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Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults. Curr Allergy Asthma Rep 2024; 24:121-131. [PMID: 38416390 PMCID: PMC10960768 DOI: 10.1007/s11882-024-01131-3] [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] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This narrative review explores food allergy prevalence and natural history stratified by life stages, especially in context of evolving knowledge over the last few decades. RECENT FINDINGS The prevalence of food allergy remains highest in early childhood with common food triggers being cow's milk, soy, hen's egg, wheat, peanut, tree nuts, sesame, fish, and shellfish. This correlates with certain risk factors especially pertinent in the postnatal period which appear to predispose an individual to developing a food allergy. Some allergies (such as milk and egg) were previously thought to be easily outgrown in early life; however, recent studies suggest increasing rates of persistence of these allergies into young adulthood; the reason behind this is unknown. Despite this, there is also evidence demonstrating that food allergies can be outgrown in adolescents and adults. An understanding of the paradigm shifts in the natural history of food allergy allows clinicians to provide updated, age-appropriate, and tailored advice for patients on the management and prognosis of food allergy.
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Affiliation(s)
- Eric C K Lee
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Brit Trogen
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kathryn Brady
- Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Lara S Ford
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Sydney Medical School, The University of Sydney, The University of Sydney, NSW, 2006, Australia.
| | - Julie Wang
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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2
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Zingone F, Bertin L, Maniero D, Palo M, Lorenzon G, Barberio B, Ciacci C, Savarino EV. Myths and Facts about Food Intolerance: A Narrative Review. Nutrients 2023; 15:4969. [PMID: 38068827 PMCID: PMC10708184 DOI: 10.3390/nu15234969] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Most adverse reactions to food are patient self-reported and not based on validated tests but nevertheless lead to dietary restrictions, with patients believing that these restrictions will improve their symptoms and quality of life. We aimed to clarify the myths and reality of common food intolerances, giving clinicians a guide on diagnosing and treating these cases. We performed a narrative review of the latest evidence on the widespread food intolerances reported by our patients, giving indications on the clinical presentations, possible tests, and dietary suggestions, and underlining the myths and reality. While lactose intolerance and hereditary fructose intolerance are based on well-defined mechanisms and have validated diagnostic tests, non-coeliac gluten sensitivity and fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) intolerance are mainly based on patients' reports. Others, like non-hereditary fructose, sorbitol, and histamine intolerance, still need more evidence and often cause unnecessary dietary restrictions. Finally, the main outcome of the present review is that the medical community should work to reduce the spread of unvalidated tests, the leading cause of the problematic management of our patients.
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Affiliation(s)
- Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
| | - Luisa Bertin
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
| | - Daria Maniero
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
| | - Michela Palo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
| | - Greta Lorenzon
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
| | - Brigida Barberio
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, 84081 Salerno, Italy;
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35124 Padua, Italy; (L.B.); (D.M.); (M.P.); (G.L.); (E.V.S.)
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy;
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3
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Mastrorilli C, Arasi S, Barni S, Caimmi D, Chiera F, Comberiati P, Dinardo G, Giannetti A, Gismondi M, Gracci S, Paravati F, Pelosi U, Miraglia Del Giudice M, Bernardini R, Pecoraro L. IgE-Mediated and Non-IgE-Mediated Fish Allergy in Pediatric Age: A Holistic Approach-A Consensus by Diagnostic Commission of the Italian Society of Pediatric Allergy and Immunology. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1651. [PMID: 37763770 PMCID: PMC10537060 DOI: 10.3390/medicina59091651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Fish is one of the "big nine" foods triggering allergic reactions. For this reason, fish allergens must be accurately specified on food labels. Fish allergy affects less than 1% of the world population, but a higher prevalence is observed in pediatric cohorts, up to 7%. Parvalbumin is the main fish allergen found in the muscles. In childhood, sensitization to fish allergens occurs most frequently through the ingestion of fish, rarely transcutaneously or by inhalation. Fish allergy symptoms usually appear within two hours of the allergen contact. The diagnosis begins with the collection of the history. If it is suggestive of fish allergy, prick tests or the measurement of serum-specific IgE should be performed to confirm the suspicion. The oral food challenge is the gold standard for the diagnosis. It is not recommended in case of a severe allergic reaction. It is important to make a differential diagnosis with anisakiasis or scombroid poisoning, which have overlapping clinical features but differ in pathogenesis. Traditionally, managing fish allergy involves avoiding the triggering species (sometimes all bony fish species) and requires an action plan for accidental exposures. The present review will analyze IgE- and non-IgE-mediated fish allergy in children from epidemiology, pathogenesis to clinical features. Moreover, clinical management will be addressed with a particular focus on potential nutritional deficiencies.
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Affiliation(s)
- Carla Mastrorilli
- Admission and Emergency Pediatric Medicine and Surgery Unit, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy; (C.M.); (M.G.)
| | - Stefania Arasi
- Area of Translational Research in Pediatric Specialities, Allergy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Simona Barni
- Allergic Unit, Department of Pediatric, Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Davide Caimmi
- Allergy Unit, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France;
- IDESP, UMR A11, Université de Montpellier, 34093 Montpellier, France
| | - Fernanda Chiera
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Pasquale Comberiati
- Section of Paediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Giulio Dinardo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.M.D.G.)
| | - Arianna Giannetti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Marco Gismondi
- Admission and Emergency Pediatric Medicine and Surgery Unit, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, 70124 Bari, Italy; (C.M.); (M.G.)
| | - Serena Gracci
- Pediatrics and Neonatology Complex Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, 50053 Empoli, Italy;
- Department of Pediatrics, University Hospital of Pisa, 56124 Pisa, Italy
| | - Francesco Paravati
- Department of Pediatrics, San Giovanni di Dio Hospital, 88900 Crotone, Italy; (F.C.); (F.P.)
| | - Umberto Pelosi
- Pediatric Unit, Santa Barbara Hospital, 09016 Iglesias, Italy;
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.M.D.G.)
| | - Roberto Bernardini
- Pediatrics and Neonatology Complex Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, 50053 Empoli, Italy;
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy;
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Spolidoro GCI, Ali MM, Amera YT, Nyassi S, Lisik D, Ioannidou A, Rovner G, Khaleva E, Venter C, van Ree R, Worm M, Vlieg-Boerstra B, Sheikh A, Muraro A, Roberts G, Nwaru BI. Prevalence estimates of eight big food allergies in Europe: Updated systematic review and meta-analysis. Allergy 2023; 78:2361-2417. [PMID: 37405695 DOI: 10.1111/all.15801] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023]
Abstract
In 2014, the European Academy of Allergy and Clinical Immunology published prevalence estimates for food allergy (FA) and food sensitization (FS) to the so-called eight big food allergens (i.e. cow's milk, egg, wheat, soy, peanut, tree nuts, fish and shellfish) in Europe for studies published between 2000 and 2012. The current work provides 10-year updated prevalence estimates for these food allergens. A protocol was registered on PROSPERO before starting the research (reference number CRD42021266657). Six databases were searched for studies published 2012-2021, added to studies published up to 2012, resulting in a total of 93 studies. Most studies were graded as at moderate risk of bias. The overall pooled estimates for all age groups of self-reported lifetime prevalence were as follows: cow's milk (5.7%, 95% confidence interval 4.4-6.9), egg (2.4%, 1.8-3.0), wheat (1.6%, 0.9-2.3), soy (0.5%, 0.3-0.7), peanut (1.5%, 1.0-2.1), tree nuts (0.9%, 0.6-1.2), fish (1.4%, 0.8-2.0) and shellfish (0.4%, 0.3-0.6). The point prevalence of food challenge-verified allergy were as follows: cow's milk (0.3%, 0.1-0.5), egg (0.8%, 0.5-1.2), wheat (0.1%, 0.01-0.2), soy (0.3%, 0.1-0.4), peanut (0.1%, 0.0-0.2), tree nuts (0.04%, 0.02-0.1), fish (0.02%, 0.0-0.1) and shellfish (0.1%, 0.0-0.2). With some exceptions, the prevalence of allergy to common foods did not substantially change during the last decade; variations by European regions were observed.
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Affiliation(s)
- Giulia C I Spolidoro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mohamed Mustafa Ali
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Yohannes Tesfaye Amera
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sungkutu Nyassi
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Daniil Lisik
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Athina Ioannidou
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Graciela Rovner
- ACT Institutet Sweden, Gothenburg, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Carina Venter
- Section of Allergy & Immunology, School of Medicine, University of Colorado Denver, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ronald van Ree
- Department of Experimental Immunology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Berber Vlieg-Boerstra
- Department of Pediatrics, OLVG Hospital, Amsterdam, The Netherlands
- Department of Pediatrics, Rijnstate Hospital, Arnhem, The Netherlands
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Antonella Muraro
- Department of Mother and Child Health, The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Padua, Italy
| | - Graham Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK
- David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, UK
| | - Bright I Nwaru
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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5
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Krajewski GS, Krajewski T. Evaluation and Management of Food Allergies in the Emergency Department. Immunol Allergy Clin North Am 2023; 43:491-501. [PMID: 37394255 DOI: 10.1016/j.iac.2022.10.003] [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: 07/04/2023]
Abstract
Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.
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Affiliation(s)
- Genevieve Schult Krajewski
- Ochsner Medical Center Emergency Department, 1514 Jefferson Highway, New Orleans, LA 70121, USA; Ochsner Emergency Medicine Residency, New Orleans, LA, USA; Ochsner Clinical School at the University of Queensland, New Orleans, LA, USA.
| | - Thomas Krajewski
- Ochsner Medical Center Emergency Department, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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6
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Ngo SY, Venter C, Anderson WC, Picket K, Zhang H, Arshad SH, Kurukulaaratchy RJ. Clinical features and later prognosis of replicable early-life wheeze clusters from two birth cohorts 12 years apart. Pediatr Allergy Immunol 2023; 34:e13999. [PMID: 37492911 PMCID: PMC10372879 DOI: 10.1111/pai.13999] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Clustering techniques can define the heterogeneity of asthma and wheezing. Defining early-life wheezing clusters and associated asthma risk could potentially inform patient management strategies. Clustering models that yield replicable cluster groups will have greater validity and clinical utility. This study sought to identify early-life wheezing clusters that are translatable into clinical practice and assess their stability over time in two whole-population birth cohorts established a decade apart from the same geographical location. METHODS Nonparametric K-means cluster analysis was performed separately on two birth cohorts from the Isle of Wight, UK; the Isle of Wight Birth Cohort (IOWBC) and Food Allergy and Intolerance Research Cohort (FAIR), using clinically defining variables in wheezing subjects in the first 3-4 years. Associations of resulting clusters with potential early-life risk factors and 10-year asthma outcomes were further assessed. RESULTS Five clusters were identified in both cohorts: (1) infantile-onset-transient-non-atopic-wheeze, (2) infantile-onset-persistent-non-atopic-wheeze, (3) infantile-onset-atopic-wheeze, (4) early-childhood-onset-non-atopic-wheeze, and (5) early-childhood-onset-atopic-wheeze. Two atopic wheezing clusters (3 and 5) were associated with greatest early-life wheeze frequency, highest wheeze persistence, and asthma prevalence at 10 years. Cluster 1 was commonest but had lowest early-life wheeze frequency and asthma prevalence at 10 years. Cluster 2, characterized by limited atopy but recurrent infantile respiratory infections and ongoing early-life wheezing, had high 10-year asthma prevalence only in IOWBC. CONCLUSIONS Early-life wheeze comprises several disease clusters (two more severe and three mild-moderate) with differing relationships to later childhood asthma, which can be replicated over time supporting their potential validity and clinical utility.
