1
|
Smeekens JM, Immormino RM, Kesselring JR, Turner AV, Kulis MD, Moran TP. A single priming event prevents oral tolerance to peanut. Clin Exp Allergy 2023; 53:930-940. [PMID: 37437951 PMCID: PMC10528191 DOI: 10.1111/cea.14373] [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: 01/30/2023] [Revised: 06/02/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Indoor dust (ID) is a source of peanut proteins and immunostimulatory adjuvants (e.g. LPS) that can promote airway sensitization to peanut. We aimed to determine whether a single airway exposure to peanut plus adjuvant is sufficient to prevent oral tolerance. METHODS To determine the effect of a single priming event, C57BL/6J mice were exposed once to peanut plus adjuvant through the airway, followed by either airway or low-dose oral exposure to peanut, and assessed for peanut allergy. Oral tolerance was investigated by feeding high-dose peanut followed by airway sensitization. To determine whether a single priming could prevent oral tolerance, the high-dose peanut regimen was applied after a single airway exposure to peanut plus adjuvant. Peanut-specific IgE and IgG1 were quantified, and mice were challenged to peanut to assess allergy. Peanut-specific CD4+ memory T cells (CD4+ TCRβ+ CD44hi CD154+ ) were quantified in mediastinal lymph nodes following airway priming. RESULTS Mice co-exposed to peanut with LPS or ID through the airway were primed to develop peanut allergy after subsequent low-dose oral or airway exposures to peanut. Oral tolerance was induced in mice fed high-dose peanut prior to airway sensitization. In contrast, mice fed high-dose peanut following a single airway exposure to peanut plus adjuvant led to allergy. Peanut-specific CD4+ memory T cells were detected as early as 7 days after the single airway priming with peanut plus adjuvant, however, delaying peanut feeding even 1 day following priming led to allergy, whereas peanut feeding the same day as priming led to tolerance. CONCLUSIONS A single airway exposure to peanut plus adjuvant is sufficient to prime the immune system to develop allergy following subsequent high-dose oral exposure. These results highlight the importance of introducing peanut as early as possible to prevent sensitization through a non-oral priming event.
Collapse
Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Robert M Immormino
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Janelle R Kesselring
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew V Turner
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael D Kulis
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pediatrics, UNC Food Allergy Initiative, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy P Moran
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
2
|
Immormino RM, Smeekens JM, Mathai PI, Kesselring JR, Turner AV, Kulis MD, Moran TP. Peanut butter feeding induces oral tolerance in genetically diverse collaborative cross mice. FRONTIERS IN ALLERGY 2023; 4:1219268. [PMID: 37528863 PMCID: PMC10387557 DOI: 10.3389/falgy.2023.1219268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023] Open
Abstract
Background Early dietary introduction of peanut has shown efficacy in clinical trials and driven pediatric recommendations for early introduction of peanut to children with heightened allergy risk worldwide. Unfortunately, tolerance is not induced in every case, and a subset of patients are allergic prior to introduction. Here we assess peanut allergic sensitization and oral tolerance in genetically diverse mouse strains. Objective We aimed to determine whether environmental adjuvant-driven airway sensitization and oral tolerance to peanut could be induced in various genetically diverse mouse strains. Methods C57BL/6J and 12 Collaborative Cross (CC) mouse strains were fed regular chow or ad libitum peanut butter to induce tolerance. Tolerance was tested by attempting to sensitize mice via intratracheal exposure to peanut and lipopolysaccharide (LPS), followed by intraperitoneal peanut challenge. Peanut-specific immunoglobulins and peanut-induced anaphylaxis were assessed. Results Without oral peanut feeding, most CC strains (11/12) and C57BL/6J induced peanut-specific IgE and IgG1 following airway exposure to peanut and LPS. With oral peanut feeding none of the CC strains nor C57BL/6J mice became sensitized to peanut or experienced anaphylaxis following peanut challenge. Conclusion Allergic sensitization and oral tolerance to peanut can be achieved across a range of genetically diverse mice. Notably, the same strains that became allergic via airway sensitization were tolerized by feeding high doses of peanut butter before sensitization, suggesting that the order and route of peanut exposure are critical for determining the allergic fate.
