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Almog M, Musallam N, Wagner R, Epov L, Kaly L, Dor V, Kessel A. Cow's milk oral immunotherapy has differentially better long-term adherence than peanut or sesame. Ann Allergy Asthma Immunol 2024; 133:105-106. [PMID: 38677475 DOI: 10.1016/j.anai.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Meital Almog
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nadira Musallam
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roni Wagner
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Larisa Epov
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Vika Dor
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Aharon Kessel
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Huerta Hernández RE, Ortega Martell JA. [Treatment for living with food allergy]. REVISTA ALERGIA MÉXICO 2023; 70:280-283. [PMID: 38506872 DOI: 10.29262/ram.v70i4.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
The treatment of food allergy involves completely removing the allergenic food from the diet, careful label reading, and ingredient awareness. Family education is crucial, understanding alternative names for the allergen. An emergency action plan provided by the doctor, with clear instructions for epinephrine application and when to seek medical attention, is essential. For mild to moderate symptoms, oral antihistamines may be prescribed. Psychological support is necessary due to emotional repercussions. Collaboration with an allergy specialist is crucial for personalized treatment. Natural tolerance to the food may be achieved, especially in non-IgE-mediated allergies. However, some allergic manifestations persist, requiring treatment alternatives. Avoidance of the allergen and epinephrine application are key measures. Immunotherapy aims to desensitize immune cells, but its effectiveness varies. Bioterapeutic agents, such as monoclonal antibodies, are under investigation, although their clinical use still requires more studies.
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Affiliation(s)
| | - José Antonio Ortega Martell
- Pediatra, Alergólogo e Inmunólogo clínico; Profesor de Inmunología, Universidad Autónoma del Estado de Hidalgo, Pachuca
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Frugier C, Begin P. An overview of current clinical practice and international oral immunotherapy guidelines: A focus on Spanish, European, and Canadian guidelines. JOURNAL OF FOOD ALLERGY 2022; 4:40-44. [PMID: 39021857 PMCID: PMC11250441 DOI: 10.2500/jfa.2022.4.220011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Oral immunotherapy (OIT) is a recent and evolving therapeutic option for the treatment of immunoglobulin E (IgE) mediated food allergies. Clinical practice guidelines are starting to emerge to establish the parameters of this new clinical offer. A comparative analysis reveals several areas of consensus, such as the need for an accurate diagnosis with immunoglobulin E testing and, if necessary, open food challenge before initiating therapy; a list of specific contraindications; the importance of performing OIT in an adequate setting with appropriate level of expertise; the possibility to use grocery products to perform OIT; and the need to adapt protocols to patient needs. Certain discrepancies among the guidelines also underscore various areas of uncertainty, which makes it important that decisions to pursue the treatment be reached by using a shared decision-making approach that involves patients and caregivers. Gaps of knowledge remain with regard to treatment of adolescents and adults, and optimal performance measures in practice. These guidelines are expected to evolve in the coming years as new scientific and experiential knowledge is gained.
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Affiliation(s)
- Cecile Frugier
- From the Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; and
| | - Philippe Begin
- From the Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; and
- Section of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Del Prado AP, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. Changes in epidemiology and clinical practice in IgE-mediated Allergy in children. An Pediatr (Barc) 2021; 95:56.e1-56.e8. [PMID: 34183295 DOI: 10.1016/j.anpede.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, it is estimated around 10% in Spain. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a significant public health problem. Taking into account epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of the European population will suffer from some type of allergic disorder. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain possible cross reactivity, anticipate potential risk of food trangressions, and prescribe correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in quality of life.
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Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología Pediátrica Clínica Juaneda, Palma de Mallorca, Spain; Centro de Salud San Agustín, Palma de Mallorca, Spain.
| | - Juan Carlos Juliá-Benito
- Centro de Salud República Argentina, Valencia, Spain; Unidad de Alergología y Neumología Pediátrica, Hospital IMED, Valencia, Spain
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Spain; Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain
| | - Ana Prieto Del Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA, Málaga, Spain
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
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5
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Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Prieto Del-Prado A, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. [Changes in epidemiology and clinical practice in IgE-mediated allergy in children]. An Pediatr (Barc) 2021. [PMID: 34119433 DOI: 10.1016/j.anpedi.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, in Spain is estimated around 10%. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a public health problem of the first magnitude. Considering epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of European population will suffer from some type of allergy. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain the possible cross reactivity, anticipate potential risk of food transgressions, and prescribe the correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in patients quality of life.
