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Ma Z, Chen L, Xian R, Fang H, Chen J, Li H, Wang J, Hu Y. Changes in risk factors for food sensitization in early life: Analysis over a period of 10 years. Front Immunol 2023; 14:1153607. [PMID: 37063872 PMCID: PMC10102490 DOI: 10.3389/fimmu.2023.1153607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundAlthough epidemiological trends of childhood food sensitization (FS) in IgE-mediated food allergy were reported in China, few studies have examined at changes in its risk factors.ObjectiveTo investigate the change in early-life risk factors associated with childhood food sensitization during 2009–2019 in China.MethodsData from two cross-sectional surveys conducted in 2009 and 2019 (401 and 513 children, respectively) were analyzed. The results of skin prick tests and information on food sensitization-related risk factors in children were summarized, including family history of atopic disease (FHA), demographic characteristics, method of delivery, feeding patterns, sibship size, pet ownership, and vitamin D supplementation. Binary logistic regression was used to calculate the odds ratio and the regression coefficient β-value of risk factors in the 2009 and 2019 surveys separately. Then, coefficient β-value differences between the two surveys were analyzed by the bdiff command in STATA to describe the change in risk factors over 10 years.ResultsThe 2009 survey revealed that FHA, age, only child, and feeding patterns were associated with food sensitization. The 2019 survey showed that food sensitization was affected by age, sex, and feeding patterns. However, from 2009 to 2019, the probability of food sensitization in the only-child group significantly increased by 226.0% (β-value difference = 0.81, P = 0.024) and decreased by 65.0% in female children (β-value difference = −1.06, P = 0.008). The effect of age on food sensitization decreased by 50.0% (β-value difference = −0.69, P < 0.001) over 10 years.ConclusionThe effect of FHA and common lifestyle factors on food sensitization did not significantly change during 2009−2019. However, the influence of demographic characteristics on food sensitization has changed since 2009; that is, older age, male gender, and only child are more likely to develop food sensitization, which needs to be considered in future epidemiological surveys.Clinical Trial Registrationhttp://www.chictr.org.cn/, identifier ChiCTR1900024338.
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Affiliation(s)
- Zhuoying Ma
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Lin Chen
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Ruoling Xian
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Heping Fang
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Jing Chen
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Haiqi Li
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Juan Wang
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yan Hu
- Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
- *Correspondence: Yan Hu,
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Fang H, Ma Z, Chen L, Xian R, Wang J, Chen J, Li H, Hu Y. Trends in the contributions of atopic family history to pediatric food sensitization and allergy. Front Pediatr 2022; 10:967930. [PMID: 36568419 PMCID: PMC9768553 DOI: 10.3389/fped.2022.967930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Family history of atopic diseases (FHA) contributes to food allergy (FA). But little is known whether FHA primarily increases IgE-mediated, non-IgE-mediated FA, or both. And the trends in the contributions of FHA to food sensitization (FS) and FA remain unclear. We aim to clarify the associations among FHA, FS and FA and to understand the trends in the contributions of FHA to FS and FA. METHODS We used chi-square test and mediating effect model to analyze the associations among FHA, FS and FA through comparisons between two cross-sectional investigations on FA in children under 2 years old in 2009 and 2019. RESULTS In 2009 and 2019, the positive FHA proportion tended to be increasing without significance (28.9% to 31.6%, P = 0.39). Subgroup analysis showed the FS rate in FA group decreased significantly (37/39 to 44/62, P = 0.003). In 2009, the FS rate and FA prevalence were higher in FHA (+) group than in FHA (-) group (26% vs. 14.7%, P = 0.008 and 15% vs. 7.7%, P = 0.03), and FS had a complete mediating effect on the association between FHA and FA (Z = 2.54, P = 0.011), but the results lost significance in 2019. CONCLUSIONS The association between FHA and FA was completely mediated by FS, which means FHA mainly increases IgE-mediated FA. And the contributions of FHA to FS and FA tended to be stabilized or even diminished, which means FHA alone could no longer be enough to screen high-risk children.
