Frequency of food allergy in Europe: An updated systematic review and meta-analysis

Re-evaluating treatment success in trials of peanut oral-immunotherapy: impact of different definitions on efficacy outcomes

PURPOSE OF REVIEW

Allergen immunotherapy (AIT) is increasingly popular as a treatment strategy for food allergy. Unfortunately, there is significant heterogeneity in reported outcomes, specifically in the dose-thresholds selected for evaluation and the symptoms used to define a "tolerated dose". These considerations are often investigator-driven and do not consider patient perspectives.

RECENT FINDINGS

A systematic review by the EAACI CO-FAITH taskforce recently flagged the need to better standardize and harmonize outcomes used in clinical trials of food-AIT. Using less objective symptoms to define dose-limiting symptoms can underestimate the reaction threshold determined at baseline food challenge. As a consequence, this can overestimate the efficacy of food-AIT by 15%. In this review, we perform an individual patient data (IPD) meta-analysis using data from three randomized-controlled trials and one real-world registry, to evaluate how the definition of dose "tolerance" impacts upon reported desensitization rates.

SUMMARY

This analysis provides insight into how clinical efficacy rates for food-AIT are impacted by using different dose thresholds and definitions for when a dose might be consider tolerated. Using more patient-centric outcomes may be a more useful metric to harmonize reporting of outcomes and inform clinical practice, paving the way towards reaching a consensus on outcome reporting in trials of food-AIT.

Standardizing outcomes in food allergy research: aligning clinical trials with patient priorities

PURPOSE OF REVIEW

This review explores the clinical outcomes used in immunoglobulin E (IgE)-mediated food allergy (FA) intervention studies, emphasizing unmet need for patient-centred outcomes. Standardizing outcome measurement is critical as research into FA treatments, particularly food immunotherapy, expands. Here we discuss how outcomes should reflect the multidimensional impact of FA on people's lives.

RECENT FINDINGS

Current evidence reveals a discrepancy between clinical trial outcomes and those most valued by patients and carers. While trials often prioritize changes in reactivity thresholds or immunological markers, patients and carers emphasize need in reducing severe reactions, improving quality of life, and enhancing confidence in disease management. This disparity highlights importance of harmonization efforts to guide FA research.The Core Outcome Measures for Food Allergy (COMFA) initiative recently identified two core outcomes - 'allergic symptoms' and 'quality of life' - through an international consensus process involving patients, caregivers, clinicians, and researchers. Outcomes like 'desensitization' and 'remission/sustained unresponsiveness' were considered important but were not seen as the most critical.

SUMMARY

Developing and implementing a COS for FA intervention studies is essential to align research with patient priorities, ensuring meaningful improvements in routine clinical care. Standardized outcome measurement will generate robust evidence, inform clinical practice, and empower patients and caregivers in decision-making about FA management.

Use of the DEFASE score in research trials

PURPOSE OF REVIEW

To explore the potential applicability in clinical trials of the groundbreaking international consensus named DEFASE (DEfinition of Food Allergy SEverity) as the unique grading system for IgE-mediated food allergy (FA) severity embracing the different aspects of the disease in a holistic approach. Herein, we discuss its relevance in clinical trials and potential applications in research and clinical settings through a few clinical scenarios.

RECENT FINDINGS

The DEFASE score has been developed to be used in research settings as a comprehensive scoring system. Researchers are currently focusing on internal and external validation of the scoring system, targeting these models to various food allergenic sources, populations, and settings.

SUMMARY

Implementing the DEFASE score in clinical trials could improve patient stratification, guide therapeutic decisions, and support regulatory assessments. Future research will focus on its external validation and integration with biomarker data to refine its predictive accuracy and make this tool applicable in the near future.

Prevalence and Clinical Symptoms of Wheat Allergy in Adults and Adolescents in Central Europe

BACKGROUND

Wheat is a well-known elicitor of food allergy, but epidemiological data are limited. The aim of this study was to investigate the prevalence of wheat allergy in an unselected population of adults and adolescents and to characterise the clinical features of this cohort, as well as those of patients who experienced wheat-induced anaphylaxis.

METHODS

A population-based cross-sectional study was conducted. Fifteen thousand individuals aged 12-80 years were randomly selected, and a standardised questionnaire was applied. If symptoms after wheat consumption were reported, telephone interviews were conducted. In the case of suspected type 1 wheat allergy, a skin prick test, specific immunoglobulin E (sIgE) and oral food challenge (OFC) were performed. The prevalence of self-reported wheat sensitivity and wheat allergy was determined after data extrapolation. For the assessment of severe wheat allergy-associated symptoms, a cohort from the European Anaphylaxis Registry was analysed.

RESULTS

The questionnaire was answered by 1770 individuals, of whom 13.1% reported symptoms due to the consumption of foods containing wheat. Following telephone interviews (n = 105) and clinical diagnostics (n = 22), type 1 sensitisation to wheat was confirmed in 8 individuals, and 2 subjects were finally diagnosed with an IgE-mediated wheat allergy. After extrapolation, the prevalence of confirmed wheat allergy in the German population reached 0.25% [95% CI 0.08-0.9]. Self-reported wheat sensitivity was predominantly seen in females (71%), with local gastrointestinal and non-specific symptoms. This contrasted with wheat-induced anaphylaxis, where less than half occurred in females, and symptoms were mainly skin, cardiovascular or respiratory.

CONCLUSION

In a population with widespread wheat consumption, self-reported wheat sensitivity was common in adults and adolescents, but confirmed wheat allergy was rare. The distinct symptom profiles allow physicians to easily differentiate these entities. Dissemination of our findings may help to improve knowledge of the low prevalence of wheat allergy and may support the reduction of unnecessary dietary restrictions.

Cross-sectional Survey of Allergic Diseases in Staff and Their Families at Designated Allergic Disease Medical Hospitals in Japan: Calculation of Age-adjusted Prevalence

BACKGROUND

Continuous epidemiological surveys using consistent methodologies are essential for assessing the prevalence of allergic diseases. In 2021, a cross-sectional survey on allergic diseases was conducted, targeting staff and their families at Designated Allergic Disease Medical Hospitals across 41 prefectures in Japan. By 2022, these hospitals had been established in all 47 prefectures of Japan.

METHODS

A prevalence survey of allergic diseases was conducted in 2022 using the same questionnaire as that used in 2021, encompassing hospitals across all 47 prefectures. Age-adjusted prevalence rates were calculated using the 2015 population model for comparison with the 2021 survey data.

RESULTS

The 2022 survey included 76 hospitals and 24,444 participants (males, 10,668; women, 13,776; median age, 35 years; interquartile range, 18-50 years). The overall prevalence of allergic diseases was 63.0% (95% confidence interval:62.3-63.6). Age-adjusted prevalence of a history per 100,000 people for each allergic disease was as follows (; 95% confidence interval): bronchial asthma (13,279; 12,776-13,782), atopic dermatitis (12,786; 12,379-13,193), food allergies (13,143; 12,689-13,596), perennial allergic rhinitis (28,132; 27,673-28,982), pollinosis (38,959; 38,216-39,703), allergic conjunctivitis (19,751; 19,188-20,313), metal allergies (2,111; 1,898-2,325), drug allergies (4,478; 4,149-4,806), and anaphylaxis (1,602; 1,417-1,787). The prevalence of perennial allergic rhinitis, pollinosis, and allergic conjunctivitis was higher than that in 2021.

CONCLUSIONS

This survey is the first in Japan to calculate the age-adjusted prevalence of allergic diseases. Moreover, pollinosis is the most common allergic disease in Japan.

Dietary AGEs and food allergy: insights into the mechanisms of AGEs-induced food allergy and mitigation strategies

Food allergy (FA) is a significant public health concern, with over one billion individuals globally affected, and its prevalence continues to rise. Advanced glycation end products (AGEs) are common hazards in various diet. Recent investigations have shown that AGEs could influence the pathogenesis of FA by interacting with AGEs receptors. This paper provides a comprehensive review of recent advances on diet AGEs, summarized the mechanisms of AGEs in regulating food allergy and mitigation strategies, analyzed the limitations of current research on AGEs and prospected the future research. AGEs could combine with the receptors for AGEs (RAGE) to induce oxidative stress, inflammation and allergic signaling pathways. AGEs can affect allergen epitopes and conformation and regulate intestinal flora in a non-receptor-dependent manner, as well as affect the intestinal barrier and Th1/Th2 immune balance through receptor-dependent pathways to regulate food allergy. Currently, the approaches to reduce the AGEs-induced food allergy mainly depended on improving food processing methods (e.g., low temperature, short time, low pH and non-thermal processing methods), natural AGEs inhibitors and RAGE inhibitors. This review elucidates the influences of AGEs on food allergy and mitigation strategies, which could provide novel insights into reducing food allergy induced by diet AGEs.

