis preparedness with families, schools, and childcare settings. We present the current evidence base, suggest resources, and highlight areas of current controversy that warrant further study.
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Affiliation(s)
- Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Theresa Bingemann
- Allergy and Clinical Immunology, Rochester Regional Health and the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Anne F Russell
- Food Allergy and Anaphylaxis Michigan Association, Ann Arbor, Mich
| | - Michael C Young
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Scott H Sicherer
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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380
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Adult-onset food allergies. Ann Allergy Asthma Immunol 2017; 119:111-119. [PMID: 28801016 DOI: 10.1016/j.anai.2017.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
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381
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Weinberger T, Feuille E, Thompson C, Nowak-Węgrzyn A. Chronic food protein-induced enterocolitis syndrome: Characterization of clinical phenotype and literature review. Ann Allergy Asthma Immunol 2017; 117:227-33. [PMID: 27613454 DOI: 10.1016/j.anai.2016.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Tamar Weinberger
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth Feuille
- Jaffe Food Allergy Institute, Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cecilia Thompson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anna Nowak-Węgrzyn
- Jaffe Food Allergy Institute, Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
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382
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Nowak-Węgrzyn A, Lawson K, Masilamani M, Kattan J, Bahnson HT, Sampson HA. Increased Tolerance to Less Extensively Heat-Denatured (Baked) Milk Products in Milk-Allergic Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:486-495.e5. [PMID: 29226808 DOI: 10.1016/j.jaip.2017.10.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/12/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Most milk-allergic children tolerate baked milk. OBJECTIVE To investigate the effect of more frequent versus less frequent introduction of higher doses of more allergenic (less heat-denatured) forms of milk (MAFM) on progression to tolerance. METHODS Milk-allergic children were challenged with increasing doses of MAFM; baked foods were incorporated into the diet; challenges were repeated at 6- or 12-month intervals over 36 months. RESULTS A total of 136 children (70% males) were enrolled in the active group (median age, 7 years). At baseline, 41 (30%) reacted to muffin, 31 (23%) to pizza, 11 (8%) to rice pudding, 43 (32%) to non-baked milk; and 10 (7%) tolerated non-baked milk. Children who tolerated baked milk but reacted to non-baked liquid milk were randomized to MAFM challenges every 6 months (n = 41) or 12 months (n = 44). At month 36, 61% children in the 6-month and 73% in the 12-month escalation groups tolerated MAFM. Overall, 41 (48%) children who ingested baked-milk diet became tolerant to non-baked milk; no difference was seen between 6- and 12- month escalations. Among children who reacted to muffin at baseline and continued avoidance, 20% developed tolerance to baked milk and 0% tolerated non-baked milk. None of the 34 children who qualified for inclusion but chose not to take part in the active study became tolerant to any form of milk by history. CONCLUSIONS Majority of children tolerated baked milk at baseline. Baked-milk diets were associated with progressive immunomodulation. Most children who incorporated baked milk into their diet progressed to tolerating MAFM, but there was no advantage to more frequent attempts to escalate to MAFM, per intention-to-treat analysis.
