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Nocerino R, Carucci L, Coppola S, Cecere G, Micillo M, Castaldo T, Russo S, Sandomenico M, Marino A, Gualano R, Ercolini P, Capasso A, Bedogni G, Berni Canani R. Epidemiology of Paediatric Italian Food Allergy: Results of the EPIFA study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100246. [PMID: 38655562 PMCID: PMC11035069 DOI: 10.1016/j.jacig.2024.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/14/2024] [Accepted: 01/27/2024] [Indexed: 04/26/2024]
Abstract
Background Updated epidemiologic data are important for defining effective public health strategies for pediatric food allergy (FA). Objective The Epidemiology of Paediatric Italian Food Allergy (EPIFA) study was designed to investigate the epidemiology of pediatric FA in one of the most heavily populated Italian regions. Methods A retrospective cohort study was performed in collaboration with family pediatricians aimed at investigating the epidemiology of Italian pediatric FA during 2009 to 2021. Family pediatricians in the Campania region were invited to use the Google Forms platform for online compilation of data forms. Data forms were reviewed by experienced pediatric allergists at the coordinating center. Results A total population of 105,151 subjects (aged 0-14 years) was screened during the study period. Data from 752 FA patients were evaluated. A progressive increase in FA incidence and prevalence was observed from 2009 to 2021, with a relative increase up to 34% and 113.6%, respectively, at the end of study period. The relative increase in FA prevalence was higher in the 0-3-year-old age group in the same study period (+120.8%). The most frequent allergens were cow's milk, hen's egg, and nuts. Conclusion The results of the EPIFA study showed an increase in pediatric FA incidence and prevalence from 2009 to 2021 in Italy. These results underline the necessity of new effective strategies for preventing and managing these conditions.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Gaetano Cecere
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Maria Micillo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Tina Castaldo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Stefania Russo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Marialuisa Sandomenico
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Antonio Marino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Renato Gualano
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Paola Ercolini
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Antonella Capasso
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Internal Medicine, S Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Italian Society of Pediatric Gastroenterology and Nutrition (SIGENP)
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Department of Internal Medicine, S Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
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Nocerino R, Carucci L, Coppola S, Oglio F, Masino A, Agizza A, Paparo L, Berni Canani R. The journey toward disease modification in cow milk protein allergy. Immunol Rev 2024. [PMID: 39046826 DOI: 10.1111/imr.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Cow milk protein allergy (CMPA) is one of the most common food allergies in the pediatric age worldwide. Prevalence, persistence, and severity of this condition are on the rise, with a negative impact on the health-related quality of life of the patients and families and on the costs related to its management. Another relevant issue is that CMPA in early life may be the first stage of the "allergic march," leading to the occurrence of other atopic manifestations later in life, especially asthma, atopic eczema, urticaria, and rhinoconjunctivitis. Thus, "disease modification" options that are able to modulate the disease course of pediatric patients affected by CMPA would be very welcomed by affected families and healthcare systems. In this review, we report the most relevant progress on this topic.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Franca Oglio
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Antonio Masino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Alessandra Agizza
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Laboratory Medicine, ASL Benevento, Benevento, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunoNutritionLab at CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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Carucci L, Coppola S, Carandente R, Canani RB. Targeting Food Allergy with Probiotics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1449:79-93. [PMID: 39060732 DOI: 10.1007/978-3-031-58572-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The globally dramatic increase in food allergy prevalence and severity is demanding effective preventive and therapeutic strategies. Food allergy derives from a defect of immune tolerance mechanisms. Immune tolerance is modulated by gut microbiome composition and function, and gut microbiome dysbiosis has been associated with the development of food allergy. Selected probiotic strains could regulate immune tolerance mechanisms. The mechanisms are multiple and are still not completely defined. Increasing evidence is providing useful information on the choice of optimal bacterial species/strains, dosage, and timing for intervention. The increased knowledge on the crucial role played by postbiotic gut microbiome-derived metabolites, such as butyrate, is also opening the way to a post- biotic approach in the stimulation of immune tolerance.
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Affiliation(s)
- Laura Carucci
- Department of Translational Medical Science at the University of Naples Federico II, Naples, Italy
| | - Serena Coppola
- Department of Translational Medical Science at the University of Naples Federico II, Naples, Italy
| | - Rosilenia Carandente
- Department of Translational Medical Science at the University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science at the University of Naples Federico II, Naples, Italy.
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Coppola S, Carucci L, Oglio F, Di Sarra C, Ozen G, Berni Canani R. Nutritional Strategies for the Prevention and Management of Cow's Milk Allergy in the Pediatric Age. Nutrients 2023; 15:3328. [PMID: 37571266 PMCID: PMC10421120 DOI: 10.3390/nu15153328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/22/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Cow's milk allergy (CMA) is one of the most common pediatric food allergies. The prevalence and severity of CMA have increased dramatically in the last decades, under the pressure of environmental factors in genetically predisposed individuals. Among the environmental influences, nutritional factors play a crucial role. Diet is the most modifiable factor, representing a potential target for the prevention and treatment of CMA. In this review, we report the most scientific-based nutritional strategies for preventing and managing pediatric CMA. In addition, we propose the most complete supplement of compounds able to prevent nutrient deficiencies in CMA pediatric patients and to positively influence the disease course.
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Affiliation(s)
- Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Franca Oglio
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Claudia Di Sarra
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
| | - Gulsum Ozen
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy; (S.C.); (L.C.); (F.O.); (C.D.S.); (G.O.)
- Immunonutrition Lab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, 80131 Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, 80131 Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, 80131 Naples, Italy
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Carucci L, Votto M, Licari A, Marseglia GL, Berni Canani R. Food allergy: cause or consequence of pediatric eosinophilic esophagitis? Potential implications of ultraprocessed foods in prevention and management. FRONTIERS IN ALLERGY 2023; 4:1138400. [PMID: 37456790 PMCID: PMC10344695 DOI: 10.3389/falgy.2023.1138400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by eosinophilic infiltration, leading to esophageal dysfunction, inflammation, and fibrotic remodeling. In the last few decades, there has been an increased prevalence of EoE at an alarming rate in the pediatric age. The pathogenesis of EoE is still largely undefined, and this limits the definition of effective strategies for the prevention and management of this condition. EoE is considered a multifactorial disease arising from a negative interaction between environmental factors and genetic background, causing an impaired esophageal epithelial barrier with subsequent abnormal allergen exposure activating type 2 (Th2) inflammation. Food antigens have been suggested as key players in Th2 inflammation in pediatric patients with EoE, but emerging evidence suggests a potential role of other dietary factors, including ultraprocessed foods, as possible triggers for the occurrence of EoE. In this paper, we discuss the potential role of these dietary factors in the development of the disease, and we propose a new approach for the management of pediatric patients with EoE.