Difference in Cow's Milk-Related Symptom Score (CoMiSSTM) Among Presumed Healthy Infants in Indonesia and Brazil

Purpose

The Cow's Milk-related Symptom Score (CoMiSS) improves the recognition of cow milk allergy (CMA) symptoms. A score of ≥10 should raise awareness of CMA. The median CoMiSS in healthy European infants aged <6 months is 3. This study aimed to determine the impact of different regions on CoMiSS in healthy infants aged <12 months to evaluate regional and age-related differences.

Methods

A prospective cross-sectional study was conducted at one hospital each in Indonesia (Jakarta) and Brazil (Sergipe). CoMiSS was assessed in healthy infants aged -12 months old.

Results

In Jakarta, a total of 286 infants (50.7% boys) were included. The median (interquartile range) CoMiSS was 1.5 (0-4); the 95th percentile was 7. In Sergipe, 101 infants (60.4% boys) were included. The median (interquartile range) CoMiSS was 4 (4-6); the 95th centile was 10.9. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.99; p<0.001) and country (OR, 2.40; 95% CI, 2.06-2.79; p<0.001) were significant independent predictors of changes in mean CoMiSS in a linear regression model (r2=0.27).

Conclusion

Median CoMiSS in healthy infants differed between Jakarta and Sergipe (1.5 vs. 4.0). These findings highlight that the perceived normality of parents may be region-dependent.

Food Allergy Test-Guided Dietary Advice for Children With Atopic Dermatitis: A Consensus Study

BACKGROUND

The use of blood specific IgE or skin prick tests (SPT) to guide dietary exclusions for disease control in children with atopic dermatitis (AD) is controversial. We undertook a consensus exercise on how to interpret SPT results and dietary history for cow's milk, hen's egg, wheat, and soy in children < 2 years old with AD.

METHODS

Fourteen clinicians from general practice, pediatrics, pediatric dermatology, pediatric allergy, and pediatric dietetics from UK and Ireland took part in an online modified Delphi study. Over three rounds, participants gave their anonymous opinions and received individualized and group feedback, based on the premise that all children had SPTs. The findings were discussed in an online workshop.

RESULTS

Of 18 symptoms, 12 were identified as relevant to immediate and 7 to delayed allergy. Regarding SPTs, there was consensus over which allergens to use for wheat and soy but not cow's milk or hen's egg; for all study foods, wheal size was determined as 0-1 mm negative, ≥ 5 mm sensitized, but between 2 and 4 mm, categorization varied by food. During the final workshop, consensus was reached on dietary advice for nine combinations of SPT results and dietary history.

CONCLUSION

We attained consensus on how SPTs and dietary history for four common food allergens should be interpreted in young children under 2 years of age with AD. These pragmatic recommendations may support clinician education, consistency of decision-making, and future research.

Oral Exposure to Clostridium difficile Toxin A Aggravates Food Allergy by Intestinal Barrier Destruction, Mast Cell Activation, and Th2-Biased Immune Responses

Food allergy is a complex disease, with multiple environmental factors involved. Considering the regulatory effect of Clostridium difficile toxin A (Tcd A) on biological processes of allergic reactions, the role of oral exposure to Tcd A on food allergy was investigated. The intestinal permeability and β-hexosaminidase were promoted by Tcd A using the in vitro Caco-2 and HT-29 cells coculture monolayer and bone marrow-derived mast cell (MCs) degranulation model. When the sensitized mice were challenged with OVA and 4 μg of Tcd A, specific IgE and MCPT-1 levels were increased. The results of flow cytometry and ELISA demonstrated that the Th1 and Treg cells were reduced and higher IL-5 was induced. The jejunum staining showed that villus injury and MC accumulation were aggravated. All of the findings demonstrated that Tcd A could aggravate food allergy, and the orally exposed risk factors aggravating food allergy warrant increasing attention.

Prevalence of food allergy and its association with atopic dermatitis in Iran: Results from the PERSIAN birth cohort

Background

The incidence of food allergy (FA) has been increasing worldwide, causing growing concern on a global scale.

Objective

This birth cohort study analyzes the incidence of reported FA and other atopic comorbidities in children from birth to age 2 years who were living in 4 urban and semiurban areas in Iran.

Methods

Children were followed from birth until age 24 months, with follow-up questionnaires administered through parent or guardian interviews conducted when the children were aged 2, 4, 6, 12, and 24 months.

Results

The rate of physician-diagnosed FA reported by parents or guardians was higher than expected, with a cumulative incidence of 7.7% in children younger than 24 months. The highest prevalence of FA was found in Yazd, the most urban of the 4 cities studied. Breast-feeding was associated with a decreased cumulative risk of FA at age 12 months, with only 5% of breast-fed children developing parent-reported pediatrician-diagnosed FA compared with 13% of infants who never received breast milk after birth.

Conclusion

This study provides valuable insight into the incidence of FA in the Middle East, which has previously not been reported on, and it is crucial in our understanding of global FA prevalence. The study demonstrates a high incidence of FA in an area with historically lower rates and confirms that breast-feeding does prevent FA during infancy in this population.

Food Allergy Prevalence in Two Population-Based UK Cohorts Born 12 Years Apart

BACKGROUND

Adverse food reactions include food allergy (FA; immune-mediated) and food intolerances (non-immune-mediated). FA are classified into IgE- and non-IgE-mediated FA. There is limited information available about changes in FA prevalence over time.

METHODS

Two cohorts of children were evaluated, born on the Isle of Wight (IOW) 12 years apart, the IOW birth cohort (IOWBC; 1989-1990) and the FA and Intolerance Research birth cohort (FAIRBC; 2001-2002). We compared the prevalence of parental reported reactions to foods (adverse food reactions), allergic sensitisation to foods and FA between the IOWBC and FAIRBC, at ages 1, 2, 3-4 and 10 years. FA included both IgE- and non-IgE-mediated FA.

RESULTS

Reported adverse reactions to food and sensitisation rates remained stable between the two cohorts. For example, FA at age 3-4 years was reported in 9.1% (95% CI: 7.5, 10.7) in IOWBC and 8.3% (95% CI: 6.5, 10.1) in FAIRBC (p = 0.57) and food sensitisation by skin prick test at age 3-4 years was found in 3.2% (95% CI: 2.1, 4.3) in IOWBC and 4.5% (95% CI: 2.9, 6.1) in FAIRBC (p = 0.20). Confirmed FA prevalence was lower in FAIRBC than IOWBC at ages 1, 2 and 3-4, but these differences were not significant after adjustment for multiple comparisons. For example, FA at age 3-4 years was confirmed in 5.0% (95% CI: 3.8, 6.2) in IOWBC and 3.0% (95% CI: 1.9, 4.2) in FAIRBC (p = 0.03, significance threshold after Bonferroni correction p < 0.004). Confirmed cow's milk allergy rate was higher in IOWBC than FAIRBC at 3 years (< 0.001) but not at other time points.

CONCLUSION

Our data show no evidence of changes in rates of adverse reactions to foods, food sensitisation or food allergy during the first 10 years of life between two cohorts born in England in 1989-1990 and 2001-2002.

Probiotics supplementation during pregnancy or infancy on multiple food allergies and gut microbiota: a systematic review and meta-analysis

CONTEXT

Probiotics show promise in preventing and managing food allergies, but the impact of supplementation during pregnancy or infancy on children's allergies and gut microbiota remains unclear.

OBJECTIVE

This study aimed to assess the effects of maternal or infant probiotic supplementation on food allergy risk and explore the role of gut microbiota.