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Affiliation(s)
- Anna Nowak-Węgrzyn
- Pediatric Allergy & Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Madhan Masilamani
- Pediatric Allergy & Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob Kattan
- Pediatric Allergy & Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Hugh A Sampson
- Pediatric Allergy & Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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383
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Lexmond WS, Goettel JA, Sallis BF, McCann K, Rings EHHM, Jensen-Jarolim E, Nurko S, Snapper SB, Fiebiger E. Spontaneous food allergy in Was -/- mice occurs independent of FcεRI-mediated mast cell activation. Allergy 2017; 72:1916-1924. [PMID: 28600891 DOI: 10.1111/all.13219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Food allergies are a growing health problem, and the development of therapies that prevent disease onset is limited by the lack of adjuvant-free experimental animal models. We compared allergic sensitization in patients with food allergy or Wiskott-Aldrich syndrome (WAS) and defined whether spontaneous disease in Was-/- mice recapitulates the pathology of a conventional disease model and/or human food allergy. METHODS Comparative ImmunoCAP ISAC microarray was performed in patients with food allergy or WAS. Spontaneous food allergy in Was-/- mice was compared to an adjuvant-based model in wild-type mice (WT-OVA/alum). Intestinal and systemic anaphylaxis was assessed, and the role of the high-affinity IgE Fc receptor (FcεRI) in allergic sensitization was evaluated using Was-/- Fcer1a-/- mice. RESULTS Polysensitization to food was detected in both WAS and food-allergic patients which was recapitulated in the Was-/- model. Oral administration of ovalbumin (OVA) in Was-/- mice induced low titers of OVA-specific IgE compared to the WT-OVA/alum model. Irrespectively, 79% of Was-/- mice developed allergic diarrhea following oral OVA challenge. Systemic anaphylaxis occurred in Was-/- mice (95%) with a mortality rate >50%. Spontaneous sensitization and intestinal allergy occurred independent of FcεRI expression on mast cells (MCs) and basophils. CONCLUSIONS Was-/- mice provide a model of food allergy with the advantage of mimicking polysensitization and low food-antigen IgE titers as observed in humans with clinical food allergy. This model will facilitate studies on aberrant immune responses during spontaneous disease development. Our results imply that therapeutic targeting of the IgE/FcεRI activation cascade will not affect sensitization to food.
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Affiliation(s)
- W. S. Lexmond
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - J. A. Goettel
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - B. F. Sallis
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital; Boston MA USA
| | - K. McCann
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital; Boston MA USA
| | - E. H. H. M. Rings
- Departments of Pediatrics; Erasmus Medical Center; Erasmus University; Rotterdam The Netherlands
- University Medical Center Leiden; Leiden University; Leiden The Netherlands
| | - E. Jensen-Jarolim
- Center of Pathophysiology, Infectiology and Immunology; Institute of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
- Comparative Medicine; The Interuniversity Messerli Research Institute; University of Veterinary Medicine Vienna, Medical University of Vienna, University of Vienna; Vienna Austria
- Allergy Care; Allergy Diagnosis and Study Center; Vienna Austria
| | - S. Nurko
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - S. B. Snapper
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - E. Fiebiger
- Department of Pediatrics; Division of Gastroenterology, Hepatology and Nutrition; Boston Children's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
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384
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Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2017; 141:41-58. [PMID: 29157945 DOI: 10.1016/j.jaci.2017.11.003] [Citation(s) in RCA: 877] [Impact Index Per Article: 125.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/31/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022]
Abstract
This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.
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Affiliation(s)
- Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Hugh A Sampson
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
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385
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Abstract
PURPOSE OF REVIEW The purpose of this review is to update what is currently known about the major non-IgE-mediated food allergies: food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). These conditions are similar in that symptoms are regulated to the gastrointestinal tract; therefore understanding their specific features is important for diagnosis and management. RECENT FINDINGS The most progress has been made in understanding FPIES with several recent large cohorts being described. The first international consensus guidelines for FPIES were published in 2017 and propose specific diagnostic criteria for acute FPIES as well as guidance for diagnosing chronic FPIES. Recent studies in FPIAP have challenged our thinking about the recommended duration of food avoidance and that cow's milk avoidance is the primary management with reports of self-resolution without dietary management. FPE continues to appear to be on the decline. FPIES, FPIAP, and FPE are distinguished from one another by their main clinical features: delayed repetitive vomiting in FPIES, benign blood in stool in FPIAP, and chronic diarrhea in FPE. Due to the risk of nutritional deficiencies with food avoidance in both infant and maternal diets if breastfeeding, confirmation of diagnosis with challenges is encouraged. Additional studies are needed for these conditions to elucidate pathophysiology, search for diagnostic markers, and understand natural history.