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Affiliation(s)
- Laura Carucci
- Department of Translational Medical Science, University of Naples “Federico II,”Naples, Italy
- ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples “Federico II,”Naples, Italy
| | - Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples “Federico II,”Naples, Italy
- ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples “Federico II,”Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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De Filippo M, Votto M, Albini M, Castagnoli R, De Amici M, Marseglia A, Pizzo A, Marseglia GL, Licari A. Pediatric Anaphylaxis: A 20-Year Retrospective Analysis. J Clin Med 2022; 11:jcm11185285. [PMID: 36142932 PMCID: PMC9502364 DOI: 10.3390/jcm11185285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anaphylaxis is a steadily increasing global problem defined as an acute hypersensitivity multisystem reaction that is potentially fatal. In the pediatric age, the leading cause is food. In other allergic diseases, intrinsic heterogeneity has been reported in the clinical presentation, severity, and triggers of anaphylaxis. This study analyzes the features and management approach of the anaphylactic reactions in children evaluated at the pediatric clinic in Pavia. MATERIALS AND METHODS A retrospective study was conducted on patients with anaphylaxis between 2001 and 2021. RESULTS A total of 148 patients with a median age of 5 years were enrolled, and 80% of the patients had other atopic comorbidities that were correlated with the severity of anaphylaxis. The main trigger of anaphylaxis was food. Most reactions involved mucocutaneous, respiratory, and gastrointestinal systems, and occurred at home. Adrenaline was administered only in a minority of cases. CONCLUSIONS Considering that anaphylaxis is a potentially life-threatening condition requiring prompt management, the use of adrenaline should be implemented. Our data also suggest the importance of educating and spreading awareness of anaphylactic management within the medical community.
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Affiliation(s)
- Maria De Filippo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Maria Albini
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Riccardo Castagnoli
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Mara De Amici
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Laboratory of Immuno-Allergology of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alessia Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Alessandro Pizzo
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-0382-502-629
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Berni Canani R, Caffarelli C, Calvani M, Martelli A, Carucci L, Cozzolino T, Alvisi P, Agostoni C, Lionetti P, Marseglia GL. Diagnostic therapeutic care pathway for pediatric food allergies and intolerances in Italy: a joint position paper by the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP). Ital J Pediatr 2022; 48:87. [PMID: 35689252 PMCID: PMC9188074 DOI: 10.1186/s13052-022-01277-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Epidemiologic data suggest an increased prevalence of pediatric food allergies and intolerances (FAIs) during the last decades. This changing scenario has led to an increase in the overall healthcare costs, due to a growing demand for diagnostic and treatment services. There is the need to establish Evidence-based practices for diagnostic and therapeutic intervention that could be adopted in the context of public health policies for FAIs are needed. This joint position paper has been prepared by a group of experts in pediatric gastroenterology, allergy and nutrition from the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP). The paper is focused on the Diagnostic Therapeutic Care Pathway (DTCP) for pediatric FAIs in Italy.
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Affiliation(s)
- Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy. .,CEINGE-Biotecnologie Avanzate s.c.ar.l. University of Naples Federico II, Naples, Italy. .,European Laboratory for the Investigation of Food-Induced Diseases, University of Naples, Federico II, Naples, Italy. .,Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy.
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mauro Calvani
- Pediatric Unit, S. Camillo Forlanini Hospital, Rome, Italy
| | - Alberto Martelli
- Department of Pediatrics, G. Salvini Hospital, Garbagnate Milanese, Milan, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l. University of Naples Federico II, Naples, Italy
| | - Tommaso Cozzolino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate s.c.ar.l. University of Naples Federico II, Naples, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Lionetti
- Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, IRCCS "S. Matteo" Foundation, University of Pavia, Pavia, Italy
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Epidemiology of Anaphylaxis Induced by Food: Incidence, Trends, Natural History, and Bias. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Immunomodulatory and Allergenic Properties of Antimicrobial Peptides. Int J Mol Sci 2022; 23:ijms23052499. [PMID: 35269641 PMCID: PMC8910669 DOI: 10.3390/ijms23052499] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023] Open
Abstract
With the growing problem of the emergence of antibiotic-resistant bacteria, the search for alternative ways to combat bacterial infections is extremely urgent. While analyzing the effect of antimicrobial peptides (AMPs) on immunocompetent cells, their effect on all parts of the immune system, and on humoral and cellular immunity, is revealed. AMPs have direct effects on neutrophils, monocytes, dendritic cells, T-lymphocytes, and mast cells, participating in innate immunity. They act on B-lymphocytes indirectly, enhancing the induction of antigen-specific immunity, which ultimately leads to the activation of adaptive immunity. The adjuvant activity of AMPs in relation to bacterial and viral antigens was the reason for their inclusion in vaccines and made it possible to formulate the concept of a “defensin vaccine” as an innovative basis for constructing vaccines. The immunomodulatory function of AMPs involves their influence on cells in the nearest microenvironment, recruitment and activation of other cells, supporting the response to pathogenic microorganisms and completing the inflammatory process, thus exhibiting a systemic effect. For the successful use of AMPs in medical practice, it is necessary to study their immunomodulatory activity in detail, taking into account their pleiotropy. The degree of maturity of the immune system and microenvironment can contribute to the prevention of complications and increase the effectiveness of therapy, since AMPs can suppress inflammation in some circumstances, but aggravate the response and damage of organism in others. It should also be taken into account that the real functions of one or another AMP depend on the types of total regulatory effects on the target cell, and not only on properties of an individual peptide. A wide spectrum of biological activity, including direct effects on pathogens, inactivation of bacterial toxins and influence on immunocompetent cells, has attracted the attention of researchers, however, the cytostatic activity of AMPs against normal cells, as well as their allergenic properties and low stability to host proteases, are serious limitations for the medical use of AMPs. In this connection, the tasks of searching for compounds that selectively affect the target and development of an appropriate method of application become critically important. The scope of this review is to summarize the current concepts and newest advances in research of the immunomodulatory activity of natural and synthetic AMPs, and to examine the prospects and limitations of their medical use.
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Serbes M, Sasihuseyinoglu AS, Ozcan D, Ufuk Altıntas D. Clinical features of anaphylaxis in children. Allergy Asthma Proc 2022; 43:50-56. [PMID: 34983711 DOI: 10.2500/aap.2022.43.210089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Despite the considerable increase in anaphylaxis frequency, there are limited studies on clinical features of anaphylaxis in children in developing countries. Objective: We aimed to analyze the demographic and clinical features of anaphylaxis in children in Turkey by comparing different age groups and triggers. Methods: Medical records of 147 children, ages 0-18 years, diagnosed with anaphylaxis between 2010 and 2019 were retrospectively analyzed. Results: The mean ± standard deviation age at first anaphylaxis episode was 5.9 ± 5.2 years, with a male predominance (63.9%); 25.2% were infants and 52.4% were < 6 years of age at their first anaphylaxis episode; 78.2% were atopic, with the highest frequency in children with food-induced anaphylaxis (FIA). The home (51.7%) was the most frequent setting. The overall leading cause of anaphylaxis was food (44.2%), which was more frequent at < 6 years of age, followed by drugs (28.6%) and bee venom (22.4%), both were more frequent among older children (>6 years). The patients with venom allergy had the highest rate of rapid onset of symptoms (p < 0.001). Gastrointestinal symptoms were observed significantly more in infants (48.6%) and in children with FIA (38.5%); cardiovascular symptoms were more frequently observed in children > 6 years of age (48.6%) and in children with drug-induced anaphylaxis (64.3%). Although recurrent anaphylaxis was reported for 23.1% of the patients, it was highest in the patients with FIA (35.9%). Overall, only 47.6% of the patients received epinephrine in the emergency department (ED) and 27.3% were referred to an allergy specialist, with the patients with FIA having the lowest rate for both, 32.3% and 10.8%, respectively. Children with drug-induced anaphylaxis had the highest rate of severe anaphylaxis (57.1%). Conclusion: There is a need to improve anaphylaxis recognition and management in all children regardless of age and trigger. Inadequate treatment was most evident in infants and patients with FIA.
