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Urashima M, Kasamatsu A, Tachimoto H. Low serum adrenic acid levels in infants and subsequent food-induced anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100291. [PMID: 39071732 PMCID: PMC11277412 DOI: 10.1016/j.jacig.2024.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 07/30/2024]
Abstract
Background The dietary fat hypothesis links increases in allergic diseases to reduced consumption of n-3 polyunsaturated fatty acids from fish, for example, eicosapentaenoic acid, and increased intake of n-6 polyunsaturated fatty acids from vegetable oils, for example, arachidonic acid. Objective Building upon the "fat hypothesis," we sought to investigate the association between 24 types of serum fatty acid levels in infants and the risk of subsequent food-induced anaphylaxis (FIA) by age 2 years as the primary outcome. Methods This study was conducted as a prespecified supplemental analysis within the ABC randomized clinical trial. We measured levels of 24 fatty acids in residual serum samples collected from 268 infants at age 5 to 6 months using gas chromatography-mass spectrometry. Results Among the 258 infants, 58 exhibited immediate-type food allergies, whereas 200 showed no food allergy. Of the 58 infants, 12 were diagnosed with FIA, whereas the remaining 46 had nonanaphylactic food allergy. Unexpectedly, among the 24 fatty acids, only adrenic acid, also known as docosatetraenoic acid, which is one of the n-6 polyunsaturated fatty acids, showed significantly lower levels in infants with FIA (median [interquartile range] (wt.%), 0.16 [0.14-0.17]), compared with those with no food allergy (0.19 [0.17-0.21]) (P = .0007). In contrast, adrenic acid levels in infants with nonanaphylactic food allergy were 0.19 [0.16-0.21] (wt.%), which did not differ significantly from those in infants with no food allergy (P = .69). Conclusions This study generated a hypothesis suggesting that infants with low serum adrenic acid levels might be at greater risk of subsequent FIA. This unexpected result warrants further investigation.
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Affiliation(s)
- Mitsuyoshi Urashima
- Division of Molecular Epidemiology, the Jikei University School of Medicine, Tokyo, Japan
- Department of Pediatrics, the Jikei University School of Medicine, Tokyo, Japan
| | - Ayu Kasamatsu
- Division of Molecular Epidemiology, the Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Tachimoto
- Department of Pediatrics, the Jikei University School of Medicine, Tokyo, Japan
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Lin M, Yanjun C. Research progress on the mechanism of probiotics regulating cow milk allergy in early childhood and its application in hypoallergenic infant formula. Front Nutr 2024; 11:1254979. [PMID: 38419849 PMCID: PMC10900986 DOI: 10.3389/fnut.2024.1254979] [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: 07/08/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Some infants and young children suffer from cow's milk allergy (CMA), and have always mainly used hypoallergenic infant formula as a substitute for breast milk, but some of these formulas can still cause allergic reactions. In recent years, it has been found that probiotic nutritional interventions can regulate CMA in children. Scientific and reasonable application of probiotics to hypoallergenic infant formula is the key research direction in the future. This paper discusses the mechanism and clinical symptoms of CMA in children. This review critically ex- amines the issue of how probiotics use intestinal flora as the main vector to combine with the immune system to exert physiological functions to intervene CMA in children, with a particular focus on four mechanisms: promoting the early establishment of intestinal microecological balance, regulating the body's immunity and alleviating allergic response, enhancing the intestinal mucosal barrier function, and destroying allergen epitopes. Additionally, it overviews the development process of hypoallergenic infant formula and the research progress of probiotics in hypoallergenic infant formula. The article also offers suggestions and outlines potential future research directions and ideas in this field.
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Affiliation(s)
- Mao Lin
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, College of Food and Health, Beijing Technology and Business University, Beijing, China
| | - Cong Yanjun
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, College of Food and Health, Beijing Technology and Business University, Beijing, China
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Yang N, Srivastava K, Chen Y, Li H, Maskey A, Yoo P, Liu X, Tiwari RK, Geliebter J, Nowak-Wegrzyn A, Zhan J, Li XM. Sustained silencing peanut allergy by xanthopurpurin is associated with suppression of peripheral and bone marrow IgE-producing B cell. Front Immunol 2024; 15:1299484. [PMID: 38380329 PMCID: PMC10876879 DOI: 10.3389/fimmu.2024.1299484] [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: 09/22/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Peanut allergy is an immunoglobulin E (IgE) mediated food allergy. Rubia cordifolia L. (R. cordifolia), a Chinese herbal medicine, protects against peanut-induced anaphylaxis by suppressing IgE production in vivo. This study aims to identify IgE-inhibitory compounds from the water extract of R. cordifolia and investigate the underlying mechanisms using in vitro and in vivo models. Methods Compounds were isolated from R. cordifolia water extract and their bioactivity on IgE production was assessed using a human myeloma U266 cell line. The purified active compound, xanthopurpurin (XPP), was identified by LC-MS and NMR. Peanut-allergic C3H/HeJ mice were orally administered with or without XPP at 200µg or 400µg per mouse per day for 4 weeks. Serum peanut-specific IgE levels, symptom scores, body temperatures, and plasma histamine levels were measured at challenge. Cytokines in splenocyte cultures were determined by ELISA, and IgE + B cells were analyzed by flow cytometry. Acute and sub-chronic toxicity were evaluated. IL-4 promoter DNA methylation, RNA-Seq, and qPCR analysis were performed to determine the regulatory mechanisms of XPP. Results XPP significantly and dose-dependently suppressed the IgE production in U266 cells. XPP significantly reduced peanut-specific IgE (>80%, p <0.01), and plasma histamine levels and protected the mice against peanut-allergic reactions in both early and late treatment experiments (p < 0.05, n=9). XPP showed a strong protective effect even 5 weeks after discontinuing the treatment. XPP significantly reduced the IL-4 level without affecting IgG or IgA and IFN-γ production. Flow cytometry data showed that XPP reduced peripheral and bone marrow IgE + B cells compared to the untreated group. XPP increased IL-4 promoter methylation. RNA-Seq and RT-PCR experiments revealed that XPP regulated the gene expression of CCND1, DUSP4, SDC1, ETS1, PTPRC, and IL6R, which are related to plasma cell IgE production. All safety testing results were in the normal range. Conclusions XPP successfully protected peanut-allergic mice against peanut anaphylaxis by suppressing IgE production. XPP suppresses murine IgE-producing B cell numbers and inhibits IgE production and associated genes in human plasma cells. XPP may be a potential therapy for IgE-mediated food allergy.
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Affiliation(s)
- Nan Yang
- R & D Division, General Nutraceutical Technology, LLC, Elmsford, NY, United States
| | - Kamal Srivastava
- R & D Division, General Nutraceutical Technology, LLC, Elmsford, NY, United States
| | - Yujuan Chen
- School of Life Science and Technology, Changchun University of Science and Technology, Changchun, Jilin, China
| | - Hang Li
- Central Lab, Shenzhen Bao’an Chinese Medicine Hospital, Shenzhen, China
| | - Anish Maskey
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
| | - Patrick Yoo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xiaohong Liu
- Department of Respiratory, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Raj K. Tiwari
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
| | - Jan Geliebter
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children’s Hospital, NYU Grossman School of Medicine, New York, NY, United States
| | - Jixun Zhan
- Department of Biological Engineering, Utah State University, Logan, UT, United States
| | - Xiu-Min Li
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
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Marrama D, Chronister WD, Westernberg L, Vita R, Koşaloğlu-Yalçın Z, Sette A, Nielsen M, Greenbaum JA, Peters B. PEPMatch: a tool to identify short peptide sequence matches in large sets of proteins. BMC Bioinformatics 2023; 24:485. [PMID: 38110863 PMCID: PMC10726511 DOI: 10.1186/s12859-023-05606-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Numerous tools exist for biological sequence comparisons and search. One case of particular interest for immunologists is finding matches for linear peptide T cell epitopes, typically between 8 and 15 residues in length, in a large set of protein sequences. Both to find exact matches or matches that account for residue substitutions. The utility of such tools is critical in applications ranging from identifying conservation across viral epitopes, identifying putative epitope targets for allergens, and finding matches for cancer-associated neoepitopes to examine the role of tolerance in tumor recognition. RESULTS We defined a set of benchmarks that reflect the different practical applications of short peptide sequence matching. We evaluated a suite of existing methods for speed and recall and developed a new tool, PEPMatch. The tool uses a deterministic k-mer mapping algorithm that preprocesses proteomes before searching, achieving a 50-fold increase in speed over methods such as the Basic Local Alignment Search Tool (BLAST) without compromising recall. PEPMatch's code and benchmark datasets are publicly available. CONCLUSIONS PEPMatch offers significant speed and recall advantages for peptide sequence matching. While it is of immediate utility for immunologists, the developed benchmarking framework also provides a standard against which future tools can be evaluated for improvements. The tool is available at https://nextgen-tools.iedb.org , and the source code can be found at https://github.com/IEDB/PEPMatch .
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Affiliation(s)
- Daniel Marrama
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - William D Chronister
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Luise Westernberg
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Randi Vita
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Zeynep Koşaloğlu-Yalçın
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
- University of California San Diego School of Medicine, La Jolla, San Diego, CA, USA
| | - Morten Nielsen
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jason A Greenbaum
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA
| | - Bjoern Peters
- Division of Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, San Diego, CA, USA.
- University of California San Diego School of Medicine, La Jolla, San Diego, CA, USA.
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Jorgensen R, Gao H, Arul Arasan TS, Van Antwerp C, Sundar V, Ng PKW, Gangur V. Is Wheat Glutenin Extract Intrinsically Allergenic? Evaluation Using a Novel Adjuvant-Free Mouse Model of Systemic Anaphylaxis. Int J Mol Sci 2023; 24:17247. [PMID: 38139075 PMCID: PMC10743909 DOI: 10.3390/ijms242417247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Wheat is a prominent allergenic food that can trigger life-threatening anaphylaxis. Presently, it remains unclear whether wheat glutenin (WG) extract possesses inherent sensitization potential independently, without the use of adjuvants, and whether it can sensitize mice to the extent of inducing life-threatening systemic anaphylaxis. In this study, we tested the hypothesis that repeated skin exposures to WG extract without adjuvant will sensitize mice with the resultant anaphylactic reaction upon systemic WG challenge. Balb/c mice were bred and maintained on a strict plant protein-free diet and were repeatedly exposed to a WG extract or vehicle once a week for 9 weeks. WG-specific (s)IgE and total (t)IgE levels were quantified. Mice were challenged with WG extract to induce anaphylactic reactions as measured by hypothermic shock response (HSR) and mucosal mast cell degranulation response (MMCR). We also conducted proteomic analysis of 120 spleen immune markers. These skin-sensitized mice exhibited exposure-dependent IgE responses and near-fatal anaphylaxis upon challenge. Proteomic analysis identified seven dramatically elevated immune biomarkers in anaphylactic mice. These data reveal that WG is intrinsically allergenic, and that chronic skin exposure to WG extract can prime the mice for potentially fatal anaphylaxis.
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Affiliation(s)
- Rick Jorgensen
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48823, USA; (R.J.); (H.G.); (T.S.A.A.); (C.V.A.); (V.S.)
| | - Haoran Gao
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48823, USA; (R.J.); (H.G.); (T.S.A.A.); (C.V.A.); (V.S.)
| | - Tamil Selvan Arul Arasan
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48823, USA; (R.J.); (H.G.); (T.S.A.A.); (C.V.A.); (V.S.)
| | - Chris Van Antwerp
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48823, USA; (R.J.); (H.G.); (T.S.A.A.); (C.V.A.); (V.S.)
| | - Vaisheswini Sundar
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48823, USA; (R.J.); (H.G.); (T.S.A.A.); (C.V.A.); (V.S.)
| | - Perry K. W. Ng
- Cereal Science Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48823, USA;
| | - Venu Gangur
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48823, USA; (R.J.); (H.G.); (T.S.A.A.); (C.V.A.); (V.S.)