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Affiliation(s)
- Stephanie A Leonard
- Division of Pediatric Allergy & Immunology, Rady Children's Hospital San Diego, University of California, 3020 Children's Way, MC 5114, San Diego, CA, 92123, USA.
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386
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Sampson HA, Shreffler WG, Yang WH, Sussman GL, Brown-Whitehorn TF, Nadeau KC, Cheema AS, Leonard SA, Pongracic JA, Sauvage-Delebarre C, Assa’ad AH, de Blay F, Bird JA, Tilles SA, Boralevi F, Bourrier T, Hébert J, Green TD, Gerth van Wijk R, Knulst AC, Kanny G, Schneider LC, Kowalski ML, Dupont C. Effect of Varying Doses of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Exposure Among Patients With Peanut Sensitivity: A Randomized Clinical Trial. JAMA 2017; 318:1798-1809. [PMID: 29136445 PMCID: PMC5820709 DOI: 10.1001/jama.2017.16591] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Epicutaneous immunotherapy may have potential for treating peanut allergy but has been assessed only in preclinical and early human trials. OBJECTIVE To determine the optimal dose, adverse events (AEs), and efficacy of a peanut patch for peanut allergy treatment. DESIGN, SETTING, AND PARTICIPANTS Phase 2b double-blind, placebo-controlled, dose-ranging trial of a peanut patch in peanut-allergic patients (6-55 years) from 22 centers, with a 2-year, open-label extension (July 31, 2012-July 31, 2014; extension completed September 29, 2016). Patients (n = 221) had peanut sensitivity and positive double-blind, placebo-controlled food challenges to an eliciting dose of 300 mg or less of peanut protein. INTERVENTIONS Randomly assigned patients (1:1:1:1) received an epicutaneous peanut patch containing 50 μg (n = 53), 100 μg (n = 56), or 250 μg (n = 56) of peanut protein or a placebo patch (n = 56). Following daily patch application for 12 months, patients underwent a double-blind, placebo-controlled food challenge to establish changes in eliciting dose. MAIN OUTCOMES AND MEASURES The primary efficacy end point was percentage of treatment responders (eliciting dose: ≥10-times increase and/or reaching ≥1000 mg of peanut protein) in each group vs placebo patch after 12 months. Secondary end points included percentage of responders by age strata and treatment-emergent adverse events (TEAEs). RESULTS Of 221 patients randomized (median age, 11 years [quartile 1, quartile 3: 8, 16]; 37.6% female), 93.7% completed the trial. A significant absolute difference in response rates was observed at month 12 between the 250-μg (n = 28; 50.0%) and placebo (n = 14; 25.0%) patches (difference, 25.0%; 95% CI, 7.7%-42.3%; P = .01). No significant difference was seen between the placebo patch vs the 100-μg patch. Because of statistical testing hierarchical rules, the 50-μg patch was not compared with placebo. Interaction by age group was only significant for the 250-μg patch (P = .04). In the 6- to 11-year stratum, the response rate difference between the 250-μg (n = 15; 53.6%) and placebo (n = 6; 19.4%) patches was 34.2% (95% CI, 11.1%-57.3%; P = .008); adolescents/adults showed no difference between the 250-μg (n = 13; 46.4%) and placebo (n = 8; 32.0%) patches: 14.4% (95% CI, -11.6% to 40.4%; P = .40). No dose-related serious AEs were observed. The percentage of patients with 1 or more TEAEs (largely local skin reactions) was similar across all groups in year 1: 50-μg patch = 100%, 100-μg patch = 98.2%, 250-μg patch = 100%, and placebo patch = 92.9%. The overall median adherence was 97.6% after 1 year; the dropout rate for treatment-related AEs was 0.9%. CONCLUSIONS AND RELEVANCE In this dose-ranging trial of peanut-allergic patients, the 250-μg peanut patch resulted in significant treatment response vs placebo patch following 12 months of therapy. These findings warrant a phase 3 trial. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01675882.