DATA SOURCES

A systematic search of databases (PubMed, Cochrane Library, Embase, and Medline) identified 37 relevant studies until May 20, 2023.

DATA EXTRACTION

Two independent reviewers extracted data, including probiotics intervention details, gut microbiota analysis, and food allergy information.

DATA ANALYSIS

Probiotics supplementation during pregnancy and infancy reduced the risk of total food allergy (relative risk [RR], 0.79; 95% CI, 0.63-0.99), cow-milk allergy (RR, 0.51; 95% CI, 0.29-0.88), and egg allergy (RR, 0.57; 95% CI, 0.39-0.84). Infancy-only supplementation lowered cow-milk allergy risk (RR, 0.69; 95% CI, 0.49-0.96), while pregnancy-only had no discernible effect. Benefits were observed with over 2 probiotic species, and a daily increase of 1.8 × 109 colony-forming units during pregnancy and infancy correlated with a 4% reduction in food allergy risk. Children with food allergies had distinct gut microbiota profiles, evolving with age.

CONCLUSIONS

Probiotics supplementation during pregnancy and infancy reduces food allergy risk and correlates with age-related changes in gut microbial composition in children.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023425988.

Novel diagnostics in food allergy

Food allergy is increasing in prevalence, posing significant challenges for individuals and their families and adversely affecting their quality of life. Misdiagnosis can lead to unnecessary dietary and social limitations and increased food allergy risk, whereas failure to diagnose may result in life-threatening anaphylaxis. Therefore, a precise diagnosis is of the utmost importance; however, barriers exist at every stage of the diagnostic process. Diagnosis of food allergy relies on clinical history, IgE sensitization tests, and oral food challenge. Component testing and identification of optimal cutoffs have improved diagnostic accuracy. Nevertheless, many patients still require an oral food challenge, and better tests are needed to reduce this need. Novel ways of detecting biomarkers, such as the basophil activation test and peptide-specific IgE level, are transitioning into clinical practice. Future approaches may include the use of alternative biologic samples, novel laboratory technologies, and analytic tools (including artificial intelligence) to integrate test results and clinical information. Conscientious use of existing tests, access to tests with superior diagnostic accuracy, and combination of tests, can lead to improved precision of diagnosis of food allergy and timely introduction of tolerated foods into the diet. This review summarizes recent advances in novel approaches to food allergy diagnosis that can enhance clinical decision making both now and in the future.

Questionnaire-based real-world survey of diagnosing food allergy in children: Utilization of oral food challenge tests and other diagnostic methods

Background

Oral food challenge tests are considered the reference standard for diagnosing food allergies; however, studies on their real-world implementation rates are limited.

Objective

The study aimed to investigate the proportion of school-age children who underwent the oral food challenge test and to understand the motivations behind food elimination and utilization of various health care services.

Methods

The questionnaire-based survey for the parents of the students who submitted the "Certificate for School Life Management (For Allergic Diseases)" was conducted across public elementary and junior high schools in Gifu prefecture, Japan.

Results

The study encompassed parents of 3457 children with food allergies who submitted the certificate. Approximately one third of those eliminating the 3 major allergens-eggs (32.5%), milk (27.6%), and wheat (33.5%)-were diagnosed via oral food challenge tests, and approximately two thirds were diagnosed using a combination of symptoms and blood tests, suggesting most children were diagnosed appropriately. However, many children were diagnosed and eliminated foods based solely on blood tests without any symptoms of other allergens, such as buckwheat (55.8%), peanuts (29.2%), and tree nuts (21.2%), suggesting that it was likely that these children unnecessarily eliminated foods. Elimination of buckwheat because of anxiety was associated with eliminating other foods for the same reason and with eliminating 2 or more foods.

Conclusion

Examination of the real-world application of the proposed recommendations for the accurate diagnosis of food allergies suggests that closely monitoring their practical application should be conducted in each case to avoid unnecessary food elimination from children's diets.

Insights into self-reported food allergies in Romanian schoolchildren

The prevalence of food allergy (FA) varies worldwide with an increasing rate in the last decades. Data of self-reported FA have been recorded by most European countries, the US, Canada and Australia, but not Romania. The aim of this study is to analyze the prevalence and severity of FA and to assess the extent of information the medical and teaching staff in schools have on students' medical history.

Methods

A cross-sectional survey was performed in schoolchildren from Cluj-Napoca, Romania, using an online questionnaire delivered to their parents.

Results and conclusions

Seven hundred and eight individuals completed the entire questionnaire. The prevalence of self-reported FA was 8.9%, 28.6% presented food-induced angioedema and 38.1% required ER presentation. Cow milk (36.5%), egg (9.5%), strawberry (20.6%) and nuts (2.7%)were the most frequent culprit foods. The lack of an appropriate and accurate communication with the medical and teaching staff in the school suggest the requirement for further measures for parents and children educations regarding food allergy detection and management.

Prevalence of Chronic Diseases, Allergies and Food Intolerance in Schoolchildren in a Network of Educational Centers with School Nurses in Spain

The prevalence of chronic diseases, including allergies, is increasing in schoolchildren, making school nurses essential in managing students' health. This study aimed to determine the prevalence of chronic conditions in schoolchildren within a network of Spanish educational centers with school nurses. A descriptive cross-sectional study was conducted in May 2023, covering 25,951 students from these centers. Schoolchildren and educational center data were collected from the school health records to document health information and nursing activities. Mean age of students was 10.11 years (50.20% female). A total of 9.45% had chronic disorders, including disorders of the respiratory (4.14%), neurological (2.94%), digestive (2.28%), musculoskeletal (1.25%), and cardiovascular (1.14%) systems. A total of 12.5% had allergies (6.10% food allergies), and 2.81% had food intolerances. Identifying and recording these diseases are key responsibilities of the school nurse, supporting improved care quality and informing policies to ensure school nurse availability and enhanced health management protocols for students.

Comparison of Double-Blind and Open Food Challenges for the Diagnosis of Food Allergy in Childhood: The ALDORADO Study

BACKGROUND

Double-blind placebo-controlled food challenge (DBPCFC) is widely regarded as the "gold standard" to diagnose food allergy. Maximum efforts are made to reduce bias, yet DBPCFCs are costly, time-, and resource-intensive. Less demanding open food challenges are increasingly used in clinical practice. However, recommendations regarding the use of these challenges are based on low certainty of evidence, and no comparative studies have been performed using the most recent international food challenge guidelines. We hypothesised that the open food challenge is non-inferior to DBPCFC in children suspected of allergy to cashew nuts, hazelnuts or peanuts.

METHODS

A total of 63 children, aged 4 years and older, were included if referred for suspected IgE-mediated allergy to cashew nut, hazelnut, or peanut. All study participants underwent DBPCFC first, followed by an open food challenge for the same food. Challenge outcomes were assessed by predefined criteria into positive, negative, or inconclusive.

RESULTS

DBPCFC and open food challenge outcomes were the same for 36/41 (87.8%) patients. Sensitivity and specificity of the open food challenge were 0.91 (95% CI 0.79, 1.03) and 0.83 (95% CI 0.63, 1.01), respectively, with an AUC value of 0.87. Eliciting and stop doses were not significantly different between both food challenges.

CONCLUSION

The Diagnostic accuracy of open food challenge is non-inferior to that of DBPCFC. This finding implies less demanding open food challenges can be implemented for children from the age of 4 years suspected to be cashew nut, hazelnut, or peanut allergic. Further research is necessary to validate our findings and to investigate the diagnostic accuracy for other major food allergens.

Trajectories of egg sensitization in childhood: Two birth cohorts in Asia and Europe

BACKGROUND

Hen's egg exposure through impaired skin barrier is considered a major mechanism of sensitization to eggs. However, the impact of filaggrin (FLG) gene loss-of-function mutations on the natural history of egg sensitization lacks consensus among studies.

OBJECTIVE

To evaluate the association between the natural course of egg sensitization and FLG mutations.

METHODS

We used Japanese and the UK birth cohorts (CHIBA and MAAS) to identify the longitudinal patterns of egg sensitization until mid-school age and examined the relationship between the identified patterns and FLG mutations. Sensitization was assessed using egg white-specific IgE levels or skin prick tests (SPTs). Egg allergy was confirmed by parental reports and sensitization. Latent class growth analysis identified longitudinal patterns.