Collapse
Affiliation(s)
- Robert M. Immormino
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Johanna M. Smeekens
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Priscilla I. Mathai
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Janelle R. Kesselring
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Andrew V. Turner
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Michael D. Kulis
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
- UNC Food Allergy Initiative, Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| | - Timothy P. Moran
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC, United States
| |
Collapse
|
3
|
Logan K, Du Toit G, Giovannini M, Turcanu V, Lack G. Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance. Annu Rev Cell Dev Biol 2020; 36:511-528. [PMID: 32634325 DOI: 10.1146/annurev-cellbio-100818-125346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.
Collapse
Affiliation(s)
- Kirsty Logan
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - George Du Toit
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - Mattia Giovannini
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom; .,Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Victor Turcanu
- School of Immunology and Microbial Sciences and School of Life Course Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| |
Collapse
|
4
|
Kulis MD, Smeekens JM, Kavanagh K, Jorgensen MJ. Peanut applied to the skin of nonhuman primates induces antigen-specific IgG but not IgE. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:211-215. [PMID: 32220059 PMCID: PMC7212195 DOI: 10.1002/iid3.296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/23/2020] [Accepted: 02/25/2020] [Indexed: 02/02/2023]
Abstract
Introduction Previous studies in humans support the dual‐allergen exposure hypothesis, and several studies in mouse models have demonstrated that cutaneous exposure to disrupted or intact skin can lead to sensitization to peanut. However, the field lacks definitive evidence that cutaneous exposure leads to peanut allergy in humans or other primates. Methods Peanut extract was applied to the shaved back of the neck of four male and four female African green monkeys three times per week for 4 weeks. An oral food challenge (OFC) was performed the following week by gavage of 200 mg of peanut protein, and vital signs were monitored for 30 minutes post‐OFC. Blood was collected at baseline, day 11, day 32, and 30 minutes post‐OFC. Total IgE, and peanut‐specific immunoglobulin E (IgE) and immunoglobulin G (IgG) were quantified in serum collected throughout the 4 weeks. Histamine was measured in serum collected 30 minutes post‐OFC. Results Peanut‐specific IgE was undetectable at any time points in any of the monkeys, and there was no consistent increase in total IgE. During the oral challenge, none of the monkeys experienced allergic symptoms and histamine levels did not change. However, seven of the eight monkeys produced increasing peanut‐specific IgG by day 32, indicating that repeated skin exposure to peanut is immunogenic. Conclusions Skin exposure to peanut did not lead to sensitization in this study, and monkeys did not experience anaphylaxis upon peanut challenge. However, monkeys produced increased peanut‐specific IgG throughout peanut exposure, indicating that repeated skin exposure to peanut is immunogenic.
Collapse
Affiliation(s)
- Michael D Kulis
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina Food Allergy Initiative, University of North Carolina, Chapel Hill, North Carolina
| | - Johanna M Smeekens
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.,Department of Pediatrics, University of North Carolina Food Allergy Initiative, University of North Carolina, Chapel Hill, North Carolina
| | - Kylie Kavanagh
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Biomedicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Matthew J Jorgensen
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
5
|
Kandhare AD, Liu Z, Mukherjee AA, Bodhankar SL. Therapeutic Potential of Morin in Ovalbumin-induced Allergic Asthma Via Modulation of SUMF2/IL-13 and BLT2/NF-kB Signaling Pathway. Curr Mol Pharmacol 2019; 12:122-138. [PMID: 30605067 DOI: 10.2174/1874467212666190102105052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/30/2018] [Accepted: 12/17/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Allergic asthma is a chronic immune-inflammatory disorder, characterized by airway inflammation and airway hyperresponsiveness (AHR). Morin is a natural flavonoid reported to exhibit inhibitory action against IgE-mediated allergic response. AIM To determine the efficacy of murine model of ovalbumin (OVA)-induced AHR inhibition by morin and decipher the molecular mechanism involved. MATERIALS AND METHODS Sprague-Dawley rats were sensitized and challenged with OVA to induce AHR. Rats received treatment with morin (10, 30 and 100 mg/kg, p.o.) for the next 28 days. RESULTS Morin (30 and 100 mg/kg) significantly and dose-dependently attenuated (p < 0.01 and p < 0.001) OVA-induced alterations in pulse oxy and lung function test, increased bronchoalveolar lavage fluid cell counts, elevated total protein and albumin levels in serum, BALF, and lungs, increased serum total and OVA-specific IgE levels and, elevated oxidative stress levels in the lung. RT-PCR analysis revealed that morin treatment (30 and 100 mg/kg) significantly (p < 0.001) up-regulated SUMF2 mRNA expression in lungs whereas mRNA expressions of BLT2, NF-κB, and Th2-cytokine (TNF-α, IL-1β, IL-4, IL-6, and IL-13) were down-regulated significantly and dose-dependently (p < 0.01 and p < 0.001). Also, histologic and ultrastructural studies showed that morin significantly inhibited (p < 0.001) OVAinduced perivascular and peribranchial inflammatory infiltration and interstitial fibrosis. CONCLUSION Morin exhibited inhibitory effect against OVA-induced allergic asthma by activation of SUMF2 which impeded IL-13 expression and in turn attenuated Th2-cytokines, BLT2, NF-κB, and IgE levels to ameliorate AHR. Thus, our findings suggested that morin could be considered as a potential alternative therapeutic agent for the management of allergic asthma.
