Evaluation and Management of Food Allergies in the Emergency Department

The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review

Importance

Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted.

Observations

This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families.

Conclusions and relevance

Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.

Lead Optimization of Butyrolactone I as an Orally Bioavailable Antiallergic Agent Targeting FcγRIIB

Food allergy (FA) poses a growing global food safety concern, yet no effective cure exists in clinics. Previously, we discovered a potent antifood allergy compound, butyrolactone I (BTL-I, 1), from the deep sea. Unfortunately, it has a very low exposure and poor pharmacokinetic (PK) profile in rats. Therefore, a series of structural optimizations toward the metabolic pathways of BTL-I were conducted to provide 18 derives (2-19). Among them, BTL-MK (19) showed superior antiallergic activity and favorable pharmacokinetics compared to BTL-I, being twice as potent with a clearance (CL) rate of only 0.5% that of BTL-I. By oral administration, Cmax and area under the concentration-time curve (AUC0-∞) were 565 and 204 times higher than those of BTL-I, respectively. These findings suggest that butyrolactone methyl ketone (BTL-BK) could serve as a drug candidate for the treatment of FAs and offer valuable insights into optimizing the druggability of lead compounds.

Socioeconomic Determinants of Food Allergy Burden-A clinical introduction

OBJECTIVE

This review characterizes what is currently known about how prevalence, severity, distribution, and management of food allergy (FA) differs across socioeconomic strata and provides guidance for practicing clinicians about how to improve equity in research participation, healthcare delivery, and patient outcomes through a deeper understanding of the socioeconomic determinants of FA.

DATA SOURCES

Epidemiological and biomedical literature published prior to April 2022.

RESULTS

Socioeconomic status (SES) is a complex concept that not only encompasses economic resources (e.g., income, wealth) but also a person's social, economic and political power and standing, each of which can impact health. However, in many studies of individuals and families with FA, assessment of SES has been limited and often a respondent's membership within a racial and ethnic group is utilized as a proxy for low SES. As a whole, findings from US-population-based studies indicate a consistent trend: those who self-identify as non-Hispanic Black, and to a lesser extent other subpopulations who identify as being of non-White race and ethnicity, experience a greater burden of food-allergic sensitization and disease including higher rates of emergency health care utilization and food-induced anaphylactic fatality as compared to those identifying as White.

CONCLUSION

Reports of FA management and outcomes highlight inequities among specific low SES populations in the US. Clinicians can and should act to reduce inequities by engaging more diverse populations in clinical research, equitably implementing FA risk screening and prevention, thoughtfully utilizing emerging technologies to ameliorate disparities based on SES in healthcare delivery and outcomes, and advocating for social change.

Effects of fucoidans and alginates from Sargassum graminifolium on allergic symptoms and intestinal microbiota in mice with OVA-induced food allergy

Food allergy has been one of the main problems threatening people's health in recent years. However, there is still no way to completely cure it at present. Therefore, the development of food allergy related drugs is still necessary. Sargassum graminifolium (SG) is a kind of polysaccharide rich marine brown alga used in food and medicine. Sargassum graminifolium polysaccharides (SGP) is mainly composed of fucoidans and alginic acid. In our study, we compared the activity of fucoidans and alginates from SG against OVA-induced food allergy in a mouse model, observed the regulatory effects of fucoidans and alginates from SG on the intestinal microbiota and summarized the possible role of the intestinal microbiota in the anti-food allergy process because polysaccharides can further act on the body through the intestinal microbiota. The results showed that fucoidans and alginates from SG could relieve the symptoms of allergy, diarrhea and jejunum injury significantly in mice with food allergy (p < 0.05). Furthermore, fucoidans at 500 mg kg-1 could reduce OVA-specific IgE and TNF-α levels significantly in the serum of food allergic mice (p < 0.05), while alginates could only significantly down-regulate serum OVA-specific IgE (p < 0.05). The results also showed that fucoidans had a stronger regulatory effect on the richness and diversity of the intestinal microbiota in food allergic mice compared to alginates at the same dose. In addition, fucoidans at 500 mg kg-1 had the most significant regulatory effect on Firmicutes, Lactobacillus and Alistipes in food allergic mice. These results suggested that fucoidans and alginates might regulate food allergy in mice through different pathways. Together, this study enriched the research on the action of alga-derived polysaccharides against food allergy.