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Worm M, Fox AT, Wickman M, Ring J, Ebisawa M, Pouessel G, Smith P. Adrenaline auto injectors pharmacokinetic/pharmacodynamic studies and potential consequences for clinical practice. Clin Transl Allergy 2023; 13:e12323. [PMID: 38146800 PMCID: PMC10728507 DOI: 10.1002/clt2.12323] [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: 07/07/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Anaphylaxis is a sudden multisystem allergic reaction which may result in a fatal outcome if not treated promptly. Guidelines worldwide suggest intramuscular adrenaline as the first-line treatment for anaphylaxis outside a perioperative reaction. Adrenaline autoinjectors (AAIs) are widely used self-administrable devices, especially in community settings. Different commercial AAIs have been authorized to be marketed in Europe. For an AAI to be efficacious, a rapid adrenaline delivery in patients, including those who are overweight or obese, resulting in an optimal cardiovascular (CV) response, is a key feature. AAIs are designed to achieve this requirement, which is reflected in their differing functional properties such as primary container selection, drug delivery mechanism (cartridge-or syringe-based), needle length, needle gauge, and adrenaline dose (150 μg, 300 μg, or 500 μg). However, the differences in functional properties across these devices may play a critical role in achieving these requirements as well as the differences in ergonomics in the handling of these devices. THE PURPOSE OF THIS REVIEW Considering the dynamic pharmacokinetic/pharmacodynamic (PK/PD) profiles of different AAIs marketed in Europe and their effect on adrenaline delivery, the expert panel, also serving as author for this paper have carried out a detailed analysis of the PK/PD profiles of four AAIs, namely, Anapen, Emerade, EpiPen, and Jext, to delineate the adrenaline delivery and their subsequent physiological effects on the backdrop of device characteristics, dose strength, and the skin-to-muscle distances of the participants.
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Affiliation(s)
- Margitta Worm
- Allergology and ImmunologyDepartment of Dermatology, Venereology and AllergologyCharité – UniversitätsmedizinBerlinGermany
| | - Adam T. Fox
- Children's Allergy ServiceGuy's & St Thomas' Hospitals NHS Foundation TrustLondonUK
| | - Magnus Wickman
- Department of Environmental medicineKarolinska InstitutetHedetorpSweden
| | - Johannes Ring
- Technical University Munich (TUM)Department Dermatology Allergology BiedersteinBerlinGermany
| | - Motohiro Ebisawa
- National Hospital OrganizationSagamihara National HospitalSagamiharaJapan
| | - Guillaume Pouessel
- Department of PediatricsAllergology UnitChildren's HospitalCH Roubaix and Pneumology and Allergology UnitChildren's hospitalLilleFrance
| | - Pete Smith
- Department of Clinical MedicineGriffith University School of MedicineSouthportQueenslandAustralia
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Shichkin VP, Kurchenko OV, Okhotnikova EN, Chopyak VV, Delfino DV. Enterosorbents in complex therapy of food allergies: a focus on digestive disorders and systemic toxicity in children. Front Immunol 2023; 14:1210481. [PMID: 37901242 PMCID: PMC10611465 DOI: 10.3389/fimmu.2023.1210481] [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: 04/22/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
The review analyzes mechanisms and concomitant factors in developing IgE-associated allergic diseases provoked by food allergens and discusses clinical symptoms and current approaches for the treatment of food allergies. The expediency of using enterosorbents in complex therapy of food allergies and skin and respiratory manifestations associated with gastroenterological disorders is substantiated. The review summarizes the experience of using enterosorbents in post-Soviet countries to detoxify the human body. In this regard, special attention is paid to the enterosorbent White Coal (Carbowhite) based on silicon dioxide produced by the Ukrainian company OmniFarma.
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Affiliation(s)
| | | | - Elena N. Okhotnikova
- Department of Pediatrics, Children’s Infectious Diseases, Immunology and Allergology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Valentyna V. Chopyak
- Department of Clinical Immunology and Allergology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Domenico V. Delfino
- Master in Musculoskeletal and Rheumatological Physiotherapy, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Firtin E, Turan I, Ozceker D, Buyuktiryaki B, Hancioglu G, Ulas S, Naiboglu S, Aydogmus C, Sancak R, Celiksoy MH. Risk factors predisposing children to food allergies. Allergol Immunopathol (Madr) 2023; 51:72-83. [PMID: 37695233 DOI: 10.15586/aei.v51i5.937] [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: 06/12/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Food allergies are the most common cause of anaphylaxis in children, and their incidence is increasing globally. The aim of this study was to determine the risk factors leading to food allergies in childhood. METHODS Children with food allergies and non-atopic healthy children were compared using a questionnaire that included prenatal, neonatal, and postnatal risk factors. RESULTS A total of 314 subjects, 155 patients and 159 healthy children for the control group, were enrolled in the study. The median age of patients with a food allergy at diagnosis was 6 months (1-156 months), and 71 patients (45.8%) were males. The median age of the control group was 12 months (1-61 months), and 67.0% were males. Older maternal age (P = 0.023), birth by caesarean section (P = 0.001), birth in the summer or autumn (P = 0.011), crowded housing (P = 0.001), damp houses (P = 0.001), being fed with breast milk and complementary food (P = 0.001), use of synthetic bedding (P = 0.024), and being the oldest child in the family (P = 0.001) were the considered risk factors for an immunoglobulin-E (IgE)-mediated food allergy. A low frequency of yoghurt consumption by mother (P = 0.001) and use of wool bedding (P = 0.018) were identified as risk factors for non-IgE-mediated food allergies. Low socioeconomic status (P = 0.001) played a protective role against both IgE- and non-IgE-mediated food allergies whereas breastfeeding played a protective role against IgE-mediated food allergies (P = 0.030). CONCLUSION The most important aspect of this study was that it separately identified prenatal, neonatal, and postnatal risk factors for IgE- and non-IgE-mediated food allergies.
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Affiliation(s)
- Ecem Firtin
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Isılay Turan
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Department of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Deniz Ozceker
- University of Health Sciences, Cemil Tascioglu City Hospital, Department of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Betul Buyuktiryaki
- Koc University, Medical Faculty, Department of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Gonca Hancioglu
- Ondokuz Mayis University, Medical Faculty, Department of Pediatric Allergy and Immunology, Samsun, Turkey
| | - Selami Ulas
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Department of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Sezin Naiboglu
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Department of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Ciğdem Aydogmus
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Department of Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Recep Sancak
- Ondokuz Mayis University, Medical Faculty, Department of Pediatric Allergy and Immunology, Samsun, Turkey
| | - Mehmet Halil Celiksoy
- University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Department of Pediatric Allergy and Immunology, Istanbul, Turkey;
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Iddagoda J, Gunasekara P, Handunnetti S, Jeewandara C, Karunatilake C, Malavige GN, de Silva R, Dasanayake D. Identification of allergens in Artocarpus heterophyllus, Moringa oleifera, Trianthema portulacastrum and Syzygium samarangense. Clin Mol Allergy 2023; 21:6. [PMID: 37568224 PMCID: PMC10416484 DOI: 10.1186/s12948-023-00187-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND It is clinically important to identify allergens in Artocarpus heterophyllus (jackfruit), Moringa oleifera (moringa), Trianthema portulacastrum (horse purslane) and Syzygium samarangense (rose apple). This study included 7 patients who developed anaphylaxis to jackfruit (1), moringa (2), horse purslane (3) and rose apple (1). We sought to determine allergens in the edible ripening stages of jackfruit (tender, mature, and ripened jackfruit) and seeds, edible parts of moringa (seeds, seedpod, flesh inside seedpod, and leaves), horse purslane leaves and ripened rose apple fruit. The persistence of the allergens after cooking was also investigated. METHODS Allergens were identified by clinical history followed by a skin prick test. Protein profiles of plant/fruit crude protein extracts were determined by SDS-PAGE. Molecular weights of the allergens were determined by immunoblotting with patient sera. RESULTS A heat-stable allergen of 114 kDa in A. heterophyllus which is shared among different ripening stages and seeds was identified. Additionally, 101 kDa allergen in boiled tender jackfruit, 86 kDa allergen in boiled seeds and 80 kDa allergen in boiled mature jackfruit were identified. Five heat-stable allergens of 14, 23, 35, 43, and 48 kDa in M. oleifera, 1 heat-stable allergen of 97 kDa in T. portulacastrum, and 4 allergens of 26, 31. 60, and 82 kDa in S. samarangense were identified. CONCLUSION Novel IgE-sensitive proteins of A. heterophyllus, M. oleifera, T. portulacastrum and S. samarangense were identified which would be especially useful in the diagnosis of food allergies. The identified allergens can be used in Component Resolved Diagnostics (CRD).
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Affiliation(s)
- Janitha Iddagoda
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka.
| | - Peshala Gunasekara
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - Shiroma Handunnetti
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | - Chandima Jeewandara
- Allergy, Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Gathsaurie Neelika Malavige
- Allergy, Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Rajiva de Silva
- Department of Immunology, Medical Research Institute, Colombo, Sri Lanka
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Management of Anaphylaxis During Peanut Oral Immunotherapy. Curr Allergy Asthma Rep 2023; 23:21-27. [PMID: 36445653 DOI: 10.1007/s11882-022-01054-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peanut oral immunotherapy (POIT) has emerged as an active management option for peanut allergy, with an FDA-approved product now available for therapy. Allergic reactions, including anaphylaxis, can occur during therapy and their management is key in optimizing this treatment and patient outcomes. PURPOSE OF REVIEW In this manuscript, we will review the rates of allergic reactions and anaphylaxis in seminal peanut oral immunotherapy research studies. We will examine factors that can alter the risk of anaphylaxis and describe various strategies, including adjunct therapies, that have the potential to mitigate anaphylaxis risk based on published evidence. RECENT FINDINGS Rates of anaphylaxis and epinephrine administration vary in different research studies, but there is consensus that most POIT-related allergic reactions are mild or moderate and not severe. Certain external factors (for example, tiredness, exercise, viral illness) as well as uncontrolled allergic co-morbidities (asthma, allergic rhinitis) have been shown to increase the risk of anaphylaxis during OIT. The search of biomarkers who may predict who is at risk for severe allergic reactions is ongoing. Adjunct therapies have shown promise, but further studies are required to optimize their use alongside POIT. Our understanding of anaphylaxis during POIT has increased in recent years, resulting in better management strategies. However, future plans will need to involve all stakeholders, including physicians, patients and families, researchers, public health authorities, and the food, hospitality, and catering industries.
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Pezeshki PS, Nowroozi A, Razi S, Rezaei N. Asthma and Allergy. Clin Immunol 2023. [DOI: 10.1016/b978-0-12-818006-8.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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12
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Appearance of food-dependent exercise-induced anaphylaxis as an inflammatory disease: a pediatric case report and differential diagnosis. Allergol Immunopathol (Madr) 2023; 51:52-58. [PMID: 36916088 DOI: 10.15586/aei.v51i2.769] [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: 09/04/2022] [Accepted: 11/25/2022] [Indexed: 03/08/2023]
Abstract
Anaphylaxis is the most serious of all allergic reactions. Despite advances in the knowledge of anaphylaxis, its clinical manifestations continue to be under-recognized. Indeed, proper diagnosis of anaphylaxis is often missed, and the treatment is delayed. The underlying causes are still under investigation globally. Inflammation represents the cornerstone of pathophysiology of anaphylaxis. Food-dependent exercise-induced anaphylaxis (FDEIA) is a rare clinical manifestation characterized by a chronological sequence in which food ingestion followed by physical exercise leads to anaphylaxis. Its mechanisms are yet to be fully explained. We report the case of a 14-year-old Chinese male who lost consciousness while undergoing physical activity at school. Several differential diagnoses were considered such as hypovolemic shock, septic shock, anaphylactic shock or neurological adverse event. Finally, the diagnosis of FDEIA was made. This case highlights the difficulties in diagnosing FDEIA and its management, especially when the clinical history is not complete and detailed.
