1
|
Che Y, Yuan J, Wang Q, Liu M, Tang D, Chen M, Xiao X, Pang Y, Chen S, Han W, Xiao Z, Zeng J, Guo J. Dietary factors and the risk of atopic dermatitis: a Mendelian randomisation study. Br J Nutr 2024; 131:1873-1882. [PMID: 38343175 DOI: 10.1017/s0007114524000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Previous studies have revealed an association between dietary factors and atopic dermatitis (AD). To explore whether there was a causal relationship between diet and AD, we performed Mendelian randomisation (MR) analysis. The dataset of twenty-one dietary factors was obtained from UK Biobank. The dataset for AD was obtained from the publicly available FinnGen consortium. The main research method was the inverse-variance weighting method, which was supplemented by MR‒Egger, weighted median and weighted mode. In addition, sensitivity analysis was performed to ensure the accuracy of the results. The study revealed that beef intake (OR = 0·351; 95 % CI 0·145, 0·847; P = 0·020) and white bread intake (OR = 0·141; 95 % CI 0·030, 0·656; P = 0·012) may be protective factors against AD. There were no causal relationships between AD and any other dietary intake factors. Sensitivity analysis showed that our results were reliable, and no heterogeneity or pleiotropy was found. Therefore, we believe that beef intake may be associated with a reduced risk of AD. Although white bread was significant in the IVW analysis, there was large uncertainty in the results given the wide 95 % CI. Other factors were not associated with AD in this study.
Collapse
Affiliation(s)
- Yuhui Che
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu610072, Sichuan Province, People's Republic of China
| | - Jinyao Yuan
- West China Second Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qian Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu610072, Sichuan Province, People's Republic of China
| | - Mengsong Liu
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu610072, Sichuan Province, People's Republic of China
| | - Dadong Tang
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Mulan Chen
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Xinyu Xiao
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Yaobin Pang
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Siyan Chen
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Wen Han
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Zhiyong Xiao
- Chengdu University of Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Jinhao Zeng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu610072, Sichuan Province, People's Republic of China
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu610072, Sichuan Province, People's Republic of China
| |
Collapse
|
2
|
Santos AF, Riggioni C, Agache I, Akdis CA, Akdis M, Alvarez-Perea A, Alvaro-Lozano M, Ballmer-Weber B, Barni S, Beyer K, Bindslev-Jensen C, Brough HA, Buyuktiryaki B, Chu D, Del Giacco S, Dunn-Galvin A, Eberlein B, Ebisawa M, Eigenmann P, Eiwegger T, Feeney M, Fernandez-Rivas M, Fisher HR, Fleischer DM, Giovannini M, Gray C, Hoffmann-Sommergruber K, Halken S, Hourihane JO, Jones CJ, Jutel M, Knol E, Konstantinou GN, Lack G, Lau S, Marques Mejias A, Marchisotto MJ, Meyer R, Mortz CG, Moya B, Muraro A, Nilsson C, Lopes de Oliveira LC, O'Mahony L, Papadopoulos NG, Perrett K, Peters RL, Podesta M, Poulsen LK, Roberts G, Sampson HA, Schwarze J, Smith P, Tham EH, Untersmayr E, Van Ree R, Venter C, Vickery BP, Vlieg-Boerstra B, Werfel T, Worm M, Du Toit G, Skypala I. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy 2023; 78:3057-3076. [PMID: 37815205 DOI: 10.1111/all.15902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023]
Abstract
This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.
Collapse
Affiliation(s)
- Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Carmen Riggioni
- Department of Allergy and Clinical Immunology, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Alberto Alvarez-Perea
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Montserrat Alvaro-Lozano
- Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Barbara Ballmer-Weber
- Clinic for Dermatology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Derek Chu
- McMaster University, Ontario, Hamilton, Canada
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Audrey Dunn-Galvin
- Paediatrics and Child Health, INFANT Centre, HRB-CRF, University College Cork, Cork, Ireland
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Children's Health Ireland, Dublin, Ireland
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Philippe Eigenmann
- Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Ontario, Toronto, Canada
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Ontario, Toronto, Canada
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St.Pölten, Austria
| | - Mary Feeney
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Montserrat Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos, Madrid, Spain
- Facultad de Medicina, IdISSC, ARADyAL, Universidad Complutense, Madrid, Spain
| | - Helen R Fisher
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - David M Fleischer
- Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Claudia Gray
- Red Cross Children's Hospital and Kidsallergy Centre, Cape Town, South Africa
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Karin Hoffmann-Sommergruber
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Christina J Jones
- Faculty of Medical Sciences, School of Psychology, University of Surrey, Surrey, UK
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Edward Knol
- Department of Dermatology/Allergology, Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Susanne Lau
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreina Marques Mejias
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | | | - Rosan Meyer
- Department of Medicine, Imperial College, London, UK
- Department of Nutrition and Dietetics, Winchester University, Winchester, UK
- Department of Medicine, KU Leuven, Leuven, Belgium
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Beatriz Moya
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Antonella Muraro
- Food Allergy Referral Centre, Padua University Hospital, Padua, Italy
| | - Caroline Nilsson
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Sachs Children and Youth Hospital, South Hospital, Stockholm, Sweden
| | | | - Liam O'Mahony
- Department of Medicine, School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Lydia Becker Institute, University of Manchester, Manchester, UK
| | - Kirsten Perrett
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Parkville, Australia
- Population Allergy Research Group, Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Rachel L Peters
- Department of Paediatrics, University of Melbourne, Victoria, Parkville, Australia
- Department of Allergy and Immunology, Royal Children's Hospital, Victoria, Parkville, Australia
- Population Allergy Research Group, Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Marcia Podesta
- EFA - European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Lars K Poulsen
- Allergy Clinic, Copenhagen University Hospital at Herlev-Gentofte, Copenhagen, Denmark
| | - Graham Roberts
- Department of Paediatric Allergy and Respiratory Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
- David Hide Asthma and Allergy Centre, St Mary Hospital, Isle of Wight, UK
| | - Hugh A Sampson
- Division of Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Jürgen Schwarze
- Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
| | - Peter Smith
- Clinical Medicine, Griffith University, Queensland, Southport, Australia
- Queensland Allergy Services Private Practice, Queensland, Southport, Australia
| | - Elizabeth Huiwen Tham
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ronald Van Ree
- Departments of Experimental Immunology and of Otorhinolaryngoloy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Carina Venter
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado, Colorado, Aurora, USA
| | - Brian P Vickery
- Emory University School of Medicine and Children's Healthcare of Atlanta, Georgia, Atlanta, USA
| | - Berber Vlieg-Boerstra
- Department of Paediatrics, OLVG Hospital, Amsterdam, the Netherlands
- Rijnstate Allergy Centre, Rijnstate Hospital, Arnhem, The Netherlands
- Vlieg Dieticians, Private Practice for Dietary Management of Food Allergy, Arnhem, The Netherlands
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Division of Allergy and immunology, Department of Dermatology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - George Du Toit
- Department of Women and Children's Health (Pediatric Allergy), Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Isabel Skypala
- Royal Brompton & Harefield Hospitals, Part of Guys & St Thomas NHS Foundation Trust, London, UK
- Department of Inflammation and Repair, Imperial College, London, UK
| |
Collapse
|
3
|
Cimen SS, Guc BU, Bulbul L. Food Sensitivity in Children Diagnosed with Atopic Dermatitis in The First 2 Years: How Many of These Patients Are Truly Allergic? SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:403-409. [PMID: 37900332 PMCID: PMC10600614 DOI: 10.14744/semb.2023.21298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 10/31/2023]
Abstract
Objectives In this study, it was aimed to examine food sensitivity in patients with atopic dermatitis (AD) and to investigate the frequency of food allergy in patients with food sensitivity. Methods Patients aged 0-2 years who were followed up with the diagnosis of AD were included in the study. The characteristics of demographic and clinical and laboratory findings of the patients were recorded retrospectively. Patients were classified as mild, moderate, and severe using the SCORing AD index according to the severity of AD. The presence of food sensitivity was evaluated by skin prick test and serum-specific immunoglobulin (Ig)E results. Food allergy was diagnosed by oral food challenge (OFC) test. Results Of the 72 patients included in the study, 62.5% (n=45) were male, and the mean age was 9±4.8 months. When the disease severity was evaluated, it was mild in 40 patients (55.6%); moderate/severe AD was present in 32 patients (44.4%). The frequency of moderate/severe AD was higher in patients who were younger (p=0.01), whose symptoms started in the first 6 months (p=0.03), who had a family history of allergic disease (p=0.001), who breastfed for <6 months (p=0.01), who had a higher median serum total IgE level, and a higher percentage of serum eosinophils (p=0.005 and p=0.01, respectively). Food sensitivity in 45.8% of patients; food allergy was detected in 41.7% of them. The most common sensitivities and allergies were eggs white/yolk and cow's milk, respectively. The rate of food sensitivity was found to be higher in male gender (p=0.03) and breastfed patients (p=0.03), whereas it was similar in patients with mild and moderate/severe AD. Conclusion In the investigation of food sensitivity in patients with AD, it is important to evaluate other demographic and clinical characteristics such as gender and breastfeeding, apart from the severity of disease. The OFC test should be performed to confirm the food allergy in patients with food sensitivity before the recommendation of an elimination diet.