RESULTS

Three similar patterns of egg sensitization (persistent, early-onset remitting, and no/low grade classes) were identified in both cohorts, with differing prevalence estimates. The proportion of children with egg allergy in the persistent class at 7 or 8 years of age was 23% (CHIBA) and 20% (MAAS). Consistently in both cohorts, FLG mutations were significantly associated only with the persistent class. Children with FLG mutations had an approximately four-fold increased risk of being in the persistent sensitization class (RRRs: 4.3, 95%C.I. (1.2-16.0), p = .03 in CHIBA; 4.3 (1.3-14.7), p = .02 in MAAS).

CONCLUSION

FLG loss-of-function mutations are associated with persistent egg sensitization in both Japanese and European ethnicities, and the mutations might be a potential biomarker for identifying the risk of persistent egg sensitization/allergy in early infancy. Future studies should incorporate oral food challenges to confirm this relationship.

Diversity of complementary diet and early food allergy risk

INTRODUCTION

Diet diversity (DD) in infancy may be protective for early food allergy (FA) but there is limited knowledge about how DD incorporating consumption frequency influences FA risk.

METHODS

Three measures of DD were investigated in 2060 infants at 6 and/or at 9 months of age within the NorthPop Birth Cohort Study: a weighted DD score based on intake frequency, the number of introduced foods, and the number of introduced allergenic foods. In multivariable logistic regression models based on directed acyclic graphs, associations to parentally reported physician-diagnosed FA at age 9 and 18 months were estimated, including sensitivity and stratified analyses.

RESULTS

High weighted DD scores (24-31p) at age 9 months were associated with 61% decreased odds of FA at age 18 months [OR (95% CI) = 0.39 0.18-0.88] compared with infants with the lowest DD scores (0-17p). The association remained significant after exclusion of early FA cases. Having introduced 13-14 foods at age 9 months, independent of consumption frequency, was associated with 45% decreased odds of FA [OR (95% CI) = 0.55 (0.31-0.98)] compared to having introduced 0-10 foods. When stratifying, significantly reduced odds for FA were seen for children with eczema and for children with no FA history in the family. No association was seen between DD at age 6 months and FA at age 18 months.

CONCLUSION

A diverse diet at age 9 months may prevent FA at age 18 months. Our results underscore the need for additional investigations on the impact of consumption frequency in infancy.

Is There a Relationship Between Physical Performance Factors and Adverse Reactions to Foodstuffs? The ALASKA Study

Background/Objectives: An optimal physical condition has beneficial effects in adults at risk of chronic diseases. However, research data on how adverse reactions to food (ARFSs) are linked to physical performance are lacking. The aims of this study were (a) to investigate the prevalence of ARFS according to age; (b) to analyze physical performance level according to the type of ARFS; and (c) to determine the probability of having a positive ARFS according to physical performance levels. Methods: A cross-sectional study with 254 Spanish adults (61% women; mean age 43.7 ± 13 y) scoring ≥ 6 in PSIMP-ARFSQ-10 (pathologies and symptomatology questionnaire associated with adverse reactions to foodstuffs) was conducted in the region of Madrid, Spain, following the ALASKA study protocol. Immune-mediated variables used to measure ARFS were sIgE and sIgG4 antibody reactions (AbR) (type 1 and type 2 food hypersensitivities, respectively); non-immune-mediated variables used to measure ARFS were lactose intolerance and fructose malabsorption. Physical performance variables were body balance, leg power, sit-to-stand speed, resting heart rate, handgrip strength, and cardiorespiratory fitness. Statistical significance was set at 0.05. Results: The most prevalent sIgE- and sIgG4-mediated ARFSs were against legumes (53% and 46%; 60% and 68% in subjects with ≤45 y and >45 y, respectively). Handgrip strength was significantly lower in subjects positive for lactose intolerance compared to subjects negative for lactose intolerance (p < 0.05). Both the positive mean sIgE and sIgG4 AbR were significantly associated with high physical performance (p < 0.05). Subjects with high physical performance showed a 1.5-fold increase in the odds of the positive mean total sIgE and positive sIgG4 AbR against legumes. Conclusions: In conclusion, subjects aged 45 or younger had a higher prevalence of total type 1 and type 2 food hypersensitivities than subjects older than 45 y. Positive lactose intolerance was linked to lower values of handgrip strength. Subjects with high physical performance, whether male or female, aged ≤45 years, or with a BMI of ≥25, showed significant odds of experiencing type 1 food hypersensitivity to nuts.

Clinical and molecular profile of 20 patients with DOCK8 deficiency-a single-center experience from Southern India

DOCK8 deficiency is the most common cause of autosomal recessive hyper-IgE syndrome (AR-HIES). The clinical spectrum is wide resulting in combined immunodeficiency, atopy, autoimmunity, and malignancies. To study the clinical and molecular profile of 20 patients with DOCK8 deficiency. Four hundred and eight patients with various inborn errors of immunity (IEIs) were diagnosed in the Pediatric Immunology Unit of our hospital during the study period of February 2017 to August 2023. Based on the clinical and immunological phenotype, DOCK8 deficiency was suspected in 31 patients. Genetic studies confirmed DOCK8 deficiency in 20 patients, and their profile was analyzed in detail. Twenty patients from 17 kindreds were diagnosed with DOCK8 deficiency. The female-to-male ratio was 1.2:1. The mean age at onset of symptoms and diagnosis was 9.8 and 69.8 months, respectively. Thirteen out of 17 families (76%) reported consanguinity. Eczema was the presenting manifestation in 19 patients (95%). Mucocutaneous manifestations included oromucosal hyperpigmentation (n = 8), scalp seborrhoea (n = 2), psoriasis (n = 2), and alopecia (n = 1). The spectrum of infections included pneumonia (n = 14), otitis media (n = 6), gastrointestinal infections (n = 6), cutaneous viral infections (n = 5), oral candidiasis (n = 4), and meningoencephalitis (n = 2). Three patients had developed bronchiectasis. Four patients had autoimmune manifestations including autoimmune hemolytic anemia (n = 2) and vasculitis (n = 2). The whole exome sequencing showed deletions (8 kindreds) as the most common mutation in the DOCK8 gene. Overall, 11 of these mutations were novel. Ten patients were on monthly intravenous immunoglobulin therapy and antibiotic prophylaxis at the time of writing this paper. Three patients underwent hematopoietic stem cell transplants elsewhere, two of whom succumbed to post-transplant complications and one is doing well. Nine patients died during the study period. We present one of the largest single-center experiences on DOCK8 deficiency from India. A significant delay in the diagnosis contributed to poor outcomes in our cohort.

Food Allergy-Related Bullying in Pediatric Patients: A Systematic Review

BACKGROUND

Food allergy (FA)-related bullying is a significant public health concern affecting pediatric patients. This systematic review investigates the prevalence, characteristics, and psychosocial impact of FA-related bullying, as well as current intervention strategies within educational and healthcare settings.

METHODS

A systematic literature search was conducted across the PubMed, Web of Science, and CINAHL databases, covering publications up to February 2024. The review followed PRISMA guidelines and included studies on children and adolescents (0-18 years) diagnosed with FAs. Studies were selected based on eligibility criteria and assessed for quality using the Newcastle-Ottawa Scale.

RESULTS

The initial search identified a total of 260 records (6 from scientific databases and 254 from registries). Twenty-six studies met the inclusion criteria. The findings of these studies reveal that FA-related bullying is prevalent, with rates varying between 17% and 60%, depending on the study population and methods. Bullying often involves verbal teasing, social exclusion, and physical threats using allergens, presenting both psychological and physical risks. Psychological consequences include increased anxiety, depression, and social withdrawal, which persist over time, significantly impacting quality of life for both children and their families. Notably, bullying often occurs in school settings, emphasizing the need for targeted interventions.

CONCLUSION

FA-related bullying profoundly affects mental health and quality of life for affected children and their families. Interventions, such as school-based allergy education programs and policies promoting inclusivity and safety, have shown promise in reducing bullying incidents. A collaborative approach involving healthcare providers, educators, and policymakers is essential to mitigate the impact of FA-related bullying and improve outcomes for affected children.