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Affiliation(s)
- Hugh A. Sampson
- Icahn School of Medicine at Mount Sinai, New York, New York
- DBV Technologies, Montrouge, France
| | | | - William H. Yang
- University of Ottawa Medical School, Ottawa, Ontario, Canada
| | | | | | - Kari C. Nadeau
- Stanford University School Medicine, Palo Alto, California
| | | | | | | | | | - Amal H. Assa’ad
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | | | - Todd D. Green
- Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Gisèle Kanny
- Hôpitaux de Brabois, University of Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - Christophe Dupont
- Hôpital Necker, Enfants Malades, Paris, France
- Université Paris-Descartes, Paris, France
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387
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Groetch M, Venter C, Skypala I, Vlieg-Boerstra B, Grimshaw K, Durban R, Cassin A, Henry M, Kliewer K, Kabbash L, Atkins D, Nowak-Węgrzyn A, Holbreich M, Chehade M. Dietary Therapy and Nutrition Management of Eosinophilic Esophagitis: A Work Group Report of the American Academy of Allergy, Asthma, and Immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:312-324.e29. [PMID: 28283156 DOI: 10.1016/j.jaip.2016.12.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic/immune-antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Dietary elimination therapy has been shown to be an effective, drug-free prescription for the treatment of EoE. A range of different dietary elimination therapies have been used. Regardless of the elimination diet chosen, dietary therapy requires in-depth nutrition assessment and management. Elimination diets are not without risk and may impact nutritional status, eating pleasure, and overall quality of life. With adequate guidance, dietary therapy can be effective and nutritionally balanced, and the adverse impact on lifestyle can be minimized. This work group report addresses the potential challenges of implementing an elimination diet for the management of EoE and provides instructions and tools for physicians, dietitians, and other allied health professionals to help guide them in planning elimination diets for both children and adults.
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Affiliation(s)
- Marion Groetch
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Carina Venter
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabel Skypala
- Allergy Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK; Department of Paediatrics, Imperial College, London, UK
| | - Berber Vlieg-Boerstra
- Onze lieve Vrouwe Gasthuis (OLVG), Department of Paediatrics, Amsterdam, The Netherlands
| | - Kate Grimshaw
- Department of Nutrition and Dietetics, Southampton's Children's Hospital, Southampton, UK; Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Raquel Durban
- Division of Food Allergy, Asthma and Allergy Specialists, PA, Charlotte, NC
| | - Alison Cassin
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michelle Henry
- Department of Medical Affairs, Fresenius Kabi USA, LLC, Lake Zurich, Ill
| | - Kara Kliewer
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lynda Kabbash
- Department of Internal Medicine, Harvard Medical School, Boston, Mass; Department of Internal Medicine, New England Baptist Hospital, Boston, Mass
| | - Dan Atkins
- Gastrointestinal Eosinophilic Diseases Program and Allergy & Immunology Section, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Anna Nowak-Węgrzyn
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Mirna Chehade
- Departments of Pediatrics and Medicine, Mount Sinai Center for Eosinophilic Disorders, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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388
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Nowak-Wegrzyn A, Spergel JM. Food protein–induced enterocolitis syndrome: Not so rare after all! J Allergy Clin Immunol 2017; 140:1275-1276. [DOI: 10.1016/j.jaci.2017.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 12/27/2022]
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389
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Mendoza J, Waibel KH. Meals-Ready-to-Eat by Almost Everyone: A Quick Reference Guide for Individuals with Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017. [DOI: 10.1016/j.jaip.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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390
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Pali‐Schöll I, De Lucia M, Jackson H, Janda J, Mueller RS, Jensen‐Jarolim E. Comparing immediate-type food allergy in humans and companion animals-revealing unmet needs. Allergy 2017; 72:1643-1656. [PMID: 28394404 DOI: 10.1111/all.13179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Abstract
Adverse food reactions occur in human as well as veterinary patients. Systematic comparison may lead to improved recommendations for prevention and treatment in both. In this position paper, we summarize the current knowledge on immediate-type food allergy vs other food adverse reactions in companion animals, and compare this to the human situation. While the prevalence of food allergy in humans has been well studied for some allergens, this remains to be investigated for animal patients, where owner-reported as well as veterinarian-diagnosed food adverse reactions are on the increase. The characteristics of the disease in humans vs dogs, cats, and horses are most often caused by similar, but sometimes species-dependent different pathophysiological mechanisms, prompting the specific clinical symptoms, diagnoses, and treatments. Furthermore, little is known about the allergen molecules causative for type I food allergy in animals, which, like in human patients, could represent predictive biomarkers for risk evaluation. The definite diagnosis of food allergy relies-as in humans-on elimination diet and provocation tests. Besides allergen avoidance in daily practice, novel treatment options and tolerization strategies are underway. Taken together, numerous knowledge gaps were identified in veterinary food allergy, which need to be filled by systematic comparative studies.