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Mullins RJ, Dear KB, Tang ML. Changes in Australian food anaphylaxis admission rates following introduction of updated allergy prevention guidelines. J Allergy Clin Immunol 2022; 150:140-145.e1. [DOI: 10.1016/j.jaci.2021.12.795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/25/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
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Tanno LK, Clark E, Mamodaly M, Cardona V, Ebisawa M, Asontegui I, Sanchez-Borges M, Santos AF, Fiocchi A, Worm M, Caimmi D, Latour Staffeld P, Muraro A, Pawankar R, Greenberger PA, Thong BYH, Martin B, Demoly P. Food-induced anaphylaxis morbidity: Emergency department and hospitalization data support preventive strategies. Pediatr Allergy Immunol 2021; 32:1730-1742. [PMID: 34142390 DOI: 10.1111/pai.13578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anaphylaxis is a recognized public health issue. There is no doubt that food-induced anaphylaxis (FIA) has tremendous impact on the quality of life of patients and their families and increases direct and indirect costs. FIA is associated with increasing rates of emergency department admissions and hospitalizations and implies the risk of death. Morbidity epidemiological data are a key to tailor public health actions to this non-communicable disease. The aim of this article was to review published morbidity epidemiological data relating to FIA and potential risk factors, in order to provide evidence-based recommendations to reduce the risk of severe adverse outcomes. METHODS We identified published studies available in PUBMED/MEDLINE (1966-2020), EMBASE (1980-2020) and CINAHL (1982-2020). The systematic review was carried out using MeSH terms related to FIA ED admissions and hospitalizations. RESULTS A total of 25 articles were selected, 80% published in the last 5 years. After critical analysis of methodological and clinical characteristics reported in the data selected, we were able to propose preventive strategies. CONCLUSION Anaphylaxis is a recognized public health issue. FIA is associated with increasing rates of ED admissions and hospitalizations and imply in risk of death. More than reviewing and critically interpreting the key patterns related to FIA morbidity published data, we proposed strategies in order to promote quality care of patients suffering from FIA. Our World Health Organization Collaborative Center is deeply involved in this process, and we believe that the proposed strategies will inform future healthcare policies on anaphylaxis. The long-term objective would be to improve clinical care and quality of life of patients and their families, and develop risk-stratified, cost-effective preventive measures.
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Affiliation(s)
- Luciana Kase Tanno
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL Research Network, Barcelona, Spain
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Ignacio Asontegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia Erandio, Bilbao, Spain
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico Docente La Trinidad, Caracas, Venezuela
| | - Alexandra F Santos
- Division of Asthma, Allergy & Lung Biology, Department of Pediatric Allergy, King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Alessandro Fiocchi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Davide Caimmi
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France
| | | | - Antonella Muraro
- Food Allergy Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | | | - Paul Allen Greenberger
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore City, Singapore
| | - Bryan Martin
- Medicine and Pediatrics, The Ohio State University in Columbus, Columbus, OH, USA
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Desbret Institute of Public Health (IDESP), INSERM - University of Montpellier, Montpellier, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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13
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Lieberman JA, Gupta RS, Knibb RC, Haselkorn T, Tilles S, Mack DP, Pouessel G. The global burden of illness of peanut allergy: A comprehensive literature review. Allergy 2021; 76:1367-1384. [PMID: 33216994 PMCID: PMC8247890 DOI: 10.1111/all.14666] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 10/30/2020] [Accepted: 11/14/2020] [Indexed: 01/05/2023]
Abstract
Peanut allergy (PA) currently affects approximately 2% of the general population of Western nations and may be increasing in prevalence. Patients with PA and their families/caregivers bear a considerable burden of self‐management to avoid accidental peanut exposure and to administer emergency medication (adrenaline) if needed. Compared with other food allergies, PA is associated with higher rates of accidental exposure, severe reactions and potentially fatal anaphylaxis. Approximately 7%–14% of patients with PA experience accidental peanut exposure annually, and one‐third to one‐half may experience anaphylaxis, although fatalities are rare. These risks impose considerably high healthcare utilization and economic costs for patients with PA and restrictions on daily activities. Measures to accommodate patients with PA are often inadequate, with inconsistent standards for food labelling and inadequate safety policies in public establishments such as restaurants and schools. Children with PA are often bullied, resulting in sadness, humiliation and anxiety. These factors cumulatively contribute to significantly reduced health‐related quality of life for patients with PA and families/caregivers. Such factors also provide essential context for risk/benefit assessments of new PA therapies. This narrative review comprehensively assessed the various factors comprising the burden of PA.
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Affiliation(s)
- Jay A. Lieberman
- University of Tennessee Health Science Center/Le Bonheur Children’s Hospital Memphis TN USA
| | - Ruchi S Gupta
- Institute for Public Health and Medicine Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern School of Medicine Chicago IL USA
| | | | | | | | - Douglas P. Mack
- Department of Pediatrics McMaster University Hamilton ON Canada
| | - Guillaume Pouessel
- Pneumology and Allergology Unit Children's HospitalLille University Hospital Jeanne de Flandre France
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14
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Paparo L, Picariello G, Bruno C, Pisapia L, Canale V, Sarracino A, Nocerino R, Carucci L, Cosenza L, Cozzolino T, Berni Canani R. Tolerogenic Effect Elicited by Protein Fraction Derived From Different Formulas for Dietary Treatment of Cow's Milk Allergy in Human Cells. Front Immunol 2021; 11:604075. [PMID: 33679694 PMCID: PMC7928417 DOI: 10.3389/fimmu.2020.604075] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/29/2020] [Indexed: 01/07/2023] Open
Abstract
Several formulas are available for the dietary treatment of cow’s milk allergy (CMA). Clinical data suggest potentially different effect on immune tolerance elicited by these formulas. We aimed to comparatively evaluate the tolerogenic effect elicited by the protein fraction of different formulas available for the dietary treatment of CMA. Five formulas were compared: extensively hydrolyzed whey formula (EHWF), extensively hydrolyzed casein formula (EHCF), hydrolyzed rice formula (HRF), soy formula (SF), and amino acid-based formula (AAF). The formulas were reconstituted in water according to the manufacturer’s instructions and subjected to an in vitro infant gut simulated digestion using a sequential gastric and duodenal static model. Protein fraction was then purified and used for the experiments on non-immune and immune components of tolerance network in human enterocytes and in peripheral mononuclear blood cells (PBMCs). We assessed epithelial layer permeability and tight junction proteins (occludin and zonula occludens-1, ZO-1), mucin 5AC, IL-33, and thymic stromal lymphopoietin (TSLP) in human enterocytes. In addition, Th1/Th2 cytokine response and Tregs activation were investigated in PBMCs from IgE-mediated CMA infants. EHCF-derived protein fraction positively modulated the expression of gut barrier components (mucin 5AC, occludin and ZO-1) in human enterocytes, while SF was able to stimulate the expression of occludin only. EHWF and HRF protein fractions elicited a significant increase in TSLP production, while IL-33 release was significantly increased by HRF and SF protein fractions in human enterocytes. Only EHCF-derived protein fraction elicited an increase of the tolerogenic cytokines production (IL-10, IFN-γ) and of activated CD4+FoxP3+ Treg number, through NFAT, AP1, and Nf-Kb1 pathway. The effect paralleled with an up-regulation of FoxP3 demethylation rate. Protein fraction from all the study formulas was unable to induce Th2 cytokines production. The results suggest a different regulatory action on tolerogenic mechanisms elicited by protein fraction from different formulas commonly used for CMA management. EHCF-derived protein fraction was able to elicit tolerogenic effect through at least in part an epigenetic modulation of FoxP3 gene. These results could explain the different clinical effects observed on immune tolerance acquisition in CMA patients and on allergy prevention in children at risk for atopy observed using EHCF.