Collapse
Affiliation(s)
- Amit D Kandhare
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Erandwane, Paud Road, Pune-411 038, India
| | - Zihao Liu
- Jiangxi Medical College, Nanchang University, Jiangxi 330006, China
| | - Anwesha A Mukherjee
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Erandwane, Paud Road, Pune-411 038, India
| | - Subhash L Bodhankar
- Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Erandwane, Paud Road, Pune-411 038, India
| |
Collapse
|
6
|
Boutin RCT, Dwyer Z, Farmer K, Rudyk C, Forbes MR, Hayley S. Perinatal antibiotic exposure alters composition of murine gut microbiota and may influence later responses to peanut antigen. Allergy Asthma Clin Immunol 2018; 14:42. [PMID: 30410548 PMCID: PMC6211427 DOI: 10.1186/s13223-018-0263-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/30/2018] [Indexed: 01/06/2023] Open
Abstract
Background Accumulating evidence suggests that the gut microbiota shapes developmental processes within the immune system. Early life antibiotic use is one factor which may contribute to immune dysfunction and the recent surge in allergies by virtue of its effects on gut microbiota. Objective and methods As a first step towards determining whether a relationship exists between perinatal antibiotic induced changes in the gut microbiota and the later development of a peanut allergy, we exposed newborn mice to either the broad-spectrum antibiotic vancomycin or to a vehicle for 6 weeks and then used a novel murine model of peanut allergy. Results Early-life treatment with vancomycin resulted in a significant shift in the gut microbiota community characterized by a reduction in the abundance of firmicutes and preponderance of inflammatory proteobacteria. Mice with an antibiotic-altered microbiota, showed a localized allergic-like response characterized by ear swelling and scratching following intra-dermal peanut antigen challenge. Likewise, circulating IgE levels were increased in antibiotic-treated mice, but no evidence of a systemic allergic or anaphylactic-like response was observed. Importantly, we utilized the naturally occurring pro-inflammatory cytokine, tumor necrosis factor-α (TNF-α), rather than the more commonly used cholera toxin, as an adjuvant together with the peanut antigen. Conclusion Our data suggest that early antibiotic exposure promotes a shift in the gut microbiota community that may in turn, influence how mice later respond to a TNF-α + antigen challenge. However, further studies verifying the capacity of microbiota restoration to protect against allergic responses will be needed to confirm a causal role of antibiotic-induced microbiota variations in promoting allergic disease phenotypes.