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Affiliation(s)
- Heping Fang
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Zhuoying Ma
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Lin Chen
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Ruoling Xian
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Juan Wang
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Jing Chen
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Haiqi Li
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yan Hu
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
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Cow's Milk Protein Allergy as a Model of Food Allergies. Nutrients 2021; 13:nu13051525. [PMID: 33946553 PMCID: PMC8147250 DOI: 10.3390/nu13051525] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
Cow's milk allergy (CMA) is one of the most common food allergies in infants, and its prevalence has increased over recent years. In the present paper, we focus on CMA as a model of food allergies in children. Understanding the diagnostic features of CMA is essential in order to manage patients with this disorder, guide the use of an elimination diet, and find the best moment to start an oral food challenge (OFC) and liberalize the diet. To date, no shared tolerance markers for the diagnosis of food allergy have been identified, and OFC remains the gold standard. Recently, oral immunotherapy (OIT) has emerged as a new therapeutic strategy and has changed the natural history of CMA. Before this, patients had to strictly avoid the food allergen, resulting in a decline in quality of life and subsequent nutritional, social, and psychological impairments. Thanks to the introduction of OIT, the passive approach involving rigid exclusion has changed to a proactive one. Both the heterogeneity in the diagnostic process among the studies and the variability of OIT data limit the comprehension of the real epidemiology of CMA, and, consequentially, its natural history. Therefore, well-planned randomized controlled trials are needed to standardize CMA diagnosis, prevention, and treatment strategies.
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Martin VM, Virkud YV, Seay H, Hickey A, Ndahayo R, Rosow R, Southwick C, Elkort M, Gupta B, Kramer E, Pronchick T, Reuter S, Keet C, Su KW, Shreffler WG, Yuan Q. Prospective Assessment of Pediatrician-Diagnosed Food Protein-Induced Allergic Proctocolitis by Gross or Occult Blood. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1692-1699.e1. [PMID: 31917366 PMCID: PMC8403015 DOI: 10.1016/j.jaip.2019.12.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Food protein-induced allergic proctocolitis (FPIAP) is an early and common manifestation of food allergy, yet its epidemiology and relationship to other allergic diseases remain unclear. OBJECTIVE To prospectively define the incidence of FPIAP as it is being diagnosed clinically in the community and to identify factors associated with its development. METHODS A total of 1003 of 1162 eligible serial healthy newborn infants recruited from a single suburban pediatrics practice were followed prospectively for the diagnosis of FPIAP. Investigators reviewed each case to confirm prespecified inclusion criteria, including documented gross or occult blood in the stool. RESULTS A total of 903 infants were analyzed (46% females, 89% term, 32% caesarian-section, 9% neonatal antibiotics); 153 cases met inclusion criteria, a cumulative incidence of 17%, while 63 (7%) had gross blood. Infants initially fed both breast milk and formula were 61% less likely to develop FPIAP compared with those exclusively formula-fed (hazard ratio, 0.39; P = .005). Breast milk and formula at any point during the first 4 months were also associated with lower risk compared with exclusive formula or exclusive breast milk (hazard ratio, 0.44; P = .005; hazard ratio, 0.62; P = .0497). Eczema (odds ratio, 1.5; 95% confidence interval, 1.1- 2.2; P = .02) or a first-degree relative with food allergies (odds ratio, 1.9; 95% confidence interval, 1.2-2.8; P = .005) were among risk factors for FPIAP development. CONCLUSIONS The prospectively defined incidence of FPIAP when diagnosed clinically by community pediatricians without challenge is markedly higher than published estimates. Combination feeding of formula and breast milk is associated with the lowest rate of FPIAP in this population.
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Affiliation(s)
- Victoria M Martin
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Food Allergy Science Initiative of the Broad Institute, Cambridge, Mass
| | - Yamini V Virkud
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Food Allergy Science Initiative of the Broad Institute, Cambridge, Mass; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Hannah Seay
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Alanna Hickey
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Renata Ndahayo
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Rachael Rosow
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Caroline Southwick
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Michael Elkort
- Department of Pediatrics, Harvard Medical School, Boston, Mass; Pediatrics at Newton Wellesley, P.C., Newton, Mass
| | - Brinda Gupta
- Pediatrics at Newton Wellesley, P.C., Newton, Mass
| | | | | | - Susan Reuter
- Pediatrics at Newton Wellesley, P.C., Newton, Mass
| | - Corinne Keet
- Division of Pediatric Allergy and Immunology, John's Hopkins Hospital, Baltimore, Md; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kuan-Wen Su
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wayne G Shreffler
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Food Allergy Science Initiative of the Broad Institute, Cambridge, Mass; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Qian Yuan
- Food Allergy Center, Massachusetts General Hospital, Boston, Mass; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass; Food Allergy Science Initiative of the Broad Institute, Cambridge, Mass; Pediatrics at Newton Wellesley, P.C., Newton, Mass.