Collapse
Affiliation(s)
- Sevgi Sipahi Cimen
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Belgin Usta Guc
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Adana City Hospital, Adana, Türkiye
| | - Lida Bulbul
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Türkiye
| |
Collapse
|
4
|
|
5
|
Oykhman P, Dookie J, Al-Rammahy H, de Benedetto A, Asiniwasis RN, LeBovidge J, Wang J, Ong PY, Lio P, Gutierrez A, Capozza K, Martin SA, Frazier W, Wheeler K, Boguniewicz M, Spergel JM, Greenhawt M, Silverberg JI, Schneider L, Chu DK. Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2657-2666.e8. [PMID: 35987995 DOI: 10.1016/j.jaip.2022.06.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/27/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The influence of diet on atopic dermatitis (AD) is complex, and the use of dietary elimination as a treatment has conflicting views. OBJECTIVE To systematically review the benefits and harms of dietary elimination for the treatment of AD. METHODS We searched MEDLINE, Embase, AMED, PsycINFO, and the Cochrane Central Register of Controlled Trials from inception to January 18, 2022, without language restrictions, for randomized controlled trials (RCTs) and observational studies comparing dietary elimination and no dietary elimination for the treatment of AD. We conducted random-effects meta-analyses of eczema outcomes. We used the grading of recommendations, assessment, development, and evaluation approach to assess certainty of evidence (CRD42021237953). RESULTS Ten RCT (n = 599; baseline median of study mean age, 1.5 years; median of study mean SCOring Atopic Dermatitis index, 20.7, range, 3.5-37.6) were included in the meta-analysis. Compared with no dietary elimination, low-certainty evidence showed that dietary elimination may slightly improve eczema severity (50% with vs 41% without dietary elimination improved the SCOring Atopic Dermatitis index by a minimally important difference of 8.7 points, risk difference of 9% [95% CI, 0-17]), pruritus (daytime itch score [range, 0-3] mean difference, -0.21 [95% CI, -0.57 to 0.15]), and sleeplessness (sleeplessness score [range, 0-3] mean difference, -0.47 [95% CI, -0.80 to -0.13]). There were no credible subgroup differences based on elimination strategy (empiric vs guided by testing) or food-specific sensitization. Insufficient data addressed harms of elimination diets among included RCTs, although indirect evidence suggests that elimination diets may increase the risk for developing IgE-mediated food allergy. CONCLUSIONS Dietary elimination may lead to a slight, potentially unimportant improvement in eczema severity, pruritus, and sleeplessness in patients with mild to moderate AD. This must be balanced against potential risks for indiscriminate elimination diets including developing IgE-mediated food allergy and withholding more effective treatment options for AD.
Collapse
Affiliation(s)
- Paul Oykhman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jared Dookie
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Husam Al-Rammahy
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anna de Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY
| | - Rachel N Asiniwasis
- Origins Dermatology Centre, University of Saskatchewan, Regina, Saskatchewan, Canada
| | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Peck Y Ong
- Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, Calif
| | - Peter Lio
- Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Alvin Gutierrez
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, Calif
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Mass
| | - Winfred Frazier
- Department of Family Medicine, UPMC St Margaret, Pittsburgh, Pa
| | - Kathryn Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Fla
| | - Mark Boguniewicz
- Divison of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Derek K Chu
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact. McMaster University, Hamilton, Ontario, Canada; Research Institute of St Joe's Hamilton, Hamilton, Ontario, Canada.
| |
Collapse
|
6
|
Atopic Dermatitis and Food Allergy: A Complex Interplay What We Know and What We Would Like to Learn. J Clin Med 2022; 11:jcm11144232. [PMID: 35887996 PMCID: PMC9317394 DOI: 10.3390/jcm11144232] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 12/07/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus, eczematous lesions, and relapsing course. It presents with great clinical heterogeneity, while underlying pathogenetic mechanisms involve a complex interplay between a dysfunctional skin barrier, immune dysregulation, microbiome dysbiosis, genetic and environmental factors. All these interactions are shaping the landscape of AD endotypes and phenotypes. In the “era of allergy epidemic”, the role of food allergy (FA) in the prevention and management of AD is a recently explored “era”. Increasing evidence supports that AD predisposes to FA and not vice versa, while food allergens are presumed as one of the triggers of AD exacerbations. AD management should focus on skin care combined with topical and/or systemic treatments; however, in the presence of suspected food allergy, a thorough allergy evaluation should be performed. Food-elimination diets in food-allergic cases may have a beneficial effect on AD morbidity; however, prolonged, unnecessary diets are highly discouraged since they can lead to loss of tolerance and potentially increase the risk of IgE-mediated food allergy. Preventive AD strategies with the use of topical emollients and anti-inflammatory agents as well as early introduction of food allergens in high-risk infants seem promising in managing and preventing food allergy in AD patients. The current review aims to overview data on the complex AD/FA relationship and provide the most recent developments on whether food allergy interventions change the AD course and vice versa.
Collapse
|
7
|
Čelakovská J, Bukač J, Vaňková R, Krejsek J, Krcmova I, Andrýs C. Egg allergy in atopic dermatitis patients-analysis of results of specific extract IgE and specific IgE to molecular components. Bird-egg syndrome. FOOD AGR IMMUNOL 2021. [DOI: 10.1080/09540105.2021.1924631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jarmila Čelakovská
- Department of Dermatology and Venereology, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Bukač
- Department of Medical Biophysic, Medical Faculty of Charles University, Hradec Králové, Czech republic
| | - R. Vaňková
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - J. Krejsek
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - I. Krcmova
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | - C. Andrýs
- Department of Clinical Immunology and Allergy, Faculty Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| |
Collapse
|
8
|
Özdoğru EE, Gönülal M. Atopic dermatitis, inhalant allergy and food allergy: A paediatric approach. Dermatol Ther 2020; 34:e14542. [PMID: 33188575 DOI: 10.1111/dth.14542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Abstract
Food and inhalant allergens have also been identified as potential trigger factors of atopic dermatitis symptoms. Here we aimed to investigate relationships between atopic dermatitis and inhalant-food allergen sensitization in Turkish children with atopic dermatitis. We included 70 patients (42 male, 28 female) with atopic dermatitis and 45 controls (30 male, 15 female) with no atopy, no atopy familial history, no atopy clinical findings no atopic dermatitis. We noted patients' and controls' age, gender, passive smoking exposure, atopy, xerosis, bath water temperature, shower gel type, clothes detergent type, blood hemoglobin, blood eosinophil count, blood eosinophil percent, values of serum immunoglobulin E, serum immunoglobulin A, serum immunoglobulin G, serum immunoglobulin M, results of inhalant allergen, and food allergen testing. We found that nine cases had inhalant allergen sensitization and 21 cases had food allergen sensitization. There were significant relationships between cases and controls in terms of count of eosinophil and percent of eosinophil (P = .008, P = .009, respectively). Humoral and cellular allergen-specific immune responses to food and inhalant allergens can be detected in patients with atopic dermatitis. Accordingly, we believe that blood eosinophil count and percent are more valuable laboratory parameters than serum total IgE for following patients with atopic dermatitis.