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Affiliation(s)
- Suzanne Y Ngo
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colo
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Carina Venter
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colo
| | - William C Anderson
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colo
| | - Kaci Picket
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, Colo
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - S Hasan Arshad
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma & Allergy Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
| | - Ramesh J Kurukulaaratchy
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma & Allergy Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
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7
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Sadighara P, Safta M, Limam I, Ghanati K, Nazari Z, Karami M, Abedini A. Association between food additives and prevalence of allergic reactions in children: a systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:181-186. [PMID: 35106984 DOI: 10.1515/reveh-2021-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Food additives contain synthetic and natural chemical compounds and are one of the causes of food allergies. In this regard, it is necessary to recognize the food additives that are of special interest for children. In this survey, the relation between food additives and allergic reactions and attention-deficit hyperactivity disorders in children was studied. The research studies with keywords "allergic reactions", "hypersensitivity", "food additives" and "children" were searched in PubMed, Scopus, Science Direct, Web of Science, and SID databases, from 1984 to 2020. Three hundred twenty-seven studies were obtained and only seven articles were finally selected according to exclusion and inclusion criteria. In the final review, seven articles were selected to investigate the relationship between food additives and hypersensitivity reactions. Some clinical factors such as urticaria, eczema, rhinitis and gastrointestinal symptoms and the prevalence of laboratory evidence in atopic children are due to increased exposure to food additives including artificial colors and sweeteners, preservatives, and monosodium glutamate. Clinical signs and laboratory evidence prove a significant association between some food additives and allergenic adverse reactions. It was also found that food additives such as artificial colors and sweeteners, preservatives, and monosodium glutamate are responsible for most cases of hypersensitivity in children, and the prevalence of hypersensitivity to food additives was estimated to be about 1.2% based on data extracted from studies.
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Affiliation(s)
- Parisa Sadighara
- Department of Environmental Health, Food Safety Division, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Safta
- Laboratory of Materials, Treatment and Analysis, (LMTA), National Institute of Research and Physicochemical Analysis, Biotechpole Sidi-Thabet, Ariana, Tunisia
- Faculty of Mathematical, Physical and Natural Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Intissar Limam
- Laboratory of Materials, Treatment and Analysis, (LMTA), National Institute of Research and Physicochemical Analysis, Biotechpole Sidi-Thabet, Ariana, Tunisia
- High School for Science and Health Techniques of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Kiandokht Ghanati
- National Nutrition & Food Technology Research Institute (NNFTRI), Director of Research & Education Affairs Office of International Affairs, The Member of Food Safety Research Center Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Nazari
- Food Quality and Safety Research Group, Food Science and Technology Research Institute, ACECR Mashhad Branch, Mashhad, Iran
| | - Marzieh Karami
- Department of Environmental Health, Food Safety Division, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Abedini
- Department of Environmental Health, Food Safety Division, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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8
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Gao H, Jorgensen R, Raghunath R, Chandra S, Othman A, Olson E, Ng PKW, Gangur V. Intrinsic Allergenicity Potential of Salt-Soluble Protein Extracts from the Diploid, Tetraploid and Hexaploid Wheats: Validation Using an Adjuvant-Free Mouse Model. Int J Mol Sci 2023; 24:ijms24065453. [PMID: 36982527 PMCID: PMC10051541 DOI: 10.3390/ijms24065453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/14/2023] Open
Abstract
Wheat allergies are potentially life-threatening and, therefore, have become a major health concern at the global level. It is largely unknown at present whether genetic variation in allergenicity potential exists among hexaploid, tetraploid and diploid wheat species. Such information is critical in establishing a baseline allergenicity map to inform breeding efforts to identify hyper-, hypo- and non-allergenic varieties. We recently reported a novel mouse model of intrinsic allergenicity using the salt-soluble protein extract (SSPE) from durum, a tetraploid wheat (Triticum durum). Here, we validated the model for three other wheat species [hexaploid common wheat (Triticum aestivum), diploid einkorn wheat (Triticum monococcum), and the ancient diploid wheat progenitor, Aegilops tauschii], and then tested the hypothesis that the SSPEs from wheat species will exhibit differences in relative allergenicities. Balb/c mice were repeatedly exposed to SSPEs via the skin. Allergic sensitization potential was assessed by specific (s) IgE antibody responses. Oral anaphylaxis was quantified by the hypothermic shock response (HSR). The mucosal mast cell response (MMCR) was determined by measuring mast cell protease in the blood. While T. monococcum elicited the least, but significant, sensitization, others were comparable. Whereas Ae. taushcii elicited the least HSR, the other three elicited much higher HSRs. Similarly, while Ae. tauschii elicited the least MMCR, the other wheats elicited much higher MMCR as well. In conclusion, this pre-clinical comparative mapping strategy may be used to identify potentially hyper-, hypo- and non-allergenic wheat varieties via crossbreeding and genetic engineering methods.
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Affiliation(s)
- Haoran Gao
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (H.G.); (R.J.); (R.R.); (S.C.); (A.O.)
| | - Rick Jorgensen
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (H.G.); (R.J.); (R.R.); (S.C.); (A.O.)
| | - Rajsri Raghunath
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (H.G.); (R.J.); (R.R.); (S.C.); (A.O.)
| | - Shivam Chandra
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (H.G.); (R.J.); (R.R.); (S.C.); (A.O.)
| | - Aqilah Othman
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (H.G.); (R.J.); (R.R.); (S.C.); (A.O.)
| | - Eric Olson
- Wheat Breeding & Genetics Laboratory, Department of Plant, Soil and Microbial Sciences, Michigan State University, East Lansing, MI 48824, USA;
| | - Perry K. W. Ng
- Cereal Science Laboratory, Department of Food Science & Human Nutrition, Michigan State University, East Lansing, MI 48824, USA;
| | - Venu Gangur
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA; (H.G.); (R.J.); (R.R.); (S.C.); (A.O.)
- Correspondence: ; Tel.: +1-517-353-3330
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9
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Barbara G, Cremon C, Bellini M, Corsetti M, Di Nardo G, Falangone F, Fuccio L, Galeazzi F, Iovino P, Sarnelli G, Savarino EV, Stanghellini V, Staiano A, Stasi C, Tosetti C, Turco R, Ubaldi E, Zagari RM, Zenzeri L, Marasco G. Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP). Dig Liver Dis 2023; 55:187-207. [PMID: 36517261 DOI: 10.1016/j.dld.2022.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 01/29/2023]
Abstract
The irritable bowel syndrome (IBS) is a chronic disorder of gut-brain interaction. IBS is still associated with areas of uncertainties, especially regarding the optimal diagnostic work-up and the more appropriate management. Experts from 7 Italian Societies conducted a Delphi consensus with literature summary and voting process on 27 statements. Recommendations and quality of evidence were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus was defined as >80% agreement and reached for all statements. In terms of diagnosis, the consensus supports a positive diagnostic strategy with a symptom-based approach, including the psychological comorbidities assessment and the exclusion of alarm symptoms, together with the digital rectal examination, full blood count, C-reactive protein, serology for coeliac disease, and fecal calprotectin assessment. Colonoscopy should be recommended in patients with alarm features. Regarding treatment, the consensus strongly supports a dietary approach for patients with IBS, the use of soluble fiber, secretagogues, tricyclic antidepressants, psychologically directed therapies and, only in specific IBS subtypes, rifaximin. A conditional recommendation was achieved for probiotics, polyethylene glycol, antispasmodics, selective serotonin reuptake inhibitors and, only in specific IBS subtypes, 5-HT3 antagonists, 5-HT4 agonists, bile acid sequestrants.
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Affiliation(s)
- Giovanni Barbara
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy.
| | - Cesare Cremon
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56010 Pisa, Italy
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham, United Kingdom
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesca Falangone
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, University Sapienza, Rome, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy
| | - Francesca Galeazzi
- Gastroenterology Unit, Azienda Ospedale Università di Padova, 35128 Padua, Italy
| | - Paola Iovino
- Gastrointestinal Unit Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | | | - Vincenzo Stanghellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences-Section of Pediatric, University Federico II, 80100 Naples, Italy
| | - Cristina Stasi
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | | | - Rossella Turco
- Department of Translational Medical Sciences-Section of Pediatric, University Federico II, 80100 Naples, Italy
| | - Enzo Ubaldi
- Primary Care, Health Care Agency of Ascoli Piceno, Ascoli Piceno, Italy
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy
| | - Letizia Zenzeri
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Marasco
- IRCCS Azienda Ospedaliero Universitaria di Bologna, 40126 Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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10
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Spolidoro GCI, Amera YT, Ali MM, Nyassi S, Lisik D, Ioannidou A, Rovner G, Khaleva E, Venter C, van Ree R, Worm M, Vlieg-Boerstra B, Sheikh A, Muraro A, Roberts G, Nwaru BI. Frequency of food allergy in Europe: An updated systematic review and meta-analysis. Allergy 2023; 78:351-368. [PMID: 36271775 PMCID: PMC10099188 DOI: 10.1111/all.15560] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 02/01/2023]
Abstract
Food allergy (FA) is increasingly reported in Europe, however, the latest prevalence estimates were based on studies published a decade ago. The present work provides the most updated estimates of the prevalence and trends of FA in Europe. Databases were searched for studies published between 2012 and 2021, added to studies published up to 2012. In total, 110 studies were included in this update. Most studies were graded as moderate risk of bias. Pooled lifetime and point prevalence of self-reported FA were 19.9% (95% CI 16.6-23.3) and 13.1% (95% CI 11.3-14.8), respectively. The point prevalence of sensitization based on specific IgE (slgE) was 16.6% (95% CI 12.3-20.8), skin prick test (SPT) 5.7% (95% CI 3.9-7.4), and positive food challenge 0.8% (95% CI 0.5-0.9). While lifetime prevalence of self-reported FA and food challenge positivity only slightly changed, the point prevalence of self-reported FA, sIgE and SPT positivity increased from previous estimates. This may reflect a real increase, increased awareness, increased number of foods assessed, or increased number of studies from countries with less data in the first review. Future studies require rigorous designs and implementation of standardized methodology in diagnosing FA, including use of double-blinded placebo-controlled food challenge to minimize potential biases.
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Affiliation(s)
- Giulia C I Spolidoro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Yohannes Tesfaye Amera
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mohamed Mustafa Ali
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sungkutu Nyassi
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Daniil Lisik
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Athina Ioannidou
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Graciela Rovner
- ACT Institutet Sweden, Gothenburg, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Carina Venter
- Section of Allergy and Immunology, School of Medicine, University of Colorado Denver, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Allergy and Venerology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Berber Vlieg-Boerstra
- Department of Pediatrics, OLVG Hospital, Amsterdam, the Netherlands.,Department of Pediatrics, Rijnstate Hospital, Arnhem, the Netherlands
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Antonella Muraro
- Department of Mother and Child Health, The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Padua, Italy
| | - Graham Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK.,David Hide Asthma and Allergy Centre, St Mary's Hospital, Isle of Wight, UK
| | - Bright I Nwaru
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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11
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Légeret C, Lohmann C, Furlano RI, Köhler H. Food intolerances in children and adolescents in Switzerland. Eur J Pediatr 2023; 182:867-875. [PMID: 36512149 PMCID: PMC9899185 DOI: 10.1007/s00431-022-04755-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
Adverse food reactions have become an important health concern in pediatrics. There are discrepancies between diagnosed and self-reported food allergies and intolerances, leading to food avoidance with possible psychological and nutritional implications in the latter. There is no data available so far on the number of children and adolescents, who reduce or completely avoid certain foods in their diet. The aim of this study was to determine the prevalence of children and adolescents in the Northwest of Switzerland, who omit foods from their diet because of a self-reported intolerance, as well as the prevalence of children and adolescents who eliminate well-tolerated foods for presumed health reasons. This is a cross-sectional study conducted in the Children's hospitals of Aarau and Basel (Switzerland) and in 4 pediatric private practices. A total of 2036 children and adolescents (54% male and 46% female) between 1 month and 18 years (mean age: 7.4 years) were included, of which 316 (16%) participants reported to avoid foods due to intolerance. Lactose intolerance is the most frequent one. In 55% of all cases, no medical tests had been performed to confirm such an intolerance. Avoiding tolerated foods for presumed health reasons was stated by 251 (12%) participants. Conclusions: Clinicians should be aware of the high frequency of food avoidance in the pediatric population due to true intolerance, functional diseases, or due to lifestyle reasons. Milk is the most avoided food and half of the affected patients avoid foods without guidance by professional dieticians, therefore risking possible negative impacts on their physical and mental health. Pediatricians should perform further investigations or advise nutritional guidance if an avoidance of foods or specific diets occurs. What is Known: • The prevalence of food intolerances in children and adolescents is unknown. • Eating behavior in children is influenced by the consumption of social media. What is New: • Based on this large cross-sectional study, it was shown that 16% of children and adolescents avoid foods, half of them without any medical advice. • Food avoidance is common among this Swiss cohort of children because of different reasons: lifestyle habits, functional diseases, true intolerances with possible consequences such as micronutrient deficiencies if not properly monitored.