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13
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Yang N, Maskey AR, Srivastava K, Kim M, Wang Z, Musa I, Shi Y, Gong Y, Fidan O, Wang J, Dunkin D, Chung D, Zhan J, Miao M, Sampson HA, Li XM. Inhibition of pathologic immunoglobulin E in food allergy by EBF-2 and active compound berberine associated with immunometabolism regulation. Front Immunol 2023; 14:1081121. [PMID: 36825019 PMCID: PMC9941740 DOI: 10.3389/fimmu.2023.1081121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/02/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Food allergy is a significant public health problem with limited treatment options. As Food Allergy Herbal Formula 2 (FAHF-2) showed potential as a food allergy treatment, we further developed a purified version named EBF-2 and identified active compounds. We investigated the mechanisms of EBF-2 on IgE-mediated peanut (PN) allergy and its active compound, berberine, on IgE production. Methods IgE plasma cell line U266 cells were cultured with EBF-2 and FAHF-2, and their effects on IgE production were compared. EBF-2 was evaluated in a murine PN allergy model for its effect on PN-specific IgE production, number of IgE+ plasma cells, and PN anaphylaxis. Effects of berberine on IgE production, the expression of transcription factors, and mitochondrial glucose metabolism in U266 cells were evaluated. Results EBF-2 dose-dependently suppressed IgE production and was over 16 times more potent than FAHF-2 in IgE suppression in U266 cells. EBF-2 significantly suppressed PN-specific IgE production (70%, p<0.001) and the number of IgE-producing plasma cells in PN allergic mice, accompanied by 100% inhibition of PN-induced anaphylaxis and plasma histamine release (p<0.001) without affecting IgG1 or IgG2a production. Berberine markedly suppressed IgE production, which was associated with suppression of XBP1, BLIMP1, and STAT6 transcription factors and a reduced rate of mitochondrial oxidation in an IgE-producing plasma cell line. Conclusions EBF-2 and its active compound berberine are potent IgE suppressors, associated with cellular regulation of immunometabolism on IgE plasma cells, and may be a potential therapy for IgE-mediated food allergy and other allergic disorders.
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Affiliation(s)
- Nan Yang
- General Nutraceutical Technology, Elmsford, NY, United States.,Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
| | - Anish R Maskey
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
| | - Kamal Srivastava
- General Nutraceutical Technology, Elmsford, NY, United States.,Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
| | - Monica Kim
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zixi Wang
- Department of Allergy, Peking Union Medical College Hospital, Beijing, China
| | - Ibrahim Musa
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States
| | - Yanmei Shi
- Academy of Chinese Medicine Sciences, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Yixuan Gong
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ozkan Fidan
- Department of Biological Engineering, Utah State University, Logan, UT, United States.,Department of Bioengineering, Abdullah Gul University, Kayseri, Türkiye
| | - Julie Wang
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David Dunkin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Danna Chung
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jixun Zhan
- Department of Biological Engineering, Utah State University, Logan, UT, United States
| | - Mingsan Miao
- Academy of Chinese Medicine Sciences, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xiu-Min Li
- Department of Pathology, Microbiology and Immunology, New York Medical College, Valhalla, NY, United States.,Department of Otolaryngology, New York Medical College, Valhalla, NY, United States
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14
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Sandhu S, Hanono M, Nagarajan S, Vastardi MA. Knowledge Assessment of Early Peanut Introduction in a New York City Population. Ann Allergy Asthma Immunol 2022; 129:380-382. [PMID: 35728745 DOI: 10.1016/j.anai.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Sumeet Sandhu
- Division of Allergy and Immunology at Center for Allergy and Asthma Research, SUNY, Brooklyn Health Sciences University, Brooklyn, NY, USA; Department of Pediatrics at SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Monique Hanono
- Department of Pediatrics at SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Sairaman Nagarajan
- Division of Allergy and Immunology at Center for Allergy and Asthma Research, SUNY, Brooklyn Health Sciences University, Brooklyn, NY, USA
| | - Maria-Anna Vastardi
- Division of Allergy and Immunology at Center for Allergy and Asthma Research, SUNY, Brooklyn Health Sciences University, Brooklyn, NY, USA; Department of Pediatrics at SUNY Downstate Medical Center, Brooklyn, NY, USA
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15
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Elghoudi A, Narchi H. Food allergy in children—the current status and the way forward. World J Clin Pediatr 2022; 11:253-269. [PMID: 35663006 PMCID: PMC9134150 DOI: 10.5409/wjcp.v11.i3.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Food allergy in children is a major health concern, and its prevalence is rising. It is often over-diagnosed by parents, resulting occasionally in unnecessary exclusion of some important food. It also causes stress, anxiety, and even depression in parents and affects the family’s quality of life. Current diagnostic tests are useful when interpreted in the context of the clinical history, although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations. Although the oral food challenge is the current gold standard for making the diagnosis, it is only available to a small number of patients because of its requirement in time and medical personnel. New diagnostic methods have recently emerged, such as the Component Resolved Diagnostics and the Basophil Activation Test, but their use is still limited, and the latter lacks standardisation. Currently, there is no definite treatment available to induce life-long natural tolerance and cure for food allergy. Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food, usually taken by accident. New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy. If standardised and widely implemented, this may result in decreasing the prevalence of food allergy.
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Affiliation(s)
- Ahmed Elghoudi
- Paediatric Department, Sheikh Khalifa Medical City, Abu Dhabi NA, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
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16
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Dribin TE, Schnadower D, Wang J, Camargo CA, Michelson KA, Shaker M, Rudders SA, Vyles D, Golden DB, Spergel JM, Campbell RL, Neuman MI, Capucilli PS, Pistiner M, Castells M, Lee J, Brousseau DC, Schneider LC, Assa’ad AH, Risma KA, Mistry RD, Campbell DE, Worm M, Turner PJ, Witry JK, Zhang Y, Sobolewski B, Sampson HA. Anaphylaxis knowledge gaps and future research priorities: A consensus report. J Allergy Clin Immunol 2022; 149:999-1009. [PMID: 34390722 PMCID: PMC8837706 DOI: 10.1016/j.jaci.2021.07.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/23/2021] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite a better understanding of the epidemiology, pathogenesis, and management of patients with anaphylaxis, there remain knowledge gaps. Enumerating and prioritizing these gaps would allow limited scientific resources to be directed more effectively. OBJECTIVE We sought to systematically describe and appraise anaphylaxis knowledge gaps and future research priorities based on their potential impact and feasibility. METHODS We convened a 25-member multidisciplinary panel of anaphylaxis experts. Panelists formulated knowledge gaps/research priority statements in an anonymous electronic survey. Four anaphylaxis themed writing groups were formed to refine statements: (1) Population Science, (2) Basic and Translational Sciences, (3) Emergency Department Care/Acute Management, and (4) Long-Term Management Strategies and Prevention. Revised statements were incorporated into an anonymous electronic survey, and panelists were asked to rate the impact and feasibility of addressing statements on a continuous 0 to 100 scale. RESULTS The panel generated 98 statements across the 4 anaphylaxis themes: Population Science (29), Basic and Translational Sciences (27), Emergency Department Care/Acute Management (24), and Long-Term Management Strategies and Prevention (18). Median scores for impact and feasibility ranged from 50.0 to 95.0 and from 40.0 to 90.0, respectively. Key statements based on median rating for impact/feasibility included the need to refine anaphylaxis diagnostic criteria, identify reliable diagnostic, predictive, and prognostic anaphylaxis bioassays, develop clinical prediction models to standardize postanaphylaxis observation periods and hospitalization criteria, and determine immunotherapy best practices. CONCLUSIONS We identified and systematically appraised anaphylaxis knowledge gaps and future research priorities. This study reinforces the need to harmonize scientific pursuits to optimize the outcomes of patients with and at risk of anaphylaxis.
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Affiliation(s)
- Timothy E. Dribin
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julie Wang
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kenneth A. Michelson
- Division of Emergency Medicine, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine, and Dartmouth-Hitchcock Medical Center, Hanover and Lebanon, NH
| | - Susan A. Rudders
- Division of Immunology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David Vyles
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - David B.K. Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan M. Spergel
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | | | - Mark I. Neuman
- Division of Emergency Medicine, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Michael Pistiner
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA
| | - Mariana Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Juhee Lee
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - David C. Brousseau
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Lynda C. Schneider
- Division of Immunology, Boston Children’s Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Amal H. Assa’ad
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kimberly A. Risma
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rakesh D. Mistry
- Section of Emergency Medicine, Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO
| | - Dianne E. Campbell
- Sydney Medical School, University of Sydney, Sydney, Australia,Department of Allergy and Immunology, Children’s Hospital at Westmead, Sydney, Australia
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charite-Universitätsmedizin Berlin, Germany
| | - Paul J. Turner
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - John K. Witry
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Yin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Brad Sobolewski
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Hugh A. Sampson
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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17
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Wen PW, Tu ZC, Hu YM, Wang H. Effects of Superheated Steam Treatment on the Allergenicity and Structure of Chicken Egg Ovomucoid. Foods 2022; 11:foods11020238. [PMID: 35053970 PMCID: PMC8774878 DOI: 10.3390/foods11020238] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to explore the effects of an emerging and efficient heating technology, superheated steam (SS), on the allergenicity and molecular structure of ovomucoid (OVM). OVM was treated with 120–200 °C of SS for 2 to 10 min. The allergenicity (IgG/IgE binding abilities and cell degranulation assay) and molecular structure (main functional groups and amino acids modification) changes were investigated. The IgG-binding ability of OVM decreased and the releases of β-hex and TNF-γ were inhibited after SS treatment, indicating that the protein allergenicity was reduced. Significant increases in oxidation degree, free SH content and surface hydrophobicity were observed in SS-treated OVM. The protein dimer and trimer appeared after SS treatment. Meanwhile, obvious changes occurred in the primary structure. Specifically, serine can be readily modified by obtaining functional groups from other modification sites during SS treatment. Moreover, the natural OVM structure which showed resistance to trypsin digestion was disrupted, leading to increased protein digestibility. In conclusion, SS-induced OVM aggregation, functional groups and amino acids modifications as well as protein structure alteration led to reduced allergenicity and increased digestibility.
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Affiliation(s)
- Ping-Wei Wen
- National R&D Branch Center for Conventional Freshwater Fish Processing, College of Chemistry and Chemical Engineering, Jiangxi Normal University, Nanchang 330022, China;
- Engineering Research Center of Freshwater Fish High-Value Utilization of Jiangxi Province, Jiangxi Normal University, Nanchang 330022, China
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; (Y.-M.H.); (H.W.)
| | - Zong-Cai Tu
- National R&D Branch Center for Conventional Freshwater Fish Processing, College of Chemistry and Chemical Engineering, Jiangxi Normal University, Nanchang 330022, China;
- Engineering Research Center of Freshwater Fish High-Value Utilization of Jiangxi Province, Jiangxi Normal University, Nanchang 330022, China
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; (Y.-M.H.); (H.W.)
- Correspondence: ; Tel.: +86-791-8812-1868; Fax: +86-791-8830-5938
| | - Yue-Ming Hu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; (Y.-M.H.); (H.W.)
| | - Hui Wang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China; (Y.-M.H.); (H.W.)