Collapse
Affiliation(s)
- Rozlyn C T Boutin
- 1Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada.,2Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada
| | - Zach Dwyer
- 1Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada.,2Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada
| | - Kyle Farmer
- 1Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada.,2Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada
| | - Chris Rudyk
- 1Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada.,2Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada
| | - Mark R Forbes
- 1Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada.,2Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada
| | - Shawn Hayley
- 1Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada.,2Department of Biology, Carleton University, 1125 Colonel By Drive, Ottawa, K1S 5B6 ON Canada
| |
Collapse
|
7
|
Al-Saud B, Sigurdardóttir ST. Early Introduction of Egg and the Development of Egg Allergy in Children: A Systematic Review and Meta-Analysis. Int Arch Allergy Immunol 2018; 177:350-359. [PMID: 30184525 DOI: 10.1159/000492131] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The timing of the introduction of egg to an infant's diet is of current interest, as new evidence raises questions regarding the benefit of delaying egg introduction. The objective of this study was to systematically review the existing literature regarding the effect of the early introduction of egg on the development of egg allergy. METHODS Literature searches were conducted in MEDLINE, EMBASE, and CENTRAL, and trial protocols were searched in Meta Register and OpenGREY. Only randomized controlled trials (RCTs) comparing early (between 3 and 6 months of age) egg introduction to no early introduction were included. The primary outcome was the development of egg allergy. RESULTS Of the 416 articles identified and screened, 6 RCTs met the eligibility criteria for data extraction. Allergic outcomes were evaluated in a total of 3,032 participants. A low to moderate level of evidence showed a benefit of the early introduction of egg (relative risk, RR 0.60, 95% CI 0.44-0.82, p = 0.002, mild heterogeneity, I2 = 23%). The absolute risk reduction for a population with an incidence of egg allergy of 9.3% was 37 fewer cases (95% CI 17-52) per 1,000 people. Consumption of < 4,000 mg/week of egg protein had a greater preventive effect than a higher dose. CONCLUSION This systematic review and meta-analysis showed an association between the early introduction of egg and a lower risk of egg allergy. Furthermore, the nature and dose of egg protein exposure may play a role. These findings should be addressed in the context of primary studies.
Collapse
Affiliation(s)
- Bandar Al-Saud
- Section of Pediatric Allergy/Immunology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi .,College of Medicine, Alfaisal University, Riyadh, Saudi
| | - Sigurveig T Sigurdardóttir
- Department of Immunology, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
8
|
Pereira E Silva A, Soares JRA, Mattos EBDA, Josetti C, Guimarães IM, Campos SMN, Teixeira GAPB. A histomorphometric classification system for normal and inflamed mouse duodenum-Quali-quantitative approach. Int J Exp Pathol 2018; 99:189-198. [PMID: 30175413 DOI: 10.1111/iep.12286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/04/2018] [Accepted: 07/16/2018] [Indexed: 12/22/2022] Open
Abstract
Gut-associated intestinal lymphoid tissue, the largest secondary lymphoid organ in the human body, constantly samples antigens from the gut lumen, presenting as a default response the activation of TCD4+ FOXP3+ regulatory T cells that secrete a profile of anti-inflammatory cytokines maintaining gut homeostasis denominated from an immunological perspective as mucosal tolerance. However, when antigens are sampled in an inflammatory setting, the immune response may either be protective, in the case of harmful pathogens, or cause further inflammatory reactions as in food allergy, inflammatory bowel diseases, coeliac disease or food protein-induced enterocolitis syndrome. Therefore, there is a need for accurate and consistent experimental models. However, a drawback in comparing these models is the lack of a classification system similar to that which is already used for humans. Thus, the aim of this work was to propose a classification system of the small intestinal histomorphology in experimental mice. To do this we used a mouse antigen-specific gut inflammation model developed by our research group. Duodenum sections stained with haematoxylin-eosin and Alcian blue were scanned using the APERIO scanning system and analysed with the ImageScope® software. The evaluated parameters were villus area, villus height and width, enterocyte count, mononuclear intra-epithelial leucocyte and goblet cell counts, and architectural and cellular ratios. Food-sensitized animals challenged with a diet containing the corresponding food allergen presented, as for humans, time-dependent shortened and widened villi accompanied by leucocyte infiltrate and loss of goblet cells. With these data, we were able to establish a classification system for experimental intestinal inflammation in mice thus permitting better comparisons among and between experiments than has been possible previously.