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Affiliation(s)
- Corinne Légeret
- University Children's Hospital Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
| | - Clarissa Lohmann
- Children's Hospital Aarau, Tellstrasse 9, 5001, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raoul I Furlano
- University Children's Hospital Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Henrik Köhler
- Children's Hospital Aarau, Tellstrasse 9, 5001, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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12
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Feng H, Luo N, Lu Y, Lu J, Zhou J, Xiong X, Chen Z, Chen Y, Wu Y. Prevalence of parent-reported food allergy among children in China: A population-based cross-sectional survey. Front Immunol 2022; 13:982660. [PMID: 36578482 PMCID: PMC9791183 DOI: 10.3389/fimmu.2022.982660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The prevalence of food allergy (FA) has been increasing in recent years and has become an important public health, food safety, and clinical nutrition problem. However, population-based studies on the prevalence of FA are very limited in China. This study aims to determine the prevalence and pattern of parent-reported FA among school children in Jiangxi Province, China. Methods A multicenter cross-sectional study on FA was conducted on primary school children aged 6-11 years old using random cluster sampling with a questionnaire survey. Parent-reported FA was used and defined as individual-reported FA by parent or guardian through a questionnaire in this study. Result Among the total of 8,856 (96.36%) complete questionnaires received, 727 (8.2%) children had adverse reactions to food (ARF). The prevalence rates of parent-reported FA and doctor-diagnosed FA were 6.2% and 3.3%, respectively. Animal-derived foods were the main causative source of FA, and the three leading allergenic foods were shrimp, mango, and mollusks. Skin reactions were the most common clinical manifestations of FA, accounting for 63.7%, and 45.32% of the subjects with parent-reported FA experienced severe allergic reactions. There was a significant difference in parent-reported FA between different survey centers, and FA risk increased significantly in children with other allergic diseases (P<0.001) and small family size (P=0.026). The FA prevalence was significantly higher among children aged 8-11 years than those aged 6-7 years (P=0.020). Conclusions A high prevalence of parent-reported FA was observed among children in general primary schools in Jiangxi Province, China. Shrimp, mango, and mollusks were the most common causative foods. The main common symptoms of FA were adverse reactions relating to the skin system. The rate of severe allergic reactions was also high in Jiangxi Children with reported FA. Local standards and policies for the prevention and management of FA need to be adjusted on a timely basis according to actual local conditions.
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Affiliation(s)
- Hua Feng
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China,School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Nan Luo
- School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Yuanan Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University of Hawaii, Hawaii, HI, United States
| | - Justin Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University of Hawaii, Hawaii, HI, United States
| | - Jiangdong Zhou
- Fengxin Center for Disease Control and Prevention, Jiangxi, Yichun, China
| | - Xiujuan Xiong
- Department of Pathology, Basic Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Zhuo Chen
- Sino German Joint Research Institute, Nanchang University, Nanchang, China
| | - Yan Chen
- Research Unit of Food Safety, Chinese Academy of Medical Sciences, National Health Commission (NHC), Key Lab of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment (CFSA), Beijing, China,*Correspondence: Yongning Wu, ; Yan Chen,
| | - Yongning Wu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, Jiangxi, China,Research Unit of Food Safety, Chinese Academy of Medical Sciences, National Health Commission (NHC), Key Lab of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment (CFSA), Beijing, China,*Correspondence: Yongning Wu, ; Yan Chen,
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13
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Do No Harm: Risk vs. Benefit of the Approach to Childhood Food Allergy. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Sayed KM, Ali AH. IgE Mediated Wheat Allergy Associated with Resistant and Severe Forms of Allergic Conjunctivitis. Open Respir Med J 2022. [DOI: 10.2174/18743064-v16-e2208170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
This study aimed to determine the prevalence and criteria of wheat allergy (WA) among patients with resistant allergic conjunctivitis (AC).
Methods:
A prospective comparative study was conducted on 100 patients with resistant AC. Skin prick-tests (SPTs), total and sIgE against a panel of inhalant and food allergens were performed in all patients’ sera. They were divided into 2 groups according to skin prick test (SPT) and specific IgE (sIgE) level, namely the wheat sensitive group (WSG) and wheat tolerant group (WTG). Total ocular symptom scores (TOSS) and 4-point sign scales were correlated for both groups.
Results:
Ten patients out of 100 with IgE-mediated resistant AC were wheat sensitive, and the other 90 were wheat tolerant patients. WSG included patients of significantly younger age. Positive family history of atopy was proven in 100% of WSG vs. 67% of WTG. A significantly higher frequency of multiorgan allergy was detected in 100% of WSG vs. 20% in WTG (P = 0.0001). Thirty (30%) of WSG had associated allergic rhinitis (AR) and bronchial asthma (BA). Another 30% had an associated AR only, 10% had an associated BA only, and another 20% had an associated skin allergy. TOSS, 4- point sign scale, and total IgE level were significantly higher in WSG.
Conclusion:
This study provides novel evidence that wheat allergy is responsible for some severe forms of AC.
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15
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Mishra M, Sarkar T, Choudhury T, Bansal N, Smaoui S, Rebezov M, Shariati MA, Lorenzo JM. Allergen30: Detecting Food Items with Possible Allergens Using Deep Learning-Based Computer Vision. FOOD ANAL METHOD 2022. [DOI: 10.1007/s12161-022-02353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Gao H, Jorgensen R, Raghunath R, Ng PKW, Gangur V. An Adjuvant-Free Mouse Model Using Skin Sensitization Without Tape-Stripping Followed by Oral Elicitation of Anaphylaxis: A Novel Pre-Clinical Tool for Testing Intrinsic Wheat Allergenicity. FRONTIERS IN ALLERGY 2022; 3:926576. [PMID: 36238931 PMCID: PMC9552944 DOI: 10.3389/falgy.2022.926576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022] Open
Abstract
Wheat is a major food allergen per the regulatory bodies of various nations. Hypersensitivity reactions to wheat have been steadily increasing for reasons that are not completely understood. Wheat-allergy models typically use adjuvants to induce sensitization to wheat proteins followed by an intraperitoneal challenge to elicit anaphylaxis. Although these models are very useful, they lack the ability to reveal the intrinsic allergenicity potential of wheat. To improve the mouse model of wheat allergy, we tested the hypothesis that repeated skin application of salt-soluble protein extract (SSPE) from durum wheat will clinically sensitize the mice to oral anaphylaxis to SSPE. Balb/c mice were bred and maintained on a plant-protein-free diet and used in the experiments. Adult female mice were exposed to SSPE once a week for 9 weeks via a solution on intact skin. Sensitization was measured by SSPE-specific IgE (sIgE) antibody and total IgE (tIgE) levels. Oral anaphylaxis was quantified by hypothermic shock response (HSR), and mucosal mast cell response (MMCR) was quantified by measuring MMCP-1 after oral challenge. Using single mouse data, correlation analyses were performed to determine the relationship among the allergenicity readouts. Spleen cytokines were quantified using a protein microarray method. Our results show that (i) repeated skin exposures to SSPE elicited robust increases in the sIgE and tIgE levels; (ii) skin exposure to SSPE was sufficient to sensitize mice for oral anaphylaxis and MMCR; (iii) both HSR and MMCR showed a strong correlation with each other, as well as with sIgE, and a modest correlation with tIgE levels; (iv) selected Th2/Th17/Th1 cytokines were elevated in skin-sensitized mice; and (v) oral allergen-challenged mice showed selective elevation of IL-6 and a panel of chemokines compared to saline-challenged mice. Together, we report the development and characterization of a novel adjuvant-free wheat-allergy mouse model that uses skin sensitization without tape-stripping followed by oral elicitation of anaphylaxis. Furthermore, validation of quantifiable wheat allergenicity readouts makes this model particularly suitable as a pre-clinical testing tool to assess the intrinsic sensitization/oral-anaphylaxis elicitation potential of novel wheat proteins (e.g., processed wheat) and to develop hypo/non-allergenic wheat products.
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Affiliation(s)
- Haoran Gao
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Rick Jorgensen
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Rajsri Raghunath
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Perry K. W. Ng
- Cereal Science Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Venu Gangur
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
- *Correspondence: Venu Gangur
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Serum Allergen-Specific IgE among Pediatric Patients with Primary Immunodeficiency. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040466. [PMID: 35455510 PMCID: PMC9029572 DOI: 10.3390/children9040466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/11/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
Abstract
Background: Allergy is a clinical condition that reflects a deviated function of the immune system. The purpose of this study was to evaluate serum allergen-specific IgE (sIgE) along with clinical manifestations of allergy in patients with diagnosed primary immunodeficiency (PID). Methods: 72 patients, aged 1−17 years, diagnosed with PID and hospitalized between July 2020 and February 2021 were included in the study. Blood samples were obtained by venipuncture. sIgE (30 allergens), blood eosinophil count, as well as total IgE and IgG were measured and assessed in relation to a detailed medical examination. Results: Serum sIgE was detected in the blood of 50% of the patients in the study group, which significantly correlated (p < 0.0001) with clinical symptoms of allergy. During the period of the study, 61.1% of the patients showed symptoms of allergy, with 77.27% of them having tested positive for sIgE. The total IgE level was elevated in 18.06% of the patients and correlated with clinical symptoms of allergy (p = 0.004). An elevated total IgE level was not observed in children receiving immunoglobulin replacement therapy. Conclusion: The study showed that serum sIgE and total IgE together might be a plausible diagnostic tool for PID patients. However, for patients receiving immunoglobulin replacement therapy, the assessment of total IgE is not useful.