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18
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Yousef E, Korotkaya Y, Simpson AB. Eosinophilic esophagitis in children: Updates and practical aspects of management for allergists in a non-tertiary care private practice setup. Allergy Asthma Proc 2022; 43:5-11. [PMID: 34983704 DOI: 10.2500/aap.2022.43.210084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Eosinophilic esophagitis (EoE) is a chronic immune and/or antigen-mediated disease characterized by eosinophilic infiltration of mucosa (≥15 eosinophils per high power field) without any secondary etiology. Non-immunoglobulin E mediated mechanisms predominate in EoE. Objective: This review concentrated on a stepwise approach for the allergist working in non-tertiary care private practice. Methods: A medical literature search that focused on several areas of the latest developments in the diagnosis and management of EoE was conducted. Results: There has been a steady increase in the prevalence and incidence of EoE. Clinical symptoms can vary from dysphagia to failure to thrive, depending on the age at presentation; some children develop adaptive behaviors to compensate for dysphagia, such as food preferences and slow eating. The diagnosis is based on a high index of clinical suspicion and is confirmed with endoscopy with biopsies after ruling out other causes of esophageal eosinophilia. Treatment options may include dietary therapy, pharmacologic therapies, or combination therapy. Therapeutic options may also include endoscopic dilation for stricturing disease. Conclusion: Providers should be aware of recent recommendation changes in the diagnostic workup, the role of skin-prick testing, and role of the proton-pump inhibitor as first-line therapy for EoE. Also, clinicians should be aware of the emerging role of empiric dietary therapy as a preferable therapeutic option when compared with the testing-directed diet and the elemental diet. Furthermore, topical glucocorticoid therapies are available, and new developing therapies are being investigated. Reevaluation of esophageal mucosa with biopsies is required approximately 2 months after therapy for a response and after a change in therapies to confirm continued resolution.
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Affiliation(s)
- Ejaz Yousef
- From the Divisions of Allergy/Immunology and Pediatric Gastroentrology, Nemours Children Specialty Care, Jacksonville, Florida; and
| | - Yelena Korotkaya
- From the Divisions of Allergy/Immunology and Pediatric Gastroentrology, Nemours Children Specialty Care, Jacksonville, Florida; and
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19
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Zhernov YV, Vysochanskaya SO, Sukhov VA, Zaostrovtseva OK, Gorshenin DS, Sidorova EA, Mitrokhin OV. Molecular Mechanisms of Eosinophilic Esophagitis. Int J Mol Sci 2021; 22:ijms222413183. [PMID: 34947981 PMCID: PMC8703627 DOI: 10.3390/ijms222413183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 12/19/2022] Open
Abstract
Food hypersensitivity is a group of diseases arising from a specific immune response that reproduces on exposure to a given food. The current understanding of molecular mechanisms and immunopathology of non-IgE-mediated/mixed food hypersensitivity, e.g., eosinophilic esophagitis, contains many gaps in knowledge. This review aims to provide a modern classification and identify the primary diseases of non-IgE-mediated/mixed food hypersensitivity reactions, delineate the distinctive molecular features, and discuss recent findings in the immunopathology of eosinophilic esophagitis that may become a basis to develop valid biomarkers and novel therapies for this disease. Eosinophilic esophagitis is a recently recognized allergic-mediated disease with eosinophil-predominant esophagus inflammation. Its pathogenesis is a complicated network of interactions and signaling between epithelial, mesenchymal, and immune cells on molecular and intercellular levels. Alterations produced by overactivation of some cytokine signaling pathways, e.g., IL-13 or thymic stromal lymphopoietin (TSLP), were evolved and observed in this review from the viewpoints of molecular, genetic, epigenetic, and transcriptomic changes. Despite substantial experimental data, the reliable and representative mechanism of eosinophilic esophagitis pathogenesis has yet to show itself. So, the place of esophagitis between mixed and non-IgE-mediated allergic disorders and between eosinophilic gastrointestinal disorders currently seems vague and unclear.
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Affiliation(s)
- Yury V. Zhernov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (S.O.V.); (V.A.S.); (O.K.Z.); (D.S.G.); (E.A.S.); (O.V.M.)
- Department of Chemistry, Lomonosov Moscow State University, 119991 Moscow, Russia
- Correspondence: ; Tel.: +7-(915)-1552000
| | - Sonya O. Vysochanskaya
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (S.O.V.); (V.A.S.); (O.K.Z.); (D.S.G.); (E.A.S.); (O.V.M.)
| | - Vitaly A. Sukhov
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (S.O.V.); (V.A.S.); (O.K.Z.); (D.S.G.); (E.A.S.); (O.V.M.)
| | - Olga K. Zaostrovtseva
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (S.O.V.); (V.A.S.); (O.K.Z.); (D.S.G.); (E.A.S.); (O.V.M.)
| | - Denis S. Gorshenin
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (S.O.V.); (V.A.S.); (O.K.Z.); (D.S.G.); (E.A.S.); (O.V.M.)
| | - Ekaterina A. Sidorova
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (S.O.V.); (V.A.S.); (O.K.Z.); (D.S.G.); (E.A.S.); (O.V.M.)
| | - Oleg V. Mitrokhin
- Department of General Hygiene, F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia; (S.O.V.); (V.A.S.); (O.K.Z.); (D.S.G.); (E.A.S.); (O.V.M.)
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20
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Ming Zhuo C, Liu C, Srivastava KD, Lin A, Lazarski C, Wang L, Maskey A, Song Y, Chen X, Yang N, Zambrano L, Bushko R, Nowak-Wegrzyn A, Cox A, Liu Z, Huang W, Dunkin D, Miao M, Li XM. Anti-IgE Effect of Small-Molecule-Compound Arctigenin on Food Allergy in association with a Distinct Transcriptome Profile. Clin Exp Allergy 2021; 52:250-264. [PMID: 34757674 DOI: 10.1111/cea.14048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Excessive production of IgE plays a major role in the pathology of food allergy. In an attempt to identify anti-IgE natural products, Arctium Lappa was one of the most effective herbs among approximately 300 screened medicinal herbs. However, little is known about its anti-IgE compounds. OBJECTIVE To identify compounds from Arctium Lappa for targeted therapy on IgE production and explore their underlying mechanisms. METHODS Liquid-liquid extraction and column chromatographic methods were used to purify the compounds. IgE inhibitory effects were determined on IgE producing human myeloma U266 cells, peanut-allergic murine model, and PBMCs from food-allergic patients. Genes involved in IgE inhibition in PBMCs were studied by RNA sequencing. RESULTS The main compounds isolated were identified as arctiin and arctigenin. Both compounds significantly inhibited IgE production in U266 cells, with arctigenin the most potent (IC50=5.09μg/mL). Arctigenin (at a dose of 13.3 mg/kg) markedly reduced peanut-specific IgE levels, blocked hypothermia and histamine release in a peanut-allergic mouse model. Arctigenin also significantly reduced IgE production and Th2 cytokines (IL5, IL13) by PBMCs. We found 479 differentially expressed genes in PBMCs with arctigenin treatment (p<0.001 and fold-change ≥1.5), involving 24 gene ontology terms (p<0.001, FDR <0.05); cell division was the most significant. Eleven genes including UBE2C and BCL6 were validated by qPCR. CONCLUSION Arctigenin markedly inhibited IgE production in U266 cells, peanut allergic murine model and PBMCs from allergic patients by down-regulating cell division, cell cycle-related genes and up-regulating anti-inflammatory factors.
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Affiliation(s)
- Cao Ming Zhuo
- Academy of Chinese Medicine Science, Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, China
| | - Changda Liu
- Academy of Chinese Medicine Science, Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, China.,Pediatric Department, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Kamal D Srivastava
- Department of Microbiology and Immunology, New York Medical College, New York, NY, 10595, USA.,General Nutraceutical Technology LLC, Elmsford, NY, 10523, USA
| | - Adora Lin
- Center for Cancer and Immunology Research, Children's National Research Institute, Washington, DC, 20010, USA
| | - Christopher Lazarski
- Center for Cancer and Immunology Research, Children's National Research Institute, Washington, DC, 20010, USA
| | - Lu Wang
- Center for Cancer and Immunology Research, Children's National Research Institute, Washington, DC, 20010, USA
| | - Anish Maskey
- Department of Microbiology and Immunology, New York Medical College, New York, NY, 10595, USA
| | - Ying Song
- Academy of Chinese Medicine Science, Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, China.,Pediatric Department, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Xiaoke Chen
- Pediatric Department, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA.,Department of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Nan Yang
- Department of Microbiology and Immunology, New York Medical College, New York, NY, 10595, USA.,General Nutraceutical Technology LLC, Elmsford, NY, 10523, USA
| | - Linda Zambrano
- Pediatric Department, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Renna Bushko
- Pediatric Department, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, Hassenfeld Children's Hospital, New York University Grossman School of Medicine, New York, NY, 10029, USA.,Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Amanda Cox
- Pediatric Department, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Zhigang Liu
- Department of Immunology, the First Affiliated Hospital of Shen Zhen University, Shenzhen, China, 518116
| | - Weihua Huang
- Department of Pathology, New York Medical College, New York, NY, 10595, USA
| | - David Dunkin
- Pediatric Department, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Mingsan Miao
- Academy of Chinese Medicine Science, Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, China
| | - Xiu-Min Li
- Department of Microbiology and Immunology, New York Medical College, New York, NY, 10595, USA.,Department of Otolaryngology, New York Medical College, New York, NY, 10595, USA
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21
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Yang LGL, Brewster RK, Donnell MT, Hirani RN. Risk characterisation of milk protein contamination in milk-alternative ice cream products sold as frozen desserts in the United States. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2021; 39:1-13. [PMID: 34732089 DOI: 10.1080/19440049.2021.1989496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Milk protein is recognised as one of the eight most common food allergens in the United States, and one of the most common causes of fatal or near-fatal food-induced anaphylactic reactions globally. Undeclared allergens in food products are the leading cause of the U.S. Food and Drug Administration (FDA) requests for food recalls, with undeclared milk protein as the most frequently cited allergen. The purpose of this study was to evaluate the prevalence of milk protein contamination in milk-alternative ice cream products sold as frozen dessert in the U.S. and labelled as 'non-dairy', 'dairy-free', and/or 'vegan', and to characterise the potential risk for allergic individuals consuming these products. Thirty-two unique milk-alternative frozen dessert products, including flavours with and without inclusions, from 16 different brands, were tested for the presence of milk proteins using enzyme-linked immunosorbent assay. Milk protein was detected in three of the tested products: two contained solid inclusions, and one did not have inclusions. One of the three products with detectable milk protein had an advisory statement indicating the product was made in a facility that processed milk. Although no consensus exists as to the minimal dose of milk protein necessary to elicit an adverse effect in a milk-sensitised individual, the milk protein quantities in one serving of each of the three products exceeded some of the published thresholds. These results suggest that one serving of certain milk-alternative frozen dessert products could potentially elicit an allergic response in highly sensitive individuals.