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Affiliation(s)
- I. Pali‐Schöll
- Comparative Medicine The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna Medical University of Vienna and University of Vienna Vienna Austria
| | - M. De Lucia
- Clinica Veterinaria Privata San Marco Padova Italy
| | - H. Jackson
- Dermatology Referral Services LTD Glasgow Scotland UK
| | - J. Janda
- Faculty of Science Charles University Prague Czech Republic
| | - R. S. Mueller
- Centre for Clinical Veterinary Medicine Ludwig Maximilian University Munich Munich Germany
| | - E. Jensen‐Jarolim
- Comparative Medicine The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna Medical University of Vienna and University of Vienna Vienna Austria
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology Infectiology and Immunology Medical University of Vienna Vienna Austria
- Allergy Care Allergy Diagnosis and Study Center Vienna Austria
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391
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Quigley J, Sanders GM. Food Allergy in Patients Seeking Mental Health Care: What the Practicing Psychiatrist Should Know. Curr Psychiatry Rep 2017; 19:99. [PMID: 29086043 DOI: 10.1007/s11920-017-0849-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW This review provides an overview of food allergy among children and adolescents in the context of its impact on psychosocial functioning, and quality of life (QoL). RECENT FINDINGS The prevalence of food allergy is increasing. The burden of day to day management of food allergy is significant and can have a negative impact on QoL for both parents of those with food allergy, and the children themselves. This can impact social functioning, academic functioning, and mental health. Children with food allergy experience more bullying than peers. Greater internalizing of symptoms has been identified in adolescents with food allergy. Typical developmental considerations in the transition from adolescence to adulthood can be impacted significantly. Those caring for children with food allergy should consider the impact of food allergy on the individual and family level within the context of social and emotional development.
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Affiliation(s)
- Joanna Quigley
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109-2700, USA.
| | - Georgiana M Sanders
- Division of Allergy and Clinical Immunology, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby H2100, PO Box 442, Ann Arbor, MI, 48106, USA.,Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby H2100, PO Box 442, Ann Arbor, MI, 48106, USA.,Department of Pediatrics and Communicable Diseases, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby H2100, PO Box 442, Ann Arbor, MI, 48106, USA.,MH Weiser Food Allergy Research Center, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby H2100, PO Box 442, Ann Arbor, MI, 48106, USA
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392
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The Current State of Epicutaneous Immunotherapy for Food Allergy: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 55:153-161. [DOI: 10.1007/s12016-017-8650-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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393
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Abstract
Food allergy diagnosis remains challenging. Most standard methods are unable to differentiate sensitization from clinical allergy. Recognizing food allergy is of utmost importance to prevent life-threatening reactions. On the other hand, faulty interpretation of tests leads to overdiagnosis and unnecessary food avoidances. Highly predictive models have been established for major food allergens based on skin prick testing and food-specific immunoglobulin E but are lacking for most other foods. Although many newer diagnostic techniques are improving the accuracy of food allergy diagnostics, an oral food challenge remains the only definitive method of confirming a food allergy.