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18
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Tsoumani M, Regent L, Warner A, Gallop K, Patel R, Ryan R, Vereda A, Acaster S, DunnGalvin A, Byrne A. Allergy to Peanuts imPacting Emotions And Life (APPEAL): The impact of peanut allergy on children, teenagers, adults and caregivers in the UK and Ireland. PLoS One 2022; 17:e0262851. [PMID: 35130296 PMCID: PMC8820639 DOI: 10.1371/journal.pone.0262851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
The Allergy to Peanuts imPacting Emotions And Life study (APPEAL) explored the psychosocial burden of living with self-reported peanut allergy experienced by children, teenagers, adults and caregivers in the UK and Ireland. A two-stage (quantitative survey and qualitative interview [APPEAL-1]), cross-sectional study of the psychosocial burden of peanut allergy (APPEAL-2) was conducted. Quantitative data were evaluated using descriptive statistics and qualitative data were analysed using MAXQDA software. A conceptual model specific to UK and Ireland was developed using the concepts identified during the analysis. A total of 284 adults in the UK and Ireland completed the APPEAL-1 survey and 42 individuals participated in APPEAL-2. Respondents reported that peanut allergy restricts their choices in various situations, especially with regard to choosing food when eating out (87% moderately or severely restricted), choosing where to eat (82%), special occasions (76%) and when buying food from a shop (71%). Fifty-two percent of survey participants and 40% of interview participants reported being bullied because of PA. Psychological impact of peanut allergy included feeling at least moderate levels of frustration (70%), uncertainty (79%), and stress (71%). The qualitative analysis identified three different types of coping strategies (daily monitoring or vigilance, communication and planning) and four main areas of individuals’ lives that are impacted by peanut allergy (social activities, relationships, emotions and work [adults and caregivers only]). The extent of the impact reported varied substantially between participants, with some reporting many negative consequences of living with peanut allergy and others feeling it has minimal impact on their health-related quality of life. This large survey and interview study highlight the psychosocial burden of peanut allergy for adults, teenagers, children and caregivers in the UK and Ireland. The analysis demonstrates the wide variation in level of impact of peanut allergy and the unmet need for those individuals who experience a substantial burden from living with peanut allergy.
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Affiliation(s)
- Marina Tsoumani
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Lynne Regent
- Anaphylaxis Campaign, Farnborough, United Kingdom
| | | | - Katy Gallop
- Acaster Lloyd Consulting, London, United Kingdom
| | - Ram Patel
- Brainsell Ltd., London, United Kingdom
| | - Robert Ryan
- Aimmune Therapeutics, A Nestlé Health Science Company, London, United Kingdom
| | - Andrea Vereda
- Aimmune Therapeutics, A Nestlé Health Science Company, London, United Kingdom
| | | | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- * E-mail:
| | - Aideen Byrne
- Allergy Dept, Children’s Health Ireland and Paediatrics and Child Health Trinity College Dublin, Dublin, Ireland
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Lange L, Klimek L, Beyer K, Blümchen K, Novak N, Hamelmann E, Bauer A, Merk HF, Rabe U, Jung K, Schlenter WW, Ring J, Chaker AM, Wehrmann W, Becker S, Mülleneisen NK, Nemat K, Czech W, Wrede H, Brehler R, Fuchs T, Jakob T, Ankermann T, Schmidt SM, Gerstlauer M, Zuberbier T, Spindler T, Vogelberg C. White Paper Erdnussallergie - Teil 1: Epidemiologie, Burden of Disease, gesundheitsökonomische Aspekte. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Abstract
Food allergies are a common and serious cause of illness, accounting for an increasing number of emergency department visits annually. Although definite diagnosis lays outside of an emergency department visit, the clinical management of the most serious food allergies highlights emergency care. The staple of acute care remains epinephrine in association with antihistamines and steroids. The greatest threat remains undertreatment for this group of disorders and underutilization of epinephrine. Those who have been treated for a food allergy need a follow-up allergist evaluation, guidance of food avoidance, and avoidance of foods with cross-sensitivities as well as ready access to epinephrine.
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21
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Onyimba F, Crowe SE, Johnson S, Leung J. Food Allergies and Intolerances: A Clinical Approach to the Diagnosis and Management of Adverse Reactions to Food. Clin Gastroenterol Hepatol 2021; 19:2230-2240.e1. [PMID: 33493695 DOI: 10.1016/j.cgh.2021.01.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/18/2020] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
Food allergy is an aberrant immunological response to food antigen, which can result in potentially life-threatening reactions. It is often challenging to differentiate food allergy from other adverse reactions to food because their presentations can be indistinguishable. The purpose of this article is to give an overview of the classification, evaluation, and management of adverse food reactions, key differentiating features of food allergy, roles and limitations of various food allergy testing, and promising areas of emerging research. Case studies are used to highlight some of the clinical pearls in diagnosing and managing food-related diseases.
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Affiliation(s)
- Frances Onyimba
- University of Maryland School of Medicine, Baltimore, Maryland.
| | - Sheila E Crowe
- University of California San Diego, La Jolla, California
| | | | - John Leung
- Boston Food Allergy Center, Boston, Massachusetts; Tufts Medical Center, Boston, Massachusetts.
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22
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Lange L, Klimek L, Beyer K, Blümchen K, Novak N, Hamelmann E, Bauer A, Merk H, Rabe U, Jung K, Schlenter W, Ring J, Chaker A, Wehrmann W, Becker S, Mülleneisen N, Nemat K, Czech W, Wrede H, Brehler R, Fuchs T, Jakob T, Ankermann T, Schmidt SM, Gerstlauer M, Zuberbier T, Spindler T, Vogelberg C. White paper on peanut allergy - part 1: Epidemiology, burden of disease, health economic aspects. ACTA ACUST UNITED AC 2021; 30:261-269. [PMID: 34603938 PMCID: PMC8477625 DOI: 10.1007/s40629-021-00189-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/21/2021] [Indexed: 01/27/2023]
Abstract
Peanuts are Leguminosae, commonly known as the legume or pea family, and peanut allergy is among the most common food allergies and the most common cause of fatal food reactions and anaphylaxis. The prevalence of peanut allergy increased 3.5-fold over the past two decades reaching 1.4–2% in Europe and the United States. The reasons for this increase in prevalence are likely multifaceted. Sensitization via the skin appears to be associated with the development of peanut allergy and atopic eczema in infancy is associated with a high risk of developing peanut allergy. Until recently, the only possible management strategy for peanut allergy was strict allergen avoidance and emergency treatment including adrenaline auto-injector in cases of accidental exposure and reaction. This paper discusses the various factors that impact the risks of peanut allergy and the burden of self-management on peanut-allergic children and their caregivers.
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Affiliation(s)
- Lars Lange
- Department of Pediatrics, St. Marien-Hospital, GFO Clinics Bonn, Bonn, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden, Wiesbaden, Germany
| | - Kirsten Beyer
- Department of Pediatrics m.S. Pneumology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Blümchen
- Center of Pediatric and Adolescent Medicine, Focus on Allergology, Pneumology and Cystic Fibrosis, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt a. M., Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Eckard Hamelmann
- Pediatric and Adolescent Medicine, Bethel Children's Center, OWL University Hospital of Bielefeld University, Bielefeld, Germany
| | - Andrea Bauer
- Clinic and Polyclinic for Dermatology, University AllergyCenter, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Hans Merk
- Department of Dermatology & Allergology, RWTH Aachen, Aachen, Germany
| | - Uta Rabe
- Clinic for Allergology, Johanniter-Krankenhaus im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Kirsten Jung
- Practice for Dermatology, Immunology and Allergology, Erfurt, Germany
| | | | | | - Adam Chaker
- Department of Otolaryngology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Center for Allergy and Environment (ZAUM), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Sven Becker
- Department of Otolaryngology, University of Tübingen, Tübingen, Germany
| | | | - Katja Nemat
- Pediatric Pneumology/Allergology Practice, Kinderzentrum Dresden (Kid), Dresden, Germany
| | - Wolfgang Czech
- Practice and clinic for allergology/dermatology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Holger Wrede
- Practice and clinic for allergology/ear, nose and throat specialist, Herford, Germany
| | - Randolf Brehler
- Clinic for Skin Diseases, Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, Münster University Hospital, Münster, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Hospital, Georg-August-University, Göttingen, Germany
| | - Thilo Jakob
- rd Clinic for Dermatology and Allergology University Hospital Giessen, UKGM Justus Liebig University Giessen, Giessen, Germany
| | - Tobias Ankermann
- th Clinic for Pediatric and Adolescent Medicine, Pneumology, Allergology, Neonatology, Intensive Care Medicine, Infectiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian M Schmidt
- th Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, Greifswald University Medical Center, Greifswald, Germany
| | - Michael Gerstlauer
- pediatric pneumologist/pediatric allergologist, II. clinic for children and adolescents, University Hospital Augsburg, Augsburg, Germany
| | - Torsten Zuberbier
- Clinic for Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Spindler
- Department of Pediatrics and Adolescent Medicine, Pediatric Pneumology, Allergology, Sports Medicine, Hochgebirgsklinik Davos, Davos-Wolfgang, Switzerland
| | - Christian Vogelberg
- TU Dresden/UKDD, Pediatric Department, University Hospital Dresden, Dresden, Germany.,Department of Pediatric Pneumology/Allergology, Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University Hospital Carl Gustav Carus, Fetscher Street 74, 01307 Dresden, Germany
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23
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Aydogan M, Topal E, Yakıcı N, Acar HC, Demirkale ZH, Arga M, Uysal P, Aydemir S, Simsek IE, Tamay Z, Cekic S, Cavkaytar O, Kaplan F, Kıykım A, Cogurlu MT, Süleyman A, Yücel E, Akkelle E, Hancıoglu G, Yasar A, Tuncel T, Nacaroglu HT, Aydogmus C, Güler N, Cokugras H, Sapan N, Yüksel H, Sancak R, Erdogan MS, Ozdemir O, Ozdemir C, Orhan F. Food-induced anaphylaxis in early childhood and factors associated with its severity. Allergy Asthma Proc 2021; 42:e135-e144. [PMID: 34474716 DOI: 10.2500/aap.2021.42.210051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods: We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension.
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Affiliation(s)
- Metin Aydogan
- From the Pediatric Allergy and Immunology Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Erdem Topal
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Nalan Yakıcı
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Karadeniz Teknik University, Trabzon, Turkey
| | - Hazal Cansu Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Hızlı Demirkale
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Arga
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Pınar Uysal
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Sezin Aydemir
- Pediatric Allergy and Immunology Department, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Isıl Eser Simsek
- From the Pediatric Allergy and Immunology Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Zeynep Tamay
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sükrü Cekic
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ozlem Cavkaytar
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Fatih Kaplan
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ayca Kıykım
- Pediatric Allergy and Immunology Department, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Müjde Tugba Cogurlu
- From the Pediatric Allergy and Immunology Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Süleyman
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Yücel
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Akkelle
- Pediatric Allergy and Immunology Department, Sancaktepe Training and Research Hospital, Istanbul, Turkey
| | - Gonca Hancıoglu
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Adem Yasar
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tuba Tuncel
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Hikmet Tekin Nacaroglu
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Cigdem Aydogmus
- Pediatric Allergy and Immunology Department, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey, and
| | - Nermin Güler
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haluk Cokugras
- Pediatric Allergy and Immunology Department, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nihat Sapan
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Hasan Yüksel
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Recep Sancak
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Mehmet Sarper Erdogan
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Oner Ozdemir
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Cevdet Ozdemir
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fazıl Orhan
- Pediatric Allergy and Immunology Department, Faculty of Medicine, Karadeniz Teknik University, Trabzon, Turkey
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24
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Jonsson M, Ekström S, Protudjer JLP, Bergström A, Kull I. Living with Food Hypersensitivity as an Adolescent Impairs Health Related Quality of Life Irrespective of Disease Severity: Results from a Population-Based Birth Cohort. Nutrients 2021; 13:nu13072357. [PMID: 34371866 PMCID: PMC8308910 DOI: 10.3390/nu13072357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/01/2023] Open
Abstract
Food hypersensitivity (FHS) refers to food-related symptoms, with or without concurrent Immunoglobulin E (IgE) antibodies related to food(s). It remains unclear how different FHS phenotypes affect health-related quality of life (HRQoL). We examined self-reported HRQoL (with the generic instrument EQ-5D (dimensions and a Visual Analogue Scale (VAS), range 0–100) in association with phenotypes of FHS, and food-specific symptoms among adolescents (n = 2990) from a population-based birth cohort. Overall, 22% of the adolescents had FHS. Compared to adolescents without FHS, those with FHS reported more problems in the dimensions of pain/discomfort (p < 0.001), and anxiety/depression (p = 0.007). Females with FHS reported more problems than males in these dimensions (p < 0.001). Different FHS phenotypes (IgE-sensitization, allergic co-morbidity, and severity of symptoms) were not associated with differences in HRQoL. EQ-VAS scores were lowest for adolescents with symptoms for wheat vs. no wheat, median 80 vs. 89, p = 0.04) and milk vs. no milk (median 85 vs. 90, p = 0.03). Physician-diagnosed lactose intolerance median EQ-VAS was 80 vs. 90, p = 0.03 and also associated with more problems in the dimension of anxious/depression. In conclusion, FHS is associated with lower HRQoL in adolescence, irrespective of phenotypes, but differentially affects females vs. males, and those with vs. without symptoms for milk or wheat.