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22
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Honjoya S, Cottel N, Saf S, Just J, Bidat E, Benoist G. Allergie au sésame : revue générale. REVUE FRANÇAISE D'ALLERGOLOGIE 2021. [DOI: 10.1016/j.reval.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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The Risk Reduction of Accidental Exposure-Related Systemic Allergic Reactions Extrapolated Based on Food Challenge Data After 1 Year of Peanut Oral Immunotherapy. Adv Ther 2021; 38:4321-4332. [PMID: 34236672 PMCID: PMC8264172 DOI: 10.1007/s12325-021-01843-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/23/2021] [Indexed: 01/28/2023]
Abstract
Introduction The phase 3 trial PALISADE, comparing peanut (Arachis hypogaea) allergen powder-dnfp (PTAH) oral immunotherapy versus placebo in peanut-allergic children, reported that a significantly higher percentage of PTAH-treated participants tolerated higher doses of peanut protein after 1 year of treatment. This study used PALISADE data to estimate the reduction in the risk of systemic allergic reaction (SAR) after accidental exposure following 1 year of PTAH treatment. Methods Participants (aged 4–17 years) enrolled in PALISADE were included. Parametric interval-censoring survival analysis with the maximum likelihood estimation was used to construct a real-world distribution of peanut protein exposure using lifetime SAR history and highest tolerated dose (HTD) from a double-blind, placebo-controlled food challenge conducted at baseline. The SAR risk reduction was extrapolated using the exposure distribution and the HTD were collected at baseline and trial exit for PTAH- and placebo-treated participants. Results Assuming a maximum peanut protein intake of 1500 mg, participants were estimated to have < 1% probability of ingesting > 0.01 mg during daily life. The mean annual SAR risk at trial entry was 9.25–9.98%. At trial exit, the relative SAR risk reduction following accidental exposure was 94.9% for PTAH versus 6.4% for placebo. For PTAH-treated participants with exit HTD of 600 or 1000 mg without dose-limiting symptoms, the SAR risk reduction increased to 97.2%. The result was consistent in the sensitivity analysis across different parametric distributions. Conclusion Oral immunotherapy with PTAH is expected to result in a substantially greater reduction in risk of SAR following accidental exposure compared to placebo among children with peanut allergy. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01843-2.
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D'Errico S, Santurro A, Scopetti M, Frati P, Fineschi V. Fatal food-induced anaphylaxis: Determination of tryptase and specific IgE on cadaveric blood samples. What else for a better methodological standard? Int J Immunopathol Pharmacol 2021; 34:2058738420950579. [PMID: 33016835 PMCID: PMC7543114 DOI: 10.1177/2058738420950579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Post-mortem investigation in cases of fatal anaphylaxis is required to provide
clarifications on the presence of macroscopic pathological changes, histological
features, and immunohistochemical positivity suggestive of the diagnosis, on
biochemical evidence of anaphylaxis and on the presence of serological data
indicative of the allergen responsible for the anaphylactic reaction. We
describe the case of a 16-year-old boy with a medical history of allergic
asthma, celiac disease, and known food-induced allergy for fish, fresh milk,
peanuts, hazelnuts, walnuts, apples, kiwis, and peaches. Acute onset of dyspnea
followed by cyanosis of the lips and respiratory failure was described
immediately after having an ice cream sandwich. Unsuccessful rescues were
immediately attempted with oral administration of betamethasone, intramuscular
injection of adrenaline, and cardiopulmonary resuscitation. A complete
post-mortem examination was performed. Serum dosage of mast cell beta-tryptase
from femoral blood detecting serum values of 41.4 mg/l. Determination of
specific IgE on cadaveric blood samples confirmed the anamnestic data related to
sensitization for several food allergens, including cod parvalbumin,
tropomyosin, brazil nut, omega-5-gliadin of foods derived from wheat and gluten.
The cause of death was identified in a cardiorespiratory failure due to
anaphylactic shock in a poly-allergic subject and anaphylaxis was ascribed to
the wheat contained in the ice cream sandwich eaten immediately before the onset
of respiratory symptoms. The need is to implement an interdisciplinary approach
capable to ascertain the sensitivity and specificity of the diagnostic tests
currently in use as well as to evaluate the possibility of introducing new
biomarkers in practice.
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Affiliation(s)
- Stefano D'Errico
- Legal Medicine Division, Sant'Andrea University Hospital, Rome, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
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Wang LT, Lv MJ, An JY, Fan XH, Dong MZ, Zhang SD, Wang JD, Wang YQ, Cai ZH, Fu YJ. Botanical characteristics, phytochemistry and related biological activities of Rosa roxburghii Tratt fruit, and its potential use in functional foods: a review. Food Funct 2021; 12:1432-1451. [PMID: 33533385 DOI: 10.1039/d0fo02603d] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Due to the growing global population, reduction in arable land and effects of climate change, incongruity between food supply and demand has become increasingly severe. Nowadays, with awareness of the elementary nutrients required for human growth, increasing attention is being paid to the health and medical functions of food. Along with increased food production achieved by modern agricultural techniques, underutilised functional foods are an important strategy for solving food security problems and maintaining the nutritional quality of the human diet. Rosa roxburghii Tratt (RRT) is a natural fruit that contains unique functional and nutritional constituents, which are characterised by a high anti-oxidant potential. This review summarises the biological characteristics, chemical composition, health-promoting properties and development status of RRT products to inspire investigations on the use of RRT fruit as a functional food, dietary supplement and pharmaceutical additive. The nutrients and functional ingredients of RRT fruit are described in detail to provide more reference information for nutritionists and pharmacists.
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Affiliation(s)
- Li-Tao Wang
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Mu-Jie Lv
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Juan-Yan An
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Xiao-Hong Fan
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Ming-Zhu Dong
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Sun-Dong Zhang
- Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, 150040, Harbin, PR China
| | - Jian-Dong Wang
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Yan-Qiu Wang
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Zi-Hui Cai
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China.
| | - Yu-Jie Fu
- The College of Forestry, Beijing Forestry University, 100083, Beijing, PR China. and Laboratory of Forest Plant Ecology, Ministry of Education, Northeast Forestry University, 150040, Harbin, PR China and Advanced Innovation Center for Tree Breeding by Molecular Design, Beijing Forestry University, 100083, Beijing, PR China
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Selvaraj G, Kaliamurthi S, Peslherbe GH, Wei DQ. Are the Allergic Reactions of COVID-19 Vaccines Caused by mRNA Constructs or Nanocarriers? Immunological Insights. Interdiscip Sci 2021; 13:344-347. [PMID: 34021862 PMCID: PMC8140554 DOI: 10.1007/s12539-021-00438-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
The Food and Drug Administration (FDA) has recently authorized the two messenger RNA (mRNA) vaccines BNT162b2 and mRNA-1273 for emergency use against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing the COVID-19 coronavirus disease. BNT162b2 and mRNA-1273 vaccines were developed by Pfizer-BioNTech and Moderna, respectively, in 2020. The United Kingdom, Bahrain, Canada, Mexico, United States, Singapore, Oman, Saudi Arabia, Kuwait, and European Union began their vaccination programs with the BNT162b2 vaccine, while the United States and Canada also started the mRNA-1273 vaccination program in mid December 2020. On 28th December 2020, studies reported severe allergic reactions in people who received the BNT162b2, and few people who received the mRNA-1273 vaccine. Authors of the letter thus attempt to explore possible causes of anaphylaxis following COVID-19 vaccination.
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Affiliation(s)
- Gurudeeban Selvaraj
- Centre for Research in Molecular Modeling, Department of Chemistry and Biochemistry, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, H4B1R6, Canada.
| | - Satyavani Kaliamurthi
- Centre for Research in Molecular Modeling, Department of Chemistry and Biochemistry, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, H4B1R6, Canada
| | - Gilles H Peslherbe
- Centre for Research in Molecular Modeling, Department of Chemistry and Biochemistry, Concordia University, 7141 Sherbrooke Street W, Montreal, QC, H4B1R6, Canada
| | - Dong-Qing Wei
- The State Key Laboratory of Microbial Metabolism, College of Life Sciences and Biotechnology, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Minhang, Shanghai, 200240, China.
- IASIA (International Association of Scientists in the Interdisciplinary Areas), 125 Boul. de Bromont, Quebec, QC, J2L 2K7, Canada.
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Gargano D, Appanna R, Santonicola A, De Bartolomeis F, Stellato C, Cianferoni A, Casolaro V, Iovino P. Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients 2021; 13:1638. [PMID: 34068047 PMCID: PMC8152468 DOI: 10.3390/nu13051638] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Adverse food reactions include immune-mediated food allergies and non-immune-mediated intolerances. However, this distinction and the involvement of different pathogenetic mechanisms are often confused. Furthermore, there is a discrepancy between the perceived vs. actual prevalence of immune-mediated food allergies and non-immune reactions to food that are extremely common. The risk of an inappropriate approach to their correct identification can lead to inappropriate diets with severe nutritional deficiencies. This narrative review provides an outline of the pathophysiologic and clinical features of immune and non-immune adverse reactions to food-along with general diagnostic and therapeutic strategies. Special emphasis is placed on specific nutritional concerns for each of these conditions from the combined point of view of gastroenterology and immunology, in an attempt to offer a useful tool to practicing physicians in discriminating these diverging disease entities and planning their correct management. We conclude that a correct diagnostic approach and dietary control of both immune- and non-immune-mediated food-induced diseases might minimize the nutritional gaps in these patients, thus helping to improve their quality of life and reduce the economic costs of their management.
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Affiliation(s)
- Domenico Gargano
- Allergy and Clinical Immunology Unit, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (D.G.); (F.D.B.)
| | - Ramapraba Appanna
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Antonella Santonicola
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Fabio De Bartolomeis
- Allergy and Clinical Immunology Unit, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (D.G.); (F.D.B.)
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Antonella Cianferoni
- Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Vincenzo Casolaro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
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Cianferoni A. Non-IgE-mediated anaphylaxis. J Allergy Clin Immunol 2021; 147:1123-1131. [PMID: 33832694 DOI: 10.1016/j.jaci.2021.02.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Anaphylaxis is a rapidly evolving, acute, life-threatening reaction that occurs rapidly on contact with a trigger. Anaphylaxis is classically defined as an allergen-driven process that induces specific IgE and the activation of mast cells and basophils through the cross-linking of IgE receptors. However, it is clear that non-IgE-mediated pathways can induce symptoms indistinguishable from those of classic anaphylaxis, and their activation could explain the severity of IgE-mediated anaphylaxis. Indeed, mast cells and basophils can be activated by antibodies against IgE or their receptors, by molecules such as anaphylatoxins, or through G-coupled receptors. Some other allergens can induce antibodies of class IgG that can activate neutrophils to produce a molecule similar to histamine to induce anaphylaxis. Finally, some inflammatory mediators such as bradykinin or prostaglandin can also modulate mast cell and basophil activation as well as directly cause vasodilation and bronchoconstriction, resulting in anaphylaxis-like reactions.
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Affiliation(s)
- Antonella Cianferoni
- Perelman School of Medicine, University of Pennsylvania, Allergy and Immunology Division, The Children's Hospital of Philadelphia, Philadelphia, Pa.
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29
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Warren C, Lei D, Sicherer S, Schleimer R, Gupta R. Prevalence and characteristics of peanut allergy in US adults. J Allergy Clin Immunol 2021; 147:2263-2270.e5. [PMID: 33579526 DOI: 10.1016/j.jaci.2020.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peanut allergy (PA) is the leading pediatric food allergy and a common cause of anaphylaxis. Little is known, however, on the prevalence and characteristics of PA in the adult population and whether phenotypic differences exist between adult-onset and childhood-onset PA. OBJECTIVES This study describes the current US population-level burden of adult PA. METHODS A cross-sectional food allergy survey was administered via phone and web in 2015 and 2016, resulting in nationally representative complex-survey weighted data for 40,443 adults. Reported food allergies were considered "convincing" if symptoms to specific allergens were consistent with an IgE-mediated reaction. RESULTS The prevalence of current self-reported PA was 2.9% among US adults, with 1.8% having convincing PA. Over 17% of adults with peanut allergy reported onset of their PA in adulthood. In adults with childhood-onset PA, 75.4% reported physician-diagnosed PA, compared with only 58.9% of adult-onset PA. Despite a similar frequency of food allergy-related emergency department visits within the past year (approximately 1 in 5 adults with PA allergy), adults with childhood-onset PA were significantly more likely to have a current epinephrine prescription compared with those with adult-onset PA (56% vs 44% respectively; P = .02) and were more likely to use an epinephrine autoinjector (48% vs 35%, P = .01). CONCLUSIONS Approximately 4.6 million US adults have PA-over 800,000 of whom appear to have developed their PA after age 18 years. Further examination of phenotypic differences between childhood-onset and adult-onset PA may improve understanding and management of adult PA.