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Affiliation(s)
- Lorella Paparo
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Gianluca Picariello
- Institute of Food Sciences, National Research Council (CNR), Avellino, Italy
| | - Cristina Bruno
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Laura Pisapia
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Valentina Canale
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Antonietta Sarracino
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Linda Cosenza
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Tommaso Cozzolino
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, University of Naples "Federico II", Naples, Italy.,European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy.,Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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15
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Carucci L, Nocerino R, Paparo L, Di Scala C, Berni Canani R. Dietary Prevention of Atopic March in Pediatric Subjects With Cow's Milk Allergy. Front Pediatr 2020; 8:440. [PMID: 32850553 PMCID: PMC7431922 DOI: 10.3389/fped.2020.00440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022] Open
Abstract
Cow's milk allergy (CMA) is one of the most prevalent food allergies and the most expensive allergic diseases in the pediatric age. There is no cure for CMA, and actual disease management is based on strict avoidance of cow milk protein-containing foods, access to rescue medication, and use of substitutive formulas. Early-life CMA could be one of the first steps of the "allergic march" (AM), leading to the occurrence of other atopic manifestations later in the life, including asthma and oculorhinitis, with subsequent further increase of costs for health care systems and families of affected children. In the last years, diet is emerged as a relevant strategy to prevent allergic diseases through, at least in part, epigenetic modulation of immune system. We provide an overview of studies that investigate the potential role of different dietary strategies in preventing the AM in pediatric patients with CMA.
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Affiliation(s)
- Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Carmen Di Scala
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.,ImmunoNutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy.,European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy.,Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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16
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Global Trends in Anaphylaxis Epidemiology and Clinical Implications. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:1169-1176. [PMID: 31786255 PMCID: PMC7152797 DOI: 10.1016/j.jaip.2019.11.027] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
The true global scale of anaphylaxis remains elusive, because many episodes occur in the community without presentation to health care facilities, and most regions have not yet developed reliable systems with which to monitor severe allergic events. The most robust data sets currently available are based largely on hospital admissions, which are limited by inherent issues of misdiagnosis, misclassification, and generalizability. Despite this, there is convincing evidence of a global increase in rates of all-cause anaphylaxis, driven largely by medication- and food-related anaphylaxis. There is no evidence of parallel increases in global all-cause anaphylaxis mortality, with surprisingly similar estimates for case-fatality rates at approximately 0.5% to 1% of fatal outcomes for hospitalizations due to anaphylaxis across several regions. Studying regional patterns of anaphylaxis to certain triggers have provided valuable insights into susceptibility and sensitizing events: for example, the link between the mAb cetuximab and allergy to mammalian meat. Likewise, data from published fatality registers can identify potentially modifiable risk factors that can be used to inform clinical practice, such as prevention of delayed epinephrine administration, correct posturing during anaphylaxis, special attention to populations at risk (such as the elderly on multiple medications), and use of venom immunotherapy in individuals at risk of insect-related anaphylaxis.
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17
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18
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Fox A, Bird JA, Fiocchi A, Knol J, Meyer R, Salminen S, Sitang G, Szajewska H, Papadopoulos N. The potential for pre-, pro- and synbiotics in the management of infants at risk of cow's milk allergy or with cow's milk allergy: An exploration of the rationale, available evidence and remaining questions. World Allergy Organ J 2019; 12:100034. [PMID: 31194186 PMCID: PMC6555906 DOI: 10.1016/j.waojou.2019.100034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/29/2019] [Accepted: 04/17/2019] [Indexed: 12/25/2022] Open
Abstract
Cow's milk allergy is one of the most commonly reported childhood food allergies, with increasing incidence, persistence and severity in many countries across the world. The World Allergy Organization Special Committee on Food Allergy has identified cow's milk allergy as an area in need of a rationale-based approach in order to make progress against what it considered an onerous problem, with worldwide public health impact. There is growing interest in the potential role of the gut microbiota in the early programming and development of immune responses and allergy. This discussion paper considers the rationale and available evidence for modulation of the gut microbiota and for the use of synbiotics in the management of infants at risk of, or living with cow's milk allergy and summarizes remaining research questions that need to be answered for the development of evidence-based recommendations.
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Affiliation(s)
- Adam Fox
- Dept of Paediatric Allergy, Guy’s & St Thomas’ Hospitals NHS Foundation Trust, Westminster Bridge, London SE1 7EH, United Kingdom
| | - J. Andrew Bird
- University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Allergy and Immunology, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA
| | - Alessandro Fiocchi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Jan Knol
- Wageningen University, Stippeneng 4, 6708 WE Wageningen, the Netherlands
| | - Rosan Meyer
- Imperial College, Dept Paediatrics, London, UK
| | - Seppo Salminen
- Functional Foods Forum, Faculty of Medicine, Itäinen pitkäkatu 4A, 20014 Turku, Finland
| | - Gong Sitang
- Guangzhou Women and Children's Medical Center, Tianhe, Guangzhou, 510620, China
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, 02-091 Warsaw, Zwiriki i Wigury 63A, Poland
| | - Nikolaos Papadopoulos
- Professor of Allergy & Paediatric Allergy Division of Infection, Immunity & Respiratory Medicine, University of Manchester, 5th Floor (Research), Royal Manchester Childrens Hospital, Manchester M13 9WL, UK
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19
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Severe food allergies: can they be considered rare diseases? Curr Opin Allergy Clin Immunol 2019; 17:201-203. [PMID: 28379865 DOI: 10.1097/aci.0000000000000368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Berni Canani R, Paparo L, Nocerino R, Di Scala C, Della Gatta G, Maddalena Y, Buono A, Bruno C, Voto L, Ercolini D. Gut Microbiome as Target for Innovative Strategies Against Food Allergy. Front Immunol 2019; 10:191. [PMID: 30828329 PMCID: PMC6384262 DOI: 10.3389/fimmu.2019.00191] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022] Open
Abstract
The dramatic increase in food allergy prevalence and severity globally requires effective strategies. Food allergy derives from a defect in immune tolerance mechanisms. Immune tolerance is modulated by gut microbiota function and structure, and microbiome alterations (dysbiosis) have a pivotal role in the development of food allergy. Environmental factors, including a low-fiber/high-fat diet, cesarean delivery, antiseptic agents, lack of breastfeeding, and drugs can induce gut microbiome dysbiosis, and have been associated with food allergy. New experimental tools and technologies have provided information regarding the role of metabolites generated from dietary nutrients and selected probiotic strains that could act on immune tolerance mechanisms. The mechanisms are multiple and still not completely defined. Increasing evidence has provided useful information on optimal bacterial species/strains, dosage, and timing for intervention. The increased knowledge of the crucial role played by nutrients and gut microbiota-derived metabolites is opening the way to a post-biotic approach in the stimulation of immune tolerance through epigenetic regulation. This review focused on the potential role of gut microbiome as the target for innovative strategies against food allergy.