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Affiliation(s)
- Marina Jonsson
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.E.); (A.B.)
- Centre for Occupational and Environmental Medicine, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden;
- Correspondence:
| | - Sandra Ekström
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.E.); (A.B.)
- Centre for Occupational and Environmental Medicine, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden
| | - Jennifer L. P. Protudjer
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1S1, Canada;
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB R3E 0T6, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- The Centre for Allergy Research, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.E.); (A.B.)
- Centre for Occupational and Environmental Medicine, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden;
- Sachs’ Children and Youth Hospital, 118 83 Stockholm, Sweden
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25
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Fan PS, Sun MJ, Qin D, Yuan CS, Chen XG, Liu Y. Nanosystems as curative platforms for allergic disorder management. J Mater Chem B 2021; 9:1729-1744. [PMID: 33475131 DOI: 10.1039/d0tb02590a] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Allergy, IgE-mediated inflammatory disorders including allergic rhinitis, asthma, and conjunctivitis, affects billions of people worldwide. Conventional means of allergy management include allergen avoidance, pharmacotherapy, and emerging therapies. Among them, chemotherapeutant intake via oral, intravenous, and intranasal routes is always the most common mean. Although current pharmacotherapy exhibit splendid anti-allergic effects, short in situ retention, low bioavailability, and systemic side effects are inevitable. Nowadays, nanoplatforms have provided alternative therapeutic options to obviate the existing weakness via enhancing the solubility of hydrophobic therapeutic agents, achieving in situ drug accumulation, exhibiting controlled and long-time drug release at lesion areas, and providing multi-functional therapeutic strategies. Herein, we highlight the clinical therapeutic strategies and deal with characteristics of the nanoplatform design in allergy interventions via intratracheal, gastrointestinal, intravenous, and ocular paths. The promising therapeutic utilization in a variety of allergic disorders is discussed, and recent perspectives on the feasible advances of nanoplatforms in allergy management are also exploited.
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Affiliation(s)
- Peng-Sheng Fan
- College of Marine Life Science, Ocean University of China, Qingdao, 266003, P. R. China.
| | - Meng-Jie Sun
- College of Marine Life Science, Ocean University of China, Qingdao, 266003, P. R. China.
| | - Di Qin
- College of Marine Life Science, Ocean University of China, Qingdao, 266003, P. R. China.
| | - Cong-Shan Yuan
- College of Marine Life Science, Ocean University of China, Qingdao, 266003, P. R. China.
| | - Xi-Guang Chen
- College of Marine Life Science, Ocean University of China, Qingdao, 266003, P. R. China.
| | - Ya Liu
- College of Marine Life Science, Ocean University of China, Qingdao, 266003, P. R. China.
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26
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Bahna SL, Assa'ad AH. Food Allergy: Catering for the Needs of the Clinician. Immunol Allergy Clin North Am 2021; 41:331-345. [PMID: 33863487 DOI: 10.1016/j.iac.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The practice of food allergy (FA) for clinicians has boomed, with a dramatic rise in the number of patients and families seeking care and with many advances on several fronts. The practice itself sometimes is evidence-based science and sometimes an art of pattern and phenotype recognition. This article examines the tools for diagnosis and management and therapy options available to physicians providing care for patients with FA. The article touches on pressing needs of clinicians and highlights the rapid and important movements in national and international support and advances that will have a positive impact on the field of FA.
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Affiliation(s)
- Sami L Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center in Shreveport, 1501 Kings Highway Rm 5-323 Shreveport, Louisiana 71130-3832, USA
| | - Amal H Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229.
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27
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Neeland MR, Andorf S, Dang TD, McWilliam VL, Perrett KP, Koplin JJ, Saffery R. Altered immune cell profiles and impaired CD4 T-cell activation in single and multi-food allergic adolescents. Clin Exp Allergy 2021; 51:674-684. [PMID: 33626189 DOI: 10.1111/cea.13857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Approximately 5% of adolescents have a food allergy, with peanut and tree nut allergies the most common. Having two or more food allergies in adolescence also doubles the risk of any adverse food reaction, and is associated with increased dietary and social burden. Investigations of immune function in persistently food allergic children are rare. OBJECTIVE In the present study, we aimed to investigate the immune mechanisms that underlie food allergy in adolescence. METHODS We used high-dimensional flow cytometry, unsupervised computational analysis and functional studies to comprehensively phenotype a range of non-antigen-specific immune parameters in a group of well-characterized adolescents with clinically defined single peanut allergy, multi-food allergy and aged-matched non-food allergic controls. RESULTS We show that food allergic adolescents have higher circulating proportions of dendritic cells (p = .0084, FDR-adjusted p = .087, median in no FA: 0.63% live cells, in FA: 0.93%), and higher frequency of activated, memory-like Tregs relative to non-food allergic adolescents (p = .011, FDR-adjusted p = .087, median in no FA: 0.49% live cells, in FA: 0.65%). Cytokine profiling revealed that CD3/CD28 stimulated naïve CD4 T cells from food allergic adolescents produced less IL-6 (p = .0020, FDR-adjusted p = .018, median log2 fold change [stimulated/unstimulated] in no FA: 3.03, in FA: 1.92) and TNFα (p = .0044, FDR-adjusted p = .020, median in no FA: 9.16, in FA: 8.64) and may secrete less IFNγ (p = .035, FDR-adjusted p = .11, median in no FA: 6.29, in FA: 5.67) than naïve CD4 T cells from non-food allergic controls. No differences between clinical groups were observed for LPS-stimulated monocyte secretion of cytokines. CONCLUSIONS These results have important implications for understanding the evolution of the immune response in food allergy throughout childhood, revealing that dendritic cell and T-cell signatures previously identified in early life may persist through to adolescence.
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Affiliation(s)
- Melanie R Neeland
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Sandra Andorf
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Divisions of Biomedical Informatics and Allergy & Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thanh D Dang
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Vicki L McWilliam
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia
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28
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Buyuktiryaki B, Masini M, Mori F, Barni S, Liccioli G, Sarti L, Lodi L, Giovannini M, du Toit G, Lopata AL, Marques-Mejias MA. IgE-Mediated Fish Allergy in Children. ACTA ACUST UNITED AC 2021; 57:medicina57010076. [PMID: 33477460 PMCID: PMC7830012 DOI: 10.3390/medicina57010076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022]
Abstract
Fish allergy constitutes a severe problem worldwide. Its prevalence has been calculated as high as 7% in paediatric populations, and in many cases, it persists into adulthood with life-threatening signs and symptoms. The following review focuses on the epidemiology of Immunoglobulin E (IgE)-mediated fish allergy, its pathogenesis, clinical manifestations, and a thorough approach to diagnosis and management in the paediatric population. The traditional approach for managing fish allergy is avoidance and rescue medication for accidental exposures. Food avoidance poses many obstacles and is not easily maintained. In the specific case of fish, food is also not the only source of allergens; aerosolisation of fish proteins when cooking is a common source of highly allergenic parvalbumin, and elimination diets cannot prevent these contacts. Novel management approaches based on immunomodulation are a promising strategy for the future of these patients.
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Affiliation(s)
- Betul Buyuktiryaki
- Division of Pediatric Allergy, Koc University Hospital, 34010 Istanbul, Turkey;
| | - Marzio Masini
- Department of Pediatrics, Sapienza University of Rome, 00185 Rome, Italy;
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Giulia Liccioli
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Lucrezia Sarti
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
| | - Lorenzo Lodi
- Department of Health Sciences, Division of Immunology, Section of Pediatrics, University of Florence and Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children’s University Hospital, 50139 Florence, Italy; (F.M.); (S.B.); (G.L.); (L.S.)
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE5 9NU, UK; (G.d.T.); (M.A.M.-M.)
- Correspondence:
| | - George du Toit
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE5 9NU, UK; (G.d.T.); (M.A.M.-M.)
- Children’s Allergy Service, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King’s College London, London SE5 9NU, UK
| | - Andreas Ludwig Lopata
- Molecular Allergy Research Laboratory, College of Public Health, Medical and Veterinary Sciences, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Maria Andreina Marques-Mejias
- Pediatric Allergy Group, Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London SE5 9NU, UK; (G.d.T.); (M.A.M.-M.)
- Children’s Allergy Service, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
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29
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ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol 2021; 116:17-44. [PMID: 33315591 DOI: 10.14309/ajg.0000000000001036] [Citation(s) in RCA: 324] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
Irritable bowel syndrome (IBS) is a highly prevalent, chronic disorder that significantly reduces patients' quality of life. Advances in diagnostic testing and in therapeutic options for patients with IBS led to the development of this first-ever American College of Gastroenterology clinical guideline for the management of IBS using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Twenty-five clinically important questions were assessed after a comprehensive literature search; 9 questions focused on diagnostic testing; 16 questions focused on therapeutic options. Consensus was obtained using a modified Delphi approach, and based on GRADE methodology, we endorse the following: We suggest that a positive diagnostic strategy as compared to a diagnostic strategy of exclusion be used to improve time to initiating appropriate therapy. We suggest that serologic testing be performed to rule out celiac disease in patients with IBS and diarrhea symptoms. We suggest that fecal calprotectin be checked in patients with suspected IBS and diarrhea symptoms to rule out inflammatory bowel disease. We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. We recommend the use of chloride channel activators and guanylate cyclase activators to treat global IBS with constipation symptoms. We recommend the use of rifaximin to treat global IBS with diarrhea symptoms. We suggest that gut-directed psychotherapy be used to treat global IBS symptoms. Additional statements and information regarding diagnostic strategies, specific drugs, doses, and duration of therapy can be found in the guideline.