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Affiliation(s)
- Christopher Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Dawn Lei
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Scott Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY
| | - Robert Schleimer
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
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Beltrán-Cárdenas CE, Granda-Restrepo DM, Franco-Aguilar A, Lopez-Teros V, Arvizu-Flores AA, Cárdenas-Torres FI, Ontiveros N, Cabrera-Chávez F, Arámburo-Gálvez JG. Prevalence of Food-Hypersensitivity and Food-Dependent Anaphylaxis in Colombian Schoolchildren by Parent-Report. ACTA ACUST UNITED AC 2021; 57:medicina57020146. [PMID: 33562800 PMCID: PMC7915673 DOI: 10.3390/medicina57020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: The epidemiology of food allergy (FA) and food-dependent anaphylaxis remains unknown in Colombia. Our aim was to estimate by parent-report the prevalence of FA and food-dependent anaphylaxis in a Colombian population of schoolchildren. Materials and methods: A printed questionnaire was sent to parents of schoolchildren aged 5–12 years old from Medellín, Colombia in order to collect FA-related data. Results: Nine hundred and sixty-nine (969) parents returned the questionnaire with valid responses (response rate, 52.5%). The estimated prevalence rates (95% CI) were: adverse food reactions 12.79% (10.76–15.07), “perceived FA, ever” 10.93% (9.08–13.08), “physician-diagnosed FA, ever” 4.33% (3.14–5.81), “immediate-type FA, ever” 6.81% (5.30–8.58), “immediate-type FA, current” 3.30% (2.26–4.63), and food-dependent anaphylaxis 1.85% (1.10–2.92). The most frequently reported food allergens were milk (1.44%), fruits (0.41%), meat (0.41%), and peanut (0.3%). Sixty-one percent of “food-dependent anaphylaxis” cases sought medical attention, but only eleven percent of the cases reported the prescription of an epinephrine autoinjector. Conclusions: FA and food-dependent anaphylaxis are not uncommon among schoolchildren from Colombia. The prescription of epinephrine autoinjectors should be encouraged among health personnel for the optimal management of suspected cases of food-dependent anaphylaxis.
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Affiliation(s)
- Carlos Eduardo Beltrán-Cárdenas
- Postgraduate Program in Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; (C.E.B.-C.); (F.I.C.-T.)
| | - Diana María Granda-Restrepo
- Food Department, Faculty of Pharmaceutical and Food Sciences, University of Antioquia, Medellín, Antioquia 50010, Colombia; (D.M.G.-R.); (A.F.-A.)
| | - Alejandro Franco-Aguilar
- Food Department, Faculty of Pharmaceutical and Food Sciences, University of Antioquia, Medellín, Antioquia 50010, Colombia; (D.M.G.-R.); (A.F.-A.)
| | - Veronica Lopez-Teros
- Postgraduate Program in Health Sciences, Division of Biological and Health Sciences, University of Sonora, Hermosillo, Sonora 83000, Mexico; (V.L.-T.); (A.A.A.-F.)
| | - Aldo Alejandro Arvizu-Flores
- Postgraduate Program in Health Sciences, Division of Biological and Health Sciences, University of Sonora, Hermosillo, Sonora 83000, Mexico; (V.L.-T.); (A.A.A.-F.)
| | - Feliznando Isidro Cárdenas-Torres
- Postgraduate Program in Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; (C.E.B.-C.); (F.I.C.-T.)
| | - Noé Ontiveros
- Clinical and Research Laboratory (LACIUS, URS), Department of Chemical, Biological, and Agricultural Sciences (DC-QB), Division of Sciences and Engineering, University of Sonora, Navojoa, Sonora 85880, Mexico;
| | - Francisco Cabrera-Chávez
- Postgraduate Program in Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; (C.E.B.-C.); (F.I.C.-T.)
- Correspondence: (F.C.-C.); (J.G.A.-G.)
| | - Jesús Gilberto Arámburo-Gálvez
- Postgraduate Program in Nutrition Sciences, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan, Sinaloa 80019, Mexico; (C.E.B.-C.); (F.I.C.-T.)
- Postgraduate Program in Health Sciences, Division of Biological and Health Sciences, University of Sonora, Hermosillo, Sonora 83000, Mexico; (V.L.-T.); (A.A.A.-F.)
- Correspondence: (F.C.-C.); (J.G.A.-G.)
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Jadhav N, Pantwalawalkar J, Sawant R, Attar A, Lohar D, Kadane P, Ghadage K. Development of Progesterone Oily Suspension Using Moringa Oil and Neusilin US2. J Pharm Innov 2021. [DOI: 10.1007/s12247-020-09529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eosinophilic Esophagitis as a Side Effect of Food Oral Immunotherapy. ACTA ACUST UNITED AC 2020; 56:medicina56110618. [PMID: 33207848 PMCID: PMC7697667 DOI: 10.3390/medicina56110618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 02/06/2023]
Abstract
Food allergies (FAs) include a spectrum of immune-mediated serious and potentially life-threatening medical conditions with an overall estimated prevalence ranging from 4% to 8% in the U.S. and Europe. Significant progress in food allergen-specific immunotherapy has been accomplished over the past 10 years. The most studied strategy has been oral immunotherapy (OIT), also known as food desensitization, a treatment in which a child is slowly and deliberately given a small amount of the food to ingest (that previously was a food allergy trigger) with the ultimate goal of the child eating that food without a reaction. OIT is now recommended in the European guidelines for the treatment of milk, egg, and peanut allergies and was the first American Food Drug Administration (FDA) approved product for the prevention of severe reaction to peanuts in 4–17 year olds to be released on the market. The side effects associated with OIT treatment trials are mild to moderate, predominantly oropharyngeal, and easily treated. More severe reactions, such as generalized urticaria/angioedema, wheezing/respiratory distress, laryngeal edema, and repetitive emesis, have been reported. However systemic reactions are very rare. Low-dose immunotherapy is associated with significantly fewer side effects. Currently, its most limiting allergic side effect is that approximately 10–15% of subjects treated with OIT experience gastrointestinal symptoms, preventing the continuation of therapy. Eosinophilic esophagitis (EoE) has also been reported as a cause of persistent abdominal symptoms in OIT.
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Oral immunotherapy for peanut allergy: The pro argument. World Allergy Organ J 2020; 13:100455. [PMID: 33005286 PMCID: PMC7519204 DOI: 10.1016/j.waojou.2020.100455] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
Food allergy (FA) is a growing public health problem with personal, social, nutritional, and economic consequences. In the United States, it is estimated that 8% of children and 10.8% of adults have food allergies. Allergies to peanuts are particularly worrisome as unlike allergies to other allergenic foods, such as milk and egg, which are commonly outgrown by 5 or 10 years of age, 80% of peanut allergies persist into adulthood. The first drug for peanut allergy, Palforzia, was approved by the US Food and Drug Administration (FDA) in January 2020. For other food allergies, the current standard of care for the management of FA is suboptimal and is limited to dietary elimination of the offending allergen, vigilance against accidental ingestion, and treatment of allergic reactions with antihistamines and epinephrine. However, dietary avoidance can be challenging, and it is estimated that approximately 40% of patients with food allergies report at least one food allergy-related emergency department in their lifetime. Reactions, even from minimal exposures, can be life-threatening. Oral immunotherapy (OIT) has been the best researched therapeutic approach for treating FA over the last decade, with clinical trials investigating its efficacy, safety, and ability to improve participants' quality of life (QoL). A number of studies and meta-analyses have shown that OIT treatment is effective in raising the threshold of reactivity to peanuts and other foods in addition to producing a measurable serum immune response to such therapy. Although OIT-related adverse events (AEs) are common during treatment, serious reactions are rare. In fact, while the majority of patients experience AEs related to dosing, most continue daily dosing in hopes of achieving protection against the culprit food. Moreover, the majority of participants report improvement of QoL after OIT and are positive about undergoing OIT. These results show patients’ commitment to OIT and their optimism regarding the benefits of treatment. As a first step in therapeutic options to protect from reactions to unintentional ingestion of allergenic foods, and importantly, to address the many psychosocial aspects of living with FA, OIT shows promise. Future research will focus on identifying optimal OIT regimens that maintain protection after therapy and allow for regular food consumption without allergic symptoms. Education and informed shared decision making between patients and providers are essential in optimizing current therapy regimens.
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Key Words
- AEs, adverse events
- AF, Adult form
- BOT, Burden of treatment
- CF, Child form
- Efficacy
- FA, Food allergy
- FAIM, Food allergy independent measure
- FAQOL, Food allergy quality of life
- OIT, Oral immunotherapy
- Oral immunotherapy
- PB, Parental burden form
- PF, Parental form
- Peanut allergy
- PedsQL, Pediatric quality of life inventory
- QoL, Quality of life
- Quality of life
- SAE, Serious adverse events
- Safety
- TF, Teenage form
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Abstract
PURPOSE OF REVIEW To analyze the status of precision medicine in atopic diseases. RECENT FINDINGS Atopic diseases are increasingly recognized as heterogeneous in nature and they can be quite different in severity, response to therapy, triggers, genetic back ground, ancestral risk and type of inflammation. This significant variability in the landscape of atopic diseases is not reflected in the common treatment guidelines that follow 'one fits all' approach for their management. Such an approach is largely based on minimal 'phenotype' elements, such as severity of disease and response to therapy and does not reflect the information accumulate in the last 20 years about particular pathogenic pathways (endotypes) leading to disease (phenotypes) based on biomolecular analysis of the single individuals. Accumulating data have defined asthma allergic rhinitis, food allergy based on their endotypes and clinically relevant phenotypes. In general, atopic diseases can be largely classified as high or low Th2 inflammatory status, which may explain the severity and response to therapy. SUMMARY Precision medicine is aiming to use known endotype phenotype to guide specific individualized treatment. The work aimed in deep characterization of diseases to guide the disease management is crucial in light of the availability of ever more precise treatment able to target specific pathways.
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Dona DW, Suphioglu C. Egg Allergy: Diagnosis and Immunotherapy. Int J Mol Sci 2020; 21:E5010. [PMID: 32708567 PMCID: PMC7404024 DOI: 10.3390/ijms21145010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Hypersensitivity or an allergy to chicken egg proteins is a predominant symptomatic condition affecting 1 in 20 children in Australia; however, an effective form of therapy has not yet been found. This occurs as the immune system of the allergic individual overreacts when in contact with egg allergens (egg proteins), triggering a complex immune response. The subsequent instantaneous inflammatory immune response is characterized by the excessive production of immunoglobulin E (IgE) antibody against the allergen, T-cell mediators and inflammation. Current allergen-specific approaches to egg allergy diagnosis and treatment lack consistency and therefore pose safety concerns among anaphylactic patients. Immunotherapy has thus far been found to be the most efficient way to treat and relieve symptoms, this includes oral immunotherapy (OIT) and sublingual immunotherapy (SLIT). A major limitation in immunotherapy, however, is the difficulty in preparing effective and safe extracts from natural allergen sources. Advances in molecular techniques allow for the production of safe and standardized recombinant and hypoallergenic egg variants by targeting the IgE-binding epitopes responsible for clinical allergic symptoms. Site-directed mutagenesis can be performed to create such safe hypoallergens for their potential use in future methods of immunotherapy, providing a feasible standardized therapeutic approach to target egg allergies safely.