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Affiliation(s)
- Roberto Berni Canani
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples “Federico II”, Naples, Italy
- ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
- Task Force on Microbiome Studies, University of Naples “Federico II”, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
- ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
| | - Rita Nocerino
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
- ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
| | - Carmen Di Scala
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
- ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
| | - Giusy Della Gatta
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
- ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
| | - Ylenia Maddalena
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
| | - Aniello Buono
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
- ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
| | - Cristina Bruno
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
- ImmunoNutritionLab at CEINGE-Advanced Biotechnologies, University of Naples “Federico II”, Naples, Italy
| | - Luana Voto
- Department of Translational Medical Science – Pediatric Section, University of Naples “Federico II”, Naples, Italy
| | - Danilo Ercolini
- Task Force on Microbiome Studies, University of Naples “Federico II”, Naples, Italy
- Department of Agricultural Sciences, University of Naples “Federico II”, Naples, Italy
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21
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Sackesen C, Altintas DU, Bingol A, Bingol G, Buyuktiryaki B, Demir E, Kansu A, Kuloglu Z, Tamay Z, Sekerel BE. Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies. Front Pediatr 2019; 7:372. [PMID: 31620408 PMCID: PMC6760011 DOI: 10.3389/fped.2019.00372] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/30/2019] [Indexed: 12/15/2022] Open
Abstract
This review addresses the current strategies of inducing tolerance development in infant and childhood cow's milk protein allergy (CMPA). The change in prevention strategies for CMPA has been emphasized based on the lack of evidence to support the efficacy of food allergen avoidance in infancy and the concept of the dual-allergen-exposure hypothesis, which suggests that allergen exposure through the skin leads to sensitization, whereas early oral consumption of allergenic food protein induces oral tolerance. The new approach is based on the likelihood of early introduction of allergenic foods to the infant's diet to reduce the development of food allergies through oral tolerance induction. The latest treatment guidelines recommend the continuation of breast feeding and the elimination of cow's milk and products from the maternal diet in exclusively breast-fed infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy, eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as well as cases of multiple system involvement, multiple food allergies, and intolerance to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current knowledge on tolerance development in infants and children with CMPA to increase the awareness of the clinicians concerning the new approaches in CMPA treatment Tolerance development is considered a relatively new concept in CMPA, inducing a shift in interventions in CMPA from a passive (avoidance of responsible allergen) toward a proactive (tolerance induction) strategy.
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Affiliation(s)
- Cansin Sackesen
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Derya Ufuk Altintas
- Division of Pediatric Allergy, Department of Pediatrics, Cukurova University School of Medicine, Adana, Turkey
| | - Aysen Bingol
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gulbin Bingol
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Acibadem University School of Medicine, Istanbul, Turkey
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esen Demir
- Division of Pediatric Allergy, Department of Pediatrics, Ege University School of Medicine, Izmir, Turkey
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Zarife Kuloglu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Tamay
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Bulent Enis Sekerel
- Division of Pediatric Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Paparo L, Nocerino R, Di Scala C, Della Gatta G, Di Costanzo M, Buono A, Bruno C, Berni Canani R. Targeting Food Allergy with Probiotics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1125:57-68. [DOI: 10.1007/5584_2018_316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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23
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Rueter K, Ta B, Bear N, Lucas M, Borland ML, Prescott SL. Increased Use of Adrenaline in the Management of Childhood Anaphylaxis Over the Last Decade. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1545-1552. [DOI: 10.1016/j.jaip.2017.11.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
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24
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Speakman S, Kool B, Sinclair J, Fitzharris P. Paediatric food-induced anaphylaxis hospital presentations in New Zealand. J Paediatr Child Health 2018; 54:254-259. [PMID: 28885749 DOI: 10.1111/jpc.13705] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023]
Abstract
AIM Globally, rates of paediatric food-induced anaphylaxis (FIA) are increasing. Little data is available regarding the epidemiology of FIA among New Zealand (NZ) children. This study investigated the incidence of paediatric (0-14 years) FIA hospital presentations in NZ over a 10-year period. METHODS Ministry of Health public hospital discharge data from 2006 to 2015 were analysed using FIA-related International Classification of Diseases codes (T78.0 - anaphylactic shock due to adverse food reaction and T78.2 - anaphylactic shock unspecified and free text qualifier) to identify acute hospital presentations. RESULTS The overall annualised FIA hospital presentation rate was 16.2 per 100 000 children. Subgroup analysis indicated a significantly higher rate in males (19.1/100 000) than in females (13.1/100 000), and among children aged less than 2 years of age (50.5/100 000) compared with older children. Rates among Asian and Pacific children were higher than Māori and NZ European children. In 67.7% of cases, a single specific allergen was suggested by the information provided; among these cases, nuts (48%), specifically peanuts (26%), were the most commonly reported allergen, followed by cow's milk (21%). Time trend analysis showed a 2.8-fold increase in the overall annualised rate for the 10-year period. CONCLUSION These findings are consistent with other international studies indicating increasing rates of FIA in children. These data will provide information for a review of NZ paediatric allergy services to ensure current international standards with regard to the equitable delivery of timely, appropriate and accessible care are being met. Reasons for differences by gender, age and ethnicity require further investigation.
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Affiliation(s)
- Sophie Speakman
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jan Sinclair
- Starship Paediatric Immunology and Allergy, Starship Children's Health, Auckland, New Zealand
| | - Penny Fitzharris
- Immunology Department, Auckland City Hospital, Auckland, New Zealand
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Burton OT, Medina Tamayo J, Stranks AJ, Miller S, Koleoglou KJ, Weinberg EO, Oettgen HC. IgE promotes type 2 innate lymphoid cells in murine food allergy. Clin Exp Allergy 2018; 48:288-296. [PMID: 29247574 DOI: 10.1111/cea.13075] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mast cells serve an important sentinel function at mucosal barriers and have been implicated as key early inducers of type 2 immune responses in food allergy. The generation of Th2 and IgE following food allergen ingestion is inhibited in the absence of mast cells. Group 2 innate lymphoid cells are also thought to play an important early role in nascent allergic responses. OBJECTIVE To test whether IgE-mediated mast cell activation promotes intestinal ILC2 responses following ingestion of food allergens and whether ILC2 amplify food allergy. METHODS Two different mouse models of food allergy, one using intraperitoneally ovalbumin (OVA)-primed BALB/c animals and the other using enterally peanut-sensitized inherently atopic IL4raF709 mice, were applied to test the contributions of IgE antibodies and mast cells to ILC2 responses. The effect of ILC2 on mast cell activation and on anaphylaxis was tested. RESULTS ILC2 responses were significantly impaired in both models of food allergy in Igh7-/- mice harbouring a targeted deletion of the gene encoding IgE. A similar reduction in food allergen-induced ILC2 was observed in mast cell-deficient Il4raF709 KitW-sh mice, and this was partially corrected by reconstituting these animals using cultured bone marrow mast cells. Mast cells activated ILC2 for IL-13 production in an IL-4Rα-dependent manner. Activated ILC2 amplified systemic anaphylaxis by increasing target tissue sensitivity to mast cell mediators. CONCLUSIONS AND CLINICAL RELEVANCE These findings support an important role for IgE-activated mast cells in driving intestinal ILC2 expansion in food allergy and reveal that ILC2, in turn, can enhance responsiveness to the mediators of anaphylaxis produced by mast cells. Strategies designed to inhibit IgE signalling or mast cell activation are likely to inhibit both type 2 immunity and immediate hypersensitivity in food allergy.