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Morillo-Argudo DA, Andrade Tenesaca DS, Rodas-Espinoza CR, Perkin MR, Gebreegziabher TL, Zuñiga GA, Andrade Muñoz DD, Ramírez PL, García García AA, Ochoa-Avilés AM. Food allergy, airborne allergies, and allergic sensitisation among adolescents living in two disparate socioeconomic regions in Ecuador: A cross-sectional study. World Allergy Organ J 2020; 13:100478. [PMID: 33294112 PMCID: PMC7677699 DOI: 10.1016/j.waojou.2020.100478] [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: 06/29/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background Allergic diseases are under-investigated and overlooked health conditions in developing countries. We measured the prevalence of food allergy (FA), airborne allergic disease, and allergic sensitisation among adolescents living in 2 socio-demographically disparate regions in Ecuador. We investigated which risk factors are associated with these conditions. Methods A cross-sectional study involved 1338 students (mean age: 13 ± 0.9 years old) living in Cuenca (n = 876) and Santa Isabel (n = 462). History of allergic symptoms (noted by parents or doctor) to food, house dust mites (HDM), pollen, and pets were recorded. Sociodemographic characteristics, environmental exposures, and parental history of allergic disorders data were collected. Sensitisation to 19 food and 20 aeroallergens was measured by skin-prick testing (SPT). FA and airborne allergic diseases (to HDM, pollen, cat, or dog) were defined as a report of allergic symptoms noted by doctor, together with a positive SPT (wheal size ≥3 mm). Logistic regression models were used to identify environmental and parental factors associated with allergic conditions. Results FA was prevalent among 0.4% (95% CI 0.2%–0.9%), and food sensitisation among 19.1% of the adolescents. Shrimp was the most frequent food linked with FA and food sensitisation. Risk factors associated with FA could not be evaluated due to the low prevalence. Food sensitisation was higher among adolescents exposed to family smoking (OR 1.63, 95% CI 1.14–2.34, p = 0.008) and those with parental history of allergic disorders (OR 1.68, 95% CI 1.13–2.49, p = 0.01), but less common among adolescents owning dogs (OR 0.59, 95% CI 0.41–0.84, p = 0.003). Airborne allergic diseases were prevalent amongst 12.0% of the adolescents (95% CI: 10.4–13.9, n = 1321), with HDM as the primary allergen (11.2%). Airborne allergic diseases were less common among adolescents with more siblings (OR 0.79, 95% CI 0.65–0.96, p = 0.02) and those who lived with farm animals in the first year of life (OR 0.47, 95% CI 0.23–0.95, p = 0.04), but, most common among adolescents with a smoking family (OR 1.67, 95% CI 1.04–2.70, p = 0.03) and with a parental history of allergic disorders (OR self-perceived: 2.62, 95% CI 1.46–4.71, p = 0.001; OR diagnosed by a doctor: 4.07, 95% CI 2.44–6.80, p < 0.001). Conclusions FA and airborne allergies are less prevalent in Ecuador than in developed regions; there is a great dissociation between the prevalence of allergic disease and allergic sensitisation. Shrimp and HDM were the most prevalent allergens. Risk factors identified in this study to be related to allergic diseases should be considered by physicians, health practitioners, and epidemiologists in Ecuador.
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Affiliation(s)
- Diana A Morillo-Argudo
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador
| | | | | | - Michael R Perkin
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, England, United Kingdom
| | | | | | - Diana D Andrade Muñoz
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Patricia L Ramírez
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Ana A García García
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador
| | - Angélica M Ochoa-Avilés
- Department of Biosciences, Faculty of Chemistry, University of Cuenca, Cuenca, Azuay, Ecuador
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The Global Rise and the Complexity of Sesame Allergy: Prime Time to Regulate Sesame in the United States of America? ALLERGIES 2020. [DOI: 10.3390/allergies1010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sesame allergy is a life-threatening disease that has been growing globally with poorly understood mechanisms. To protect sensitive consumers, sesame is regulated in many countries. There were four research goals for this work on sesame allergy: (i) to map the timeline, and the extent of its global rise; (ii) to dissect the complexity of the disease, and its mechanisms; (iii) to analyze the global regulation of sesame; and (iv) to map the directions for future research and regulation. We performed a literature search on PubMed and Google Scholar, using combinations of key words and analyzed the output. Regulatory information was obtained from the government agencies. Information relevant to the above goals was used to make interpretations. We found that: (i) the reports appeared first in 1950s, and then rapidly rose globally from 1990s; (ii) sesame contains protein and lipid allergens, a unique feature not found in other allergenic foods; (iii) it is linked to five types of diseases with understudied mechanisms; and (iv) it is a regulated allergen in 32 advanced countries excluding the USA. We also provide directions for filling gaps in the research and identify implications of possible regulation of sesame in the USA.
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Grabenhenrich L, Trendelenburg V, Bellach J, Yürek S, Reich A, Fiandor A, Rivero D, Sigurdardottir S, Clausen M, Papadopoulos NG, Xepapadaki P, Sprikkelman AB, Dontje B, Roberts G, Grimshaw K, Kowalski ML, Kurowski M, Dubakiene R, Rudzeviciene O, Fernández‐Rivas M, Couch P, Versteeg SA, Ree R, Mills C, Keil T, Beyer K. Frequency of food allergy in school-aged children in eight European countries-The EuroPrevall-iFAAM birth cohort. Allergy 2020; 75:2294-2308. [PMID: 32219884 DOI: 10.1111/all.14290] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of food allergy (FA) among European school children is poorly defined. Estimates have commonly been based on parent-reported symptoms. We aimed to estimate the frequency of FA and sensitization against food allergens in primary school children in eight European countries. METHODS A follow-up assessment at age 6-10 years of a multicentre European birth cohort based was undertaken using an online parental questionnaire, clinical visits including structured interviews and skin prick tests (SPT). Children with suspected FA were scheduled for double-blind, placebo-controlled oral food challenges (DBPCFC). RESULTS A total of 6105 children participated in this school-age follow-up (57.8% of 10 563 recruited at birth). For 982 of 6069 children (16.2%), parents reported adverse reactions after food consumption in the online questionnaire. Of 2288 children with parental face-to-face interviews and/or skin prick testing, 238 (10.4%) were eligible for a DBPCFC. Sixty-three foods were challenge-tested in 46 children. Twenty food challenges were positive in 17 children, including seven to hazelnut and three to peanut. Another seventy-one children were estimated to suffer FA among those who were eligible but refused DBPCFC. This yielded prevalence estimates for FA in school age between 1.4% (88 related to all 6105 participants of this follow-up) and 3.8% (88 related to 2289 with completed eligibility assessment). INTERPRETATION In primary school children in eight European countries, the prevalence of FA was lower than expected even though parents of this cohort have become especially aware of allergic reactions to food. There was moderate variation between centres hampering valid regional comparisons.
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Affiliation(s)
- Linus Grabenhenrich
- Department for Methodology and Research Infrastructure Robert Koch‐Institut Berlin Germany
- Department of Dermatology, Venerology and Allergology Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Valérie Trendelenburg
- Department of Paediatric Pneumology, Immunology and Intensive Care Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Johanna Bellach
- Department of Paediatric Pneumology, Immunology and Intensive Care Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Department of Psychiatry and Psychotherapy Ernst von Bergmann Academic Educational Hospital Berlin Germany
| | - Songül Yürek
- Department of Paediatric Pneumology, Immunology and Intensive Care Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Andreas Reich
- Epidemiology Unit German Rheumatism Research Centera Leibniz Institute Berlin Germany
| | - Ana Fiandor
- Department of Allergy Hospital Universitario La Paz Madrid Spain
| | - Daniela Rivero
- Department of Allergy Hospital Universitario La Paz Madrid Spain
| | - Sigurveig Sigurdardottir
- Department of Immunology Landspitali University Hospital Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Michael Clausen
- Faculty of Medicine University of Iceland Reykjavik Iceland
- Children's Hospital Reykjavik Reykjavik Iceland
- Department of Allergy Landspitali University Hospital Reykjavik Iceland
| | - Nikolaos G. Papadopoulos
- Division of Infection Immunity & Respiratory Medicine University of Manchester Manchester UK
- Allergy Department 2nd Paediatric Clinic, National and Kapodistrian University of Athens Athens Greece
| | - Paraskevi Xepapadaki
- Allergy Department 2nd Paediatric Clinic, National and Kapodistrian University of Athens Athens Greece
| | - Aline B. Sprikkelman
- Department of Pediatric Pulmonology & Pediatric Allergology University Medical Center Groningen Groningen The Netherlands
| | - Bianca Dontje
- Department of Pediatric Pulmonology & Pediatric Allergology Emma Kinderziekenhuis AMC Amsterdam The Netherlands
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health Faculty of Medicine University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Kate Grimshaw
- Clinical and Experimental Sciences Academic Units Faculty of Medicine University of Southampton Southampton UK
- Department of Dietetics Salford Care Organisation Salford UK
| | - Marek L. Kowalski
- Department of Immunology, Allergy and Rheumatology Medical University Łódź Poland
| | - Marcin Kurowski
- Department of Immunology, Allergy and Rheumatology Medical University of Łódź Łódź Poland
| | - Ruta Dubakiene
- Faculty of Medicine Vilnius University Vilnius Lithuania
| | - Odilija Rudzeviciene
- Clinic of Children's Diseases Faculty of Medicine Vilnius University Vilnius Lithuania
| | | | - Philip Couch
- School of Health Sciences Centre for Health Informatics University of Manchester Manchester UK
| | - Serge A. Versteeg
- Departments of Experimental Immunology Academic Medical Center Amsterdam The Netherlands
| | - Ronald Ree
- Departments of Experimental Immunology and of Otorhinolaryngology Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Clare Mills
- Division of Infection, Immunity and Respiratory Medicine University of Manchester Manchester UK
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry University of Würzburg Würzburg Germany
- State Institute of Health Bavarian Health and Food Safety Authority Bad Kissingen Germany
- Institute for Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Kirsten Beyer
- Department of Paediatric Pneumology, Immunology and Intensive Care Charité ‐ Universitätsmedizin Berlin Berlin Germany
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Lozoya-Ibáñez C, Morgado-Nunes S, Rodrigues A, Fernandes P, Lourenço O, Mafalda Fonseca A, Taborda-Barata L. Prevalence and clinical features of adverse food reactions in Portuguese adolescents. World Allergy Organ J 2020; 13:100453. [PMID: 32817783 PMCID: PMC7424229 DOI: 10.1016/j.waojou.2020.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background & aims The objective of the present study was to determine, for the first time, the prevalence and clinical features of food allergy in Portuguese adolescents. Methods Cross-sectional study performed in various secondary schools in central Portugal. Randomly selected adolescents replied to a validated food allergy questionnaire. Those who reported an adverse food reaction were seen at participating hospitals, where clinical history was taken, skin prick (SPT) and prick-prick skin (SPPT) tests were performed, and food allergen-specific IgE levels (sIgE) were determined. An open oral challenge was performed in selected cases. Cases of positive clinical history of immediate (up to 2 h after ingestion) reaction in association with positive food sIgE levels and/or SPT were classified as IgE-associated probable food allergy and as confirmed IgE-mediated food allergy if food challenges were positive. Cases of positive clinical history of delayed (more than 2 h after ingestion) and negative food sIgE levels independently of positive SPT or SPPT results, were classified as non-IgE associated probable food allergy. Results The prevalence of probable food allergy in Portuguese adolescents was 1.41% (95% CI: 0.90–2.03%), with fresh fruits, shellfish, nuts, and peanut as the most frequently implicated foods. IgE-mediated probable food allergy occurred in 1.23% (95% CI: 0.67–1.72%) of cases, with fresh fruits, shellfish, and nuts mainly involved. Cutaneous symptoms were most frequently reported. Conclusions The prevalence of probable food allergies in Portuguese adolescents is low, is mostly related to fresh fruits, shellfish, nuts, and peanut, and most frequently involves cutaneous symptoms.