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Affiliation(s)
| | - Cenk Suphioglu
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, 75 Pigdons Road, Geelong 3216 VIC, Australia;
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Jarkvist J, Brockow K, Gülen T. Low Frequency of IgE-Mediated Food Hypersensitivity in Mastocytosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3093-3101. [PMID: 32534147 DOI: 10.1016/j.jaip.2020.05.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with mastocytosis have an increased risk for severe anaphylaxis, particularly to Hymenoptera venoms. These patients may also develop more often systemic hypersensitivity reactions to certain foods. However, this issue has not been systematically investigated. OBJECTIVE To determine prevalence and severity of food hypersensitivity (FH) reactions among patients with clonal mast cell disorders (CMDs). METHODS A retrospective study was conducted among 204 (age ≥18 years) consecutive patients who presented with confirmed CMD (170 with mastocytosis and 34 with monoclonal mast cell activation syndrome). All patients underwent thorough allergy workup where self-reported FH reactions were evaluated. RESULTS The prevalence of self-reported FH was 20.6%. The frequency of immunologically mediated reactions was uncommon, because only 3.4% were confirmed by relevant history and IgE sensitization. Among patients with FH, 5 had severe anaphylaxis corresponding to an overall prevalence of 2.5%. Most symptoms were restricted to skin (86%), followed by gastrointestinal tract symptoms (45%)-similar to symptoms that occur in patients with mastocytosis also without food intake. Nuts, spicy foods, seafood, and alcohol were the most common incriminated elicitors. There was no significant difference between the groups regarding age, sex, atopic status, or IgE levels. CONCLUSIONS Anaphylaxis from foods in mastocytosis does exist and is severe, although foods are less frequent elicitors than insect venoms. Furthermore, the frequency of overall FH reactions is comparable with that in the general population and most reactions are mild, nonallergic, and unconfirmed. Consequently, our results do not support the elimination of any diet in patients with CMD without a history of FH.
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Affiliation(s)
- Jesper Jarkvist
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Mastocytosis Center Karolinska, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden; Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Mastocytosis Center Karolinska, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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Majumder K, Jin Y, Shibata H, Mine Y. Oral intervention of Lactobacillus pentosus S-PT84 attenuates the allergenic responses in a BALB/C mouse model of egg allergy. Mol Immunol 2020; 120:43-51. [DOI: 10.1016/j.molimm.2020.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/18/2020] [Accepted: 01/31/2020] [Indexed: 01/31/2023]
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De Martinis M, Sirufo MM, Viscido A, Ginaldi L. Food Allergy Insights: A Changing Landscape. Arch Immunol Ther Exp (Warsz) 2020; 68:8. [PMID: 32239297 DOI: 10.1007/s00005-020-00574-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
The panorama of food allergies (FA) has changed profoundly in recent years. In light of recent advances in knowledge of pathogenetic mechanisms and a greater attention to the multifaceted range of possible clinical manifestations, there is a need for a critical review of past classifications. Changes in nutrition, environment and lifestyles around the world are modifying the global FA epidemiology and new FA phenotypes are also emerging. Furthermore, both biotechnological advances in this field and recent personalized therapies have improved the diagnostic and therapeutic approach to FA. Consequently, both the prevention and clinical management of FA are rapidly changing and new therapeutic strategies are emerging, even revolutionizing the current medical practice. Given the significant increase in the prevalence of FA in recent years, the objective of this review is to provide an updated and complete overview of current knowledge in its etiopathogenesis, diagnostics and therapy, useful not only for a better understanding of this frequent and complex pathology but also for practical guidance in its clinical management.
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Affiliation(s)
- Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. .,Allergy and Clinical Immunology Unit, AUSL 04, Teramo, Italy.
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, AUSL 04, Teramo, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Allergy and Clinical Immunology Unit, AUSL 04, Teramo, Italy
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Guler N, Cokugras F, Sapan N, Selimoglu A, Turktas I, Cokugras H, Aydogan M, Beser O. Diagnosis and management of cow's milk protein allergy in Turkey: Region-specific recommendations by an expert-panel. Allergol Immunopathol (Madr) 2020; 48:202-210. [PMID: 31477392 DOI: 10.1016/j.aller.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/06/2019] [Indexed: 01/12/2023]
Abstract
Cow's milk protein allergy (CMPA) is the most common type of food-allergy in younger children. Prognosis is usually good, with most children developing tolerance before school age. Children may present with a wide spectrum of symptoms that range from mild to severe; skin reactions such as angioedema and urticaria and gastrointestinal symptoms are the most common presentations of CMPA. Approximately one-third of CMPA patients suffer from multiple food-allergies; severe conditions such as anaphylactic shock (9%), eosinophilic esophagitis (4.7%), and food-protein induced enterocolitis (1%) may also develop in some children. Timely and accurate diagnosis and management is essential for proper growth and development of children with CMPA. In this expert consensus report, we aimed to adapt current understandings in the CMPA field to the specific conditions in Turkey and health system to help physicians with their day-to-day decision making.
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Sharma N, Bhatia S, Chunduri V, Kaur S, Sharma S, Kapoor P, Kumari A, Garg M. Pathogenesis of Celiac Disease and Other Gluten Related Disorders in Wheat and Strategies for Mitigating Them. Front Nutr 2020; 7:6. [PMID: 32118025 PMCID: PMC7020197 DOI: 10.3389/fnut.2020.00006] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/20/2020] [Indexed: 12/12/2022] Open
Abstract
Wheat is a major cereal crop providing energy and nutrients to the billions of people around the world. Gluten is a structural protein in wheat, that is necessary for its dough making properties, but it is responsible for imparting certain intolerances among some individuals, which are part of this review. Most important among these intolerances is celiac disease, that is gluten triggered T-cell mediated autoimmune enteropathy and results in villous atrophy, inflammation and damage to intestinal lining in genetically liable individuals containing human leukocyte antigen DQ2/DQ8 molecules on antigen presenting cells. Celiac disease occurs due to presence of celiac disease eliciting epitopes in gluten, particularly highly immunogenic alpha-gliadins. Another gluten related disorder is non-celiac gluten-sensitivity in which innate immune-response occurs in patients along with gastrointestinal and non-gastrointestinal symptoms, that disappear upon removal of gluten from the diet. In wheat allergy, either IgE or non-IgE mediated immune response occurs in individuals after inhalation or ingestion of wheat. Following a life-long gluten-free diet by celiac disease and non-celiac gluten-sensitivity patients is very challenging as none of wheat cultivar or related species stands safe for consumption. Hence, different molecular biology, genetic engineering, breeding, microbial, enzymatic, and chemical strategies have been worked upon to reduce the celiac disease epitopes and the gluten content in wheat. Currently, only 8.4% of total population is affected by wheat-related issues, while rest of population remains safe and should not remove wheat from the diet, based on false media coverage.
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Affiliation(s)
- Natasha Sharma
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Simran Bhatia
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Venkatesh Chunduri
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Satveer Kaur
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Saloni Sharma
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Payal Kapoor
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Anita Kumari
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
| | - Monika Garg
- Agri-Food Biotechnology Laboratory, National Agri-Food Biotechnology Institute, Mohali, India
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Lee MP, Saffari SE, Loh W, Goh SH, Goh A, Chiang WC, Chong KW. A 5-year retrospective review of children with peanut allergy in the largest paediatric hospital in Singapore. Asia Pac Allergy 2020; 10:e6. [PMID: 32099828 PMCID: PMC7016321 DOI: 10.5415/apallergy.2020.10.e6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/23/2020] [Indexed: 11/04/2022] Open
Abstract
Background The prevalence of peanut allergy (PA) among children has increased significantly over the past decade. Even though the prevalence of PA in Singapore is considered low, peanut is the top trigger for food-induced anaphylaxis in Singaporean children. Objective To describe the demographic characteristics and clinical features of children with PA. Methods This is a 5-year retrospective review of children diagnosed with PA based on clinical history coupled with a positive skin prick test to peanut or positive oral food challenge results. Results There were 269 patients (53.9% males) with a clinical diagnosis of PA. The median age at first allergic presentation for the PA group was 24 months old, with interquartile range of 13-39 months. The most common form of peanut introduced was roasted peanut. The rate of peanut anaphylaxis was 7.1%. Concomitant tree nut sensitization was found in 32.3% of this cohort, predominantly to cashew nut. Majority of them have a personal history of atopy - 75.8% with eczema, 63.6% with allergic rhinitis, and 19.7% with asthma. Conclusion This is the first large review of peanut-allergic children in Singapore. Prospective population-based studies are needed to establish the true prevalence and risk factors associated with the development of this potentially life-threatening condition.
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Affiliation(s)
- May Ping Lee
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Wenyin Loh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Si Hui Goh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Anne Goh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Wen Chin Chiang
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Kok Wee Chong
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
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Abstract
Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody- mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein-induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. Non-IgE mediated food allergies are being being investigated.
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Affiliation(s)
- Antonella Cianferoni
- Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, United States
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43
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Abstract
IMPORTANCE Sesame allergy is of growing concern in the United States. The US Food and Drug Administration recently issued a request for epidemiological data on the prevalence and severity of sesame allergies in the United States to inform possible regulatory action requiring sesame to be labeled as an allergen on packaged foods. OBJECTIVE To provide current estimates of the prevalence, severity, distribution, and clinical characteristics of sesame allergy in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study assessed findings of web- and telephone-based food allergy questionnaires. Study participants were first recruited from NORC (National Opinion Research Center) at the University of Chicago's probability-based AmeriSpeak panel, and additional participants were recruited through Survey Sampling International. Surveys were administered to a nationally representative sample of 51 819 US households from October 1, 2015, through September 31, 2016. Responses for 40 453 adults and 38 408 children were included in the analysis. Data were analyzed from January 1, 2017, through May 1, 2019. EXPOSURES Demographic and allergic characteristics of participants. MAIN OUTCOMES AND MEASURES Self-reported sesame allergy was the main outcome and was considered convincing if reported symptoms to sesame-allergic reactions were consistent with an IgE-mediated reaction. Diagnostic history of specific allergens and use of food allergy-related health care services were also primary outcomes. RESULTS Using survey responses from 78 851 individuals, an estimated 0.49% (95% CI, 0.40%-0.58%) of the US population reported a current sesame allergy, whereas 0.23% (95% CI, 0.19%-0.28%) met symptom-report criteria for convincing IgE-mediated allergy. An additional 0.11% (95% CI, 0.08%-0.16%) had a sesame allergy reported as physician diagnosed but did not report reactions fulfilling survey-specified convincing reaction symptoms. Among individuals with convincing IgE-mediated sesame allergy, an estimated 23.6% (95% CI, 16.9%-32.0%) to 37.2% (95% CI, 29.2%-45.9%) had previously experienced a severe sesame-allergic reaction, depending on the definition used, and 81.6% (95% CI, 71.0%-88.9%) of patients with convincing sesame allergy had at least 1 additional convincing food allergy. Roughly one-third of patients with convincing sesame allergy (33.7%; 95% CI, 26.3%-42.0%) reported previous epinephrine use for sesame allergy treatment. CONCLUSIONS AND RELEVANCE These data indicate a substantial burden of sesame allergy and provide valuable context to physicians and policy makers in their efforts to evaluate and reduce the public health burden of sesame allergy. Moreover, the relatively low rates of physician diagnosis observed among individuals with convincing IgE-mediated sesame allergy seem to indicate the need for clear diagnosis and appropriate management.