Collapse
Affiliation(s)
- Emine Ece Özdoğru
- Department of pediatric allergy, immunology, and pulmonology, Health Science University, İzmir Training and Research Hospital, İzmir, Turkey
| | - Melis Gönülal
- Department of Dermatology, Health Science University, İzmir Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
9
|
Selbuz SK, Altuntaş C, Kansu A, Kırsaçlıoğlu CT, Kuloğlu Z, İlarslan NEÇ, Doğulu N, Günay F, Topçu S, Ulukol B. Assessment of cows milk-related symptom scoring awareness tool in young Turkish children. J Paediatr Child Health 2020; 56:1799-1805. [PMID: 32468665 DOI: 10.1111/jpc.14921] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/19/2020] [Accepted: 04/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The diagnosis of cows milk protein allergy (CMPA) is not always easy. Cow's Milk-related Symptom Score (CoMiSS) has been developed to raise the awareness of CMPA among the primary health-care providers. In this study, we aimed to evaluate the validity of CoMiSS as a diagnostic approach of CMPA in infants in our country. METHODS Infants with a CoMiSS of more than 12 points were included. An elimination diet was implemented in these infants for 4 weeks, and CoMiSS was reapplied. Infants with a reduction of ≥3 points in CoMiSS were considered responsive to the elimination diet, and an open oral challenge test was performed. Infants with symptom recurrence were diagnosed with CMPA. RESULTS The study included 168 infants. When they were included in the study, the first CoMiSS score was 13.6 ± 1.9. After the elimination diet, the number of responsive infants was 154 (91.7%). Of the infants, 91 (54.2%) were diagnosed with CMPA with positive challenge. The majority of the patients diagnosed with CMPA presented with gastrointestinal and/or dermatological symptoms (80.3%). Positive family history of allergy was more prevalent in CMPA(+) infants (P < 0.001). The mean atopic dermatitis score was higher in CMPA(+) infants (P = 0.001). Eosinophilia and cows milk-specific IgE (CM-sIgE) positivity were more prevalent in infants with CMPA (P = 0.01 and P < 0.001, respectively). CONCLUSIONS CoMiSS is a valuable tool to evaluate CMPA in primary care. The presence of multiple symptoms, especially skin involvement, helps to recognise infants with CMPA. Family history and eosinophilia also support the diagnosis of CMPA.
Collapse
Affiliation(s)
- Suna Kaymak Selbuz
- Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University, Ankara, Turkey
| | - Cansu Altuntaş
- Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University, Ankara, Turkey
| | - Aydan Kansu
- Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University, Ankara, Turkey
| | | | - Zarife Kuloğlu
- Pediatric Gastroenterology, Hepatology, and Nutrition, Ankara University, Ankara, Turkey
| | | | - Neslihan Doğulu
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatih Günay
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Seda Topçu
- Division of Social Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Betül Ulukol
- Division of Social Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
10
|
|
11
|
Abstract
Food allergy is an important public health problem that affects children and adults, and it has been increasing in prevalence in the last 2 to 3 decades. The symptoms can vary from mild to severe, and in extreme cases food allergy can lead to anaphylaxis, which is a life-threatening allergic reaction. Currently, there is no cure for food allergy. Management of food allergy includes allergen avoidance or emergency treatment. The eight most common food allergens are eggs, milk, peanuts, tree nuts, soy, wheat, crustacean shellfish, and fish, all of which are frequently consumed in the US. Thus, patients and their families must remain constantly vigilant, which can often be stressful. Moreover, nonallergic food reactions, such as food intolerance, are commonly mistaken as food allergies. This article highlights risk factors, natural history, diagnosis, and management of food allergy. [Pediatr Ann. 2020;49(1):e50-e58.].
Collapse
|
12
|
A Comprehensive Review on Mustard-Induced Allergy and Implications for Human Health. Clin Rev Allergy Immunol 2019; 57:39-54. [PMID: 29159565 DOI: 10.1007/s12016-017-8651-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mustard is widely used in a variety of foods/food products to enhance the flavor and nutritional value that subsequently raise the risk of hypersensitivity reactions. Mustard allergy has been reported for many years and is increasing gradually especially in the areas where its consumption is comparatively higher, and it may be considered among the most important food allergies. A number of relevant clinical studies focused on mustard-induced allergic manifestations are summarized in the current review. In addition, the knowledge regarding the immunological as well as biochemical characteristics of mustard allergens that have been known till date and their cross-reactivity with other food allergens have also been discussed here. Notably, mustard may also be present as a hidden allergen in foods; therefore, it is important to recognize food products that may contain mustard as it may pose potential risk for the allergic individuals. Additionally, the better understanding of the underlying mechanism in mustard allergy is a prerequisite for the development of specific therapeutic procedures. Conclusively, mustard sensitivity should be routinely tested in patients with idiopathic anaphylaxis for the safety of the allergic patients.
Collapse
|
13
|
Bascuñán KA, Roncoroni L, Branchi F, Doneda L, Scricciolo A, Ferretti F, Araya M, Elli L. The 5 Ws of a gluten challenge for gluten-related disorders. Nutr Rev 2019; 76:79-87. [PMID: 29325090 DOI: 10.1093/nutrit/nux068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Gluten-related disorders (GRDs) are gradually emerging as epidemiologically relevant diseases, with a global prevalence estimated to be approximately 5% in the population. Conditions related to gluten ingestion include celiac disease (CD), wheat allergy (WA), and nonceliac gluten sensitivity (NCGS). Although mediated by different pathogenic pathways, these 3 conditions share similar clinical manifestations and can present a difficult differential diagnosis. The gluten challenge (GC) is an important diagnostic tool for GRDs, but there is great variability in regards to deciding which patients should be challenged, what amount of gluten should be used, what the GC duration should be, when and where the GC should occur, and, sometimes, why to conduct a GC. This review summarizes the current knowledge about the desirable characteristics of GCs in the 3 main GRDs following a 5 Ws approach-that is, the 5 main journalistic questions: who, what, when, where, why. The answers will help to determine the correct use of the GC in diagnosing GRDs.
Collapse
Affiliation(s)
- Karla A Bascuñán
- Department of Nutrition, School of Medicine, University of Chile, Santiago, Chile
| | - Leda Roncoroni
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Federica Branchi
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Luisa Doneda
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Alice Scricciolo
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Francesca Ferretti
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Magdalena Araya
- Institute of Nutrition and Food Technology, INTA, University of Chile, Santiago, Chile
| | - Luca Elli
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
14
|
Ridd MJ, Edwards L, Santer M, Chalmers JR, Waddell L, Marriage D, Muller I, Roberts K, Garfield K, Coast J, Selman L, Clement C, Shaw ARG, Angier E, Blair PS, Turner NL, Taylor J, Kai J, Boyle RJ. TEST (Trial of Eczema allergy Screening Tests): protocol for feasibility randomised controlled trial of allergy tests in children with eczema, including economic scoping and nested qualitative study. BMJ Open 2019; 9:e028428. [PMID: 31076476 PMCID: PMC6527983 DOI: 10.1136/bmjopen-2018-028428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Early onset eczema is associated with food allergy, and allergic reactions to foods can cause acute exacerbations of eczema. Parents often pursue dietary restrictions as a way of managing eczema and seek allergy testing for their children to guide dietary management. However, it is unclear whether test-guided dietary management improves eczema symptoms, and whether the practice causes harm through reduced use of conventional eczema treatment or unnecessary dietary restrictions. The aim of the Trial of Eczema allergy Screening Tests Study is to determine the feasibility of conducting a trial comparing food allergy testing and dietary advice versus usual care, for the management of eczema in children. METHODS AND ANALYSIS Design: A single centre, two-group, individually randomised, feasibility randomised controlled trial (RCT) with economic scoping and a nested qualitative study. SETTING General Practioner (GP) surgeries in the west of England. PARTICIPANTS children aged over 3 months and less than 5 years with mild to severe eczema. INTERVENTIONS allergy testing (structured allergy history and skin prick tests) or usual care. Sample size and outcome measures: we aim to recruit 80 participants and follow them up using 4-weekly questionnaires for 24 weeks. Nested qualitative study: We will conduct ~20 interviews with parents of participating children, 5-8 interviews with parents who decline or withdraw from the trial and ~10 interviews with participating GPs. Economic scoping: We will gather data on key costs and outcomes to assess the feasibility of carrying out a cost-effectiveness analysis in a future definitive trial. ETHICS AND DISSEMINATION The study has been reviewed by the Health Research Authority and given a favourable opinion by the NHS REC (West Midlands - South Birmingham Research Ethics Committee, Reference Number 18/WM/0124). Findings will be submitted for presentation at conferences and written up for publication in peer-reviewed journals, which may include mixed-method triangulation and integration of the quantitative and qualitative findings. TRIAL REGISTRATION ISRCTN15397185; Pre-results.