Collapse
Affiliation(s)
- Airton Pereira E Silva
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - João R A Soares
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Erika Bertozzi de Aquino Mattos
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Claudia Josetti
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Isabelle M Guimarães
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | - Sylvia M N Campos
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Department of Nutrition, VP Graduation Program, São Paulo, Brazil
| | - Gerlinde A P B Teixeira
- Gastrointestinal Immunology Group, Department of Immunobiology, Institute of Biology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Pathology, Medicine School, Antônio Pedro Hospital, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil.,Graduate Program in Science and Biotechnology, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Remington B, Broekman HCH, Blom WM, Capt A, Crevel RWR, Dimitrov I, Faeste CK, Fernandez-Canton R, Giavi S, Houben GF, Glenn KC, Madsen CB, Kruizinga AK, Constable A. Approaches to assess IgE mediated allergy risks (sensitization and cross-reactivity) from new or modified dietary proteins. Food Chem Toxicol 2017; 112:97-107. [PMID: 29258956 DOI: 10.1016/j.fct.2017.12.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 11/03/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
Abstract
The development and introduction of new dietary protein sources has the potential to improve food supply sustainability. Understanding the potential allergenicity of these new or modified proteins is crucial to ensure protection of public health. Exposure to new proteins may result in de novo sensitization, with or without clinical allergy, or clinical reactions through cross-reactivity. In this paper we review the potential of current methodologies (in silico, in vitro degradation, in vitro IgE binding, animal models and clinical studies) to address these outcomes for risk assessment purposes for new proteins, and especially to identify and characterise the risk of sensitization for IgE mediated allergy from oral exposure. Existing tools and tests are capable of assessing potential crossreactivity. However, there are few possibilities to assess the hazard due to de novo sensitization. The only methods available are in vivo models, but many limitations exist to use them for assessing risk. We conclude that there is a need to understand which criteria adequately define allergenicity for risk assessment purposes, and from these criteria develop a more suitable battery of tests to distinguish between proteins of high and low allergenicity, which can then be applied to assess new proteins with unknown risks.
Collapse
Affiliation(s)
| | - H C H Broekman
- Dep. Dermatology/Allergology, University Medical Centre Utrecht (UMCU), P.O. Box 85500, The Netherlands
| | | | - A Capt
- Bayer SAS, Sophia Antipolis, France
| | - R W R Crevel
- Safety & Environmental Assurance Centre, Unilever, Bedford, UK
| | - I Dimitrov
- Faculty of Pharmacy, Medical University of Sofia, Sofia, 1000 Bulgaria
| | - C K Faeste
- Norwegian Veterinary Institute, Oslo, Norway
| | - R Fernandez-Canton
- Monsanto Europe S.A., Avenue de Tervuren 270-272, B-1150 Brussels, Belgium
| | - S Giavi
- Allergy Department, 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | | | - K C Glenn
- Monsanto Company, 800 N. Lindbergh Boulevard, St. Louis, MO 63017, USA
| | - C B Madsen
- National Food Institute, Technical University of Denmark, Søborg, Denmark
| | | | - A Constable
- Nestec Ltd, P.O. Box 44, CH-1000 Lausanne 26, Switzerland
| |
Collapse
|
10
|
Foong RX, Brough H. The role of environmental exposure to peanut in the development of clinical allergy to peanut. Clin Exp Allergy 2017; 47:1232-1238. [PMID: 28779526 DOI: 10.1111/cea.12992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 01/17/2023]
Abstract
The prevalence of peanut allergy has increased over the years and still remains one of the most common causes of food-related anaphylaxis. The way in which peanut sensitization occurs has been explored, such as via maternal consumption in pregnancy, via breastmilk and through a disrupted skin barrier. It has previously been shown that environmental exposure to aeroallergens in household dust can be a risk factor for the development of allergic asthma. There is an increasing body of evidence that the combination of cutaneous sensitization via a disrupted skin barrier (ie children with eczema or with filaggrin mutations) and environmental peanut exposure influences the development of peanut allergy. This review aims to explore routes of peanut sensitization and the current evidence on how environmental exposure to peanut affects the development of peanut allergy.
Collapse
Affiliation(s)
- R X Foong
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London and Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK.,Institute of Child Health, University College of London, London, UK
| | - H Brough
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London and Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Marco-Martín G, La Rotta Hernández A, Vázquez de la Torre M, Higaki Y, Zubeldia JM, Baeza ML. Differences in the Anaphylactic Response between C3H/HeOuJ and BALB/c Mice. Int Arch Allergy Immunol 2017; 173:204-212. [DOI: 10.1159/000478983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/26/2017] [Indexed: 01/14/2023] Open
|
12
|
Smole U, Schabussova I, Pickl WF, Wiedermann U. Murine models for mucosal tolerance in allergy. Semin Immunol 2017; 30:12-27. [PMID: 28807539 DOI: 10.1016/j.smim.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/21/2017] [Indexed: 02/07/2023]
Abstract
Immunity is established by a fine balance to discriminate between self and non-self. In addition, mucosal surfaces have the unique ability to establish and maintain a state of tolerance also against non-self constituents such as those represented by the large numbers of commensals populating mucosal surfaces and food-derived or air-borne antigens. Recent years have seen a dramatic expansion in our understanding of the basic mechanisms and the involved cellular and molecular players orchestrating mucosal tolerance. As a direct outgrowth, promising prophylactic and therapeutic models for mucosal tolerance induction against usually innocuous antigens (derived from food and aeroallergen sources) have been developed. A major theme in the past years was the introduction of improved formulations and novel adjuvants into such allergy vaccines. This review article describes basic mechanisms of mucosal tolerance induction and contrasts the peculiarities but also the interdependence of the gut and respiratory tract associated lymphoid tissues in that context. Particular emphasis is put on delineating the current prophylactic and therapeutic strategies to study and improve mucosal tolerance induction in allergy.