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Affiliation(s)
- Christopher M. Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine and Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Avneet S. Chadha
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine and Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Scott H. Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy, Department of Pediatrics, Mount Sinai School of Medicine, New York, New York
| | - Jialing Jiang
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine and Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Ruchi S. Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine and Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
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Shah F, Shi A, Ashley J, Kronfel C, Wang Q, Maleki SJ, Adhikari B, Zhang J. Peanut Allergy: Characteristics and Approaches for Mitigation. Compr Rev Food Sci Food Saf 2019; 18:1361-1387. [DOI: 10.1111/1541-4337.12472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/19/2019] [Accepted: 05/22/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Faisal Shah
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key research Laboratory of Agro‐Products ProcessingMinistry of Agriculture Beijing 100193 P. R. China
| | - Aimin Shi
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key research Laboratory of Agro‐Products ProcessingMinistry of Agriculture Beijing 100193 P. R. China
| | - Jon Ashley
- International Iberian Nanotechnology LaboratoryFood Quality and Safety Research group Berga 4715‐330 Portugal
| | - Christina Kronfel
- Food Processing and Sensory Quality ResearchUnited States Dept. of Agriculture New Orleans LA 70124 USA
| | - Qiang Wang
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key research Laboratory of Agro‐Products ProcessingMinistry of Agriculture Beijing 100193 P. R. China
| | - Soheila J. Maleki
- Food Processing and Sensory Quality ResearchUnited States Dept. of Agriculture New Orleans LA 70124 USA
| | - Benu Adhikari
- School of ScienceRMIT Univ. Melbourne VIC 3083 Australia
| | - Jinchuang Zhang
- Inst. of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key research Laboratory of Agro‐Products ProcessingMinistry of Agriculture Beijing 100193 P. R. China
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Mine Y, Jin Y, Zhang H, Majumder K, Zeng Y, Sakurai T, Taniguchi Y, Takagaki R, Watanabe H, Mitsuzumi H. Therapeutic effects of isomaltodextrin in a BALB/c mouse model of egg allergy. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Suárez-Fariñas M, Suprun M, Chang HL, Gimenez G, Grishina G, Getts R, Nadeau K, Wood RA, Sampson HA. Predicting development of sustained unresponsiveness to milk oral immunotherapy using epitope-specific antibody binding profiles. J Allergy Clin Immunol 2018; 143:1038-1046. [PMID: 30528770 DOI: 10.1016/j.jaci.2018.10.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/30/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In a recent trial of milk oral immunotherapy (MOIT) with or without omalizumab in 55 patients with milk allergy treated for 28 months, 44 of 55 subjects passed a 10-g desensitization milk protein challenge; 23 of 55 subjects passed the 10-g sustained unresponsiveness (SU) challenge 8 weeks after discontinuing MOIT. OBJECTIVE We sought to determine whether IgE and IgG4 antibody binding to allergenic milk protein epitopes changes with MOIT and whether this could predict the development of SU. METHODS By using a novel high-throughput Luminex-based assay to quantitate IgE and IgG4 antibody binding to 66 sequential epitopes on 5 milk proteins, serum samples from 47 subjects were evaluated before and after MOIT. Machine learning strategies were used to predict whether a subject would have SU after 8 weeks of MOIT discontinuation. RESULTS MOIT profoundly altered IgE and IgG4 binding to epitopes, regardless of treatment outcome. At the initiation of MOIT, subjects achieving SU exhibited significantly less antibody binding to 40 allergenic epitopes than subjects who were desensitized only (false discovery rate ≤ 0.05 and fold change > 1.5). Based on baseline epitope-specific antibody binding, we developed predictive models of SU. Using simulations, we show that, on average, IgE-binding epitopes alone perform significantly better than models using standard serum component proteins (average area under the curve, >97% vs 80%). The optimum model using 6 IgE-binding epitopes achieved a 95% area under the curve and 87% accuracy. CONCLUSION Despite the relatively small sample size, we have shown that by measuring the epitope repertoire, we can build reliable models to predict the probability of SU after MOIT. Baseline epitope profiles appear more predictive of MOIT response than those based on serum component proteins.
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Affiliation(s)
- Mayte Suárez-Fariñas
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maria Suprun
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY; Pediatrics, Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Helena L Chang
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gustavo Gimenez
- Pediatrics, Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Galina Grishina
- Pediatrics, Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Kari Nadeau
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Robert A Wood
- Department of Pediatrics, Division of Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Hugh A Sampson
- Pediatrics, Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Motosue MS, Bellolio MF, Van Houten HK, Shah ND, Campbell RL. Risk factors for recurrent anaphylaxis-related emergency department visits in the United States. Ann Allergy Asthma Immunol 2018; 121:717-721.e1. [PMID: 30189249 DOI: 10.1016/j.anai.2018.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/21/2018] [Accepted: 08/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anaphylaxis is a potentially life-threatening allergic reaction with a strong risk of recurrence. OBJECTIVE To assess risk factors associated with recurrent anaphylaxis-related emergency department (ED) visits within 1 year of an ED visit for anaphylaxis in a large observational cohort study. METHODS We used an administrative claims database to identify patients seen from 2008 through 2012 in the ED for anaphylaxis based on an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Patients with at least 2 years of continuous enrollment in a health plan were included. Multivariable logistic regression analysis was used to determine associations with recurrence of anaphylaxis within 1 year. RESULTS During the 5-year study period, 7,367 patients (median age, 42 years; <18 years old, 23.3%) met the inclusion criteria. The most common anaphylaxis trigger was unspecified (56.2%), followed by food (25.3%), medication (14.6%), and venom (3.9%). Overall, 3.0% of patients had an additional anaphylaxis-related ED visit within 1 year (3.61 episodes per 100 patient-years). On multivariable analysis, risk factors associated with anaphylaxis recurrence were food trigger (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.34-3.99), history of asthma (OR, 1.30; 95% CI, 1.13-1.51), and intensive care unit admission at the index anaphylaxis event (OR, 1.95; 95% CI, 1.41-2.69). CONCLUSION In this contemporary cohort study, history of asthma, food trigger, and greater index anaphylaxis severity, as measured by intensive care unit admission, were associated with a higher likelihood of a recurrent anaphylaxis-related ED visit within 1 year.
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Affiliation(s)
- Megan S Motosue
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota
| | - M Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Holly K Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Nilay D Shah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; OptumLabs, Cambridge, Massachusetts
| | - Ronna L Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
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Echeverria L, Martin-Muñoz MF, Martorell C, Belver MT, Alonso Lebrero E, Zapatero L, Fuentes V, Piqué M, Plaza A, Muñoz C, Martorell A, Blasco C, Villa B, Gómez C, Nevot S, García JM, Madero R. Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP). Allergol Immunopathol (Madr) 2018; 46:415-420. [PMID: 29804794 DOI: 10.1016/j.aller.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/18/2018] [Accepted: 01/25/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life. One treatment option in such cases is oral immunotherapy (OIT) with foods. METHODS We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT. RESULTS The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE specific of egg white titer was 38.5kU/l. A double-blind placebo-controlled food challenge with cooked egg white was performed, and if the test proved positive, it was repeated with pasteurized raw egg white. The mean symptoms-provoking dose was 1.26g and 0.55g for cooked egg white and raw egg white, respectively. An IgE specific of ovomucoid titer of <2.045kU/l differentiated those patients that tolerated cooked egg white. CONCLUSIONS OIT with egg is regarded as an option in patients with persistent egg allergy. In the previous challenge test, an IgE specific of ovomucoid titer of <2.045kU/l differentiates those patients that tolerate cooked egg white.
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Affiliation(s)
- L Echeverria
- Severo Ochoa University Hospital, Leganés, Madrid, Spain.
| | - M F Martin-Muñoz
- Idipaz, Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - C Martorell
- Valencia University General Hospital, Valencia, Spain
| | - M T Belver
- Idipaz, Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | | | - L Zapatero
- Gregorio Marañón Hospital, Madrid, Spain
| | - V Fuentes
- Gregorio Marañón Hospital, Madrid, Spain
| | - M Piqué
- San Juan de Dios Hospital, Barcelona, Spain
| | - A Plaza
- San Juan de Dios Hospital, Barcelona, Spain
| | - C Muñoz
- Carlos Haya Hospital, Málaga, Spain
| | - A Martorell
- Valencia University General Hospital, Valencia, Spain
| | - C Blasco
- Vall Hebrón Hospital, Barcelona, Spain
| | - B Villa
- Vall Hebrón Hospital, Barcelona, Spain
| | - C Gómez
- Fundación Althaia San Juan de Dios Hospital, Sabadell, Barcelona, Spain
| | - S Nevot
- Fundación Althaia San Juan de Dios Hospital, Sabadell, Barcelona, Spain
| | | | - R Madero
- Idipaz, Institute for Health Research, La Paz University Hospital, Madrid, Spain
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49
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Gohal G. Food Allergy Knowledge and Attitudes Among School Teachers in Jazan, Saudi Arabia. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/1874838401809010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Food allergy topic has become more widely discussed in developed countries, but with less interest in Middle Eastern Arabian Countries.
Objectives:
The main objective of this paper is to assess the knowledge and perception of schoolteachers about food allergy.
Methods:
A cross sectional study was conducted among a sample of 360 school teachers between May 2013 and February 2014 in province of Jazan in Saudi Arabia, using a validated web-based self-administered survey.
Results:
The results revealed that almost (59.7%) of the schoolteachers had a medium insufficient knowledge about food allergy; only 17.3% had good knowledge about food allergy. Female teachers had higher knowledge scores (58.5 ± 17.2) as compared to male (51.8 ± 16.0) with statistically significant difference (p = 0.017). The majority of schoolteachers have a significantly poor knowledge in most of food allergy domains. More than half of responders either do not know or they disagree that the food allergy is a serious problem and can lead to death. Regression analysis revealed that participant’s level of knowledge is significantly associated with school teacher’s attitudes towards food allergy (OR = 0.06, 95% CI: 0.39 - 0.92, p = 0.01), practice (OR = 1.68, 95% CI: 1.11 - 2.56, p = 0.01), and years of experiences (OR = 1.8, 95% CI; 1.15 - 2.98, p = 0.011).
Conclusion:
Knowledge of food allergy among schoolteachers is not adequate, failing to recognize and treat fatal food allergy reactions necessitate an urgent need to set a school policy to improve the food allergy situation.
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Gonzales-González VA, Díaz AM, Fernández K, Rivera MF. Prevalence of food allergens sensitization and food allergies in a group of allergic Honduran children. Allergy Asthma Clin Immunol 2018; 14:23. [PMID: 29946340 PMCID: PMC6004676 DOI: 10.1186/s13223-018-0245-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/28/2018] [Indexed: 12/03/2022] Open
Abstract
Background Food allergy is a public health problem that has increased in the last decade. Despite the increasing rates in children, quality data on the burden of these diseases is lacking particularly in developing countries. Honduras has no studies in pediatric patients. Objectives The objective of this research was to identify the most common sensitization patterns to food through epicutaneous skin testing and food allergy rates in children and their correlation with common allergic diseases in a group of patients from Hospital of Pediatrics Maria. Methods Cross-sectional retrospective, descriptive study in which records and database of all allergic patients in the immunology outpatient clinic from Hospital of Pediatrics Maria were reviewed between the periods of January 2015 through June 2016. Results A total of 365 children were analyzed, the age of participants were in the range from 1 to 18 years, with an average of 9.8 years. Sensitization to food allergens were found in 23, and 58.3% were poly-sensitized. The most common food allergens that patients were sensitized to: milk 9.0%, eggs 6.9%, peanut 4.9% and pork meat 4.4%. Food allergy was confirmed via oral food challenged in 9.3% of the patients. The most frequent food allergies found were: cow’s milk allergy 6%, hen’s egg allergy 5.2% and wheat allergy 1.9%. Conclusions Milk and egg were the most common a food allergens found in the population studied. Most of the patients were found to be poly-sensitized. The frequent food allergies confirmed via oral food challenge were cow’s milk allergy, hen’s egg allergy and wheat allergy.
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Affiliation(s)
| | - Adolfo Martin Díaz
- Division of Pediatric Allergy and Immunology, Hospital María de Especialidades Pediátricas, Tegucigalpa, Francisco Morazán, Honduras
| | - Karla Fernández
- Division of Pediatric Allergy and Immunology, Hospital María de Especialidades Pediátricas, Tegucigalpa, Francisco Morazán, Honduras
| | - María Félix Rivera
- 3Division of Epidemiology, Facultad de Ciencias Medicas, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Francisco Morazán, Honduras
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