Collapse
Affiliation(s)
| | - Louisa Edwards
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Joanne R Chalmers
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | | | | | - Ingrid Muller
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Kirsty Garfield
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics at Bristol, University of Bristol, Bristol, UK
| | - Lucy Selman
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | | | - Elizabeth Angier
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | | | - Jodi Taylor
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Joe Kai
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
15
|
Walter A, Seegräber M, Wollenberg A. Food-Related Contact Dermatitis, Contact Urticaria, and Atopy Patch Test with Food. Clin Rev Allergy Immunol 2018; 56:19-31. [DOI: 10.1007/s12016-018-8687-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
16
|
Abstract
In the last decade, the ingestion of gluten, a heterogeneous complex of proteins present in wheat, rice, barley and probably in oats, has been associated with clinical disorders, such as celiac disease, wheat allergy and recently to non-celiac gluten sensitivity or wheat intolerance syndrome. Gluten-related disorders, which are becoming epidemiologically relevant with an estimated global prevalence of about 5%, require the exclusion of gluten from the diet. For the past 5 years, an important shift in the availability of gluten-free products, together with increased consumption in the general population, has been recorded and is estimated to be about 12-25%. Many people follow a self-prescribed gluten-free diet, despite the fact that the majority have not first been previously excluded, or confirmed, as having gluten disorders. They rely on claims that a gluten-free diet improves general health. In this review, we provide an overview of the clinical disorders related to gluten or wheat ingestion, pointing out the current certainties, open questions, possible answers and several doubts in the management of these conditions. KEY MESSAGE Incidence of gluten-related disorders is increased in the last decade and self-diagnosis is frequent with inappropriate starting of a gluten-free diet. Gluten and wheat are considered as the most important triggers to coeliac disease, wheat allergy and non-celiac gluten sensitivity. Pediatricians, allergologist and gastroenterologist are involved in the management of these conditions and appropriate diagnostic protocols are required.
Collapse
Affiliation(s)
- Simona Valenti
- a Pediatrics Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
| | - Domenico Corica
- a Pediatrics Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
| | - Luisa Ricciardi
- b Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Claudio Romano
- a Pediatrics Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi" , University of Messina , Messina , Italy
| |
Collapse
|
17
|
Park HY, Yoon TJ, Kim HH, Han YS, Choi HD. Changes in the antigenicity and allergenicity of ovalbumin in chicken egg white by N-acetylglucosaminidase. Food Chem 2017; 217:342-345. [DOI: 10.1016/j.foodchem.2016.08.112] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 07/04/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
|
18
|
|
19
|
Gray CL, Levin ME, du Toit G. Egg sensitization, allergy and component patterns in African children with atopic dermatitis. Pediatr Allergy Immunol 2016; 27:709-715. [PMID: 27434263 DOI: 10.1111/pai.12615] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Egg allergy is the most common food allergy in children with atopic dermatitis (AD). This study aimed to determine the prevalence of egg allergy, component patterns and predictive values of screening tests in egg allergy in South African children with AD. METHODOLOGY This was a prospective, observational study in a paediatric university hospital in Cape Town. Children with AD, aged 6 months to 10 years, were recruited randomly. They were assessed for sensitization and allergy to egg by questionnaire, skin prick tests (SPT), Immuno Solid Phase Allergen Chip (ISAC 103® ) test, ImmunoCAP component tests to egg and ovomucoid (Gal d 1) and incremental food challenges. RESULTS Hundred participants (59 Black Africans and 41 of mixed ethnicity) were enrolled, median age 42 months. There was a high rate of egg sensitization of 54% and prevalence of confirmed egg allergy of 25%. History and screening laboratory tests overestimated egg allergy significantly. SPT to fresh egg white was significantly more sensitive in diagnosing egg allergy than SPT to the commercial egg white extract and produced the highest area under the receiver operator characteristics curve of all the screening tests in predicting true egg allergy. In those participants sensitized to egg, the component ovomucoid was best at differentiating true egg allergy from tolerance. Commonly used 95% positive predictive values (PPVs) for SPT to egg and ImmunoCAP egg white produced low PPV of 57% and 74%, respectively, in this population overall, with generally poorer predictive values amongst the Black Africans than the mixed ethnicity participants. A SPT to fresh egg of 17 mm and ImmunoCAP egg white of 13 kU/l produced the best PPV for egg allergy in this population. CONCLUSION The prevalence of egg allergy is high in African children with AD, but history of egg allergy and sensitization to egg significantly overestimate the true egg allergy rate. SPT to fresh egg white was more sensitive than that to commercial egg white extract; hence, fresh egg white should be recommended in an egg allergy screening panel. The component ovomucoid was useful for differentiating allergy from tolerance in egg-sensitized participants. Population-specific 95% PPV for egg allergy tests may need to be established in developing world populations.
Collapse
Affiliation(s)
- Claudia L Gray
- Division of Allergology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. .,Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
| | - Michael E Levin
- Division of Allergology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - George du Toit
- King's Health Partners, MRM & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.,Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
20
|
Čelakovská J, Ettlerová K, Ettler K, Vaněčková J, Bukač J. The Effect of Wheat Allergy on the Course of Atopic Eczema in Patients over 14 Years of Age. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016. [DOI: 10.14712/18059694.2016.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Few studies concerning the importance of wheat allergy affecting the course of atopic eczema in adolescents and adult patients exist. Aim: The evaluation if wheat allergy can deteriorate the course of atopic eczema. Follow-up of patients with confirmed food allergy to wheat. Method: Altogether 179 persons suffering from atopic eczema were included in the study: 51 men and 128 women entered the study with an average age of 26.2 (s.d. 9.5 years) Dermatological and allergological examinations were performed, including skin prick tests, atopy patch tests, and specific serum IgE for wheat, open exposure test and double-blind, placebo-controlled food challenge test with wheat flour. Results: Wheat allergy affecting the coures of atopic eczema was confirmed in eight patients (4.5%) out of 179 patients enrolled in this study by double-blind, placebo controlled food challenge test. The course of atopic eczema showed a positive trend in patients with confirmed food allergy at 3, 6, 9, 12 month follow-up (statistical evaluation with paired t-test) after the elimination of wheat flour. Conclusion: Wheat allergy may play an important role in the worsening of atopic eczema (acting as a triggering exacerbating factor) only in a minority of adolescents and adult patients (4.5% in our study). The diagnostic methods (skin prick test, specific IgE, atopy patch test, history) cannot be used as separated tests for the determination of food allergy to wheat in patients with atopic eczema.Open exposure tests and double-blind, placebo-controlled food challenge should be used for the confirmation of wheat allergy affecting the course of atopic eczema.
Collapse
|
21
|
Wu JJ, Cao CM, Meng TT, Zhang Y, Xu SL, Feng SB, Li Y, Wang XC. Induction of immune responses and allergic reactions in piglets by injecting glycinin. ITALIAN JOURNAL OF ANIMAL SCIENCE 2016. [DOI: 10.1080/1828051x.2016.1144488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
22
|
Roerdink EM, Flokstra-de Blok BMJ, Blok JL, Schuttelaar MLA, Niggemann B, Werfel T, Van der Heide S, Kukler J, Kollen BJ, Dubois AE. Association of food allergy and atopic dermatitis exacerbations. Ann Allergy Asthma Immunol 2016; 116:334-8. [PMID: 26947239 DOI: 10.1016/j.anai.2016.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/26/2016] [Accepted: 01/28/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) and food allergy frequently coexist in children. OBJECTIVE To examine the association between food allergy and AD. METHODS Between 2001 and 2011, children referred to our tertiary care center underwent double-blind, placebo-controlled food challenges (DBPCFCs) for one or more suspected food allergies as part of regular care. Immediate reactions were observed and recorded by allergy nursing staff, whereas late reactions were ascertained by semistructured telephone interview 48 hours after challenge. To test to which degree specific IgE results were predictive in the outcome of DBPCFCs in children with and without (previous and current) AD, logistic regression analysis was performed. RESULTS A total of 1186 DBPCFCs were studied. Sensitization to foods occurred significantly more often in children with previous AD. The association between specific IgE results and the outcome of DBPCFCs was significant for children with and without (previous and current) AD but stronger for children without current AD. The positivity rate of DBPCFCs in children with mild, moderate, and severe AD was 53.3%, 51.7%, and 100%, respectively. Children with AD and a history of worsening AD as their only symptom reacted as often to placebo as to challenge food. CONCLUSION Children with current AD are more frequently asymptomatically sensitized to the foods in question than those without AD. In addition, children suspected of food allergy should be considered for testing, regardless of the severity of their AD. Our results suggest that children with exacerbation of AD in the absence of other allergic symptoms are unlikely to be food allergic.
