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Hicks A, Fleischer D, Venter C. The future of cow's milk allergy - milk ladders in IgE-mediated food allergy. Front Nutr 2024; 11:1371772. [PMID: 38496796 PMCID: PMC10941844 DOI: 10.3389/fnut.2024.1371772] [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: 01/16/2024] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Cow's milk allergy (CMA) is one of the most common and complex presentations of allergy in early childhood. CMA can present as IgE and non-IgE mediated forms of food allergy. Non-IgE mediated CMA includes food protein-induced enterocolitis syndrome (FPIES), eosinophilic gastrointestinal disorders (EGIDs), and food protein-induced proctocolitis (FPIAP). There are recent guidelines addressing CMA diagnosis, management, and treatment. Each of these guidelines have their own strengths and limitations. To best manage CMA, individualized avoidance advice should be given. Cow's milk (CM) can be replaced in the diet by using hypoallergenic formulas or plant-based milk, depending on factors such as the child's age and their current food intake. Oral and epicutaneous immunotherapy is used to increase tolerance in children with CMA but is not without risk, and the long-term outcome of sustained unresponsiveness is still unclear. The allergenicity of CM proteins are affected differently by different forms of heating, leading to the use of baked milk or milk ladders in the management of CMA, most likely the most promising option for future management and treatment of CMA. Future management of children with CMA will also include discussion around the immunomodulatory potential of the child's dietary intake.
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Affiliation(s)
| | | | - Carina Venter
- Section of Pediatric Allergy and Immunology, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
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Hicks AG, Pickett K, Casale TB, Cassimos D, Elverson W, Gerdts J, Gray S, Jones C, LeBovidge J, Levin M, Mack DP, Minshall E, Nowak-Wegrzyn A, Pistiner M, Protudjer JLP, Said M, Schaible A, Smith P, Vassilopoulou E, Venter C. Educational resources received by families after successful baked egg/baked milk oral food challenge: An international survey. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3328-3332.e2. [PMID: 36184022 DOI: 10.1016/j.jaip.2022.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Allison G Hicks
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Children's Hospital Colorado, Aurora, Colo.
| | - Kaci Pickett
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Thomas B Casale
- Department of Medicine, University of South Florida, Tampa, Fla; Food Allergy Research and Education (FARE), McLean, Va
| | - Dimitrios Cassimos
- Department of Pediatrics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Wendy Elverson
- Center for Nutrition, Boston Children's Hospital, Boston, Mass
| | | | - Sarah Gray
- ausEE Inc, Sunshine Coast, QLD, Australia
| | | | | | - Michael Levin
- Division of Paediatric Allergy, University of Cape Town, Cape Town, South Africa
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Eleanor Minshall
- Department of Paediatric Allergy, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Michael Pistiner
- Food Allergy Center, Mass General Hospital for Children, Boston, Mass
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Maria Said
- Allergy and Anaphylaxis Australia, Sydney, NSW, Australia
| | - Allison Schaible
- The Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pete Smith
- Clinical Medicine Griffith University, Southport, QLD, Australia; Observational and Pragmatic Research Institute, Singapore
| | - Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Carina Venter
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Children's Hospital Colorado, Aurora, Colo
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Nairn SA. Passive tolerance and productive uncertainties in food allergy immunotherapy biomedical practices. SOCIOLOGY OF HEALTH & ILLNESS 2022. [PMID: 36001390 DOI: 10.1111/1467-9566.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
There has been little sociological research on food allergy in North America, despite the fact that it impacts a significant population in the US and Canada. Immunotherapy for food allergy is now a prominent area of investigation and experts argue it is one dimension of a 'paradigm shift' that encourages exposure to food allergens in contrast to avoidance of them. This article reports on an ethnographic investigation of immunotherapy for food allergy research and practice between the years 2015 and 2020. I report on analyses of N = 31 in-depth interviews with spokespersons with different types of engagement in immunotherapy and over 100 h of ethnographic observations at clinical and scientific conferences. My research revealed the entangled ontologies of food and drug in immunotherapy and related uncertainties in the diagnoses of food allergy, which catalysed further uncertainty about who is receiving and who should receive immunotherapy (IT). Relatedly, there are uncertainties about the goals and/or outcomes of IT. I elaborate on previous sociological work about how uncertainty is valued in medicine and science. I argue shared uncertainties and mutual scepticism in IT co-exist, representing a passive (productive) tolerance and reticently accepted form of tension in the domain, which have resulted in calls for intra-professional and inter-professional collaborations and the involvement of other stakeholders in knowledge making regarding food allergy immunotherapy.