Collapse
Affiliation(s)
- Ursula Smole
- Institute of Immunology, Center for Pathophysiology, Infectiology, and Immunology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Irma Schabussova
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Winfried F Pickl
- Institute of Immunology, Center for Pathophysiology, Infectiology, and Immunology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
| | - Ursula Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
13
|
Huang A, Cho C, Leung DYM, Brar K. Atopic Dermatitis: Early Treatment in Children. CURRENT TREATMENT OPTIONS IN ALLERGY 2017; 4:355-369. [PMID: 29868331 DOI: 10.1007/s40521-017-0140-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Therapeutic regimens for the treatment and long-term management of AD traditionally had a two-fold objective of decreasing skin inflammation and repairing the defective skin barrier. Essential treatments for AD in children should include topical moisturizers for skin hydration and prevention of flares, topical anti-inflammatory medications (e.g. corticosteroids, calcineurin inhibitors, PDE4 inhibitor), allergen/irritant avoidance, and treatment of skin infections. Treatment regimens should be severity-based, and implemented in a stepwise approach tailored to the individual patient. This stepwise approach includes initial use of emollients, gentle skin care, and escalating to more potent anti-inflammatory treatments as the disease severity increases. Currently available systemic medications should be reserved for the presence of recalcitrance to topical therapies due to associated toxicities. We believe that early treatment of AD is not only essential in treating the skin disease, but also in preventing the development of additional atopic diseases, such as food allergy, asthma and allergic rhinitis. The defective skin barrier of AD permits a route of entry for food and environmental allergens, and upon exposure, keratinocytes secrete TSLP, which activates the TH2 pathway. This TH2 differentiation sets off the atopic march and the subsequent diseases that are seen. This review highlights treatment options and strategies in pediatric AD therapy with an emphasis on early therapy. Supporting evidence on the efficacy and safety of each intervention will be discussed.
Collapse
Affiliation(s)
- Amy Huang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
| | - Christine Cho
- Department of Pediatrics, National Jewish Health, Denver, CO
| | | | - Kanwaljit Brar
- Department of Pediatrics, National Jewish Health, Denver, CO
| |
Collapse
|
14
|
|
15
|
Wood RA. Advances in food allergy in 2015. J Allergy Clin Immunol 2016; 138:1541-1547. [DOI: 10.1016/j.jaci.2016.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 12/17/2022]
|
16
|
Kelleher MM, Dunn-Galvin A, Gray C, Murray DM, Kiely M, Kenny L, McLean WHI, Irvine AD, Hourihane JO. Skin barrier impairment at birth predicts food allergy at 2 years of age. J Allergy Clin Immunol 2016; 137:1111-1116.e8. [PMID: 26924469 DOI: 10.1016/j.jaci.2015.12.1312] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/03/2015] [Accepted: 12/03/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Transcutaneous exposure to food allergens can lead to food sensitization (FS)/food allergy (FA). We measured skin barrier function in early infancy and related it to the later development of FS/FA at age 2 years. OBJECTIVE We sought to examine the relationship between early life skin barrier function and FA in infancy. METHODS Infants in the Babies After Scope: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints (BASELINE) birth cohort had transepidermal water loss (TEWL) measured in the early newborn period and at 2 and 6 months of age. At age 2 years, infants had FS/FA screening with skin prick tests and oral food challenges. RESULTS One thousand nine hundred three infants were enrolled. One thousand three hundred fifty-five were retained to age 2 years, and 1260 underwent FS screening. FS was present in 6.27% (79/1260; 95% CI, 4.93% to 7.61%), and FA prevalence was 4.45% (56/1258; 95% CI, 3.38% to 5.74%). Egg was the most prevalent allergen (2.94%), followed by peanut (1.75%) and cow's milk (0.74%). Day 2 upper-quartile TEWL (>9 g water/m(2)/h) was a significant predictor of FA at age 2 years (odds ratio [OR], 4.1; 95% CI, 1.5-4.8). Seventy-five percent of children with FA at 2 years of age had day 2 TEWL in the upper quartile. Even in those without atopic dermatitis (AD), infants with upper-quartile day 2 TEWL were 3.5 times more likely to have FA at 2 years than infants in the lowest quartile (95% CI, 1.3-11.1; P = .04). CONCLUSION Neonatal skin barrier dysfunction predicts FA at 2 years of age, supporting the concept of transcutaneous allergen sensitization, even in infants who do not have AD. TEWL could be used for stratifying infants in the first few days of life before development of AD or FA for targeted intervention studies to potentially alter the atopic march.