Biosensing strategies using recombinant luminescent proteins and their use for food and environmental analysis

Progress in synthetic biology and nanotechnology plays at present a major role in the fabrication of sophisticated and miniaturized analytical devices that provide the means to tackle the need for new tools and methods for environmental and food safety. Significant research efforts have led to biosensing experiments experiencing a remarkable growth with the development and application of recombinant luminescent proteins (RLPs) being at the core of this boost. Integrating RLPs into biosensors has resulted in highly versatile detection platforms. These platforms include luminescent enzyme-linked immunosorbent assays (ELISAs), bioluminescence resonance energy transfer (BRET)-based sensors, and genetically encoded luminescent biosensors. Increased signal-to-noise ratios, rapid response times, and the ability to monitor dynamic biological processes in live cells are advantages inherent to the approaches mentioned above. Furthermore, novel fusion proteins and optimized expression systems to improve their stability, brightness, and spectral properties have enhanced the performance and pertinence of luminescent biosensors in diverse fields. This review highlights recent progress in RLP-based biosensing, showcasing their implementation for monitoring different contaminants commonly found in food and environmental samples. Future perspectives and potential challenges in these two areas of interest are also addressed, providing a comprehensive overview of the current state and a forecast of the biosensing strategies using recombinant luminescent proteins to come.

Management and disease burden of children and adults with severe IgE-mediated food allergy: Are adults the lost population?

Background

Lacking causal treatment options in most cases, severe IgE-mediated food allergies (IgE-FA) are associated with a high burden of disease due to permanent risk of anaphylactic reactions after accidental allergen ingestion. To date, only few data comparing health resources and burden of disease between the pediatric and adult population are available.

Objective

Our survey aimed to assess the care situation of pediatric and adult patients with severe, self-reported physician-diagnosed IgE-FA.

Methods

The survey was conducted via an online questionnaire consisting of 32 items covering participant demographics, comorbidities, triggers, utilization of health resources, current management and burden of disease of FA, according to age groups (<18 years: proxy report by parents or ≥ 18 years: self-report by adults).

Results

A total of 367 participants (n = 237 children/parents, n = 130 adults) with self-reported physician-diagnosed IgE-FA and physician-prescribed adrenalin autoinjector were enrolled. Emergency training and having an emergency action plan were significantly more common in the pediatric group (81.4%) than in the adult group (36.2%). Children had clearer medical contact points (pediatrician or [pediatric] pulmonologist, 89.0%), while adults visited a variety of specialized physicians according to their FA-related symptoms. Adults were more unsatisfied with their overall coping-strategy for allergen avoidance (18.5%), daily FA management (27.9%), and treating physician (34.4%) than the pediatric group (2.6%/17.0%/14.8%, respectively, p < 0.05).

Discussion

Our data reveal a general undersupply for severe IgE-FA in Germany, with adults being significantly more affected. This may lead to the reported higher burden of disease in this age group. Increasing clearer medical contact points (eg, qualified allergologists specialized in food allergy)-especially for the adult patient population, finding available therapeutic options for this group of patients, and increasing the awareness of severe food allergy in the general population might overcome this problem.

Probiotics as adjuvants to mitigate adverse reactions and enhance effectiveness in Food Allergy Immunotherapy

In the past decades, food allergies became increasingly dominant since early childhood, leading to a lower quality of life and to increasing costs addressed by the health care system. Beside standard avoidance of specific allergens and drug treatments following allergen exposure, a great deal of research has lately focused on Food Allergy Allergen Immunotherapy (FA-AIT). SCIT and EPIT (Subcutaneous and Epicutaneous Immunotherapy), OIT (Oral Immunotherapy), and SLIT (Sublingual Immunotherapy) consist in gradual exposure to allergens to desensitize and achieve tolerance once therapy has ended. Although promising, FA-AIT may bring acute local and systemic adverse reactions. To enhance efficacy, safety and convenience of AIT, the quest of potential adjuvants to mitigate the adverse reactions becomes crucial. Immunomodulatory activities, such as that of increasing the regulatory T cells and decreasing the IgE, have been observed in specific probiotics' strains and multiple studies elucidated the role of gut microbiota as a major interplayer among the host and its immune system. In this review, the microbiome modulation is shown as potential AIT adjuvant, nevertheless the need of more clinical studies in the near future is pivotal to assess the efficacy of targeted bacterial therapies and faecal microbiota transplantation.

Diagnostic Accuracy of Lipid Transfer Proteins (LTPs) Specific IgE Assay in Food Allergy: A Systematic Review

The aim of this systematic review was to evaluate the diagnostic accuracy of molecular-based LTPs serum sIgE for the diagnosis of food allergies in patients with suspected allergy to one of the LTPs-containing foods. Cohort, prospective or retrospective cross-sectional studies were considered for inclusion in this review. Oral food challenge (both open and double-blind placebo-controlled) was the reference standard for the diagnosis. PubMed (MEDLINE), Web of Science, Scopus, and ClinicalTrial.org were searched for relevant papers. The risk of bias was assigned by the QUADAS-2 tool. Data were reported as the sensitivity and specificity. The study protocol was registered in the PROSPERO database (CRD42022321985). Fifteen articles, including 2395 individuals, were included. The sensitivity of Ara h 9 for peanut allergy diagnosis ranged from 6 to 61%; the specificity ranged from 57 to 100%. The Cor a 8 sensitivity ranged from 11 to 43%, with the specificity ranging from 59 to 94%. Ara h 9 and Cor a 8 serum sIgE may be useful for confirming the diagnosis of peanut and hazelnut allergy in symptomatic patients, although the diagnostic accuracy is limited by the low sensitivity. More investigation on other LTPs and in adult populations may be important to define the clinical role of this test in food allergy diagnostics.

From bite to brain: Neuro-immune interactions in food allergy

Immunoglobulin E (IgE)-mediated food allergies are reported to affect around 3.5% of children and 2.4% of adults, with symptoms varying in range and severity. While being the gold standard for diagnosis, oral food challenges are burdensome, and diagnostic tools based on specific IgE can be flawed. Furthering our understanding of the mechanisms behind food allergy onset, severity and persistence could help reveal immune profiles associated with the disease, to ultimately aid in diagnosis. Alterations to cytokine levels and immune cell ratios have been identified, though further research is needed to fully capture the heterogenous nature of food allergy. Moreover, the existence of such immune alterations also raises the question of potential wider systemic effects. For example, recent research has emphasised the existence and impact of neuro-immune interactions and implicated behavioural and neurological changes associated with food allergy. This review will provide an overview of such food allergy-driven neuro-immune interactions, with the aim of emphasising the importance of furthering our understanding of the immune mechanisms underlying IgE-mediated food allergy.

10 practical priorities to prevent and manage serious allergic reactions: GA2LEN ANACare and EFA Anaphylaxis Manifesto

This Anaphylaxis Manifesto calls on communities to prioritise 10 practical actions to improve the lives of people at risk of serious allergic reactions. The Global Allergy and Asthma European Network and the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) compiled patient-centric priorities. We used qualitative consensus methods, research evidence and feedback from over 200 patient groups, stakeholder organisations and healthcare professionals. We encourage healthcare, education and food organisations to collaborate with people at risk of serious allergic reactions to tackle safety, anxiety and financial burdens for individuals and societies. Key priorities for prevention include awareness-raising campaigns for the public and professionals, school and workplace initiatives and mandatory precautionary allergen labels on food. Priorities for improving immediate and long-term management include educating healthcare professionals, patients and schools about when and how to use adrenaline, funding two approved adrenaline devices for everyone at risk, and facilitating access to allergy specialists. Integrated care pathways should include clinical and non-clinical management options such as individualised risk assessment and quality of life assessment, self-management plans, dietetic and psychosocial support and peer support. Organisations around the world are committing to work together towards these priorities.

Symptomatology and Management of Adult Anaphylaxis according to Trigger: A Cross-Sectional Study

INTRODUCTION

Anaphylaxis is an acute life-threatening allergy, most commonly provoked by food, venom, or drugs. There is limited data regarding differences in symptomatology between anaphylaxis provoked by different triggers. This study aimed to assess sociodemographic characteristics, clinical symptoms, and management of anaphylaxis, according to triggers in adults.