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Affiliation(s)
- Malika Gupta
- Division of Allergy & Immunology, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Suite H-2100, Ann Arbor, MI 48106, USA
| | - Amanda Cox
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, One Gustave Levy Place, Box 1198, New York, NY 10029, USA
| | - Anna Nowak-Węgrzyn
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, One Gustave Levy Place, Box 1198, New York, NY 10029, USA
| | - Julie Wang
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, One Gustave Levy Place, Box 1198, New York, NY 10029, USA.
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394
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Cuomo B, Indirli GC, Bianchi A, Arasi S, Caimmi D, Dondi A, La Grutta S, Panetta V, Verga MC, Calvani M. Specific IgE and skin prick tests to diagnose allergy to fresh and baked cow's milk according to age: a systematic review. Ital J Pediatr 2017; 43:93. [PMID: 29025431 PMCID: PMC5639767 DOI: 10.1186/s13052-017-0410-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of IgE-mediated cow's milk allergy is often based on anamnesis, and on specific IgE (sIgE) levels and/or Skin Prick Tests (SPT), which have both a good sensitivity but a low specificity, often causing positive results in non-allergic subjects. Thus, oral food challenge is still the gold standard test for diagnosis, though being expensive, time-consuming and possibly at risk for severe allergic reactions. AIM The aim of the present study was to perform a systematic review of the studies that have so far analyzed the positive predictive values for sIgE and SPT in the diagnosis of allergy to fresh and baked cow's milk according to age, and to identify possible cut-offs that may be useful in clinical practice. METHODS A comprehensive search on Medline via PubMed and Scopus was performed August 2017. Studies were included if they investigated possible sIgE and/or SPT cut-off values for cow's milk allergy diagnosis in pediatric patients. The quality of the studies was evaluated according to QUADAS-2 criteria. RESULTS The search produced 471 results on Scopus, and 2233 on PubMed. Thirty-one papers were included in the review and grouped according to patients' age, allergen type and cooking degree of the milk used for the oral food challenge. In children < 2 years, CMA diagnosis seems to be highly likely when sIgE to CM extract are ≥ 5 KUA/L or when SPT with commercial extract are above 6 mm or Prick by Prick (PbP) with fresh cow's milk are above 8 mm. Any cut-offs are proposed for single cow's milk proteins and for baked milk allergy in children younger than 2 years. In Children ≥ 2 years of age it is hard to define practical cut-offs for allergy to fresh and baked cow's milk. Cut-offs identified are heterogeneous. CONCLUSIONS None of the cut-offs proposed in the literature can be used to definitely confirm cow's milk allergy diagnosis, either to fresh pasteurized or to baked milk. However, in children < 2 years, cut-offs for specific IgE or SPT seem to be more homogeneous and may be proposed.
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Affiliation(s)
- Barbara Cuomo
- Operative Complex Unit of Pediatrics, Belcolle Hospital, Viterbo, Italy.