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Affiliation(s)
- O T Burton
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - J Medina Tamayo
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - A J Stranks
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - S Miller
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - K J Koleoglou
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - E O Weinberg
- Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA
| | - H C Oettgen
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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26
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Lee S. The past, present, and future of research on anaphylaxis in Korean children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.s1.s21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sooyoung Lee
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
- Suwon Center for Environmental Disease and Atopy, Suwon, Korea
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Sánchez-Borges M, Cardona V, Worm M, Lockey RF, Sheikh A, Greenberger PA, Ansotegui IJ, Ebisawa M, El-Gamal Y, Fineman S, Geller M, Gonzalez-Estrada A, Tanno L, Thong BY. In-flight allergic emergencies. World Allergy Organ J 2017; 10:15. [PMID: 28496564 PMCID: PMC5415712 DOI: 10.1186/s40413-017-0148-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/23/2017] [Indexed: 01/20/2023] Open
Abstract
Allergic and hypersensitivity reactions such as anaphylaxis and asthma exacerbations may occur during air travel. Although the exact incidence of in-flight asthma and allergic emergencies is not known, we have concerns that this subject has not received the attention it warrants. There is a need to provide passengers at risk and airlines with the necessary measures to prevent and manage these emergencies. A review of the epidemiology, management and approaches to prevention of allergic and asthma emergencies during air travel is presented with the goal of increasing awareness about these important, potentially preventable medical events.
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Affiliation(s)
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
- Clínica El Avila, 6a.transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Group, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Margitta Worm
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Richard F. Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
| | - Aziz Sheikh
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Paul A. Greenberger
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bizkaia, Spain
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Yehia El-Gamal
- Pediatric Allergy & Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
| | - Stanley Fineman
- Department of Pediatric Allergy & Immunology, Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, USA
| | - Mario Geller
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexei Gonzalez-Estrada
- Division of Allergy and Clinical Immunology, Department of Medicine, Quillen College of Medicine and Center for Excellence for Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN USA
| | - Luciana Tanno
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
| | - Bernard Y. Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
| | - on behalf of the WAO Anaphylaxis Committee
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Group, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Allergie-Centrum-Charité, Klinik für Dermatologie, Venerologie und Allergologie, Campus Charité Mitte, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL USA
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bizkaia, Spain
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
- Pediatric Allergy & Immunology Unit, Children’s Hospital, Ain Shams University, Cairo, Egypt
- Department of Pediatric Allergy & Immunology, Emory University School of Medicine, Atlanta Allergy & Asthma, Atlanta, USA
- Division of Medicine, Academy of Medicine of Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Allergy and Clinical Immunology, Department of Medicine, Quillen College of Medicine and Center for Excellence for Inflammation, Infectious Disease and Immunity, East Tennessee State University, Johnson City, TN USA
- Hospital Sírio Libanês, São Paulo, Brazil
- University Hospital of Montpellier, Montpellier, and Sorbonne Universités, Paris, France
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
- Clínica El Avila, 6a.transversal Urb. Altamira, piso 8, consultorio 803, Caracas, 1060 Venezuela
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Rueter K, Ta B, Bear N, Lucas M, Prescott S. Physician training programs significantly improve diagnosis in cases coded as anaphylaxis over time: A major factor compounding time-trend data? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:858-860. [DOI: 10.1016/j.jaip.2016.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 09/07/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
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Amino Acid-based Formula in Cow's Milk Allergy: Long-term Effects on Body Growth and Protein Metabolism. J Pediatr Gastroenterol Nutr 2017; 64:632-638. [PMID: 27437928 DOI: 10.1097/mpg.0000000000001337] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The long-term effects of amino acid-based formula (AAF) in the treatment of cow's milk allergy (CMA) are largely unexplored. The present study comparatively evaluates body growth and protein metabolism in CMA children treated with AAF or with extensively hydrolyzed whey formula (eHWF), and healthy controls. METHODS A 12-month multicenter randomized control trial was conducted in outpatients with CMA (age 5-12 m) randomized in 2 groups, treated with AAF (group 1) and eHWF (group 2), and compared with healthy controls (group 3) fed with follow-on (if age <12 months) or growing-up formula (if age >12 months). At enrolment (T0), after 3 (T3), 6 (T6), and 12 months (T12) a clinical evaluation was performed. At T0 and T3, in subjects with CMA serum levels of albumin, urea, total protein, retinol-binding protein, and insulin-like growth factor 1 were measured. RESULTS Twenty-one subjects in group 1 (61.9% boys, age 6.5 ± 1.5 months), 19 in group 2 (57.9% boys, age 7 ± 1.7 months) and 25 subjects in group 3 (48% boys, age 5.5 ± 0.5 months) completed the study. At T0, the weight z score was similar in group 1 (-0.74) and 2 (-0.76), with differences compared to group 3 (-0.17, P < 0.05). At T12, the weight z score value was similar between the 3 groups without significant differences. There were no significant changes in protein metabolism in children in groups 1 and 2. CONCLUSION Long-term treatment with AAF is safe and allows adequate body growth in children with CMA.
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Ganapathy S, Lwin Z, Ting DH, Goh LS, Chong SL. Anaphylaxis in Children: Experience of 485 Episodes in 1,272,482 Patient Attendances at a Tertiary Paediatric Emergency Department from 2007 to 2014. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2016; 45:542-548. [PMID: 28062882 DOI: 10.47102/annals-acadmedsg.v45n12p542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Introduction: Anaphylaxis is a predominantly childhood disease. Most of the literature on anaphylaxis has emerged from Western countries. This study aimed to describe the incidence, triggers and clinical presentation of anaphylaxis among children in Singapore, look for predictors for anaphylaxis with severe outcomes, and study the incidence of biphasic reactions. Materials and Methods: We retrospectively reviewed records of children presenting with anaphylaxis to our paediatric emergency department from 1 January 2007 to 31 December 2014. Results: We identified 485 cases of anaphylaxis in 445 patients. Cutaneous symptoms (urticarial/angio-oedema) were the most common across all age groups (481 cases, 99%), followed by respiratory (412, 85%), gastrointestinal (118, 24%) and cardiovascular (35, 7.2%) symptoms. Central nervous system symptoms (drowsiness/ irritability) were rare across all age groups (11, 2.2%). Food was identified as the most common trigger across all age groups (45% to 63%). Seafood was the most common food trigger (57, 25%). A total of 420 (86.6%) children were treated with adrenaline, 451 (93%) received steroids and 411 (85%) received antihistamines. Sixty-three (13%) children fulfilled the criteria of severe anaphylaxis. There was no statistically significant association between severe anaphylaxis and the type of trigger (P = 0.851), nor an overall past history of atopy (P = 0.428). The only independent predictor for severe anaphylaxis was a previous drug allergy (P = 0.016). A very low prevalence of biphasic reactions (0.6% of study population) was noted in our study. Conclusion: We described the presentation and management of anaphylaxis in the Singapore population. A history of drug allergy is associated with severe presentation. Biphasic reactions are rare in our population.