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Affiliation(s)
- Stephanie A Nairn
- Department of Psychiatry & Addiction, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Centre, CHU Ste-Justine, Montreal, Quebec, Canada
- Department of Sociology, McGill University, Montreal, Quebec, Canada
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Bogahawaththa D, Chandrapala J, Vasiljevic T. Thermal denaturation of bovine β-lactoglobulin in different protein mixtures in relation to antigenicity. Int Dairy J 2019. [DOI: 10.1016/j.idairyj.2018.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Upton J, Nowak-Wegrzyn A. The Impact of Baked Egg and Baked Milk Diets on IgE- and Non-IgE-Mediated Allergy. Clin Rev Allergy Immunol 2018. [PMID: 29516263 DOI: 10.1007/s12016-018-8669-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Baked milk (BM) and baked egg (BE) diets are increasingly used in the management of milk and egg allergy, rather than avoidance. Children with tolerance versus reactivity to BM and BE may have smaller skin prick test and lower specific IgE, and BM-tolerant children have less basophil reactivity and more peripheral T regulatory cells. However, most milk- and egg-allergic children tolerate BM and BE and an individual's reactivity is unpredictable. Non-reactivity is due to conformational changes in the allergens. Significant differences in the published advice about methods of introduction exist from graded introduction at home to a medically supervised full dose. These approaches carry different risks and may have different immunological effects. Reactivity to BM is a predictor of a severe milk allergy. Therefore, medical supervision for BM and BE introduction is prudent. The baked diet allows dietary liberation. Most, but not all, BM- and BE-tolerant children continue eating the baked foods. The prognosis of children who can eat BM and BE is favorable with likely resolution of their allergy over the next few years. Murine models of BE diets demonstrate that heated egg can impart clinical protection against anaphylaxis and cause immune changes. Most observational human studies of BM and BE diets demonstrate clinical resolution of allergy and favorable immune changes versus regular care controls. However, the one randomized controlled trial for the BE diet in BE-tolerant children did not support an immune-modifying effect of the BE diet. Another study of BE immunotherapy is expected to be completed in 2018. There is currently no evidence for prevention of allergy with the baked diets. There may be a future role for BM and BE in liberating the diets of individuals with non-IgE-mediated allergy given recent studies that a subset of these patients can consume BM without a clinical reaction.
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Affiliation(s)
- Julia Upton
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Anna Nowak-Wegrzyn
- Jaffe Food Allergy Institute, Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Konstantinou GN. Safety and Efficacy Balance of Baked Milk and Egg Oral Immunotherapy. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Netting M, Gold M, Quinn P, El-Merhibi A, Penttila I, Makrides M. Randomised controlled trial of a baked egg intervention in young children allergic to raw egg but not baked egg. World Allergy Organ J 2017; 10:22. [PMID: 28649294 PMCID: PMC5472868 DOI: 10.1186/s40413-017-0152-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/19/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Consumption of baked egg by raw egg allergic children is associated with immune changes suggesting development of tolerance. However, causation has not been tested using a double blind randomized controlled trial (RCT). We aimed to compare clinical and immunological outcomes after baked egg (BE) consumption in young BE tolerant egg allergic children. METHODS In a double blind RCT, BE tolerant egg allergic children consumed 10 g BE (1.3 g protein) 2 to 3 times per week for 6 months (n = 21 intervention group) or similar egg free baked goods (n = 22 control group) while maintaining an otherwise egg free diet. The final assessment was a raw egg oral food challenge (OFC) 1 month after ceasing the intervention product. Egg specific IgE and IgG4 were assessed at baseline and 7 months. RESULTS After the intervention there was no difference in raw egg tolerance between groups, (23.5% (4/17) intervention group and 33.3% (6/18) control group). This was independent of age and amount of BE consumed (aOR 0.50 CI 0.11-2.40 p = 0.39). Both groups demonstrated decreased egg specific serum IgE titres and decreased whole egg specific IgE/IgG4 ratios. DISCUSSION We conducted this trial because inclusion of baked egg protein in the diet of egg allergic children appears to move children towards a more tolerant immune profile. Strengths of our study include design of the blinded intervention, the consistent dosing protocol and the regular monitoring of symptoms and intake. However, the study was limited by small sample size resulting in insufficient power to show statistically significant results. CONCLUSION Our study suggests that short term, regular consumption of BE by BE tolerant 1 to 5 year old children with IgE mediated raw egg allergy may not induce, accelerate or slow development of tolerance to raw egg in this selected population. Trials with larger sample sizes are required to further test this hypothesis. TRIAL REGISTRATION The trial was registered on 7th February 2012 with the Australian New Zealand Clinical Trials Registry (ACTRN 12612000173897).