METHODS

We conducted a cross-sectional study recruiting adult patients with anaphylactic reactions across 8 emergency departments (EDs) and 1 electronic medical service (EMS) in Canada. Univariate and multivariate regression models were used to evaluate symptoms involving all patients with the outcome of drug-induced anaphylaxis (DIA), venom-induced anaphylaxis (VIA), peanut-induced anaphylaxis (PIA), shellfish-induced anaphylaxis, tree-nut induced anaphylaxis (TIA) and nut-induced anaphylaxis (NIA). We assessed comorbidities associated with severe reactions, stratified by triggers listed above. Additionally, we evaluated the association of each trigger with treatment through regression models involving all patients with medications used as outcome and anaphylaxis triggers used as independent variables.

RESULTS

From April 2011 to November 2023, 1,135 adults presenting with anaphylaxis to EDs were recruited. The median age was 35.5 (interquartile range 25.3-51.1). Most of the patients presented with FIA (50.3%). Regarding symptomatology, hypotension was more likely associated with DIA (aOR = 1.20, 95% CI = 1.11-1.30, p < 0.01). When adjusted for age at reaction and male sex, alcohol was more likely associated (aOR = 1.51, 95% CI = 1.04-2.19, p = 0.035) with NIA. Regarding management, TIA was more likely associated with inpatient epinephrine (aOR = 2.05, 95% CI = 1.16-3.64, p = 0.014). DIA was less likely associated with outpatient antihistamine (aOR = 0.68, 95% CI = 0.48-0.89, p < 0.01) whereas TIA was more likely associated with outpatient antihistamine (aOR = 1.81, 95% CI = 1.03-3.19, p = 0.040).

CONCLUSION

Our study underscores associations between specific triggers, clinical manifestations and managements, such as the potential link between TIA and throat tightness and hypotension and VIA. Identifying such associations can aid with the prompt diagnosis of anaphylaxis in patients presenting to the ED, leading to swifter treatment initiation and improving overall outcomes.

The future of food allergy diagnosis

Food allergy represents an increasing global health issue, significantly impacting society on a personal and on a systems-wide level. The gold standard for diagnosing food allergy, the oral food challenge, is time-consuming, expensive, and carries risks of allergic reactions, with unpredictable severity. There is, therefore, an urgent need for more accurate, scalable, predictive diagnostic techniques. In this review, we discuss possible future directions in the world of food allergy diagnosis. We start by describing the current clinical approach to food allergy diagnosis, highlighting novel diagnostic methods recommended for use in clinical practice, such as the basophil activation test and molecular allergology, and go on to discuss tests that require more research before they can be applied to routine clinical use, including the mast cell activation test and bead-based epitope assay. Finally, we consider exploratory approaches, such as IgE glycosylation, IgG4, T and B cell assays, microbiome analysis, and plasma cytokines. Artificial intelligence is assessed for potential integrated interpretation of panels of diagnostic tests. Overall, a framework is proposed suggesting how combining established and emerging technologies can effectively enhance the accuracy of food allergy diagnosis in the future.

Utility of epitope-specific IgE, IgG4, and IgG1 antibodies for the diagnosis of wheat allergy

BACKGROUND

The bead-based epitope assay has been used to identify epitope-specific (es) antibodies and successfully used to diagnose clinical allergy to milk, egg, and peanut.

OBJECTIVE

We sought to identify es-IgE, es-IgG4, and es-IgG1 of wheat proteins and determine the optimal peptides to differentiate wheat-allergic from wheat-tolerant using the bead-based epitope assay.

METHODS

Children and adolescents who underwent an oral food challenge to confirm their wheat allergy status were enrolled. Seventy-nine peptides from α-/β-gliadin, γ-gliadin, ω-5-gliadin, and high- and low-molecular-weight glutenin were commercially synthesized and coupled to LumAvidin beads (Luminex Corporation, Austin, Tex). Machine learning methods were used to identify diagnostic epitopes, and performance was evaluated using the DeLong test.

RESULTS

The analysis included 122 children (83 wheat-allergic and 39 wheat-tolerant; 57.4% male). Machine learning coupled with simulations identified wheat es-IgE, but not es-IgG4 or es-IgG1, to be the most informative for diagnosing wheat allergy. Higher es-IgE binding intensity correlated with the severity of allergy phenotypes, with wheat anaphylaxis exhibiting the highest es-IgE binding intensity. In contrast, wheat-dependent exercise-induced anaphylaxis showed lower es-IgG1 binding intensity than did all the other groups. A set of 4 informative epitopes from ω-5-gliadin and γ-gliadin were the best predictors of wheat allergy, with an area under the curve of 0.908 (sensitivity, 83.4%; specificity, 88.4%), higher than the performance exhibited by wheat-specific IgE (area under the curve = 0.646; P < .001). The predictive ability of our model was confirmed in an external cohort of 71 patients (29 allergic, 42 nonallergic), with an area under the curve of 0.908 (sensitivity, 75.9%; specificity, 90.5%).

CONCLUSIONS

The wheat bead-based epitope assay demonstrated greater diagnostic accuracy compared with existing specific IgE tests for wheat allergy.

AAAAI-EAACI PRACTALL: Standardizing oral food challenges-2024 Update

This common statement of the American Academy of Allergy, Asthma and Immunology (AAAAI) and The European Academy of Allergy and Clinical Immunology (EAACI) provides an update of the 2012 published guidelines on food challenges. The guidelines equally address food challenges in the research and the clinical settings. They first address the diagnostic tests which can guide the decision to conduct a challenge. Safety of food challenges is prime, and the various procedures and safety issues as well as medications potentially involved in challenges are extensively discussed. Challenges are suggested to be conducted with semi-logarithmic incremental doses based on the protein content, typically for IgE-mediated food allergy with intervals of 20-30 min between doses. Specific protocols for other types of reactions such atopic dermatitis or gastrointestinal food allergy are detailed separately. Proper stopping criteria are essential in order to reduce the risk of false-positive diagnoses, but also severe reactions. The guidelines recommend criteria based on "go on," "stop," or "observation." These revised guidelines will clearly provide much needed guidance for food challenges in the research and clinical settings. They will continue to evolve with new diagnostic tests or new needs in the field of food allergy.

The Relationship Between Asthma and Food Allergies in Children

Asthma and food allergy are two complex allergic diseases with an increasing prevalence in childhood. They share risk factors, including atopic family history, atopic dermatitis, allergen sensitization, and T2 inflammatory pathways. Several studies have shown that in children with a food allergy, the risk of developing asthma, particularly in early childhood, is high. Food allergen intake or the inhalation of aerosolized allergens can induce respiratory symptoms such as bronchospasm. Patients with both conditions have an increased risk of severe asthma exacerbations, hospitalization, and mortality. The current management of clinical food hypersensitivity primarily involves the dietary avoidance of food allergens and the use of self-injectable adrenaline for severe reactions. Poorly controlled asthma limits the prescription of oral immunotherapy to foods, which has emerged as an alternative therapy for managing food allergies. Biological therapies that are effective in severe asthma have been explored for treating food allergies. Omalizumab improves asthma control and, either alone or in combination with oral immunotherapy, increases the threshold of allergen tolerance. Understanding the interplay between asthma and food allergy is crucial for developing successful treatment approaches and ameliorating patient results.

Investigating Exposure and Hazards of Micro- and Nanoplastics During Pregnancy and Early Life (AURORA Project): Protocol for an Interdisciplinary Study

BACKGROUND

Micro- and nanoplastics (MNPs) are emerging pollutants of concern with ubiquitous presence in global ecosystems. MNPs pose potential implications for human health; however, the health impacts of MNP exposures are not yet understood. Recent evidence suggests that MNPs can cross the placental barrier, underlying the urgent need to understand their impact on reproductive health and development.

OBJECTIVE

The Actionable eUropean ROadmap for early-life health Risk Assessment of micro- and nanoplastics (AURORA) project will investigate MNP exposures and their biological and health effects during pregnancy and early life, which are critical periods due to heightened vulnerability to environmental stressors. The AURORA project will enhance exposure assessment capabilities for measuring MNPs, MNP-associated chemicals, and plastic additives in human tissues, including placenta and blood.

