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Tran KL, Wisner EL, Jeha GM, Wall LA. Development of IgE-mediated food allergies in children with history of food protein-induced allergic proctocolitis: a series of five cases. FRONTIERS IN ALLERGY 2024; 5:1354106. [PMID: 38650862 PMCID: PMC11033684 DOI: 10.3389/falgy.2024.1354106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Food protein-induced allergic proctocolitis (FPIAP) is a non-IgE-mediated allergic condition that presents with hematochezia in otherwise healthy infants. It is most commonly induced by cow's milk protein via breast milk or formula. The prognosis for FPIAP is generally considered favorable with most infants achieving symptomatic resolution after diet modification. Most infants go on to tolerate the offending foods by 1-3 years of age. Over 8 years at our institution, five patients were identified and noted to have FPIAP to cow's milk during infancy with subsequent development of IgE-mediated allergic reaction to cow's milk and other foods. All five cases developed other atopic disorders (atopic dermatitis in four cases). IgE-mediated cow's milk allergy has persisted beyond the preschool years in at least two patients (currently 8 and 16 years old). For three of the patients, the IgE-mediated reaction to cow's milk was severe with development of anaphylaxis or angioedema. In addition, three patients experienced anaphylaxis or angioedema to allergens other than milk. While FPIAP is a non-IgE-mediated process traditionally thought not to progress past the first year of life, some infants with FPIAP develop severe, persistent IgE-mediated cow's milk allergy. To our knowledge, this is the first detailed clinical description of such patients.
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Affiliation(s)
- Kim L. Tran
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
| | - Elizabeth L. Wisner
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
- Allergy and Immunology, Children’s Hospital of New Orleans, New Orleans, LA, United States
| | - George M. Jeha
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
| | - Luke A. Wall
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
- Allergy and Immunology, Children’s Hospital of New Orleans, New Orleans, LA, United States
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PARLAK Z, İLGÜN GÜREL D, SOYER Ö, ŞEKEREL BE, ŞAHİNER ÜM. Nutritional risks in children with food allergy. Turk J Med Sci 2023; 53:845-858. [PMID: 38031941 PMCID: PMC10765559 DOI: 10.55730/1300-0144.5648] [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: 02/15/2023] [Revised: 08/18/2023] [Accepted: 04/04/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Food allergies (FA) are a growing problem in the pediatric population and clinical features differ according to the underlying immunological mechanisms. While the primary management strategy is to eliminate the culprit food from the diet, assessment of the potential nutritional risks of elimination is also an integral part of management. In cases that do not improve over time; if you have basic food allergies and multiple food allergies, this can also lead to negative nutritional consequences. The contribution of basic nutrients, economical and easily accessible foods to the diet, is critical and has an important place in meeting the daily adequate intake of many nutrients. In the presence of food allergy, it is necessary to meet the vitamins and minerals that cannot be obtained from allergic foods, with alternative sources or supplements. For example, insufficient calcium intake in cow's milk allergy (CMA), the most common FA in early childhood, is very likely if an alternative supplement has not been introduced. In the management of CMA, choosing the appropriate formula and/or supplement for the clinical characteristics of children, when necessary, has an important place. In conclusion, nutritional risk assessment of children with FA requires a comprehensive, detailed, and multidisciplinary approach.