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Affiliation(s)
- Merryn Netting
- Children’s Nutrition Research Centre, South Australian Health Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
| | - Michael Gold
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Department of Allergy and Immunology, Women’s and Children’s Health Network, Adelaide, Australia
| | - Patrick Quinn
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Department of Allergy and Immunology, Women’s and Children’s Health Network, Adelaide, Australia
| | | | - Irmeli Penttila
- Children’s Nutrition Research Centre, South Australian Health Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Maria Makrides
- Children’s Nutrition Research Centre, South Australian Health Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
- Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia
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Bogahawaththa D, Chandrapala J, Vasiljevic T. Modulation of milk immunogenicity by thermal processing. Int Dairy J 2017. [DOI: 10.1016/j.idairyj.2017.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Barbosa C, Castro A, Yonamine G, Gushken A, Beck C, Macedo P, Dorna M, Santos C, Pastorino A, Jacob C. Baked milk tolerant patient: Is there any special feature? Allergol Immunopathol (Madr) 2017; 45:283-289. [PMID: 28159383 DOI: 10.1016/j.aller.2016.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/06/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Determining whether patients with cow's milk allergy (CMA) can tolerate foods produced with baked milk could provide a better quality of life, a better prognosis, and an option for desensitization. OBJECTIVES The aim of this study was to identify which patients over four years of age with persistent CMA could tolerate baked milk, to compare the clinical and laboratory characteristics of reactive and non-reactive groups and to describe their clinical evolution. MATERIALS AND METHODS A cross-sectional study was conducted (January/13 to November/14) that included all the patients followed at a food allergy center who met the inclusion criteria. The patients underwent an oral food challenge (OFC) with a muffin (2.8g of cow's milk protein). To exclude cow's milk (CM) tolerance, the patients were subsequently challenged with unheated CM. RESULTS Thirty patients met all the inclusion criteria. Fourteen patients (46.7%) were considered non-reactive to baked milk and reactive to unheated CM. When the groups that were reactive and non-reactive to baked milk were compared, no statistically significant differences in clinical features were found. The prick test for α-lactalbumin (p=0.01) and casein (p=0.004) and the serum specific IgE for casein (p=0.05) presented statistical differences. After one year, none of the patients who were reactive to baked milk were ingesting CM, while 28% of the tolerant patients were consuming fresh CM (p=0.037). CONCLUSIONS Baked milk can be tolerated by patients with CMA, especially those with lower levels of casein and α-lactalbumin. This option can improve quality of life and accelerate tolerance.
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Abstract
Food allergy is a public health concern especially after recognizing its constantly increased prevalence and severity. Despite careful reading of food ingredient statements, food allergic individuals may experience reactions caused by "hidden", "masked", or "contaminated" proteins that are known major allergens. Many techniques have been developed to detect even small traces of food allergens, for clinical or laboratory purposes. Enzyme-linked immunosorbent assay (ELISA) is one of the best validated and most routinely used immunoassay in allergy research, in allergy diagnosis in allergy-related quality control in various industries. Although as a technique it has been implemented for the last 45 years, the evolution in biochemistry allowed the development of ultrasensitive ELISA variations that are capable of measuring quantities in the scale of picograms, rendering ELISA attractive, robust, and very famous.
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Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, 11 Eleftheriou Venizelou Street, Kalamaria, 55 133, Thessaloniki, Greece.
- Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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11
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Nowak-Węgrzyn A, Albin S. Oral immunotherapy for food allergy: mechanisms and role in management. Clin Exp Allergy 2015; 45:368-83. [PMID: 25077670 DOI: 10.1111/cea.12382] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the emergence of food allergy as an important public health problem, it has become clear that there is an unmet need in regard to treatment. In particular, IgE-mediated food allergy that is associated with risk of fatal anaphylaxis has been the subject of multiple studies in the past decade. The growing body of evidence derived from multiple centres and various study designs indicates that for IgE-mediated food allergy, immunomodulation through food immunotherapy is possible; however, the extent of protection afforded by such treatment is highly variable. At this time, the capacity for food immunotherapy to restore permanent tolerance to food has not been demonstrated conclusively. This review will discuss these topics as they apply to the most important studies of food oral immunotherapy.
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Affiliation(s)
- A Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
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12
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Goldberg MR, Nachshon L, Appel MY, Elizur A, Levy MB, Eisenberg E, Sampson HA, Katz Y. Efficacy of baked milk oral immunotherapy in baked milk-reactive allergic patients. J Allergy Clin Immunol 2015; 136:1601-1606. [PMID: 26194541 DOI: 10.1016/j.jaci.2015.05.040] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with IgE-mediated cow's milk allergy who are nonreactive to baked milk (BM) can be desensitized with BM to promote tolerance to unheated milk (UM). OBJECTIVE We sought to test whether patients who are BM reactive can progress in BM oral immunotherapy (OIT) and become desensitized to UM as well. METHODS Fifteen patients (>4 years) who previously failed to complete our milk OIT program were enrolled into the BM OIT protocol. A dose of BM (180 °C for 30 minutes) which was less than the eliciting dose was increased 50% monthly while under medical supervision until the primary outcome dose of 1.3 g/d BM protein was achieved. Basophil reactivity and milk protein-specific IgE binding were analyzed at the first round of BM OIT therapy (T0) and at 12 months of BM treatment. RESULTS In terms of the primary outcome, only 3 (21%) of 14 patients tolerated the 1.3 g/d BM dose. Although some patients initially progressed in BM OIT, 8 of 11 failed because of IgE-mediated reactions. Three did not complete the program because of non-IgE-mediated factors. An increase in challenge threshold to UM was noted in patients continuing until 12 months (P = .003), including those among whom reactions precluded continuation in the program. Patients (n = 3) who successfully reached maintenance had decreased milk-specific IgE reactivity. Furthermore, the mean difference at T0 between induced HM and UM percentages of CD203c expression was significantly lower in patients who successfully completed BM OIT than in those who did not (-11% vs 4.4%, P = .0002), which is consistent with their decreased clinical reactivity to BM. CONCLUSIONS Although use of hypoallergenic BM in OIT is a promising therapy, care must be taken before its administration in BM-reactive patients because of the risk for anaphylaxis and only limited increase in challenge threshold attained.
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Affiliation(s)
- Michael R Goldberg
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Zerifin, Israel.
| | - Liat Nachshon
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Michael Y Appel
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Arnon Elizur
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, New York, NY
| | - Michael B Levy
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Eli Eisenberg
- Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - Hugh A Sampson
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yitzhak Katz
- Allergy and Immunology Institute, Assaf Harofeh Medical Center, Zerifin, Israel; Department of Pediatrics, Sackler Faculty of Medicine, New York, NY
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Abstract
The last 50 years in allergy could almost be considered the first 50 years. Over this time period, we have witnessed the emergence of allergy as a subspecialty, have seen and continue to observe a tremendous change in prevalence of allergic disease and have gained insight into the mechanisms that underlie allergic predisposition and disease manifestation. We have improved the care of children with many forms of allergic disease and now sit poised to be able to alter the natural history of allergic disease with the use of specific immunotherapy. There is much left to do in the next 50 years including understanding what underlies both the predisposition to atopic disease and its natural resolution and identifying the environmental cofactors involved in the 'allergic epidemic' and therefore targets for effective primary prevention.