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Affiliation(s)
- Carlos Lozoya-Ibáñez
- Allergy Department, Castelo Branco Local Health Unit, Portugal.,CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Sara Morgado-Nunes
- CACB - Clinical Academic Center of Beiras, Portugal.,Polytechnic Institute of Castelo Branco, Escola Superior de Gestão, Castelo Branco, Portugal
| | - Alexandra Rodrigues
- CACB - Clinical Academic Center of Beiras, Portugal.,Outpatient Clinic Department, Castelo Branco Local Health Unit, Portugal
| | - Patrícia Fernandes
- CACB - Clinical Academic Center of Beiras, Portugal.,Clinical Pathology Department, Castelo Branco Local Health Unit, Portugal
| | - Olga Lourenço
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Ana Mafalda Fonseca
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal
| | - Luis Taborda-Barata
- CICS-Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,CACB - Clinical Academic Center of Beiras, Portugal.,Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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James P, Caballero MR. Illness perception of adolescents with allergic conditions under specialist care. Pediatr Allergy Immunol 2020; 31:197-202. [PMID: 31680338 DOI: 10.1111/pai.13169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/15/2019] [Accepted: 10/28/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Our understanding of how adolescents perceive and cope with their allergic condition/s is limited. This study used the Brief Illness Perception Questionnaire (BIPQ) in a group of adolescents with allergies and correlates the findings with demographic and clinical conditions. METHODS In this retrospective questionnaire-based study, we analysed 100 valid questionnaires from adolescents (11-18 years) attending our service after receiving management and treatment for their allergic condition/s. RESULTS The overall BIPQ score was 4.8 (IQR 3.6-5.6). The highest item-related scores were for "timeline" (illness duration) followed by "concern." The lowest scores were found for "coherence/understanding," demonstrating that adolescents do not perceive that they have a sound understanding of their condition/s. We found a significant difference in the overall BIPQ scores between the genders and in the emotional representation score, with females showing a highest score. Older adolescents reported a more chronic perception of the allergic disease/s. CONCLUSION Our results suggest that a better understanding and support of the allergic condition/s in adolescents, particularly in females, are likely an important target for intervention intended to improve their quality of life. BIPQ can be used as adjunct to routine allergy clinic appointments for further exploration of the wider impact of allergies on adolescents' lives.
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Affiliation(s)
- Polly James
- Clinical Psychologist in Paediatric Allergy, Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Rosario Caballero
- Consultant in Allergy, Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Acquisition and generalization of cough trigger beliefs in allergic rhinitis. J Behav Med 2019; 43:286-296. [PMID: 31848795 DOI: 10.1007/s10865-019-00124-2] [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: 05/03/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
In allergic conditions, trigger identification is often inaccurate, and may be influenced by pre-existing beliefs. In this study, we investigated the acquisition and generalization of symptom trigger beliefs in individuals with allergic rhinitis (n = 24) and control participants (n = 24). In a lab-based trigger acquisition task, unique exemplars of two trigger categories were either paired with saline inhalation (CS- category) or citric acid inhalation (CS+ category). The next day, we tested recognition and symptom expectancy for CS category exemplars and exemplars of novel trigger categories. Participants acquired differential symptom expectancies for CS+ compared to CS- exemplars, with faster acquisition in participants with rhinitis. Differential symptom expectancies persisted the next day, and generalized to novel trigger categories, with stronger generalization in rhinitis vs. control participants. These patterns of acquisition and generalization suggest that overgeneralization of trigger beliefs may complicate trigger identification in participants with allergic conditions.
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Jorge A, Santos Silva M, Lozoya-Ibánez C, Lorente F, Sarinho E, Afonso RM, Pereira H, Taborda-Barata L. Development of a tool for screening adverse food reactions and food allergy in Portuguese children. Allergol Immunopathol (Madr) 2019; 47:342-349. [PMID: 30503673 DOI: 10.1016/j.aller.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/04/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES A standardised questionnaire may be an excellent tool for epidemiological studies aiming at screening children with suspected food allergies. Thus, the aim of the present study was to develop a screening questionnaire for assessing children with suspected food allergy and to analyse its reproducibility. MATERIALS AND METHODS A questionnaire of adverse food reactions was developed by literary review of similar questionnaires validated in other countries as well as less well defined, non-validated Portuguese questionnaires. Peer review of the questionnaire by a panel of specialists and subsequent exploratory analysis was carried out by applying the questionnaire in children with confirmed food allergy. Test-retest analysis was performed by giving a face-to-face questionnaire to 159 children with suspected adverse food reactions, aged between three and 11 years. Temporal stability using Spearman Rho correlation test and reproducibility was studied using Cohen's Kappa index. RESULTS 115 children confirmed adverse food reactions that occurred with one or more foods. Retest was given about three weeks after the test, to 50 of these children who were randomly selected. The questionnaire showed good temporal stability (Spearman correlation coefficient of 0.834), and good reproducibility (only two of the 27 items had a Kappa index <0.60). CONCLUSIONS This questionnaire showed good temporal stability and reproducibility. Its validation for screening children with suspected food allergy will allow a standardised approach to diagnosis and comparison of results obtained in different centres.
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Affiliation(s)
- A Jorge
- CICS - Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; Department of Paediatrics, Cova da Beira Hospital Centre, Covilhã, Portugal
| | - M Santos Silva
- Quality Management Unit, Cova da Beira Hospital Centre, Covilhã, Portugal
| | - C Lozoya-Ibánez
- CICS - Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; Allergy Department, Castelo Branco Local Health Unit, Castelo Branco, Portugal
| | - F Lorente
- Department of Pediatrics, Salamanca University Hospital, Spain
| | - E Sarinho
- Center for Research in Allergy and Clinical Immunology (HC/UFPE), Federal University of Pernambuco, Recife, Brazil
| | - R M Afonso
- Psychology and Education Department, University of Beira Interior, Covilhã, Portugal
| | - H Pereira
- Psychology and Education Department, University of Beira Interior, Covilhã, Portugal
| | - L Taborda-Barata
- CICS - Health Sciences Research Centre, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; Department of Allergy & Clinical Immunology, Cova da Beira Hospital Centre, Covilhã, Portugal.
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Parental and child factors associated with inhalant and food allergy in a population-based prospective cohort study: the Generation R Study. Eur J Pediatr 2019; 178:1507-1517. [PMID: 31414213 PMCID: PMC6733817 DOI: 10.1007/s00431-019-03441-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/09/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022]
Abstract
The prevalence of allergic diseases in children is markedly increasing to epidemic proportions. The aim of this study is to describe the presence and examine associated parental and child characteristics of allergic sensitization and physician-diagnosed allergy in Dutch children at age 10 years. This study among 5471 children was performed in a population-based prospective cohort from fetal life onwards. Allergic sensitization was measured by skin prick tests. Physician-diagnosed allergy and parental and child characteristics were collected by questionnaires. In children aged 10 years, inhalant and food allergic sensitization was present in 32.2% and 7.1%, and physician-diagnosed inhalant and food allergy in 12.4% and 2.3%. Maternal and paternal history of allergy, eczema or asthma was associated with increased risks of physician-diagnosed inhalant allergy (aOR (95% CI) 1.44 (1.23-1.70) and 1.59 (1.30-1.94), respectively), but not with food allergy. Asthma and eczema ever at age 10 years were associated with increased risks of physician-diagnosed inhalant allergy (4.60 (3.55-5.96) and 2.42 (1.94-3.03), respectively). Eczema ever at age 10 years was associated with an increased risk of physician-diagnosed food allergy (5.78, 3.04-9.52), with the highest risk of cashew (7.36, 3.20-16.94) and peanut (5.58, 3.08-10.10) food allergy.Conclusions: We found strong effects of parental history of allergy, eczema or asthma on the presence of physician-diagnosed inhalant allergy in children at age 10 years. Eczema ever at age 10 years was a strong risk factor for the development of physician-diagnosed inhalant and food allergy. What is Known: • The prevalence of allergic diseases in children has markedly increased. • Early-life influences are critically important in the development of allergic diseases. What is New: • Maternal and paternal history of allergy, eczema or asthma is associated with increased risks of physician-diagnosed inhalant allergy but not with food allergy. • Eczema ever at age 10 years is associated with an increased risk of physician-diagnosed food allergy, with the highest risk for cashew and peanut food allergy.
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Abstract
PURPOSE OF REVIEW This review examines the current literature and provides insight into the role of food immunotherapy in the management of food-allergic children. Key food immunotherapy trials, benefits, and risks of the intervention, as well as areas requiring further study are all discussed. RECENT FINDINGS Research studies have reported encouraging results regarding the efficacy of food immunotherapy in desensitizing food-allergic patients with an acceptable safety profile and a documented improvement in quality of life. The role of biologics and long-term effects of food immunotherapy are still under investigation. SUMMARY The burden of food allergy is significant, multifaceted, and well documented. Food immunotherapy is a novel treatment option and an exciting area of research that has seen tremendous progress over the last decade, presenting encouraging results for the treatment of children with food allergies.
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The Epidemiology of Food Allergy in the Global Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092043. [PMID: 30231558 PMCID: PMC6163515 DOI: 10.3390/ijerph15092043] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/06/2018] [Accepted: 09/13/2018] [Indexed: 01/27/2023]
Abstract
There is a lack of high-quality evidence based on the gold standard of oral food challenges to determine food allergy prevalence. Nevertheless, studies using surrogate measures of food allergy, such as health service utilization and clinical history, together with allergen-specific immunoglobulin E (sIgE), provide compelling data that the prevalence of food allergy is increasing in both Western and developing countries. In Western countries, challenge-diagnosed food allergy has been reported to be as high as 10%, with the greatest prevalence noted among younger children. There is also growing evidence of increasing prevalence in developing countries, with rates of challenge-diagnosed food allergy in China and Africa reported to be similar to that in Western countries. An interesting observation is that children of East Asian or African descent born in a Western environment are at higher risk of food allergy compared to Caucasian children; this intriguing finding emphasizes the importance of genome-environment interactions and forecasts future increases in food allergy in Asia and Africa as economic growth continues in these regions. While cow’s milk and egg allergy are two of the most common food allergies in most countries, diverse patterns of food allergy can be observed in individual geographic regions determined by each country’s feeding patterns. More robust studies investigating food allergy prevalence, particularly in Asia and the developing world, are necessary to understand the extent of the food allergy problem and identify preventive strategies to cope with the potential increase in these regions.
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Nilsson N, Nilsson C, Ekoff H, Wieser-Pahr S, Borres MP, Valenta R, Hedlin G, Sjölander S. Grass-Allergic Children Frequently Show Asymptomatic Low-Level IgE Co-Sensitization and Cross-Reactivity to Wheat. Int Arch Allergy Immunol 2018; 177:135-144. [PMID: 29894999 DOI: 10.1159/000489610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Specific immunoglobulin E (IgE) sensitization to wheat is more common than a doctor's confirmed wheat allergy and is also frequently observed in grass pollen-allergic patients (pollinosis patients). Thus, the objective of this study was to investigate the level and feature of serological IgE cross-reactivity between grass pollen and wheat in a cohort of pollinosis subjects with no diagnosis of wheat allergy. METHODS Seventy-two children, aged 5-17 years, with a doctor's diagnosis of pollinosis, IgE towards grass pollen, and currently eating wheat were recruited. Serum samples were analyzed for IgE against wheat, timothy grass/wheat-specific allergen components, Pru p 3, and cross-reactive carbohydrate determinants (CCD) and specific IgE-binding inhibition experiments were performed. RESULTS Sixty percent of the grass pollen subjects were sensitized to wheat with a median of 0.5 kUA/L. Wheat-sensitized subjects were more often sensitized to the two allergens, Phl p 12 and CCD, known to be cross-reactive between grass and wheat. Sensitizations to seven wheat-specific allergens derived from the gluten fraction were, with the exception of one individual, only found in wheat-sensitized subjects. These subjects also more often reported current and past history of allergy to staple foods (milk, egg, wheat, soy, and fish). CONCLUSION Wheat sensitization caused by cross-reactivity but also by sensitization to wheat-specific allergens was common in the grass-allergic children and also associated with allergy to staple foods other than wheat. The results indicate the presence of a subgroup of pollinosis patients with simultaneous sensitization to wheat and food allergy not only caused by cross-reactions.