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Sánchez-Valverde F, Etayo V, Gil F, Aznal E, Martínez D, Amézqueta A, Mendizábal M, Galbete A, Pastor N, Vanderhoof J. Factors Associated with the Development of Immune Tolerance in Children with Cow’s Milk Allergy. Int Arch Allergy Immunol 2019; 179:290-296. [DOI: 10.1159/000499319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/01/2019] [Indexed: 11/19/2022] Open
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Nosan G, Jakic M, Jager M, Paro-Panjan D. Prognostic accuracy of clinical signs and diagnostic tests in cow's milk allergy in newborns. Pediatr Neonatol 2017; 58:449-454. [PMID: 28416249 DOI: 10.1016/j.pedneo.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/12/2016] [Accepted: 09/29/2016] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The aim of the study was to explore the correlation between clinical signs and confirmatory tests for cow's milk allergy (CMA) in the neonatal period and their relation to family history and the occurrence of food allergies in the postneonatal period. METHODS The medical documentation of 361 newborns with suspected CMA and exclusion of other comorbidities was analyzed. The correlations between clinical signs and methods to confirm CMA [elevated levels of total immunoglobulin E (IgE) and/or specific IgE for cow's milk, improvement after the introduction of a cow's milk-free diet and positive challenge procedure] were studied. In 90 children, the data were additionally analyzed in relation to outcome (at the age of 1-11 years), evaluated by questionnaires, which inquired about signs and symptoms of food allergy, methods of CMA confirmation, and the presence of other food allergies. RESULTS There was a positive correlation between exanthema and confirmed CMA in the neonatal period (R = 0.184; p = <0.001; n = 361), and hematochezia and confirmed CMA in the neonatal (R = 0.203; p < 0.001; n = 361) and postneonatal period (R = 0.215; p = 0.042; n = 90). Additional food allergies in the postneonatal period were positively correlated with neonatal CMA (R = 0.275; p = 0.009; n = 90). No correlation was found between a positive family history of food allergies and CMA in the neonatal (R = -0.66; p = 0.398; n = 165) and postneonatal periods (R = 0.00; p = 1.000; n = 116). CONCLUSION Neonatal exanthema and hematochezia were the predominant clinical signs in neonates with CMA. Allergies to other food allergens appeared more frequently in children with CMA in the neonatal period. Neonatal CMA did not occur more frequently in families with food allergies.
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Affiliation(s)
- Gregor Nosan
- Division of Pediatrics, Department of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Jakic
- Division of Pediatrics, Department of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Miha Jager
- Division of Pediatrics, Department of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Darja Paro-Panjan
- Division of Pediatrics, Department of Neonatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Abstract
Cow's milk protein allergy (CMPA) is a common condition encountered in children with incidence estimated as 2% to 7.5% in the first year of life. Formula and breast-fed babies can present with symptoms of CMPA. It is important to accurately diagnose CMPA to avoid the consequences of either under- or overdiagnosis. CMPA is classically categorized into immunoglobulin E (IgE)- or non-IgE-mediated reaction that vary in clinical manifestations, diagnostic evaluation, and prognosis. The most commonly involved systems in patients with CMPA are gastrointestinal, skin, and respiratory. Evaluation of CMPA starts with good data gathering followed by testing if indicated. Treatment is simply by avoidance of cow's milk protein (CMP) in the child's or mother's diet, if exclusively breast-feeding. This article reviews the definition, epidemiology, risk factors, pathogenesis, clinical presentation, evaluation, management, and prognosis of CMPA and provides an overview of different options for formulas and their indication in the treatment of CMPA.