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Affiliation(s)
- Dianne E Campbell
- Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
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Bloom KA, Huang FR, Bencharitiwong R, Bardina L, Ross A, Sampson HA, Nowak-Węgrzyn A. Effect of heat treatment on milk and egg proteins allergenicity. Pediatr Allergy Immunol 2014; 25:740-6. [PMID: 25251921 DOI: 10.1111/pai.12283] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heating destroys many conformational epitopes and reduces allergenicity of some foods. IgE-epitope binding has been shown to be different among patients who outgrew their cow's milk or hen's egg allergy and those who did not. A significant proportion of milk- or egg-allergic children are tolerant to these foods in their baked forms. We sought to explore the effects of heating on milk and egg proteins and to evaluate for differences in immunolabeling among children with regard to reactivity to heated milk or egg. METHODS Sera from participants in clinical dietary intervention trials were utilized. Milk and egg samples were variably heated and prepared (at times within a wheat matrix). Sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis (PAGE), protein transfer, and Western blot were completed. RESULTS Sera from 20 milk-allergic and 24 egg-allergic children were utilized. Gel electrophoresis showed strongly staining casein bands that persisted for up to 60 min of heating. In contrast, β-lactoglobulin and α-lactalbumin bands became progressively weaker with increasing heating times, with no detectable β-lactoglobulin after 15-20 min of heating. The ovalbumin band became progressively weaker, whereas ovomucoid remained stable after 25 min of heating. Immunolabeling revealed that all heated milk-reactive children possessed IgE antibodies that bound the casein fraction regardless of heating time. Presence of wheat during heating resulted in decreased IgE antibody binding to milk and egg white proteins. CONCLUSION Heating has a different effect on whey and caseins in cow's milk and ovalbumin and ovomucoid in hen's egg white. The effect of heat on protein allergenicity is affected by the temperature and duration, along with the presence of wheat.
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Affiliation(s)
- Katherine A Bloom
- Division of Allergy/Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Greenhawt M, Aceves SS. Non-IgE Medicated Food Allergy: Eosinophilic Esophagitis Update on the Pathogenesis, Clinical Features, and Management of Eosinophilic Esophagitis in Children. CURRENT PEDIATRICS REPORTS 2014. [DOI: 10.1007/s40124-014-0045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Bartnikas LM, Phipatanakul W. Turning up the heat on skin testing for baked egg allergy. Clin Exp Allergy 2014; 43:1095-6. [PMID: 24074327 DOI: 10.1111/cea.12183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L M Bartnikas
- Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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17
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Lee SY. The antigenicities of heat treated and hydrolyzed cow's milk protein. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.4.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- So-Yeon Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Peters RL, Dharmage SC, Gurrin LC, Koplin JJ, Ponsonby AL, Lowe AJ, Tang MLK, Tey D, Robinson M, Hill D, Czech H, Thiele L, Osborne NJ, Allen KJ. The natural history and clinical predictors of egg allergy in the first 2 years of life: a prospective, population-based cohort study. J Allergy Clin Immunol 2013; 133:485-91. [PMID: 24373356 DOI: 10.1016/j.jaci.2013.11.032] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/16/2013] [Accepted: 11/21/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is a paucity of data examining the natural history of and risk factors for egg allergy persistence, the most common IgE-mediated food allergy in infants. OBJECTIVE We aimed to assess the natural history of egg allergy and identify clinical predictors for persistent egg allergy in a population-based cohort. METHODS The HealthNuts study is a prospective, population-based cohort study of 5276 infants who underwent skin prick tests to 4 allergens, including egg. Infants with a detectable wheal were offered hospital-based oral food challenges (OFCs) to egg, irrespective of skin prick test wheal sizes. Infants with challenge-confirmed raw egg allergy were offered baked egg OFCs at age 1 year and follow-up at age 2 years, with repeat OFCs to raw egg. RESULTS One hundred forty infants with challenge-confirmed egg allergy at age 1 year participated in the follow-up. Egg allergy resolved in 66 (47%) infants (95% CI, 37% to 56%) by 2 years of age; however, resolution was lower in children with baked egg allergy at age 1 year compared with baked egg tolerance (13% and 56%, respectively; adjusted odds ratio, 5.27; 95% CI, 1.36-20.50; P = .02). In the subgroup of infants who were tolerant to baked egg at age 1 year, frequent ingestion of baked egg (≥5 times per month) compared with infrequent ingestion (0-4 times per month) increased the likelihood of tolerance (adjusted odds ratio, 3.52; 95% CI, 1.38-8.98; P = .009). Mutation in the filaggrin gene was not associated with the resolution of either egg allergy or egg sensitization at age 2 years. CONCLUSION Phenotyping of egg allergy (baked egg tolerant vs allergic) should be considered in the management of this allergy because it has prognostic implications and eases dietary restrictions. Randomized controlled trials for egg oral immunotherapy should consider stratifying at baseline by the baked egg subphenotype to account for the differential rate of tolerance development.