METHODS

In this interdisciplinary project, we will advance methods for in-depth characterization and scalable chemical analytical strategies, enabling high-resolution and large-scale toxicological, exposure assessment, and epidemiological studies. The AURORA project performs observational studies to investigate determinants and health impacts of MNPs by including 800 mother-child pairs from 2 existing birth cohorts and 110 women of reproductive age from a newly established cohort. This will be complemented by toxicological studies using a tiered-testing approach and epidemiological investigations to evaluate associations between maternal and prenatal MNP exposures and health perturbations, such as placental function, immune-inflammatory responses, oxidative stress, accelerated aging, endocrine disruption, and child growth and development. The ultimate goal of the AURORA project is to create an MNP risk assessment framework and identify the remaining knowledge gaps and priorities needed to comprehensively assess the impact of MNPs on early-life health.

RESULTS

In the first 3 years of this 5-year project (2021-2026), progress was made toward all objectives. This includes completion of recruitment and data collection for new and existing cohorts, development of analytical methodological protocols, and initiation of the toxicological tiered assessments. As of September 2024, data analysis is ongoing and results are expected to be published starting in 2025.

CONCLUSIONS

As plastic pollution increases globally, it is imperative to understand the impact of MNPs on human health, particularly during vulnerable developmental stages such as early life. The contributions of the AURORA project will inform future risk assessment.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63176.

Skin and oral intervention for food allergy prevention based on dual allergen exposure hypothesis

Early-onset atopic dermatitis increases an individual's risk of food allergies, suggesting that transcutaneous sensitization may occur through inflamed skin. Regarding food allergy causation, the dual allergen exposure hypothesis proposes that oral allergen exposure leads to immune tolerance, whereas allergen exposure via inflamed skin causes food allergies. This hypothesis suggests that it is important to induce oral immune tolerance and prevent allergic food sensitization through the skin. This review focuses on the breakthrough evidence based on the dual allergen exposure hypothesis that involves both skin and oral interventions for food allergy prevention.

Machine learning-derived phenotypic trajectories of asthma and allergy in children and adolescents: protocol for a systematic review

INTRODUCTION

Development of asthma and allergies in childhood/adolescence commonly follows a sequential progression termed the 'atopic march'. Recent reports indicate, however, that these diseases are composed of multiple distinct phenotypes, with possibly differential trajectories. We aim to synthesise the current literature in the field of machine learning-based trajectory studies of asthma/allergies in children and adolescents, summarising the frequency, characteristics and associated risk factors and outcomes of identified trajectories and indicating potential directions for subsequent research in replicability, pathophysiology, risk stratification and personalised management. Furthermore, methodological approaches and quality will be critically appraised, highlighting trends, limitations and future perspectives.

METHODS AND ANALYSES

10 databases (CAB Direct, CINAHL, Embase, Google Scholar, PsycInfo, PubMed, Scopus, Web of Science, WHO Global Index Medicus and WorldCat Dissertations and Theses) will be searched for observational studies (including conference abstracts and grey literature) from the last 10 years (2013-2023) without restriction by language. Screening, data extraction and assessment of quality and risk of bias (using a custom-developed tool) will be performed independently in pairs. The characteristics of the derived trajectories will be narratively synthesised, tabulated and visualised in figures. Risk factors and outcomes associated with the trajectories will be summarised and pooled estimates from comparable numerical data produced through random-effects meta-analysis. Methodological approaches will be narratively synthesised and presented in tabulated form and figure to visualise trends.

ETHICS AND DISSEMINATION

Ethical approval is not warranted as no patient-level data will be used. The findings will be published in an international peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023441691.

Epidemiology of Paediatric Italian Food Allergy: Results of the EPIFA study

Background

Updated epidemiologic data are important for defining effective public health strategies for pediatric food allergy (FA).

Objective

The Epidemiology of Paediatric Italian Food Allergy (EPIFA) study was designed to investigate the epidemiology of pediatric FA in one of the most heavily populated Italian regions.

Methods

A retrospective cohort study was performed in collaboration with family pediatricians aimed at investigating the epidemiology of Italian pediatric FA during 2009 to 2021. Family pediatricians in the Campania region were invited to use the Google Forms platform for online compilation of data forms. Data forms were reviewed by experienced pediatric allergists at the coordinating center.

Results

A total population of 105,151 subjects (aged 0-14 years) was screened during the study period. Data from 752 FA patients were evaluated. A progressive increase in FA incidence and prevalence was observed from 2009 to 2021, with a relative increase up to 34% and 113.6%, respectively, at the end of study period. The relative increase in FA prevalence was higher in the 0-3-year-old age group in the same study period (+120.8%). The most frequent allergens were cow's milk, hen's egg, and nuts.

Conclusion

The results of the EPIFA study showed an increase in pediatric FA incidence and prevalence from 2009 to 2021 in Italy. These results underline the necessity of new effective strategies for preventing and managing these conditions.

Children's food allergy: Effects of environmental influences and antibiotic use across critical developmental windows

BACKGROUND

Increasing studies linked outdoor air pollution (OAP), indoor environmental factors (IEFs), and antibiotics use (AU) with the first wave of allergies (i.e., asthma, allergic rhinitis, and eczema), yet the role of their exposures on children's second wave of allergy (i.e., food allergy) are unknown.

OBJECTIVES

To investigate the association between exposure to OAP and IEFs and childhood doctor-diagnosed food allergy (DFA) during the pre-pregnancy, prenatal, early postnatal, and current periods, and to further explore the effect of OAP and IEFs on DFA in children co-exposed to antibiotics.

METHODS

A retrospective cohort study involving 8689 preschoolers was carried out in Changsha, China. Data on the health outcomes, antibiotic use, and home environment of each child were collected through a questionnaire. Temperature and air pollutants data were obtained from 8 and 10 monitoring stations in Changsha, respectively. Exposure levels to temperature and air pollutants at individual home addresses were calculated by the inverse distance weighted (IDW) method. Multiple logistic regression models were employed to assess the associations of childhood DFA with exposure to OAP, IEF, and AU.

RESULTS

Childhood ever doctor-diagnosed food allergy (DFA) was linked to postnatal PM10 exposure with OR (95% CI) of 1.18 (1.03-1.36), especially for CO and O3 exposure during the first year with ORs (95% CI) = 1.08 (1.00-1.16) and 1.07 (1.00-1.14), as well as SO2 exposure during the previous year with OR (95% CI) of 1.13 (1.02-1.25). The role of postnatal air pollution is more important for the risk of egg, milk and other food allergies. Renovation-related IAP (new furniture) and dampness-related indoor allergens exposures throughout all time windows significantly increased the risk of childhood DFA, with ORs ranging from 1.23 (1.03-1.46) to 1.54 (1.29-1.83). Furthermore, smoke-related IAP (environmental tobacco smoke [ETS], parental and grandparental smoking) exposure during pregnancy, first year, and previous year was related to DFA. Additionally, exposure to pet-related indoor allergens (cats) during first year and total plant-related allergens (particularly nonflowering plants) during previous year were associated with DFA. Moreover, exposure to plant-related allergy during first and previous year was specifically associated with milk allergy, while keeping cats during first year increased the risk of fruits/vegetables allergy. Life-time and early-life AU was associated with the increased risk of childhood DFA with ORs (95% CI) = 1.57 (1.32-1.87) and 1.46 (1.27-1.67), including different types food allergies except fruit/vegetable allergy.

CONCLUSIONS

Postnatal OAP, life-time and early-life IEFs and AU exposure played a vital role in the development of DFA, supporting the "fetal origin of childhood FA" hypothesis.

Lifestyle Changes and Industrialization in the Development of Allergic Diseases

PURPOSE OF REVIEW

Modernization and Westernization in industrialized and developing nations is associated with a substantial increase in chronic noncommunicable diseases. This transformation has far-reaching effects on lifestyles, impacting areas such as economics, politics, social life, and culture, all of which, in turn, have diverse influences on public health. Loss of contact with nature, alternations in the microbiota, processed food consumption, exposure to environmental pollutants including chemicals, increased stress and decreased physical activity jointly result in increases in the frequency of inflammatory disorders including allergies and many autoimmune and neuropsychiatric diseases. This review aims to investigate the relationship between Western lifestyle and inflammatory disorders.