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Affiliation(s)
- Zeynep PARLAK
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
- Department of Nutrition and Dietetics, Hacettepe İhsan Doğramacı Children’s Hospital, Hacettepe University, Ankara,
Turkiye
| | - Deniz İLGÜN GÜREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Özge SOYER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Bülent Enis ŞEKEREL
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Ümit Murat ŞAHİNER
- Department of Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
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Bahceci S, Töz PK, Celik FC, Can D. A different starting line for allergic march: food protein-induced allergic proctocolitis. Allergol Immunopathol (Madr) 2023; 51:40-45. [PMID: 37422778 DOI: 10.15586/aei.v51i4.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/30/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the long-term prognosis of food protein--induced allergic proctocolitis (FPIAP) patients, the risk of developing both allergic and gastrointestinal diseases, and to evaluate whether it leads to allergic march. METHODS A total of 149 children who were diagnosed with FPIAP and developed tolerance at least 5 years prior to the study and 41 children (with no history of food allergy) as a control group were enrolled. Both groups were re-evaluated for allergic diseases as well as gastrointestinal disorders. RESULTS The mean age of diagnosis for the FPIAP group was 4.2 ± 3.0 months, while the mean age of tolerance was 13.9 ± 7.7 months. The mean age of both FPIAP and control groups at the last visit was 101.6 ± 24.4 and 96.3 ± 24.1 months, respectively (P = 0.213). At the final evaluation of both groups, the comorbid allergic disease was significantly higher in the FPIAP group (P < 0.001). There was no significant difference between the two groups in terms of functional gastrointestinal disorders (FGIDs), eosinophilic gastrointestinal diseases, and inflammatory bowel disease (P = 0.198, 0.579, and 0.579, respectively).In the FPIAP group, the allergic disease was significantly higher at the final visit in patients with comorbid allergic disease at diagnosis (P < 0.001). In the FPIAP group, FGID was significantly higher in the group that developed allergic diseases in the future, compared to the group that did not develop allergic diseases in the future (P = 0.034). The proportion of both FGID and allergic diseases was significantly higher in subjects that developed tolerance at >18 months, compared to subjects that developed tolerance at >18 months (P < 0.001 and <0.001, respectively). CONCLUSIONS Patients with FPIAP may develop allergic diseases as well as FGID in the long term.
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Affiliation(s)
- Semiha Bahceci
- Department of Pediatric Allergy and Immunology, Çiğli Training and Research Hospital, Izmir Bakırçay University, Faculty of Medicine, Izmir, Turkey
| | - Pınar Kuyum Töz
- Department of Pediatric Gastroenterology, Çiğli Training and Research Hospital, Izmir, Turkey
| | - Figen Celebi Celik
- Department of Pediatric Allergy and Immunology, Dr Behcet Uz Children's Hospital, Izmir, Turkey;
| | - Demet Can
- Department of Pediatric Allergy and Immunology, Dr Behcet Uz Children's Hospital, Izmir, Turkey
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Chiaranairungroj M, Chatchatee P, Srituravanich W. The effect of applied force and device design on skin prick test performance. Ann Allergy Asthma Immunol 2023; 130:312-316. [PMID: 36436784 DOI: 10.1016/j.anai.2022.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin prick tests (SPTs) are difficult to standardize, and SPT performance mainly relies on the clinician's expertise. So far, the effect of various factors such as device types, shape, variety of material type, and applied force on the performance of SPT has not been extensively investigated. OBJECTIVE To investigate the effect of various factors, including type or shape of devices, material type, and applied force, on the performance of SPT. METHODS Four SPT devices with different shapes and materials were applied on 12 subjects under 3 different applied forces (30, 45, and 60 g). The results were compared with standard method using an ALK lancet pricked by an experienced clinician. RESULTS A total of 480 pricks were conducted on 12 subjects. The wheal sizes and sensitivities of all devices increased with higher applied forces. The thinner lancets with a long sharp tip had relatively higher analytical sensitivities and provided 100% sensitivity at applied forces of 45 g and above. The pain scores of all devices at applied forces of 30 to 60 g ranged from 1.00 to 1.81 with minimal incidences of bleeding (0%-4.17%), whereas the pain score of the standard method by the ALK lancet was 2.08 with much higher incidences of bleeding at 27.08%. CONCLUSION The type/shape of the SPT device and applied force are the essential factors affecting the performance of SPT. The study result could pave the way toward higher performance and standardized SPT. TRIAL REGISTRATION The Thai Clinical Trials Registry identification number: TCTR20220627004 (https://www.thaiclinicaltrials.org/show/TCTR20220627004).