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31
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Mechanisms of anaphylaxis in human low-affinity IgG receptor locus knock-in mice. J Allergy Clin Immunol 2016; 139:1253-1265.e14. [PMID: 27568081 DOI: 10.1016/j.jaci.2016.06.058] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 05/13/2016] [Accepted: 06/13/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anaphylaxis can proceed through distinct IgE- or IgG-dependent pathways, which have been investigated in various mouse models. We developed a novel mouse strain in which the human low-affinity IgG receptor locus, comprising both activating (hFcγRIIA, hFcγRIIIA, and hFcγRIIIB) and inhibitory (hFcγRIIB) hFcγR genes, has been inserted into the equivalent murine locus, corresponding to a locus swap. OBJECTIVE We sought to determine the capabilities of hFcγRs to induce systemic anaphylaxis and identify the cell types and mediators involved. METHODS hFcγR expression on mouse and human cells was compared to validate the model. Passive systemic anaphylaxis was induced by injection of heat-aggregated human intravenous immunoglobulin and active systemic anaphylaxis after immunization and challenge. Anaphylaxis severity was evaluated based on hypothermia and mortality. The contribution of receptors, mediators, or cell types was assessed based on receptor blockade or depletion. RESULTS The human-to-mouse low-affinity FcγR locus swap engendered hFcγRIIA/IIB/IIIA/IIIB expression in mice comparable with that seen in human subjects. Knock-in mice were susceptible to passive and active anaphylaxis, accompanied by downregulation of both activating and inhibitory hFcγR expression on specific myeloid cells. The contribution of hFcγRIIA was predominant. Depletion of neutrophils protected against hypothermia and mortality. Basophils contributed to a lesser extent. Anaphylaxis was inhibited by platelet-activating factor receptor or histamine receptor 1 blockade. CONCLUSION Low-affinity FcγR locus-switched mice represent an unprecedented model of cognate hFcγR expression. Importantly, IgG-related anaphylaxis proceeds within a native context of activating and inhibitory hFcγRs, indicating that, despite robust hFcγRIIB expression, activating signals can dominate to initiate a severe anaphylactic reaction.
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Ansotegui IJ, Sánchez-Borges M, Cardona V. Current Trends in Prevalence and Mortality of Anaphylaxis. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0094-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Wawrzyniak P, Akdis CA, Finkelman FD, Rothenberg ME. Advances and highlights in mechanisms of allergic disease in 2015. J Allergy Clin Immunol 2016; 137:1681-1696. [PMID: 27090934 DOI: 10.1016/j.jaci.2016.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/03/2016] [Accepted: 02/17/2016] [Indexed: 01/08/2023]
Abstract
This review highlights some of the advances in mechanisms of allergic disease, particularly anaphylaxis, including food allergy, drug hypersensitivity, atopic dermatitis (AD), allergic conjunctivitis, and airway diseases. During the last year, a mechanistic advance in food allergy was achieved by focusing on mechanisms of allergen sensitization. Novel biomarkers and treatment for mastocytosis were presented in several studies. Novel therapeutic approaches in the treatment of atopic dermatitis and psoriasis showed that promising supplementation of the infant's diet in the first year of life with immunoactive prebiotics might have a preventive role against early development of AD and that therapeutic approaches to treat AD in children might be best directed to the correction of a TH2/TH1 imbalance. Several studies were published emphasizing the role of the epithelial barrier in patients with allergic diseases. An impaired skin barrier as a cause for sensitization to food allergens in children and its relationship to filaggrin mutations has been an important development. Numerous studies presented new approaches for improvement of epithelial barrier function and novel biologicals used in the treatment of inflammatory skin and eosinophilic diseases. In addition, novel transcription factors and signaling molecules that can develop as new possible therapeutic targets have been reported.
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Affiliation(s)
- Paulina Wawrzyniak
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland, Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland, Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
| | - Fred D Finkelman
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, University of Cincinnati College of Medicine, and the Department of Medicine, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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Cervellin G, Sanchis-Gomar F, Lippi G. Adrenaline in anaphylaxis treatment. Balancing benefits and harms. Expert Opin Drug Saf 2016; 15:741-6. [DOI: 10.1517/14740338.2016.1167870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Abstract
PURPOSE OF REVIEW The role of vitamin D in the development of food allergy is unclear. We summarize recent data on the epidemiologic link between sunlight (UVB) and food allergy, and evidence for and against a specific role for vitamin D status. RECENT FINDINGS Since 2007, most epidemiologic studies have supported low sunlight (as measured by season of birth and latitude) as a risk factor for food allergy. Investigators have also looked directly at vitamin D status (as measured by serum 25OHD level) and its potential role. Although conflicting, the vitamin D studies suggest a more complicated association than a linear dose response in all individuals, with some studies indicating different associations based on host characteristics (e.g. concominant eczema, genetic polymorphisms, country of birth). Most studies have not fully examined the myriad effects of sunlight but have instead focused on a single maternal, neonatal or childhood 25OHD level. SUMMARY Many studies have linked sunlight with the development of food allergy but whether this is directly related to vitamin D status or a myriad of other sunlight-derived, seasonal and/or geographic factors remains uncertain. More studies are needed to investigate the role of sunlight and vitamin D status in food allergy because of their potential for primary prevention and disease modification.
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Grabenhenrich LB, Dölle S, Moneret-Vautrin A, Köhli A, Lange L, Spindler T, Ruëff F, Nemat K, Maris I, Roumpedaki E, Scherer K, Ott H, Reese T, Mustakov T, Lang R, Fernandez-Rivas M, Kowalski ML, Bilò MB, Hourihane JO, Papadopoulos NG, Beyer K, Muraro A, Worm M. Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. J Allergy Clin Immunol 2016; 137:1128-1137.e1. [PMID: 26806049 DOI: 10.1016/j.jaci.2015.11.015] [Citation(s) in RCA: 324] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/09/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anaphylaxis in children and adolescents is a potentially life-threatening condition. Its heterogeneous clinical presentation and sudden occurrence in virtually any setting without warning have impeded a comprehensive description. OBJECTIVE We sought to characterize severe allergic reactions in terms of elicitors, symptoms, emergency treatment, and long-term management in European children and adolescents. METHODS The European Anaphylaxis Registry recorded details of anaphylaxis after referral for in-depth diagnosis and counseling to 1 of 90 tertiary allergy centers in 10 European countries, aiming to oversample the most severe reactions. Data were retrieved from medical records by using a multilanguage online form. RESULTS Between July 2007 and March 2015, anaphylaxis was identified in 1970 patients younger than 18 years. Most incidents occurred in private homes (46%) and outdoors (19%). One third of the patients had experienced anaphylaxis previously. Food items were the most frequent trigger (66%), followed by insect venom (19%). Cow's milk and hen's egg were prevalent elicitors in the first 2 years, hazelnut and cashew in preschool-aged children, and peanut at all ages. There was a continuous shift from food- to insect venom- and drug-induced anaphylaxis up to age 10 years, and there were few changes thereafter. Vomiting and cough were prevalent symptoms in the first decade of life, and subjective symptoms (nausea, throat tightness, and dizziness) were prevalent later in life. Thirty percent of cases were lay treated, of which 10% were treated with an epinephrine autoinjector. The fraction of intramuscular epinephrine in professional emergency treatment increased from 12% in 2011 to 25% in 2014. Twenty-six (1.3%) patients were either admitted to the intensive care unit or had grade IV/fatal reactions. CONCLUSIONS The European Anaphylaxis Registry confirmed food as the major elicitor of anaphylaxis in children, specifically hen's egg, cow's milk, and nuts. Reactions to insect venom were seen more in young adulthood. Intensive care unit admissions and grade IV/fatal reactions were rare. The registry will serve as a systematic foundation for a continuous description of this multiform condition.