Collapse
Affiliation(s)
- Emmy M Roerdink
- Department of Pediatric Pulmonology and Allergy, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands.
| | - Bertine M J Flokstra-de Blok
- Department of General Practice, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
| | - Janine L Blok
- Department of Dermatology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marie-Louise A Schuttelaar
- Department of Dermatology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Bodo Niggemann
- Department of Pediatric Pneumology and Immunology, University Hospital Charité, Berlin, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Sicco Van der Heide
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
| | - Jeanet Kukler
- Department of Pediatric Pulmonology and Allergy, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
| | - Boudewijn J Kollen
- Department of General Practice, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
| | - Anthony E Dubois
- Department of Pediatric Pulmonology and Allergy, University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, the Netherlands
| |
Collapse
|
23
|
Galli E, Neri I, Ricci G, Baldo E, Barone M, Belloni Fortina A, Bernardini R, Berti I, Caffarelli C, Calamelli E, Capra L, Carello R, Cipriani F, Comberiati P, Diociaiuti A, El Hachem M, Fontana E, Gruber M, Haddock E, Maiello N, Meglio P, Patrizi A, Peroni D, Scarponi D, Wielander I, Eichenfield LF. Consensus Conference on Clinical Management of pediatric Atopic Dermatitis. Ital J Pediatr 2016; 42:26. [PMID: 26936273 PMCID: PMC4776387 DOI: 10.1186/s13052-016-0229-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/14/2016] [Indexed: 01/01/2023] Open
Abstract
The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.
Collapse
Affiliation(s)
- Elena Galli
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
| | - Iria Neri
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Giampaolo Ricci
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Ermanno Baldo
- Pediatric Department, "S. Maria del Carmine" Hospital of Rovereto, APSS (Provincial Agency for Health Services), Trento, Italy.
| | | | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
| | | | - Irene Berti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
| | - Carlo Caffarelli
- Pediatric Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
| | - Elisabetta Calamelli
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Lucetta Capra
- Department of Medical Sciences, Section of Paediatrics, University of Ferrara, Ferrara, Italy.
| | - Rossella Carello
- Pediatric Allergy Unit, Research Center, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
| | - Francesca Cipriani
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | | | - Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Fontana
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.
| | - Michaela Gruber
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy.
| | - Ellen Haddock
- Departments of Pediatrics and Dermatology, School of Medicine, University of California, San Diego, CA, USA.
| | - Nunzia Maiello
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
| | - Paolo Meglio
- Primary Care Pediatrician, Health National Service, Rome, Italy.
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Diego Peroni
- Department of Medical Sciences, Section of Paediatrics, University of Ferrara, Ferrara, Italy.
| | - Dorella Scarponi
- Pediatric Unit - Department of Medical and Surgical Sciences, S. Orsola Malpighi Hospital, University of Bologna, Pad. 16, Via Massarenti, 11 - 40138, Bologna, Italy.
| | - Ingrid Wielander
- Department of Pediatrics, Central Hospital of Bolzano, Bolzano, Italy.
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Dermatology, School of Medicine, University of California, San Diego, CA, USA.
| |
Collapse
|
24
|
Abstract
Triticum aestivum (bread wheat) is the most widely grown crop worldwide. In genetically predisposed individuals, wheat can cause specific immune responses. A food allergy to wheat is characterized by T helper type 2 activation which can result in immunoglobulin E (IgE) and non-IgE mediated reactions. IgE mediated reactions are immediate, are characterized by the presence of wheat-specific IgE antibodies, and can be life-threatening. Non-IgE mediated reactions are characterized by chronic eosinophilic and lymphocytic infiltration of the gastrointestinal tract. IgE mediated responses to wheat can be related to wheat ingestion (food allergy) or wheat inhalation (respiratory allergy). A food allergy to wheat is more common in children and can be associated with a severe reaction such as anaphylaxis and wheat-dependent, exercise-induced anaphylaxis. An inhalation induced IgE mediated wheat allergy can cause baker’s asthma or rhinitis, which are common occupational diseases in workers who have significant repetitive exposure to wheat flour, such as bakers. Non-IgE mediated food allergy reactions to wheat are mainly eosinophilic esophagitis (EoE) or eosinophilic gastritis (EG), which are both characterized by chronic eosinophilic inflammation. EG is a systemic disease, and is associated with severe inflammation that requires oral steroids to resolve. EoE is a less severe disease, which can lead to complications in feeding intolerance and fibrosis. In both EoE and EG, wheat allergy diagnosis is based on both an elimination diet preceded by a tissue biopsy obtained by esophagogastroduodenoscopy in order to show the effectiveness of the diet. Diagnosis of IgE mediated wheat allergy is based on the medical history, the detection of specific IgE to wheat, and oral food challenges. Currently, the main treatment of a wheat allergy is based on avoidance of wheat altogether. However, in the near future immunotherapy may represent a valid way to treat IgE mediated reactions to wheat.
Collapse
Affiliation(s)
- Antonella Cianferoni
- Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, PA, USA
| |
Collapse
|
25
|
Abstract
Food allergy in atopic dermatitis (AD) is debatable from decades. Role of diet in the cause and treatment of AD is controversial and is not well-defined. Allergists and pediatricians are convinced about the food allergy in AD whereas many dermatologists are contrary for this. However, there are studies in the Indian and western literature supporting the evidence that elimination diet may improve the severe type of AD. There is increasing awareness and lot of misconception among caregivers about food allergy and hence careful understanding about this concept is necessary to counsel parents. Recent evidence-based literature suggests avoidance of proven food allergens in AD could be beneficial in moderate to severe type of AD.
Collapse
Affiliation(s)
- Sandipan Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, West Bengal, India
| | - Sahana M Srinivas
- Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| |
Collapse
|
26
|
Beyer K, Niggemann B. Nahrungsmittelprovokationen. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
27
|
Spergel JM, Boguniewicz M, Schneider L, Hanifin JM, Paller AS, Eichenfield LF. Food Allergy in Infants With Atopic Dermatitis: Limitations of Food-Specific IgE Measurements. Pediatrics 2015; 136:e1530-8. [PMID: 26598458 DOI: 10.1542/peds.2015-1444] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with atopic dermatitis (AD) have a higher risk for development of food allergies. The objective of this study was to examine incidence of food allergy development in infants with AD and the predictive value of food-antigen-specific immunoglobulin E measurements. METHODS This trial examined the long-term safety and efficacy of pimecrolimus cream 1% in >1000 infants (3-18 months) with mild-to-severe AD without a history of food allergy. Food allergy development was followed throughout a 36-month randomized double-blind phase followed by an open-label (OL) phase up to 33 months. Additionally, sIgE for cow's milk, egg white, peanut, wheat, seafood mix, and soybean was measured by ImmunoCAP at baseline, end of the double-blind phase, and end of OL phase. RESULTS By the end of the OL phase, 15.9% of infants with AD developed at least 1 food allergy; allergy to peanut was most common (6.6%), followed by cow's milk (4.3%) and egg white (3.9%). Seafood, soybean, and wheat allergies were rare. Levels of sIgE for milk, egg, and peanut increased with severity of AD, as determined by Investigator's Global Assessment score. We assigned sIgE decision points for the 6 foods and tested their ability to predict definite food allergy in this population. Positive predictive values for published and newly developed sIgE decision points were low (<0.6 for all values tested). CONCLUSIONS In a large cohort of infants at risk for development of food allergy, sIgE levels were not clinically useful for predicting food allergy development.