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Affiliation(s)
- Muthita Chiaranairungroj
- Biomedical Engineering Program, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Pantipa Chatchatee
- HAUS IAQ Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Werayut Srituravanich
- Biomedical Engineering Program, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand; Biomedical Engineering Research Center, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand; Department of Mechanical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.
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Feketea G, Lakoumentas J, Konstantinou GN, Douladiris N, Papadopoulos NG, Petrodimopoulou M, Tasios I, Valianatou M, Vourga V, Vassilopoulou E. Dietary Factors May Delay Tolerance Acquisition in Food Protein-Induced Allergic Proctocolitis. Nutrients 2023; 15:nu15020425. [PMID: 36678296 PMCID: PMC9862452 DOI: 10.3390/nu15020425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Dietary and environmental factors may influence tolerance acquisition in food protein-induced allergic proctocolitis (FPIAP). This retrospective observational study explored the role of maternal diet during pregnancy and breastfeeding in tolerance acquisition in infantile FPIAP. METHODS Breastfed infants with FPIAP from six diverse regions in Greece were divided into two groups, based on development of tolerance to the trigger food: Group A (n = 43), before, and Group B (n = 53), after, the 6th month of age. Maternal diet during pregnancy and breastfeeding was elicited using the Mediterranean Diet Score Questionnaire and the Mediterranean Oriented Culture Specific Semi-Quantitative Food Frequency Questionnaire. RESULTS Mean age at diagnosis of FPIAP (1.5 months) and weaning (5.5 months) were the same in both groups. The main trigger was cow's milk. Group A received infant milk formula earlier than Group B. Group B had a higher incidence of asthma/wheeze, siblings with milk allergy, maternal smoking and rural residence. On multivariate analysis, earlier resolution of FPIAP was associated with higher maternal education and with salt intake and consumption of goat/sheep cheese during pregnancy and olive oil during breastfeeding. Consumption of multivitamins during pregnancy and meat, winter fruits, green vegetables, butter, salt, "ready-to-eat" meals and pastries during breastfeeding were correlated with longer duration of symptoms. CONCLUSIONS Mothers of children with FPIAP to cow's milk protein can be advised to eat more yogurt, cheese and olive oil during subsequent pregnancies, and avoid multivitamins, grilled food, "ready-to-eat" meals, pastries, meat and alcohol during breastfeeding, to reduce the duration of FPIAP presenting in future infants.
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Affiliation(s)
- Gavriela Feketea
- Department of Hematology, “luliu Hatieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
- “Karamandaneio” Children’s Hospital of Patra, 26331 Patra, Greece
| | - John Lakoumentas
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, 56429 Thessaloniki, Greece
| | - Nikolaos Douladiris
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Maria Petrodimopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Ioannis Tasios
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Mina Valianatou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Vasiliki Vourga
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece
- Correspondence:
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Ballegaard ASR, Bøgh KL. Intestinal protein uptake and IgE-mediated food allergy. Food Res Int 2023; 163:112150. [PMID: 36596102 DOI: 10.1016/j.foodres.2022.112150] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022]
Abstract
Food allergy is affecting 5-8% of young children and 2-4% of adults and seems to be increasing in prevalence. The cause of the increase in food allergy is largely unknown but proposed to be influenced by both environmental and lifestyle factors. Changes in intestinal barrier functions and increased uptake of dietary proteins have been suggested to have a great impact on food allergy. In this review, we aim to give an overview of the gastrointestinal digestion and intestinal barrier function and provide a more detailed description of intestinal protein uptake, including the various routes of epithelial transport, how it may be affected by both intrinsic and extrinsic factors, and the relation to food allergy. Further, we give an overview of in vitro, ex vivo and in vivo techniques available for evaluation of intestinal protein uptake and gut permeability in general. Proteins are digested by gastric, pancreatic and integral brush border enzymes in order to allow for sufficient nutritional uptake. Absorption and transport of dietary proteins across the epithelial layer is known to be dependent on the physicochemical properties of the proteins and their digestion fragments themselves, such as size, solubility and aggregation status. It is believed, that the greater an amount of intact protein or larger peptide fragments that is transported through the epithelial layer, and thus encountered by the mucosal immune system in the gut, the greater is the risk of inducing an adverse allergic response. Proteins may be absorbed across the epithelial barrier by means of various mechanisms, and studies have shown that a transcellular facilitated transport route unique for food allergic individuals are at play for transport of allergens, and that upon mediator release from mast cells an enhanced allergen transport via the paracellular route occurs. This is in contrast to healthy individuals where transcytosis through the enterocytes is the main route of protein uptake. Thus, knowledge on factors affecting intestinal barrier functions and methods for the determination of their impact on protein uptake may be useful in future allergenicity assessments and for development of future preventive and treatment strategies.