RECENT FINDINGS

Several hypotheses have been put forth trying to explain the observed increases in these diseases, such as 'Hygiene Hypothesis', 'Old Friends', and 'Biodiversity and Dysbiosis'. The recently introduced 'Epithelial Barrier Theory' incorporates these former hypotheses and suggests that toxic substances in cleaning agents, laundry and dishwasher detergents, shampoos, toothpastes, as well as microplastic, packaged food and air pollution damage the epithelium of our skin, lungs and gastrointestinal system. Epithelial barrier disruption leads to decreased biodiversity of the microbiome and the development of opportunistic pathogen colonization, which upon interaction with the immune system, initiates local and systemic inflammation. Gaining a deeper comprehension of the interplay between the environment, microbiome and the immune system provides the data to assist with legally regulating the usage of toxic substances, to enable nontoxic alternatives and to mitigate these environmental challenges essential for fostering a harmonious and healthy global environment.

The Prevalence of IgE-Mediated Food Allergy and Other Allergic Diseases in the First 10 Years: The Population-Based, Longitudinal HealthNuts Study

BACKGROUND

There are limited longitudinal data on the population prevalence of allergic conditions during childhood, and few studies have incorporated the reference standard oral food challenge to confirm food allergy.

OBJECTIVE

To describe the population prevalence of IgE-mediated food allergy, eczema, asthma, and rhinitis at ages 6 and 10 years in Melbourne, Australia.

METHODS

The HealthNuts study recruited 5,276 1-year-old infants in Melbourne, Australia, with repeat assessments at ages 6 and 10 years. At ages 6 and 10 years, carers completed a questionnaire on symptoms and doctor diagnosis of allergic conditions (International Study of Asthma and Allergies in Children). Children were invited to attend a clinic assessment including skin prick test, lung function tests, and oral food challenges when indicated. To minimize the impact of attrition bias, prevalence estimates among participants at ages 6 and 10 years were weighted to reflect characteristics of the whole cohort at recruitment.

RESULTS

In total, 4,455 and 4,065 families participated at ages 6 and 10 years, respectively (84% and 77% of the original cohort). Of those, 73% and 55% of participants ages 6 and 10 years, respectively, completed clinical assessments. Overall, 36.5% (95% CI, 34.8-38.2) and 38.2% (95% CI, 36.5-40.1%) of 6- and 10-year-olds had at least one current allergic disease, and around one third of those had two or more allergic diseases. Food allergy occurred in 6.4% (95% CI, 5.6-7.2) of 6-year olds and 6.3% (95% CI, 5.5-7.2) of 10-year-olds. Among infants with challenge-confirmed food allergy in infancy, 45% had persistent disease at age 10 years. The prevalence of current diagnosed asthma at ages 6 and 10 years were 12.1% (95% CI, 10.9-13.3) and 13.1% (95% CI, 11.9-14.4), respectively, current eczema decreased slightly from 15.3% (95% CI, 14.1-19.7) at age 6 years to 12.9% (95% CI, 11.7-14.2) at age 10 years, and current rhinitis increased from 15.1% (95% CI, 13.9-16.5) at age 6 years to 25.0% (95% CI, 23.4-26.7) at age 10 years.

CONCLUSIONS

Allergic diseases affect 40% of primary school-age children; one third have multiple allergic diagnoses. Challenge-confirmed food allergy prevalence remains high, and 45% of infants with food allergy have persistent disease to age 10 years.

Association between gut microbiota development and allergy in infants born during pandemic-related social distancing restrictions

BACKGROUND

Several hypotheses link reduced microbial exposure to increased prevalence of allergies. Here we capitalize on the opportunity to study a cohort of infants (CORAL), raised during COVID-19 associated social distancing measures, to identify the environmental exposures and dietary factors that contribute to early life microbiota development and to examine their associations with allergic outcomes.

METHODS

Fecal samples were sequenced from infants at 6 (n = 351) and repeated at 12 (n = 343) months, using 16S sequencing. Published 16S data from pre-pandemic cohorts were included for microbiota comparisons. Online questionnaires collected epidemiological information on home environment, healthcare utilization, infant health, allergic diseases, and diet. Skin prick testing (SPT) was performed at 12 (n = 343) and 24 (n = 320) months of age, accompanied by atopic dermatitis and food allergy assessments.

RESULTS

The relative abundance of bifidobacteria was higher, while environmentally transmitted bacteria such as Clostridia was lower in CORAL infants compared to previous cohorts. The abundance of multiple Clostridia taxa correlated with a microbial exposure index. Plant based foods during weaning positively impacted microbiota development. Bifidobacteria levels at 6 months of age, and relative abundance of butyrate producers at 12 months of age, were negatively associated with AD and SPT positivity. The prevalence of allergen sensitization, food allergy, and AD did not increase over pre-pandemic levels.

CONCLUSIONS

Environmental exposures and dietary components significantly impact microbiota community assembly. Our results also suggest that vertically transmitted bacteria and appropriate dietary supports may be more important than exposure to environmental microbes alone for protection against allergic diseases in infancy.

Dietary Polyphenols, Plant Metabolites, and Allergic Disorders: A Comprehensive Review

Given the ongoing rise in the occurrence of allergic disorders, alterations in dietary patterns have been proposed as a possible factor contributing to the emergence and progression of these conditions. Currently, there is a significant focus on the development of dietary therapies that utilize natural compounds possessing anti-allergy properties. Dietary polyphenols and plant metabolites have been intensively researched due to their well-documented anti-inflammatory, antioxidant, and immunomodulatory characteristics, making them one of the most prominent natural bioactive chemicals. This study seeks to discuss the in-depth mechanisms by which these molecules may exert anti-allergic effects, namely through their capacity to diminish the allergenicity of proteins, modulate immune responses, and modify the composition of the gut microbiota. However, further investigation is required to fully understand these effects. This paper examines the existing evidence from experimental and clinical studies that supports the idea that different polyphenols, such as catechins, resveratrol, curcumin, quercetin, and others, can reduce allergic inflammation, relieve symptoms of food allergy, asthma, atopic dermatitis, and allergic rhinitis, and prevent the progression of the allergic immune response. In summary, dietary polyphenols and plant metabolites possess significant anti-allergic properties and can be utilized for developing both preventative and therapeutic strategies for targeting allergic conditions. The paper also discusses the constraints in investigating and broad usage of polyphenols, as well as potential avenues for future research.

Dismantling the myth of "all foods fit" in eating disorder treatment

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

Adult-onset asthma, allergy, and aspirin hypersensitivity associate with self-reported food avoidance

Background

The adoption of avoidance diets by adult-onset asthmatics has not previously been studied. We hypothesized that avoidance diets would associate with adult-onset asthma, allergy, and aspirin-exacerbated respiratory disease (AERD).

Methods

A total of 1247 subjects with adult-onset asthma (age range: 31-91) from the Finnish national registry, and age- and sex-matched controls (n = 1970) participated in a questionnaire study in 1997. We estimated the association between asthma/allergy/AERD and avoidance diets, adjusting for potential confounding factors and validated the results in two retrospective cohorts of 5080 rhinitis/rhinosinusitis patients and 167 AERD patients from 2019 to 2020.

Results

The presence of asthma positively associated with adoption of any avoidance diet (adjusted OR [CI95%] 1.24 [1.02-1.51], p = 0.029) as did allergic disease and self-reported AERD within the asthmatic group (1.79 [1.29-2.48], p = 0.001 and 1.69 [1.15-2.49], p = 0.007, respectively). Asthmatics and allergic asthmatics were more likely to report avoidance of fish, fruits and vegetables, and spices (p ≤ 0.03) compared to controls and non-allergic asthmatics. The adjusted OR for multiple diets among AERD patients was 2.57 [1.34-4.95] p = 0.005. In the validation, 26.2% of the allergic asthmatics and 10.8% of AERD patients had documented avoidance diets.

Conclusions

Our study shows a positive association between avoidance diets and adult-onset asthma, and with allergic disease or AERD within asthmatic patients. Although we lack information on the reason patients chose to observe a specific diet, our results reinforce the importance of asking patients about their diet and if needed, giving dietary advice for adult asthma patients to help them avoid the adoption of unnecessarily restrictive diets.