| | - Giovanni Cosimo Indirli
- Operative Unit of PediatricAllergy, San Giuseppe da Copertino Hospital, Copertino, LE, Italy
| | - Annamaria Bianchi
- Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Stefania Arasi
- Department of Pediatrics, University of Messina, Messina, Italy
| | - Davide Caimmi
- Allergy Unit of the Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, France.,Sorbonnes Universités, UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, F-75013, Paris, France
| | - Arianna Dondi
- Department of Pediatric Emergency, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology, National Research Council, 90100, Palermo, Italy
| | - Valentina Panetta
- L'altrastatisticasrl, Consultancy & Training, Biostatistics office, Rome, Italy
| | | | - Mauro Calvani
- Operative Complex Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy
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395
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Bartuzi Z, Cocco RR, Muraro A, Nowak-Węgrzyn A. Contribution of Molecular Allergen Analysis in Diagnosis of Milk Allergy. Curr Allergy Asthma Rep 2017; 17:46. [PMID: 28597347 DOI: 10.1007/s11882-017-0716-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW We sought to describe the available evidence supporting the utilization of the molecular allergen analysis (MAA) for diagnosis and management of cow milk protein allergy (CMPA). RECENT FINDINGS Cow milk proteins are among the most common food allergens in IgE- and non-IgE-mediated food allergic disorders in children. Most individuals with CMPA are sensitized to both caseins and whey proteins. Caseins are more resistant to high temperatures compared to whey proteins. MAA is not superior to the conventional diagnostic tests based on the whole allergen extracts for diagnosis of CMPA. However, MAA can be useful in diagnosing tolerance to extensively heated milk proteins in baked foods. Children with CMPA and high levels of casein IgE are less likely to tolerate baked milk compared to children with low levels of casein IgE. Specific IgE-binding patterns to casein and betalactoglobulin peptides may predict the natural course of CMPA and differentiate subjects who are more likely to develop CMPA at a younger age versus those with a more persistent CMPA. Specific IgE-binding patterns to casein and beta-lactoglobulin peptides may also predict response to milk OITand identify patientsmost likely to benefit fromOIT.
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Affiliation(s)
- Zbigniew Bartuzi
- Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Renata Rodrigues Cocco
- Allergy and Immunology Division, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Anna Nowak-Węgrzyn
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, One Gustave L. Levy Place, Box 1198, New York, NY, 10029, USA.
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396
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Abstract
PURPOSE OF REVIEW Food allergy prevalence is increasing very rapidly, causing a significant disease burden. The threat of severe allergic reactions occurring unexpectedly and in settings that are not equipped to recognize and treat anaphylaxis is a constant source of worry for individuals and families with food allergies. Inadequate knowledge and understanding in the community significantly impairs the overall quality of life of these individuals and families. Additionally, families face challenges in finding and affording appropriate allergen-free foods. RECENT FINDINGS Advancements have been made in understanding the impact of food allergies on patient-centered outcomes such as quality of life and economic impact, and attempts have been made to develop tools to assess patient-centered variables. Innovative national and regional initiatives are helping to spread awareness of the disease condition and to create resources, including access to allergen-free foods. While there is a growing momentum toward recognition of food allergic disorders as a condition that profoundly impacts activities of daily living, greater effort needs to be expounded to develop validated tools and interventions that can adequately address these issues.
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Affiliation(s)
- Brooke I Polk
- Section of Allergy/Immunology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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397
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Meglio P, Giampietro PG, Carello R, Galli E. Oral immunotherapy in children with IgE-mediated hen's egg allergy: Follow-ups at 2.5 and 7 years. ALLERGY & RHINOLOGY 2017; 8:157-169. [PMID: 29070273 PMCID: PMC5662541 DOI: 10.2500/ar.2017.8.0211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: The present report was a follow-up investigation at 2.5- and 7-year intervals of a previous study of 20 children with moderate-to-severe immunoglobulin E (IgE) mediated hen's egg (HE) allergy who received oral immunotherapy (OIT) with raw HE. The study design of the previous study divided the 20 subjects into two groups of 10 each: (1) group 1, the OIT group (OIT-G), and, (2) group 2, an age-matched control group (C-G). In that study, 8 of 10 of the children in the OIT-G were successfully desensitized, one child was partially desensitized, and desensitization failed in one child. The aims of the present study were to evaluate the long-term effectiveness and safety profile of OIT with raw HE, and to assess the course and prognostic value of skin-prick tests (SPT) and serum-specific HE-IgEs in this study population. Methods: Of the 20 children who were recalled, 2 dropped out, which left 18 to be evaluated. Information on their HE intake was recorded, and SPTs with HE allergen extracts and with raw and hard-boiled HE were performed. Ovomucoid- and ovalbumin-specific IgE levels were also measured. Results: At the first (2.5-year) and second (7-year) follow-ups, 87.5% of the children in the OIT-G who tolerated raw HE were still tolerant, whereas the children in the C-G were significantly less tolerant. Overall, cutaneous sensitivity to HE significantly decreased after the 6-month desensitization period and at both follow-ups with regard to the OIT-G but not with regard to the C-G. A significant reduction in serum ovomucoid- and ovalbumin-specific IgE levels was seen in both the OIT-G and the C-G. Conclusion: Clinical raw HE tolerance induced by OIT persists over time. Negativization of SPTs could be considered a more reliable prognostic indicator of clinical tolerance to raw HE than the reduction in specific-HE IgE levels. Raw-HE OIT would seem to be a promising method to treat HE allergy.