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Affiliation(s)
| | - Katrine Lindholm Bøgh
- National Food Institute, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark.
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Assessment of intracellular zinc levels in infants with food protein-induced allergic proctocolitis. Allergol Immunopathol (Madr) 2023; 51:9-15. [PMID: 36617816 DOI: 10.15586/aei.v51i1.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Food protein-induced allergic proctocolitis (FPIAP) is characterized by bloody stools in well-appearing infants. Zinc is a micronutrient that plays a crucial role in immune modulation and is essential for cellular function during immune response. Although there are studies on the assessment of intracellular zinc levels in allergic diseases, no data is available on erythrocyte zinc levels of patients with FPIAP. OBJECTIVE This study aimed to assess the erythrocyte zinc levels of children with allergic proctocolitis and compare zinc levels with clinical and demographic characteristics. METHODS This was a case-control study that prospectively compared 50 patients with FPIAP and 50 healthy children without malnutrition. The erythrocyte zinc levels of children were determined using atomic absorption spectrophotometry. RESULTS Fifty patients with FPIAP, including 28 (51%) girls, with median age of 7.1 ± 2.9 (3-14) months and 50 healthy children, including 26 (53.1%) girls, with median age of 7.7 ± 2.8 (3-13) months were included in the study. Seventy percent (n = 35) of the patients with FPIAP started to have symptoms while they were exclusively breastfeeding. Offending allergen foods were cow's milk (78%), egg (40%), sesame (10%), hazelnut (8%), almond (6%), beef (6%), and peanuts (6%, n = 3). Intracellular (erythrocyte) zinc levels in patients with FPIAP were lower than in the healthy control group (495.5 ± 134 µg/dL, 567.3 ± 154.4 µg/dL, respectively, P = 0.01). Patients with FPIAP aged younger than 6 months had lower intracellular zinc levels compared with those aged above 6 months (457 ± 137 µg/dL; 548 ± 112 µg/dL, respectively, P = 0.01). There was no relationship between zinc levels and time of symptom onset, presence of concomitant disease, being allergic to multiple foods, and family history of atopy (P > 0.05). CONCLUSIONS FPIAP is a food allergy with limited information on its pathogenesis. Considering the beneficial effects on gastrointestinal system epithelia, zinc may be involved in the pathogenesis of FPIAP. Future comprehensive prospective research on this subject is of importance.