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Affiliation(s)
- Rachel L Peters
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Shyamali C Dharmage
- Murdoch Childrens Research Institute, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Australia
| | - Lyle C Gurrin
- Murdoch Childrens Research Institute, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Australia
| | - Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Adrian J Lowe
- Murdoch Childrens Research Institute, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Australia
| | - Mimi L K Tang
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Dean Tey
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Marnie Robinson
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - David Hill
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Helen Czech
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Leone Thiele
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Nicholas J Osborne
- Department of Paediatrics, University of Melbourne, Parkville, Australia; Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Parkville, Australia; European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Truro, United Kingdom
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; University of Manchester, Manchester, United Kingdom.
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19
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Food allergen selective thermal processing regimens may change oral tolerance in infancy. Allergol Immunopathol (Madr) 2013; 41:407-17. [PMID: 23253679 DOI: 10.1016/j.aller.2012.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 08/03/2012] [Indexed: 12/20/2022]
Abstract
Food allergy can be considered a failure in the induction of oral tolerance. Recently, great interest has been focused on understanding the mechanisms and the contributing factors of oral tolerance development, hoping for new definitive interventions in the prevention and treatment of food allergy. Given that food processing may modify the properties and the nature of dietary proteins, several food processing methods could affect the allergenicity of these proteins and consequently may favour oral tolerance induction to food allergic children. Indeed, effective thermal food processing regimens of altering food proteins to reduce allergenicity have been recently reported in the literature. This article is mainly focused on the effect of selective thermal processing regimens on the main infant allergenic foods, with a potential clinical relevance on their allergenicity and therefore on oral tolerance induction. In the light of recent findings, the acquisition of tolerance in younger age and consequently the ability of young children to "outgrow" food allergy could be achieved through the application of selective thermal processing regimens on certain allergenic foods. Therefore, the ability of processed foods to circumvent clinical disease and at the same time to have an impact on the immune system and facilitate tolerance induction could be invaluable as a component of a successful therapeutic strategy. The opening in the new avenues of research in the use of processed foods in clinical practice for the amelioration of the impact on the quality of life of patients and possibly in food allergy prevention is warranted.
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Netting M, Makrides M, Gold M, Quinn P, Penttila I. Heated allergens and induction of tolerance in food allergic children. Nutrients 2013; 5:2028-46. [PMID: 23739144 PMCID: PMC3725491 DOI: 10.3390/nu5062028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 01/25/2023] Open
Abstract
Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow's milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow's milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow's milk and egg allergy.
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Affiliation(s)
- Merryn Netting
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
| | - Maria Makrides
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
| | - Michael Gold
- Children’s Youth and Women’s Health Network, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.G.); (P.Q.)
| | - Patrick Quinn
- Children’s Youth and Women’s Health Network, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.G.); (P.Q.)