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Affiliation(s)
- Paolo Meglio
- From the San Pietro Hospital, Fatebenefratelli Research Center, Rome, Italy
| | | | - Rossella Carello
- From the San Pietro Hospital, Fatebenefratelli Research Center, Rome, Italy
| | - Elena Galli
- From the San Pietro Hospital, Fatebenefratelli Research Center, Rome, Italy
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398
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Elimination diet and the development of multiple tree-nut allergies. Pediatr Res 2017; 82:671-677. [PMID: 28549059 DOI: 10.1038/pr.2017.127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/21/2017] [Indexed: 11/08/2022]
Abstract
BackgroundDespite its high prevalence, relatively little is known about the characteristics of patients with multiple tree-nut allergies.MethodsPatients (n=60, aged 4-15 years), recruited for a multiple food (tree nuts, peanut, milk, egg, soy, sesame, and wheat) oral immunotherapy (OIT) study, filled a questionnaire on their initial allergy evaluation. Medical records were reviewed. At OIT enrollment (median interval, 7.5 years), patients underwent oral food challenges (OFCs) to foods still eliminated.ResultsThere was significantly less evidence for eliminating tree nuts compared with other foods, as reflected by a lower rate of acute reaction to the offending food, either as the trigger for initial allergy evaluation (5.9% for tree-nuts vs. 20-40% for other foods, respectively P<0.001) or later in life (14.5% vs. 38-75%, respectively P=0.001), and a higher rate of negative skin prick test (SPT)/specific IgE (sIgE) at initial diagnosis (25% vs. <10%, P<0.001). SPT/sIgE increased significantly from past initial levels to present for tree nuts (P<0.001) and peanut (P=0.001) but not for other foods, and most OFCs performed at present were positive.ConclusionsTree nuts are often eliminated from the diet of multiple-food-allergic patients, despite their low probability for allergy. Sensitization and allergy to most tree nuts exist years later, suggesting that it developed during the period of elimination.
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399
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Bartuzi Z, Kaczmarski M, Czerwionka-Szaflarska M, Małaczyńska T, Krogulska A. The diagnosis and management of food allergies. Position paper of the Food Allergy Section the Polish Society of Allergology. Postepy Dermatol Alergol 2017; 34:391-404. [PMID: 29507553 PMCID: PMC5831274 DOI: 10.5114/ada.2017.71104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/22/2022] Open
Abstract
The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely, the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, in this publication we also used the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID).
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Affiliation(s)
- Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Maciej Kaczmarski
- Medical University of Bialystok, professor emeritus, Bialystok, Poland
| | - Mieczysława Czerwionka-Szaflarska
- Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Teresa Małaczyńska
- Department of Pediatrics, Allergology and Immunology, Children’s Hospital “Polanki”, Gdansk, Poland
| | - Aneta Krogulska
- Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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400
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Arasi S, Pajno GB. Evidence Gaps in Oral Immunotherapy for Food Allergy. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0146-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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