Collapse
Affiliation(s)
- Jonathan M Spergel
- The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Mark Boguniewicz
- National Jewish Health and University of Colorado School of Medicine, Denver, Colorado
| | - Lynda Schneider
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jon M Hanifin
- Oregon Health and Science University, Portland, Oregon
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Lawrence F Eichenfield
- Rady Children's Hospital, San Diego, University of California San Diego, San Diego, California
| |
Collapse
|
28
|
Boženský J, Hill M, Zelenka R, Skýba T. Prebiotics Do Not Influence the Severity of Atopic Dermatitis in Infants: A Randomised Controlled Trial. PLoS One 2015; 10:e0142897. [PMID: 26571488 PMCID: PMC4646669 DOI: 10.1371/journal.pone.0142897] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/26/2015] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED The objective was to evaluate the effects of a hypoallergenic (HA) formula supplemented with prebiotic galacto-oligosaccharides on the severity of atopic manifestations. A randomised clinical trial was conducted. The control group was infants, fed with hypoallergenic formula and without supplementation. The duration of the study was six months. The primary outcome of the study was a difference in the severity of atopic dermatitis measured using SCORAD (Scoring Atopic Dermatitis) criteria. Secondary outcomes were anthropometry (length, weight, and head circumference), together with the tolerance and incidence of infections. Both groups showed a decrease of average SCORAD values, but no statistically significant difference between the evaluated groups was observed. There were no statistically significant differences in anthropometry, or the tolerance or incidence of infections. Although there is no evidence, that consumption of a hypoallergenic infant formula enriched with prebiotic galacto-oligosaccharides had any effect on SCORAD, it was safe and well tolerated. TRIAL REGISTRATION www.clinicaltrials.gov NCT 02077088.
Collapse
Affiliation(s)
- Jan Boženský
- Paediatrics Department, Vitkovice Hospital, Ostrava, Czech Republic
| | - Martin Hill
- Institute of Endocrinology, Prague, Czech Republic
| | | | - Tomáš Skýba
- Paediatrics Department, Vitkovice Hospital, Ostrava, Czech Republic
| |
Collapse
|
29
|
Affiliation(s)
- Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| |
Collapse
|
30
|
Abstract
Since 1943, cases of sensitization or allergy to soy-based formulas (SBFs) have been described without any consensus on their real prevalence. We identified the adjusted prevalence of IgE-mediated soy allergies in children and performed a secondary analysis of the impact of age (less than and more than 6 months). We performed a systematic review with meta-analysis of studies published from 1909 to 2013 in PubMed, Embase, LILACS, ARTEMISA, Cochrane, Bandolier, DARE and the GRADE system for grading quality. Results are presented in tables and graphs using a forest plot. The 40 studies identified established weighted prevalence of soy allergies of 0 to 0.5 % (0.27) for the general population, 0.4 to 3.1 % (1.9) for the referred population, and 0 to 12.9 % (2.7) for allergic children. Prevalence of sensitization after the use of SBFs is 8.7 and 8.8 %, depending on the method used. The prevalence of allergies to soy and IgE sensitization to the use of SBFs is less than reported. Not enough evidence exists to show a higher risk of allergy in infants younger than 6 months. The concern about soy allergy is no reason to postpone the use of SBFs in IgE-mediated cow's milk allergy infants until the age of 6 months.
Collapse
|
31
|
Christensen MJ, Eller E, Mortz CG, Bindslev-Jensen C. Patterns of suspected wheat-related allergy: a retrospective single-centre case note review in 156 patients. Clin Transl Allergy 2014; 4:39. [PMID: 25905008 PMCID: PMC4405838 DOI: 10.1186/2045-7022-4-39] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/06/2014] [Indexed: 12/25/2022] Open
Abstract
Background Allergy to wheat can present clinically in different forms: Sensitization to ingested wheat via the gastrointestinal tract can cause traditional food allergy or in combination with exercise, Wheat-Dependent Exercise-Induced Anaphylaxis (WDEIA). Sensitization to inhaled wheat flour may lead to occupational rhinitis and/or asthma. Methods We retrospectively reviewed the case notes of 156 patients (age 0.7 – 73.3 years) with a case history of wheat allergy. The population was divided into three groups, 1: Wheat allergy elicited by ingestion, 2: By inhalation and 3: WDEIA. All patients were examined with detailed case history, specific IgE (sIgE), Skin Prick Test (SPT) and wheat challenge (nasal or oral ± exercise). Details of the case history were extracted from the patients´ case records. Results Group 1: Twenty one of 95 patients were challenge positive (15 children, 6 adults). All children had atopic dermatitis, and most (13/15) outgrew their wheat allergy. Most children (13/15) had other food allergies. Challenge positive patients showed significantly higher levels of sIgE to wheat and significantly more were SPT positive than challenge negative. Group 2: Eleven out of 13 adults with occupational asthma or rhinitis were challenge positive. None outgrew their allergy. Seven had positive sIgE and 10 had positive SPT to wheat. Group 3: Ten of 48 (adolescent/adults) were positive when challenged during exercise. Challenge positive patients showed significantly higher levels of sIgE to ω-5-gliadin. The natural course is presently unknown. Conclusion Wheat allergy can manifest in different disease entities, rendering a detailed case history and challenge mandatory. Patient age, occupation, concomitant allergies (food or inhalant) and atopic dermatitis are important factors for evaluation.
Collapse
Affiliation(s)
- Morten J Christensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
| | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense C, 5000 Odense, Denmark
| |
Collapse
|
32
|
Scientific Opinion on the evaluation of allergenic foods and food ingredients for labelling purposes. EFSA J 2014. [DOI: 10.2903/j.efsa.2014.3894] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
33
|
Nahrungsmittelallergie und atopische Dermatitis. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
34
|
Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 520] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
Collapse
|
35
|
Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, Cardona V, Dubois A, duToit G, Eigenmann P, Fernandez Rivas M, Halken S, Hickstein L, Høst A, Knol E, Lack G, Marchisotto MJ, Niggemann B, Nwaru BI, Papadopoulos NG, Poulsen LK, Santos AF, Skypala I, Schoepfer A, Van Ree R, Venter C, Worm M, Vlieg-Boerstra B, Panesar S, de Silva D, Soares-Weiser K, Sheikh A, Ballmer-Weber BK, Nilsson C, de Jong NW, Akdis CA. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69:1008-25. [PMID: 24909706 DOI: 10.1111/all.12429] [Citation(s) in RCA: 782] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2014] [Indexed: 12/11/2022]
Abstract
Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.
Collapse
|
36
|
Passeti SRM, Fonseca FLA, Wandalsen NF. Response of Specific Immunoglobulin E to Foods in Children with Atopic Dermatitis. Arch Immunol Ther Exp (Warsz) 2014; 62:405-10. [DOI: 10.1007/s00005-014-0288-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/06/2013] [Indexed: 11/28/2022]
|
37
|
Lin YT, Wu CT, Huang JL, Cheng JH, Yeh KW. Correlation of ovalbumin of egg white components with allergic diseases in children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:112-8. [PMID: 24662019 DOI: 10.1016/j.jmii.2014.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 09/10/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Immunoglobulin E (IgE)-mediated food allergy, such as egg white allergy, is common in young children (<3 years old), but not all young children sensitive to egg white present with allergic symptoms. This study investigated the relationship between sensitization to egg white component allergens and clinical manifestations of allergic diseases in young children. METHODS From March to December 2010, 2256 children with physician-diagnosed allergic diseases were tested for serum levels of egg white, ovalbumin, and ovomucoid-specific IgE in the Pediatric Allergy and Asthma Center of Chang Gung Memorial Hospital. Serum was analyzed for specific IgE antibodies to egg white, ovalbumin, and ovomucoid by ImmunoCAP (Phadia, Uppsala, Sweden). Allergen-specific IgE levels ≥0.35 kUA/L were defined as positive. RESULTS There was a significantly higher sensitization rate to egg white and its components in children aged 2-4 years old. The sensitization rate to egg white, ovalbumin, and ovomucoid in this age group was 53.5%, 48.3%, and 37.2%, respectively, and the trend of the sensitization decreased with age (p < 0.001). After adjusting for age, sensitization to egg white and ovalbumin was associated with children with dermatitis [egg white: odds ratio (OR) = 1.28, 95% confidence intervals (CI) = 1.03-1.58, p < 0.05; ovalbumin: OR = 1.30, 95% CI = 1.04-1.62, p < 0.05]. Children with ovomucoid sensitization had no statistically significant risk among different groups in the current study. CONCLUSION Children aged 2-4 years old have higher sensitivity to egg white, ovalbumin, and ovomucoid. Children with egg white and ovalbumin sensitization have a higher risk for atopic dermatitis, and ovalbumin has a more important contribution. Furthermore, we suggested that in children with atopic dermatitis, if they are aged 2-4 years old and are having egg white and ovalbumin sensitization, avoiding eating raw or slightly heated eggs might have a beneficial effect.