| | - Irmeli Penttila
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
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21
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Alessandri C, Sforza S, Palazzo P, Lambertini F, Paolella S, Zennaro D, Rafaiani C, Ferrara R, Bernardi ML, Santoro M, Zuzzi S, Giangrieco I, Dossena A, Mari A. Tolerability of a fully maturated cheese in cow's milk allergic children: biochemical, immunochemical, and clinical aspects. PLoS One 2012; 7:e40945. [PMID: 22829901 PMCID: PMC3400663 DOI: 10.1371/journal.pone.0040945] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/15/2012] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND From patients' reports and our preliminary observations, a fully maturated cheese (Parmigiano-Reggiano; PR) seems to be well tolerated by a subset of cow's milk (CM) allergic patients. OBJECTIVE AND METHODS To biochemically and immunologically characterize PR samples at different maturation stage and to verify PR tolerability in CM allergic children. Seventy patients, with suspected CM allergy, were enrolled. IgE to CM, α-lactalbumin (ALA), β-lactoglobulin (BLG) and caseins (CAS) were tested using ImmunoCAP, ISAC103 and skin prick test. Patients underwent a double-blind, placebo-controlled food challenge with CM, and an open food challenge with 36 months-maturated PR. Extracts obtained from PR samples were biochemically analyzed in order to determine protein and peptide contents. Pepsin and trypsin-chymotrypsin-pepsin simulated digestions were applied to PR extracts. Each PR extract was investigated by IgE Single Point Highest Inhibition Achievable assay (SPHIAa). The efficiency analysis was carried out using CM and PR oral challenges as gold standards. RESULTS The IgE binding to milk allergens was 100% inhibited by almost all PR preparations; the only difference was for CAS, mainly α(S1)-CAS. Sixteen patients sensitized to CM tolerated both CM and PR; 29 patients tolerated PR only; 21 patients, reacted to both CM and PR, whereas 4 patients reactive to CM refused to ingest PR. ROC analysis showed that the absence of IgE to BLG measured by ISAC could be a good marker of PR tolerance. The SPHIAa using digested PR preparations showed a marked effect on IgE binding to CAS and almost none on ALA and BLG. CONCLUSIONS 58% of patients clinically reactive to CM tolerated fully maturated PR. The preliminary digestion of CAS induced by PR maturation process, facilitating a further loss of allergenic reactivity during gut digestion, might explain the tolerance. This hypothesis seems to work when no IgE sensitization to ISAC BLG is detected.
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Affiliation(s)
| | - Stefano Sforza
- Department of Organic and Industrial Chemistry, University of Parma, Parma, Italy
| | - Paola Palazzo
- Center for Molecular Allergology, IDI-IRCCS, Rome, Italy
| | - Francesca Lambertini
- Department of Organic and Industrial Chemistry, University of Parma, Parma, Italy
| | - Sara Paolella
- Department of Organic and Industrial Chemistry, University of Parma, Parma, Italy
| | - Danila Zennaro
- Center for Molecular Allergology, IDI-IRCCS, Rome, Italy
| | | | | | | | - Mario Santoro
- Center for Molecular Allergology, IDI-IRCCS, Rome, Italy
| | - Sara Zuzzi
- Center for Molecular Allergology, IDI-IRCCS, Rome, Italy
| | | | - Arnaldo Dossena
- Department of Organic and Industrial Chemistry, University of Parma, Parma, Italy
| | - Adriano Mari
- Center for Molecular Allergology, IDI-IRCCS, Rome, Italy
- * E-mail:
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Faraj Z, Kim HL. Skin prick testing with extensively heated milk or egg products helps predict the outcome of an oral food challenge: a retrospective analysis. Allergy Asthma Clin Immunol 2012; 8:5. [PMID: 22591833 PMCID: PMC3394206 DOI: 10.1186/1710-1492-8-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 05/16/2012] [Indexed: 11/10/2022] Open
Abstract
Background Cow’s milk and hen’s egg are the most frequently encountered food allergens in the pediatric population. Skin prick testing (SPT) with commercial extracts followed by an oral food challenge (OFC) are routinely performed in the diagnostic investigation of these children. Recent evidence suggests that milk-allergic and/or egg-allergic individuals can often tolerate extensively heated (EH) forms of these foods. This study evaluated the predictive value of a negative SPT with EH milk or egg in determining whether a child would tolerate an OFC to the EH food product. Methods Charts from a single allergy clinic were reviewed for any patient with a negative SPT to EH milk or egg, prepared in the form of a muffin. Data collected included age, sex, symptoms of food allergy, co-morbidities and the success of the OFC to the muffin. Results Fifty-eight patients had negative SPTs to the EH milk or egg in a muffin and underwent OFC to the appropriate EH food in the outpatient clinic. Fifty-five of these patients tolerated the OFC. The negative predictive value for the SPT with the EH food product was 94.8%. Conclusions SPT with EH milk or egg products was predictive of a successful OFC to the same food. Larger prospective studies are required to substantiate these findings.
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Affiliation(s)
- Zein Faraj
- Michael G, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
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