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Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología pediátrica Clínica Juaneda, Palma de Mallorca, España; Centro de salud San Agustín, Palma de Mallorca, España.
| | - Juan Carlos Juliá-Benito
- Centro de salud República Argentina, Valencia, España; Unidad de alergología y neumología pediátrica, Hospital IMED, Valencia, España
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, España; Universidad Alfonso X el Sabio, Villanueva de la Cañada, España
| | - Ana Prieto Del-Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga. IBIMA, Málaga, España
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España; Institut de Recerca Sant Joan de Déu, Barcelona, España; Universitat de Barcelona, Barcelona, España
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Peters RL, Krawiec M, Koplin JJ, Santos AF. Update on food allergy. Pediatr Allergy Immunol 2021; 32:647-657. [PMID: 33370488 PMCID: PMC8247869 DOI: 10.1111/pai.13443] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/01/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022]
Abstract
Food allergy is a major public health issue with growing prevalence in the urbanized world and significant impact on the lives of allergic patients and their families. Research into the risk factors that have contributed to this increase and their underlying immune mechanisms could lead us to definitive ways for treatment and prevention of food allergy. For the time being, introduction of peanut and other allergenic foods in the diet at the time of weaning seems to be an effective way to prevent the development of food allergy. Improved diagnosis and appropriate management and support of food allergic patients are central to patient care with food immunotherapy and biologics making the transition to clinical practice. With the new available treatments, it is becoming increasingly important to include patients' and family preferences to provide a management plan tailored to their needs.
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Affiliation(s)
- Rachel L Peters
- Murdoch Children's Research Institute Melbourne, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Marta Krawiec
- Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Women and Children's Health (Paediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Jennifer J Koplin
- Murdoch Children's Research Institute Melbourne, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Alexandra F Santos
- Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Women and Children's Health (Paediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK.,Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Asthma UK Centre for Allergic Mechanisms of Asthma, London, UK
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Boné Calvo J, Clavero Adell M, Guallar Abadía I, Laliena Aznar S, Sancho Rodríguez ML, Claver Monzón A, Aliaga Mazas Y. As soon as possible in IgE-cow's milk allergy immunotherapy. Eur J Pediatr 2021; 180:291-294. [PMID: 32653937 DOI: 10.1007/s00431-020-03731-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022]
Abstract
Oral immunotherapy is a common treatment in cow's milk protein allergy. The Department of Pediatric Allergology at the Children's Hospital of Zaragoza performed a retrospective analysis of 335 infants under 1 year of age diagnosed with IgE-mediated cow's milk and early treated. Clinical evaluation, skin prick test, and serum-specific IgE level control were performed before starting and after finishing treatment. Upon completion of treatment, more than 98% of patients became tolerant to milk and no one presented serious adverse reactions. Nowadays, the remaining non-tolerant patients (1.8%) can take milk or derivatives daily-as prophylaxis-to a certain maximum dose and still remain asymptomatic. After immunotherapy, both positive skin prick tests and a progressive decrease in specific IgE levels were found, as desensitization to milk increased.Conclusion: Oral immunotherapy is a safe and effective treatment against allergy to cow's milk proteins in infants. Such treatment should be offered to the children's families from the first moment of diagnosis. What is known: • Cow's milk proteins are responsible for the earliest IgE-mediated allergic reactions in children. • Oral immunotherapy (OIT) is commonly used as cow's milk allergy treatment and it is proposed at different ages. What is new: • OIT it is an effective and safe method with no severe reactions at early ages. • The number of reaching successful treatments is awesome so we believe that immunity response can be molded at the first months of life, so the probability of success with infants is greater than in older children.