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Affiliation(s)
- Grace Mousan
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Deepak Kamat
- Children's Hospital of Michigan, Detroit, MI, USA
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Esparza-Gordillo J, Matanovic A, Marenholz I, Bauerfeind A, Rohde K, Nemat K, Lee-Kirsch MA, Nordenskjöld M, Winge MCG, Keil T, Krüger R, Lau S, Beyer K, Kalb B, Niggemann B, Hübner N, Cordell HJ, Bradley M, Lee YA. Maternal filaggrin mutations increase the risk of atopic dermatitis in children: an effect independent of mutation inheritance. PLoS Genet 2015; 11:e1005076. [PMID: 25757221 PMCID: PMC4355615 DOI: 10.1371/journal.pgen.1005076] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/16/2015] [Indexed: 12/31/2022] Open
Abstract
Epidemiological studies suggest that allergy risk is preferentially transmitted through mothers. This can be due to genomic imprinting, where the phenotype effect of an allele depends on its parental origin, or due to maternal effects reflecting the maternal genome's influence on the child during prenatal development. Loss-of-function mutations in the filaggrin gene (FLG) cause skin barrier deficiency and strongly predispose to atopic dermatitis (AD). We investigated the 4 most prevalent European FLG mutations (c.2282del4, p.R501X, p.R2447X, and p.S3247X) in two samples including 759 and 450 AD families. We used the multinomial and maximum-likelihood approach implemented in the PREMIM/EMIM tool to model parent-of-origin effects. Beyond the known role of FLG inheritance in AD (R1meta-analysis = 2.4, P = 1.0 x 10−36), we observed a strong maternal FLG genotype effect that was consistent in both independent family sets and for all 4 mutations analysed. Overall, children of FLG-carrier mothers had a 1.5-fold increased AD risk (S1 = 1.50, Pmeta-analysis = 8.4 x 10−8). Our data point to two independent and additive effects of FLG mutations: i) carrying a mutation and ii) having a mutation carrier mother. The maternal genotype effect was independent of mutation inheritance and can be seen as a non-genetic transmission of a genetic effect. The FLG maternal effect was observed only when mothers had allergic sensitization (elevated allergen-specific IgE antibody plasma levels), suggesting that FLG mutation-induced systemic immune responses in the mother may influence AD risk in the child. Notably, the maternal effect reported here was stronger than most common genetic risk factors for AD recently identified through genome-wide association studies (GWAS). Our study highlights the power of family-based studies in the identification of new etiological mechanisms and reveals, for the first time, a direct influence of the maternal genotype on the offspring’s susceptibility to a common human disease. Most human diseases are caused by a combination of multiple environmental and genetic influences. The widely used case/control approach aims to identify disease risk genes by comparing the genetic constitution of affected and healthy individuals. Although successful, this approach ignores additional mechanisms influencing disease risk. Here, we studied mutations in the filaggrin gene (FLG), which are strong risk factors for atopic dermatitis (AD) and allergies, in a large number of families with AD. We found that FLG mutations in the mother, not the father, increased the AD risk of the children, even if the child did not inherit the mutation. Thus, our study revealed, for the first time, a direct influence of a maternal mutation on the child’s risk for a common disease. The maternal FLG effect was only found when the mothers were allergic, and was absent in families of non-allergic mothers. This finding suggests that FLG-induced changes in the maternal immune response shape the child’s immune system during pregnancy and increase the child’s risk for AD. Our study indicates that maternal FLG mutations act as strong environmental risk factors for the child and highlights the potential of family-based studies in uncovering novel disease mechanisms in medical genetics.
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Affiliation(s)
- Jorge Esparza-Gordillo
- Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Matanovic
- Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Marenholz
- Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Bauerfeind
- Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany
| | - Klaus Rohde
- Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany
| | - Katja Nemat
- Klinik fur Kinder- und Jugendmedizin, Technical University Dresden, Dresden, Germany
| | - Min-Ae Lee-Kirsch
- Klinik fur Kinder- und Jugendmedizin, Technical University Dresden, Dresden, Germany
| | - Magnus Nordenskjöld
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Marten C. G. Winge
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Renate Krüger
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Lau
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kirsten Beyer
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Kalb
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bodo Niggemann
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Norbert Hübner
- Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany
| | - Heather J. Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Maria Bradley
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Dermatology Unit, Department of Medicine, Solna Karolinska University Hospital, Stockholm, Solna, Sweden
| | - Young-Ae Lee
- Max-Delbrück-Centrum (MDC) for Molecular Medicine, Berlin, Germany
- Clinic for Pediatric Allergy, Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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Koplin JJ, Allen KJ, Gurrin LC, Peters RL, Lowe AJ, Tang MLK, Dharmage SC. The impact of family history of allergy on risk of food allergy: a population-based study of infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5364-77. [PMID: 24284354 PMCID: PMC3863850 DOI: 10.3390/ijerph10115364] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/11/2013] [Accepted: 10/14/2013] [Indexed: 01/01/2023]
Abstract
The apparent rapid increase in IgE-mediated food allergy and its implications are now widely recognized, but little is known about the relationship between family history (an indirect measure of genetic risk) and the risk of food allergy. In a population-based study of 5,276 one year old infants (HealthNuts), the prevalence of oral food challenge-confirmed food allergy was measured. Associations between family history of allergic disease and food allergy in infants were examined using multiple logistic regression. Food allergy was diagnosed in 534 infants. Compared to those with no family history of allergic disease, children meeting the current definition of "high risk" for allergic disease (one immediate family member with a history of any allergic disease) showed only a modest increase (OR 1.4, 95% CI 1.1-1.7) in food allergy, while having two or more allergic family members was more strongly predictive of food allergy in the child (OR 1.8, 95% CI 1.5-2.3). There were also differences in the associations between family history and egg and peanut allergy in the child. Re-defining "high risk" as two or more allergic family members may be more useful for identification of groups with a significantly increased risk of food allergy both clinically and within research studies.