Collapse
Affiliation(s)
- Yang-Te Lin
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Te Wu
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, Taoyuan, Taiwan
| | - Jing-Long Huang
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, Taoyuan, Taiwan
| | - Ju-Hui Cheng
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkuo, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
38
|
Forsey RGP. Prevalence of childhood eczema and food sensitization in the First Nations reserve of Natuashish, Labrador, Canada. BMC Pediatr 2014; 14:76. [PMID: 24649812 PMCID: PMC3994483 DOI: 10.1186/1471-2431-14-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background The Mushua Innu of Natuashish, Labrador, Canada seem to have a high rate of childhood eczema. Anecdotally this problem seems to be more common now than 20 years ago. There has been speculation that this could be related to food sensitization that may have arisen coincident with a move away from a traditional Innu diet. We undertook to assess the prevalence and severity of pediatric eczema in Natuashish (population 792), and investigate the level of sensitization to common food antigens. Methods Over a three-month period we performed a population survey of all children in the community from the ages of 2–12 inclusive. The one-year prevalence of eczema was assessed using the United Kingdom Working Party’s diagnostic criteria, and graded on the Nottingham Severity Scale. All children with eczema and twice as many age/sex matched controls were offered complete blood counts, total IgE, and food specific IgE levels for egg white, cow’s milk protein and wheat. Results One hundred and eighty two (95% of the eligible children) were assessed. Of the 182 children examined eczema was diagnosed in 30 (16.5%) - 22 females and 8 males. The majority of children with eczema (20/30) were classified as being in the moderate and severe category. Of the 22 with eczema and 40 controls who consented to venipuncture all but 3 had IgE levels above the lab's reference range. Food specific antibody assays showed that 32, 23, and 5 percent of children with eczema were sensitized to egg, milk, and wheat respectively. None of the controls were sensitized. Conclusions The children of Natuashish, Labrador have a high rate of eczema, much of it graded as moderate or severe. IgE levels were markedly elevated in children with and without eczema, with average values at least ten-fold higher than other populations. There is no evidence of an unusual amount of sensitization to egg, milk or wheat.
Collapse
Affiliation(s)
- Robert G P Forsey
- Discipline of Family Medicine, Memorial University of Newfoundland, Labrador-Grenfell Health, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.
| |
Collapse
|
39
|
Soares-Weiser K, Takwoingi Y, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Halken S, Poulsen L, van Ree R, Vlieg-Boerstra BJ, Sheikh A. The diagnosis of food allergy: a systematic review and meta-analysis. Allergy 2014; 69:76-86. [PMID: 24329961 DOI: 10.1111/all.12333] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND We investigated the accuracy of tests used to diagnose food allergy. METHODS Skin prick tests (SPT), specific-IgE (sIgE), component-resolved diagnosis and the atopy patch test (APT) were compared with the reference standard of double-blind placebo-controlled food challenge. Seven databases were searched and international experts were contacted. Two reviewers independently identified studies, extracted data, and used QUADAS-2 to assess risk of bias. Where possible, meta-analysis was undertaken. RESULTS Twenty-four (2831 participants) studies were included. For cows' milk allergy, the pooled sensitivities were 53% (95% CI 33-72), 88% (95 % CI 76-94), and 87% (95% CI 75-94), and specificities were 88% (95% CI 76-95), 68% (95% CI 56-77), and 48% (95% CI 36-59) for APT, SPT, and sIgE, respectively. For egg, pooled sensitivities were 92% (95% CI 80-97) and 93% (95% CI 82-98), and specificities were 58% (95% CI 49-67) and 49% (40-58%) for skin prick tests and specific-IgE. For wheat, pooled sensitivities were 73% (95% CI 56-85) and 83% (95% CI 69-92), and specificities were 73% (95% CI 48-89) and 43% (95% CI 20-69%) for SPT and sIgE. For soy, pooled sensitivities were 55% (95% CI 33-75) and 83% (95% CI 64-93), and specificities were 68% (95% CI 52-80) and 38% (95% CI 24-54) for SPT and sIgE. For peanut, pooled sensitivities were 95% (95% CI 88-98) and 96% (95% CI 92-98), and specificities were 61% (95% CI 47-74), and 59% (95% CI 45-72) for SPT and sIgE. CONCLUSIONS The evidence base is limited and weak and is therefore difficult to interpret. Overall, SPT and sIgE appear sensitive although not specific for diagnosing IgE-mediated food allergy.
Collapse
Affiliation(s)
| | - Y. Takwoingi
- Public Health Epidemiology and Biostatistics; School of Health and Population Sciences; University of Birmingham; Birmingham UK
| | - S. S. Panesar
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
| | - A. Muraro
- Department of Pediatrics; Center for Food Allergy Diagnosis and Treatment, Veneto Region; University of Padua; Padua Italy
| | - T. Werfel
- Department of Dermatology and Allergy; Hannover Medical School; Hannover Germany
| | - K. Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research; Medical University of Vienna; Vienna Austria
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Newport Isle of Wight UK
- NIHR Southampton Respiratory Biomedical Research Unit; University of Southampton and University Hospital Southampton NHS Foundation Trust; Southampton UK
- Human Development and Health Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | - S. Halken
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
| | - L. Poulsen
- Laboratory of Medical Allergology; Allergy Clinic; Copenhagen University Hospital Gentofte; Hellerup Denmark
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - B. J. Vlieg-Boerstra
- Department of Pediatric Respiratory Medicine and Allergy; Academic Medical Center; Emma Children's Hospital; Amsterdam the Netherlands
| | - A. Sheikh
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital/Harvard Medical School; Boston MA USA
| | | |
Collapse
|
40
|
Wang X, Geng F, Wu J, Kou Y, Xu S, Sun Z, Feng S, Ma L, Luo Y. Effects of β-conglycinin on growth performance, immunoglobulins and intestinal mucosal morphology in piglets. Arch Anim Nutr 2014; 68:186-95. [PMID: 24870267 DOI: 10.1080/1745039x.2014.919733] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the main causes of allergic reactions in young animals is β-conglycinin, an antigenic glycoprotein found in soya beans. Therefore, the objective of the study was to investigate the effects of a prior immunisation with β-conglycinin on growth performance, serum immunoglobulin levels and intestinal histology in piglets. Forty piglets (7 d of age) were randomly divided into four groups of ten piglets each. Piglets of Groups Im and Im+S were immunised twice by hypodermic injection with β-conglycinin at 500 μg/kg body weight (BW) at day 7 and 21 of age. At day 23, Groups Im+S and S were intramuscularly injected with 5000 μg β-conglycinin per kg BW. The piglets of Group C received a physiological saline solution by hypodermic injection. All piglets were weaned at the age of 23 d and blood samples were taken on days 7, 21 and 35. At the end of the trial, five piglets per group were slaughtered and the intestine was collected for evaluating mucosal histology. Compared to Group C, in Group S the average daily gain (ADG), feed intake and gain:feed ratio were decreased (p < 0.01), and serum levels of IgG and IgE were increased (p < 0.01). Furthermore, in this group the structure of duodenal and jejunal mucosa was severely damaged. But in Groups Im and Im+S the ADG was increased (p < 0.05), serum IgE levels were decreased (p < 0.01) and the intestinal mucosa was not damaged. The results suggest that prior immunisation with β-conglycinin can increase ADG and serum IgG levels and decrease serum IgE levels. Therefore, this method is also potentially able to protect the structural integrity of the intestinal mucosal epithelia and alleviate allergic reactions in piglets.
Collapse
Affiliation(s)
- Xichun Wang
- a College of Animal Science and Technology , Anhui Agricultural University , Hefei , P. R. China
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Čelakovská J, Ettlerová K, Ettler K, Vaněčková J, Bukač J. Evaluation of allergy to soy in patients with atopic dermatitis older than 14 years of age. FOOD AGR IMMUNOL 2013. [DOI: 10.1080/09540105.2013.864604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
42
|
Čelakovská J, Ettlerová K, Ettler K, Vaněčková J, Bukač J. Evaluation of food allergy to wheat, cow milk, egg, soy and peanuts in patients suffering from atopic dermatitis. FOOD AGR IMMUNOL 2013. [DOI: 10.1080/09540105.2013.864603] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
43
|
Abstract
Food allergy is a serious health issue affecting roughly 4% of children, with a substantial effect on quality of life. Prognosis is good for the most frequent allergens with almost all children outgrowing their allergy. However, the long-term implications for disease burden are substantial for children with persistent allergies (eg, peanuts, tree nuts, fish, and shellfish) and for those with high concentrations of milk, egg, and wheat IgE. Antigen avoidance has been the time-honoured approach both for prevention and treatment. However, findings from studies done in the past 5 years show that early contact with food can induce tolerance and desensitisation to foods. We review the epidemiology, natural history, and management of food allergy, and discuss the areas of controversy and future directions in research and clinical practice.