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Affiliation(s)
- Javier Boné Calvo
- Pediatric Allergy Unit, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain
| | - Marcos Clavero Adell
- Pediatric Allergy Unit, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain.
| | - Isabel Guallar Abadía
- Pediatric Allergy Unit, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain
| | - Sara Laliena Aznar
- Pediatric Allergy Unit, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain
| | | | | | - Yolanda Aliaga Mazas
- Pediatric Allergy Unit, Miguel Servet University Hospital, Paseo Isabel La Católica 1-3, 50009, Zaragoza, Spain
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Abstract
PURPOSE OF REVIEW To critically appraise the recent most relevant studies in the rapidly advancing field of food oral and sublingual immunotherapy. RECENT FINDINGS Food allergen-specific immunotherapy via oral (OIT) and sublingual route (SLIT) increases the threshold of reactivity to peanut, cow's milk, egg, wheat, and many other foods in the majority of the treated individuals. This desensitized state is contingent upon the continued ingestion of the maintenance doses of the food. Permanent oral tolerance is achievable in a smaller subset of the treated individuals. The optimal duration of therapy has not been firmly established but is likely dependent on the phenotype (severity and persistence). Efficacy of food-OIT is superior compared with SLIT, whereas the safety of OIT is less favorable. Standardization of treatment protocols, maintenance dosing, duration of therapy, target populations and harmonization of the outcomes are top priorities at this stage. SUMMARY OIT and SLIT represent two different routes of food allergen-specific immunotherapy. Although significant progress has been made in the last decade, both treatment modalities are still in the very early stages of development and further investigations are necessary to optimize the protocols and improve safety while maximizing efficacy.
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Alves-Correia M, Gaspar Â, Borrego LM, Azevedo J, Martins C, Morais-Almeida M. Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up. Allergol Immunopathol (Madr) 2019; 47:133-140. [PMID: 30482599 DOI: 10.1016/j.aller.2018.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary. OBJECTIVE We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA. MATERIALS AND METHODS The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells). RESULTS The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127-/dim regulatory T cells were increased after OIT. CONCLUSIONS OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.
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Mota I, Piedade S, Gaspar Â, Benito-Garcia F, Sampaio G, Borrego LM, Morais-Almeida M. Cow's milk oral immunotherapy in real life: 8-year long-term follow-up study. Asia Pac Allergy 2018; 8:e28. [PMID: 30079306 PMCID: PMC6073178 DOI: 10.5415/apallergy.2018.8.e28] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 07/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Oral immunotherapy (OIT) has been recognized as a promising treatment for severe and long-lasting cow's milk (CM) allergy. Once maintenance has been achieved, patients should maintain daily intake of CM to ensure desensitization. Clinical experience concerning long-term follow-up is scarce. Objective The authors aimed to assess long-term efficacy and safety of a maintenance phase of OIT in real life. Methods Prospective study of all children and adolescents, who underwent CM-OIT and were subsequently followed at our allergy center on maintenance dose (200 mL daily) for at least 36 months after reaching the maintenance phase (from 2009 to 2016). Results Forty-two patients were enrolled: 60% male, 36% with history of anaphylaxis and 57% with asthma. The median time of follow-up was 69 months (range, 39–105 months) and the median age at the last clinical evaluation was 13 years (range, 6–23 years). Regarding adherence to the protocol: 92% are on free diet (at least 200 mL of CM daily; 7-g protein); 14% had transient interruptions and 7% definitely withdrawn with loss of tolerance. During maintenance, 45% developed mild to severe allergic reactions, and 7% had more than 3 episodes. A positive correlation between the occurrence of allergic reactions and history of anaphylaxis (p < 0.001) was found. The coexistence of asthma was risk factor for the occurrence of allergic reactions during maintenance. Conclusion This real-life study supports long-term efficacy and safety of CM-OIT. Despite daily intake, 41% had symptoms at some moment during the complete follow-up period; a total of 33 symptomatic days in patients with mean follow-up time of 67.5 months. Clinical tolerance depends on daily intake. The protective effect reached can be lost after CM withdrawal. History of anaphylaxis was a risk factor for the occurrence of allergic reactions during the maintenance phase.
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Affiliation(s)
- Inês Mota
- Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Susana Piedade
- Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Ângela Gaspar
- Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
| | | | - Graça Sampaio
- Immunoallergy Department, CUF Descobertas Hospital, Lisbon, Portugal
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