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Affiliation(s)
- Jennifer J. Koplin
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Victoria 3052, Australia; E-Mails: (J.J.K.); (L.C.G.); (A.J.L.); (S.C.D.)
- Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; E-Mails: (R.L.P.); (M.L.K.T.)
| | - Katrina J. Allen
- Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; E-Mails: (R.L.P.); (M.L.K.T.)
- Department of Allergy and Immunology, Royal Children’s Hospital, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-3-9936-6585; Fax: +61-3-9348-1391
| | - Lyle C. Gurrin
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Victoria 3052, Australia; E-Mails: (J.J.K.); (L.C.G.); (A.J.L.); (S.C.D.)
- Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; E-Mails: (R.L.P.); (M.L.K.T.)
| | - Rachel L. Peters
- Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; E-Mails: (R.L.P.); (M.L.K.T.)
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Adrian J. Lowe
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Victoria 3052, Australia; E-Mails: (J.J.K.); (L.C.G.); (A.J.L.); (S.C.D.)
- Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; E-Mails: (R.L.P.); (M.L.K.T.)
| | - Mimi L. K. Tang
- Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; E-Mails: (R.L.P.); (M.L.K.T.)
- Department of Allergy and Immunology, Royal Children’s Hospital, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Shyamali C. Dharmage
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Victoria 3052, Australia; E-Mails: (J.J.K.); (L.C.G.); (A.J.L.); (S.C.D.)
- Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; E-Mails: (R.L.P.); (M.L.K.T.)
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Clinical predictors for favorable outcomes in an oral immunotherapy program for IgE-mediated cow's milk allergy. Ann Allergy Asthma Immunol 2013; 112:58-63.e1. [PMID: 24331395 DOI: 10.1016/j.anai.2013.10.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Avoidance strategies in patients with cow's milk allergy occasionally fail to protect these patients from inadvertent exposures, leading to life-threatening reactions. OBJECTIVE To assess the safety and efficacy of milk oral immunotherapy as an alternative therapeutic strategy. METHODS Patients (n = 280, >4 years old) with IgE-mediated cow's milk allergy were enrolled into a milk oral immunotherapy program at a single hospital center. High-risk patients were not excluded. The treatment protocol consisted of 3 rounds of oral induction performed every 4 weeks. On day 1, a patient's reaction threshold was determined. On days 2 and 3, a tolerated starting dose below the threshold was confirmed. Day 4 mimicked the home treatment, which continued until the next induction. RESULTS The median initial starting dose was 52.5 mg of cow's milk protein. Excluding those whose treatment failed in the first week (n = 5) or are still undergoing treatment (n = 15), 61.5% (160 of 260 patients) achieved 7,200 mg and 85.4% of patients were consuming at least 180 mg of milk protein. Reactions at home requiring the use of injectable epinephrine occurred in 15.7% of patients (44 of 280) and in 0.075% (58 of 77,098) of doses administered. Predictors for achieving a full dose in multivariate analysis included a starting dose higher than 30 mg of milk protein (odds ratio 4.6, P < .001), not requiring epinephrine during induction (odds ratio 5.2, P < .001) or home treatment (odds ratio 2.6, P = .037), and the lack of nonanaphylactic type symptoms (odds ratio 15.6, P < .001). CONCLUSION Milk oral immunotherapy, carried out in a highly controlled setting, is successful in protecting the overwhelming majority of patients from accidental exposures to cow's milk protein.
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