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Vassilopoulou E, Feketea G, Konstantinou GN, Zekakos Xypolias D, Valianatou M, Petrodimopoulou M, Vourga V, Tasios I, Papadopoulos NG. Food Protein-Induced Allergic Proctocolitis: The Effect of Maternal Diet During Pregnancy and Breastfeeding in a Mediterranean Population. Front Nutr 2022; 9:843437. [PMID: 35433785 PMCID: PMC9005850 DOI: 10.3389/fnut.2022.843437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/11/2022] [Indexed: 12/21/2022] Open
Abstract
Background The aim of the current investigation was to explore the association of food protein-induced allergic proctocolitis (FPIAP) with the maternal diet during pregnancy and breastfeeding in Greek infants. Methods A multicenter retrospective case-control study was conducted in 6 regions in Greece, with 96 mothers of infants with and 141 mothers of infants without a history of FPIAP. Maternal dietary habits during pregnancy and breastfeeding were evaluated with the following validated questionnaires: (a) The Mediterranean Diet Score and (b) The Mediterranean Oriented Culture-Specific Semi-Quantitative Food Frequency Questionnaire. Results FPIAP was associated with cow's milk (83.6%), egg (7.3%), wheat (6.4%), and beef (6.4%) in the maternal diet. Adherence to Mediterranean Diet was similar among the mothers. Mothers of FPIAP infants consumed more vegetables. Elastic net prediction models showed that, in this Mediterranean population, increased consumption during pregnancy and lactation of common allergens, whole grain products, homemade food, fish and shellfish, and fruits was associated with a decreased risk of FPIAP. Conversely, a high intake of vegetables, sugar and total fat, and non-stick/grilled cooking, were associated with increased risk of FPIAP, as was a high intake of salt and white flour during lactation only. Conclusions Components of a maternal Mediterranean Diet may protect against FPIAP when traditional cooking methods are adopted and fish, fruit, and whole wheat products are consumed frequently during pregnancy and breastfeeding.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Gavriela Feketea
- PhD School, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Pediatrics, Pediatric Allergy Outpatient Clinic, Hospital Unit of Amaliada, General Hospital of Ilia, Amaliada, Greece
- *Correspondence: Gavriela Feketea
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Dimitris Zekakos Xypolias
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Mina Valianatou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Petrodimopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Vasiliki Vourga
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Ioannis Tasios
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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Calvani M, Anania C, Cuomo B, D’Auria E, Decimo F, Indirli GC, Marseglia G, Mastrorilli V, Sartorio MUA, Santoro A, Veronelli E. Non-IgE- or Mixed IgE/Non-IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis. Nutrients 2021; 13:226. [PMID: 33466746 PMCID: PMC7829867 DOI: 10.3390/nu13010226] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/11/2022] Open
Abstract
non-IgE and mixed gastrointestinal food allergies present various specific, well-characterized clinical pictures such as food protein-induced allergic proctocolitis, food protein-induced enterocolitis and food protein-induced enteropathy syndrome as well as eosinophilic gastrointestinal disorders such as eosinophilic esophagitis, allergic eosinophilic gastroenteritis and eosinophilic colitis. The aim of this article is to provide an updated review of their different clinical presentations, to suggest a correct approach to their diagnosis and to discuss the usefulness of both old and new diagnostic tools, including fecal biomarkers, atopy patch tests, endoscopy, specific IgG and IgG4 testing, allergen-specific lymphocyte stimulation test (ALST) and clinical score (CoMiss).
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Affiliation(s)
- Mauro Calvani
- Operative Unit of Pediatrics, S. Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Caterina Anania
- Immunology and Allergology Unit, Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Barbara Cuomo
- Operative Complex Unit of Pediatrics, Belcolle Hospital, 00100 Viterbo, Italy;
| | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (E.D.); (M.U.A.S.)
| | - Fabio Decimo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy;
| | - Giovanni Cosimo Indirli
- Pediatric Allergology and Immunology (SIAIP) for Regions Puglia and Basilicata, 73100 Lecce, Italy;
| | - Gianluigi Marseglia
- Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy;
| | - Violetta Mastrorilli
- Operative Complex Unit of Pediatrics and Emergency, Giovanni XXIII Hospital, 70056 Bari, Italy;
| | - Marco Ugo Andrea Sartorio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (E.D.); (M.U.A.S.)
| | - Angelica Santoro
- Pediatric Clinic, Mother-Child Department, University of Parma, 43121 Parma, Italy;
| | - Elisabetta Veronelli
- Food Allergy Committee of the Italian Society of Pediatric Allergy and Immunology (SIAIP), Pediatric Department, Garbagnate Milanese Hospital, ASST Rhodense, 70056 Garbagnate Milanese, Italy;
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