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Affiliation(s)
- Nora Nilsson
- Lung/Allergy Department, Karolinska Institutet and Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Nilsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and Sachs Children's Hospital, Stockholm, Sweden
| | - Helena Ekoff
- Thermo Fisher Scientific, ImmunoDiagnostics, Uppsala, Sweden
| | - Sandra Wieser-Pahr
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for the Development of Allergen Chips, Medical University of Vienna, Vienna, Austria
| | - Magnus P Borres
- Thermo Fisher Scientific, ImmunoDiagnostics, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for the Development of Allergen Chips, Medical University of Vienna, Vienna, Austria
| | - Gunilla Hedlin
- Lung/Allergy Department, Karolinska Institutet and Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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41
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Abstract
The estimated prevalence of food allergy amongst children in the west is around 6-8% but there is paucity of data in the Indian population. There is a complex interplay of environmental influences and genetic factors in the immuno-pathogenesis and manifestations of food allergy. A reliable thorough clinical history, combined with positive skin prick tests or food-specific IgE, is essential for a more precise diagnosis of food allergy. Currently there is no cure for food allergy. The management of food allergy usually includes strict avoidance, patient education and provision of emergency medication (adrenaline-autoinjectors). Emerging therapies based on evolving research are focused on a more active approach to management which includes early introduction of potentially allergenic foods, anticipatory testing and desensitisation to food allergens. Lack of food labelling policy and non availability of adrenaline auto-injectors is a huge limiting factor for effective management of food allergy among children in India. The present review focuses on IgE mediated food allergy.
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42
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Stiefel G, Anagnostou K, Boyle RJ, Brathwaite N, Ewan P, Fox AT, Huber P, Luyt D, Till SJ, Venter C, Clark AT. BSACI guideline for the diagnosis and management of peanut and tree nut allergy. Clin Exp Allergy 2018; 47:719-739. [PMID: 28836701 DOI: 10.1111/cea.12957] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/01/2017] [Accepted: 05/08/2017] [Indexed: 12/17/2022]
Abstract
Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.
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Affiliation(s)
- G Stiefel
- Leicester Royal Infirmary, Leicester, UK
| | - K Anagnostou
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - N Brathwaite
- King's College Hospital NHS Foundation Trust, London, UK
| | - P Ewan
- Addenbrooke's Hospital, Cambridge, UK
| | - A T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Huber
- British Society for Allergy and Clinical Immunology, London, UK
| | - D Luyt
- Leicester Royal Infirmary, Leicester, UK
| | - S J Till
- King's College Hospital NHS Foundation Trust, London, UK
| | - C Venter
- St. Mary's Hospital, Isle of Wight, UK
| | - A T Clark
- Addenbrooke's Hospital, Cambridge, UK
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43
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Modification of IgE binding to α S1-casein by proteolytic activity of Enterococcus faecium isolated from Iranian camel milk samples. J Biotechnol 2018; 276-277:10-14. [PMID: 29669265 DOI: 10.1016/j.jbiotec.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/02/2023]
Abstract
Milk is a perfect source of nutrients for neonates. When breast feeding cannot be done, an infant's alimentation is usually initiated to cow's milk, among the primary foods. It has been reported that about 2.5% of juveniles under the age of 3 years manifest allergic reactions to cow's milk proteins. Among the cow's milk proteins, casein fractions are considered as the strongest allergenic proteins. The proteolytic enzymes of lactic acid bacteria (LAB), during fermentation of dairy products, can break down milk proteins especially caseins and subsequently reduce the immune reactivity of allergenic proteins. In this research, raw bovine and camel milk samples were screened for cocci LAB strains and after isolation, their proteolytic activity against bovine milk caseins were evaluated by SDS-PAGE and RP-HPLC. The potential of cocci LAB strains on αS1-casein degradation and their potential to break down the principle allergenic epitopes of this protein was detected using indirect competitive ELISA. Molecular identification of the best proteolytic strain was fulfilled by 16S rDNA fragment sequencing with universal primers. The obtained results demonstrated that Enterococcus faecium isolated from raw camel milk samples was the most efficient isolate in hydrolyzing Na-caseinate and αS1-casein. Hydrolysated αS1-casein by Enterococcus faecium was also less recognized by IgE of bovine milk allergic patients' sera in comparison with native αS1-casein. It has been proposed that Enterococcus faecium could be an efficient strain in allergenicity reduction of cow's milk proteins. So it could be an excellent candidate to be potentially used in dairy industries.
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44
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Brotons-Canto A, Gamazo C, Martín-Arbella N, Abdulkarim M, Matías J, Gumbleton M, Irache JM. Evaluation of nanoparticles as oral vehicles for immunotherapy against experimental peanut allergy. Int J Biol Macromol 2018; 110:328-335. [DOI: 10.1016/j.ijbiomac.2017.09.109] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/27/2017] [Indexed: 01/07/2023]
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45
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Sasaki M, Peters RL, Koplin JJ, Field MJ, McWilliam V, Sawyer SM, Vuillermin PJ, Pezic A, Gurrin LC, Douglass JA, Tang ML, Dharmage SC, Allen KJ. Risk Factors for Food Allergy in Early Adolescence: The SchoolNuts Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:496-505. [DOI: 10.1016/j.jaip.2017.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 11/17/2022]
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46
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Mejrhit N, Azdad O, El Kabbaoui M, Chda A, Tazi A, Bencheikh R, Aarab L. Fish consumption associated with reduction of fish allergy. ACTA ACUST UNITED AC 2018. [DOI: 10.1108/nfs-04-2017-0062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to examine the differences in the self-reported allergies to food, especially fish and shellfish, between children and adults, and to study the association between fish consumption and self-reported fish and shellfish allergy (FSA) according to age.
Design/methodology/approach
This study is based on a survey conducted between April 2014 and December 2016 where children and adults were recruited from the general population of the Fez-Meknes region. The total studied population was 4,046 people.
Findings
The results show that the self-reported food allergy (FA) of the general population was more frequent among children (28.2 per cent) than adults (16.8 per cent), in which eggs, fish/shellfish, milk and cereals were the most common food cited. With regard to the self-reported FSA, the authors found a prevalence of 9.5 per cent in both children and adults, whereas fish species allergies were more frequent among adults than children. The most common clinical manifestations observed in this population were cutaneous reactions. The study of the association between fish consumption and FSA shows that people who consumed fish had a lower rate of FSA, especially in adults (p < 0.001).
Originality/value
The self-reported FA of the general population was more pronounced in children than adults. Regarding the self-reported FSA, the authors have shown a prevalence of 9.5 per cent in both children and adults, indicating an important sensitivity of their population to fish and shellfish. The authors have shown that consumption of fish was associated significantly with a lower rate of FSA, especially in adults.
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47
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Venkataraman D, Erlewyn-Lajeunesse M, Kurukulaaratchy RJ, Potter S, Roberts G, Matthews S, Arshad SH. Prevalence and longitudinal trends of food allergy during childhood and adolescence: Results of the Isle of Wight Birth Cohort study. Clin Exp Allergy 2018; 48:394-402. [PMID: 29315919 DOI: 10.1111/cea.13088] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence and time trends of food allergy change during childhood depending on the age of the child and the type of food. OBJECTIVE To study prevalence and longitudinal trends in food allergy from birth to 18 years in an unselected birth cohort in the Isle of Wight. METHOD Information on food allergy was collected at ages 1, 2, 4, 10 and 18 years from the Isle of Wight Birth Cohort (n = 1456). Skin prick testing (SPT) was performed at the age of 1 and 2 years in symptomatic children. At 4, 10 and 18 years of age, participants were tested to a panel of food and aeroallergens. Food allergy was diagnosed based on the criteria: symptoms suggestive of a typical IgE-mediated reaction and reaction <4 hours following exposure to a known food allergen. McNemar's test was used to determine significance of changes in prevalence over time. RESULTS The prevalence of food allergy remained relatively constant in early childhood (5.3%, 4.4% and 5.0% at 1, 2 and 4 years, respectively), with significant decline at 10 years (2.3%, P < .001 vs 4 years) followed by significant rise at 18 years (4%, P = .02 vs 10 years). Cow's milk (1.6%-3.5%) and egg (1.1%-1.4%) were the most common allergens in the first 10 years with peanut (1%) and tree nuts (0.5%) becoming more prevalent beyond 10 years. Fruit and wheat allergy were less common at 10 years, and shellfish and kiwi emerged during adolescence. The prevalence of food allergy plus positive SPT was 1.3%, 0.8%, 0.8%, 0.9% and 2.2% at 1, 2, 4, 10 and 18 years, respectively. CONCLUSION Food allergy is highly prevalent in infancy with partial resolution during late childhood. However, a number of children acquire new food allergy during adolescence resulting in a relatively higher prevalence at 18 years.
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Affiliation(s)
- D Venkataraman
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - M Erlewyn-Lajeunesse
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - R J Kurukulaaratchy
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - S Potter
- The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - G Roberts
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - S Matthews
- The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - S H Arshad
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
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48
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Sasaki M, Koplin JJ, Dharmage SC, Field MJ, Sawyer SM, McWilliam V, Peters RL, Gurrin LC, Vuillermin PJ, Douglass J, Pezic A, Brewerton M, Tang ML, Patton GC, Allen KJ. Prevalence of clinic-defined food allergy in early adolescence: The SchoolNuts study. J Allergy Clin Immunol 2018; 141:391-398.e4. [DOI: 10.1016/j.jaci.2017.05.041] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
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49
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Venter C, Maslin K, Grundy J, Glasbey G, Dean T. Should lip dosing be reconsidered when performing open food challenges? Pediatr Allergy Immunol 2017; 28:707-711. [PMID: 28782200 DOI: 10.1111/pai.12765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carina Venter
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK.,Section of Allergy and Immunology, Colorado Children's Hospital, Aurora, CO, USA
| | - Kate Maslin
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK
| | - Jane Grundy
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK
| | - Gillian Glasbey
- David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK
| | - Tara Dean
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.,David Hide Asthma and Allergy Centre, St. Mary's Hospital, Isle of Wight, UK
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50
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Abstract
PURPOSE OF THE REVIEW Whilst food allergy seems to have increased significantly in many developed countries in the past few decades, quality data on the burden of food allergy in many developing countries is scanty. Until recently, South Africa had a dearth of robustly designed food allergy studies. This article summarizes some of the recent research and observations regarding food allergy from the South African setting. RECENT FINDINGS South Africa has recently seen two important food allergy prevalence studies in selected and unselected populations. Both show allergy rates in keeping with those in several westernized countries. The major difference between sensitization and allergy rates in these studies emphasizes the vital role of the food challenge in differentiating true food allergy from asymptomatic sensitisation in equivocal cases. Eczema, young age and living in an urban population are important risk factors for food allergy in South Africa. Egg and peanut allergy are the most common food allergies in both selected and unselected populations in South Africa. In peanut allergy, Ara h 2 is the most useful component in differentiating true allergy from tolerance in peanut-sensitized patients. Use of internationally derived 95% positive predictive values for peanut and egg allergy produced many false positives in South African studies. Studies in South Africa show a trend towards more conservative introduction of peanut in eczema patients, which needs to be addressed in the light of recent studies showing a protective effect of earlier introduction of peanut. "Novel" allergies such as galactose-alpha-1,3-galactose allergy, food protein-induced enterocolitis syndrome and eosinophilic oesophagitis are being described with increasing frequency in South Africa. The surprisingly high prevalence of food allergy in South Africa points towards possible involvement of South Africa in the so-called "food allergy epidemic". This has major implications on the planning of health services in the allergy sector. Food challenges will form a vital role in allergy services. Ninety-five percent positive predictive values for peanut and egg allergy may need revision to be more applicable to the local population.
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