Collapse
Affiliation(s)
- Giorgio Longo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | | | | |
Collapse
|
44
|
Lee WY, Lee R, Kim HC, Lee KH, Noh KS, Kim HW, Kim JH, Ahn DU, Jang IS, Jang A, Lee HT, Song H. Consumption of Water-Soluble Egg Yolk Extract on Growth Rate, Changes in Blood Cholesterol Levels, and Immune Modulation in BALB/c Mice. Korean J Food Sci Anim Resour 2013. [DOI: 10.5851/kosfa.2013.33.5.587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
45
|
Monitoring immune modulation by nutrition in the general population: identifying and substantiating effects on human health. Br J Nutr 2013; 110 Suppl 2:S1-30. [PMID: 23228631 PMCID: PMC3734536 DOI: 10.1017/s0007114513001505] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Optimal functioning of the immune system is crucial to human health, and nutrition is one of the major exogenous factors modulating different aspects of immune function. Currently, no single marker is available to predict the effect of a dietary intervention on different aspects of immune function. To provide further guidance on the assessment and interpretation of the modulation of immune functions due to nutrition in the general population, International Life Sciences Institute Europe commissioned a group of experts from academia, government and the food industry to prepare a guidance document. A draft of this paper was refined at a workshop involving additional experts. First, the expert group defined criteria to evaluate the usefulness of immune function markers. Over seventy-five markers were scored within the context of three distinct immune system functions: defence against pathogens; avoidance or mitigation of allergy; control of low-grade (metabolic) inflammation. The most useful markers were subsequently classified depending on whether they by themselves signify clinical relevance and/or involvement of immune function. Next, five theoretical scenarios were drafted describing potential changes in the values of markers compared with a relevant reference range. Finally, all elements were combined, providing a framework to aid the design and interpretation of studies assessing the effects of nutrition on immune function. This stepwise approach offers a clear rationale for selecting markers for future trials and provides a framework for the interpretation of outcomes. A similar stepwise approach may also be useful to rationalise the selection and interpretation of markers for other physiological processes critical to the maintenance of health and well-being.
Collapse
|
46
|
Jarmila C, Květuše E, Karel E, Jaroslava V, Josef B. Soy allergy in patients suffering from atopic dermatitis. Indian J Dermatol 2013; 58:325. [PMID: 23919016 PMCID: PMC3726893 DOI: 10.4103/0019-5154.113938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: The evaluation of soy allergy in patients over 14 years of age suffering from atopic dermatitis. The evaluation of the correlation to the occurence of peanut and pollen allergy. Materials and Methods: Altogether 175 persons suffering from atopic dermatitis were included in the study: Specific IgE, skin prick tests, atopy patch tests to soy, history and food allergy to peanut and pollen allergy were evaluated. Results: The early allergic reaction to soy was recorded in 2.8% patients. Sensitization to soy was found in another 27.2% patients with no clinical manifestation after soy ingestion. The correlation between the positive results of examinations to soy and between the occurence of peanut and pollen allergy was confirmed in statistics. Conclusion: Almost one third of patients suffering from atopic dermatitis are sensitized to soy without clinical symptoms. The early allergic reaction to soy occur in minority of patients suffering from atopic dermatitis.
Collapse
Affiliation(s)
- Celakovská Jarmila
- Department of Dermatology and Venereology, University Hospital and Medical Faculty of Charles University, Hradec Králové, Czech Republic
| | | | | | | | | |
Collapse
|
47
|
Aguiar ALO, Maranhão CM, Spinelli LC, de Figueiredo RM, Maia JMC, Gomes RC, Maranhão HDS. Clinical and follow up assessment of children in a program directed at the use of formulas for cow's milk protein allergy. REVISTA PAULISTA DE PEDIATRIA 2013; 31:152-8. [PMID: 23828050 DOI: 10.1590/s0103-05822013000200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/15/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine clinical and follow up characteristics of children enrolled in a program to supply formulas for cow's milk allergy. METHODS descriptive study of a convenience sample composed of 214 children up to three years old, with clinical diagnosis of cow's milk allergy and/or standardized oral challenge, referred to the Program of Formulas for Cow's Milk Allergy at a Pediatric University Hospital, in Natal, Rio Grande do Norte, Brazil (2007/2009). Clinical-epidemiological data and formula indication (soy, protein hydrolysates or aminoacid formula) were assessed at the first consultation. Clinical response and nutritional evolution (Anthro-OMS2006) were observed after three months. Chi-square and paired t-test were used, being p<0.05 significant. RESULTS At the first consultation, mean age was 9.0±6.9 months. Digestive manifestations occurred in 81.8%; cutaneous ones, in 36.9% and respiratory ones in 23.8%. BMI Z-score <-2.0 standard deviations (SD) was found in 17.9% of children with isolated digestive symptoms, in 41.7% of those using cow's milk and in 8.7% of those using other formulas (p<0.01). The following formulas were used: soy in 61.2%, protein hydrolysates in 35.4% and aminoacids in 3.3%. Mean BMI Z-scores at initial consultation and after three months were, respectively: -0.24±1.47SD and 0.00±1.26SD (p=0.251), with soy formula, and -0.70±1.51SD and -0.14±1.36SD (p=0.322) with protein hydrolysates formula. CONCLUSIONS Digestive manifestations of cow's milk allergy were preponderant, and lead to greater nutritional impairment. The use of replacement formulas (isolated soy protein and protein hydrolysates) was important to maintain the nutritional status.
Collapse
Affiliation(s)
- Ana Laissa O Aguiar
- Faculdade de Medicina, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brasil
| | | | | | | | | | | | | |
Collapse
|
48
|
Mancini AJ, Paller AS, Simpson EL, Ellis CN, Eichenfield LF. Improving the patient-clinician and parent-clinician partnership in atopic dermatitis management. ACTA ACUST UNITED AC 2013; 31:S23-8. [PMID: 23021782 DOI: 10.1016/j.sder.2012.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Long-term adherence to carefully developed, individualized strategies is necessary for the optimum treatment outcomes in patients with atopic dermatitis (AD). However, the parents of children with AD frequently lack sufficient information about the disease and its treatment, hold incorrect and sometimes harmful beliefs about these issues, and too often do not follow through consistently with the treatment plan. The health care provider is the primary source of such education, so an effective provider relationship is fundamental to adherence. In addition to the provision of correct information and the correction of misinformation, clinicians must be aware of and must address barriers to adherence with AD therapy, especially parent anxiety about the safety of topical medications (corticosteroids and topical calcineurin inhibitors).
Collapse
Affiliation(s)
- Anthony J Mancini
- Northwestern University Feinberg School of Medicine, and Head, Division of Pediatric Dermatology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611-2605,, USA.
| | | | | | | | | |
Collapse
|
49
|
Eigenmann PA, Atanaskovic-Markovic M, O'B Hourihane J, Lack G, Lau S, Matricardi PM, Muraro A, Namazova Baranova L, Nieto A, Papadopoulos NG, Réthy LA, Roberts G, Rudzeviciene O, Wahn U, Wickman M, Høst A. Testing children for allergies: why, how, who and when: an updated statement of the European Academy of Allergy and Clinical Immunology (EAACI) Section on Pediatrics and the EAACI-Clemens von Pirquet Foundation. Pediatr Allergy Immunol 2013; 24:195-209. [PMID: 23506293 DOI: 10.1111/pai.12066] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 12/20/2022]
Abstract
Allergic diseases are common in childhood and can cause a significant morbidity and impaired quality-of-life of the children and their families. Adequate allergy testing is the prerequisite for optimal care, including allergen avoidance, pharmacotherapy and immunotherapy. Children with persisting or recurrent or severe symptoms suggestive for allergy should undergo an appropriate diagnostic work-up, irrespective of their age. Adequate allergy testing may also allow defining allergic trigger in common symptoms. We provide here evidence-based guidance on when and how to test for allergy in children based on common presenting symptoms suggestive of allergic diseases.
Collapse
Affiliation(s)
- P A Eigenmann
- Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol 2013. [PMID: 23195525 DOI: 10.1016/j.jaci.2012.10.017] [Citation(s) in RCA: 488] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|