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Affiliation(s)
- Linus B Grabenhenrich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Dölle
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alice Köhli
- Division of Allergology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lars Lange
- Department of Pediatrics, St Marien-Hospital, Bonn, Germany
| | - Thomas Spindler
- Pediatric Pneumology and Allergology, Lungenzentrum Süd-West, Wangen, Germany
| | - Franziska Ruëff
- Department of Dermatology and Allergology, Ludwig-Maximilian-Universität, Munich, Germany
| | - Katja Nemat
- Pediatric Pneumology and Allergology, Kinderzentrum Dresden-Friedrichstadt, Dresden, Germany
| | - Ioana Maris
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | | | - Kathrin Scherer
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Hagen Ott
- Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Thomas Reese
- Rheine Kinderklinik, Mathias-Spital, Rheine, Germany
| | - Tihomir Mustakov
- Clinical Centre of Allergology, University Hospital Alexandrovska/Medical University Sofia, Sofia, Bulgaria
| | - Roland Lang
- Department of Dermatology, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria
| | | | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Maria B Bilò
- Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | | | - Kirsten Beyer
- Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Antonella Muraro
- Department of Mother and Child Health, Padua General University Hospital, Padua, Italy
| | - Margitta Worm
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Kim SH, Ban GY, Park HS, Kim SC, Ye YM. Regional differences in vitamin D levels and incidence of food-induced anaphylaxis in South Korea. Ann Allergy Asthma Immunol 2016; 116:237-243.e1. [PMID: 26803537 DOI: 10.1016/j.anai.2015.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/26/2015] [Accepted: 12/21/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have suggested low vitamin D as a potential risk factor for food allergy/anaphylaxis. However, few studies have investigated the association between vitamin D and food-induced anaphylaxis (FIA) in South Korea. OBJECTIVE To examine regional differences in serum vitamin D levels and FIA incidence. METHODS We used nationwide data collected from 2011 to 2013. Data on vitamin D were obtained from the Korea National Health and Nutrition Examination Survey; data on FIA were obtained from the Health Insurance and Assessment Service. Districts were grouped into region 1 (lower solar radiation) and region 2 (higher solar radiation). We examined differences in FIA incidence and vitamin D levels between the regions, adjusting for age. RESULTS The study included 2,814 patients with FIA and 15,367 people with available serum vitamin D measurements. Age-adjusted FIA incidence was 2.2 per 100,000 person-years in region 1 and 1.8 per 100,000 person-years in region 2 (relative risk, 1.23; 95% confidence interval, 1.09-1.39). Age-adjusted serum vitamin D levels were 16.5 ng/mL in region 1 and 17.8 ng/mL in region 2 (mean difference, 1.3 ng/mL; 95% confidence interval, 0.9-1.9). After stratification by age, sex, and area of residence, region 1 still had higher FIA incidence and lower vitamin D levels than region 2. CONCLUSION The present study found a higher incidence of FIA in regions with lower vitamin D levels in the population. Further investigation is necessary to identify any direct associations between vitamin D and food allergy/anaphylaxis.
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Affiliation(s)
- Si-Heon Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Su-chin Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.
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Matsumoto K, Izuhara K. Anaphylaxis--two stories not covered by the current guidelines. Allergol Int 2016; 65:1-2. [PMID: 26740297 DOI: 10.1016/j.alit.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Indexed: 11/26/2022] Open
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40
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Simons FER, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF, El-Gamal YM, Brown SG, Park HS, Sheikh A. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J 2015; 8:32. [PMID: 26525001 PMCID: PMC4625730 DOI: 10.1186/s40413-015-0080-1] [Citation(s) in RCA: 317] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis provide a unique global perspective on this increasingly common, potentially life-threatening disease. Recommendations made in the original WAO Anaphylaxis Guidelines remain clinically valid and relevant, and are a widely accessed and frequently cited resource. In this 2015 update of the evidence supporting recommendations in the Guidelines, new information based on anaphylaxis publications from January 2014 through mid- 2015 is summarized. Advances in epidemiology, diagnosis, and management in healthcare and community settings are highlighted. Additionally, new information about patient factors that increase the risk of severe and/or fatal anaphylaxis and patient co-factors that amplify anaphylactic episodes is presented and new information about anaphylaxis triggers and confirmation of triggers to facilitate specific trigger avoidance and immunomodulation is reviewed. The update includes tables summarizing important advances in anaphylaxis research.
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Affiliation(s)
- F Estelle R Simons
- Department of Pediatrics & Child Health and Department of Immunology, College of Medicine, Faculty of Health Sciences, The University of Manitoba, Room FE125, 820 Sherbrook Street, Winnipeg, R3A 1R9 MB Canada
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela
| | - Bernard Y Thong
- Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Margitta Worm
- Allergie-Centrum-Charite, Klinik fur Dermatologie, Venerologie und Allergologie, Campus Charite Mitte, Universitatsmedizin, Berlin, Germany
| | - Luciana Kase Tanno
- Department of Allergy and Clinical Immunology, Hospital Servidor Publico Estadual de Sao Paulo and Hospital Sirio-Libanes, Sao Paulo, Brazil
| | | | - Yehia M El-Gamal
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Simon Ga Brown
- Royal Hobart Hospital, Tasmania, and University of Western Australia and Royal Perth Hospital, Perth, Western Australia
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Seoul, South Korea
| | - Aziz Sheikh
- Allergy & Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Mullins RJ, Dear KBG, Tang MLK. Time trends in Australian hospital anaphylaxis admissions in 1998-1999 to 2011-2012. J Allergy Clin Immunol 2015; 136:367-75. [PMID: 26187235 DOI: 10.1016/j.jaci.2015.05.009] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies from the United Kingdom, the United States, and Australia have reported increased childhood food allergy and anaphylaxis prevalence in the 15 years after 1990. OBJECTIVE We sought to examine whether childhood food allergy/anaphylaxis prevalence has increased further since 2004-2005. METHODS We examined hospital anaphylaxis admission rates between 2005-2006 and 2011-2012 and compared findings with those from 1998-1999 to 2004-2005. RESULTS Overall population food-related anaphylaxis admission rates (per 10(5) population per year) increased from 5.6 in 2005-2006 to 8.2 in 2011-2012 (a 1.5-fold increase over 7 years). The highest rates occurred in children aged 0 to 4 years (21.7 in 2005-2006 and 30.3 in 2011-2012, a 1.4-fold increase), but the greatest proportionate increase occurred in those aged 5 to 14 years (5.8-12.1/10(5) population/y, respectively, a 2.1-fold increase) compared with those aged 15 to 29 years and 30 years or older (a 1.5- and 1.3-fold increase, respectively). Not only did absolute food-related anaphylaxis admissions increase, but the modeled year-on-year rate of increase in overall food-related anaphylaxis admissions also increased over time from an additional 0.35 per 10(5) population/y in 1998-1999 (all ages) to 0.49 in 2004-2005 and 0.63 in 2011-2012 (P < .001). CONCLUSIONS Food-related anaphylaxis has increased further in all age groups since 2004-2005. Although the major burden falls on those aged 0 to 4 years, there is preliminary evidence for a recent acceleration in incidence rates in those aged 5 to 14 years. This contrasts with the previous decade in which the greatest proportionate increase was in those aged 0 to 4 years. These findings suggest a possible increasing burden of disease among adolescents and adults who carry the highest risk for fatal anaphylaxis.
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Affiliation(s)
- Raymond James Mullins
- John James Medical Centre, Deakin, Canberra, Australia; Medical School, Australian National University Canberra, Canberra, Australia; Health Sciences, University of Canberra, Bruce, Canberra, Australia.
| | - Keith B G Dear
- Duke Global Health Institute, Duke University, Durham, NC; Duke Kunshan University, Kunshan, China
| | - Mimi L K Tang
- The Royal Children's Hospital, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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