Collapse
Affiliation(s)
- Maeve M Kelleher
- Paediatrics and Child Health, University College Cork, Cork, Ireland
| | | | - Claire Gray
- Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M Murray
- Paediatrics and Child Health, University College Cork, Cork, Ireland; National Children's Research Centre, Dublin, Ireland
| | - Mairead Kiely
- Vitamin D Research Group, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Louise Kenny
- Irish Centre for Fetal and Neonatal Translational Research, University College Cork, and Cork University Maternity Hospital, Cork, Ireland
| | - W H Irwin McLean
- Dermatology and Genetic Medicine, University of Dundee, Dundee, United Kingdom
| | - Alan D Irvine
- National Children's Research Centre, Dublin, Ireland; Paediatric Dermatology, Our Lady's Children's Hospital, Dublin, Ireland; Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, University College Cork, Cork, Ireland; National Children's Research Centre, Dublin, Ireland.
| |
Collapse
|
17
|
Abstract
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder present in up to 20% of children. Recent advances implicate skin barrier dysfunction as central to disease pathogenesis. Genetic defects in the filaggrin gene, the product of which is important for maintaining the epidermal barrier, are a strong predisposing factor in the development of AD. In addition to reducing identifiable triggers, treatment should focus on the four clinical characteristics of eczema: emollients for dry skin, topical anti-inflammatory agents to reduce inflammation and itch, and strategies to reduce infection/colonization, which can include diluted bleach baths. New studies demonstrate that early emollient application from birth may prevent development of AD. [Pediatr Ann. 2016;45(8):e280-e286.].
Collapse
|
18
|
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: 57] [Impact Index Per Article: 7.1] [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
|
19
|
Yang H, Lee J, Seo JH, Oh KH, Cho YH, Yoo YC. Induction of Oral Tolerance by Gamma-Irradiated Ovalbumin Administration. Korean J Food Sci Anim Resour 2016; 36:14-8. [PMID: 27499658 PMCID: PMC4973942 DOI: 10.5851/kosfa.2016.36.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hui Yang
- Department of Microbiology, Konyang University, Daejeon 35365, Korea
- These authors contributed equally to this work
| | - Junglim Lee
- Department of Microbiology, Konyang University, Daejeon 35365, Korea
- Myunggok Medical Research Institute of Konyang University, Daejeon 35365, Korea
- These authors contributed equally to this work
| | - Ji Hyun Seo
- Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup 56212, Korea
| | - Kwang Hoon Oh
- Department of Physical Education, Konju National University, Gongju 32688, Korea
| | - Young Ho Cho
- Department of Pharmaceutics & Biotechnology, Konyang University, Daejeon 35365, Korea
| | - Yung Choon Yoo
- Department of Microbiology, Konyang University, Daejeon 35365, Korea
- Myunggok Medical Research Institute of Konyang University, Daejeon 35365, Korea
- Corresponding author: Yung Choon Yoo, Department of Microbiology, Konyang University, Daejeon 35365, Korea. Tel: +82-42-600-6495, Fax: +82-42-600-6495, E-mail:
| |
Collapse
|
20
|
Kim DC, Seo AD, Yang SI, Lee HR, Lee SY. Breastfeeding increases the risk of food sensitization but not affect food allergy symptoms in young children with atopic dermatitis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.3.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Dong Chan Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - An Deok Seo
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Song I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hae Ran Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW The paradigm for the primary prevention of peanut allergy was, until recently, strict avoidance of peanut during pregnancy, infancy, and early childhood. However, in countries that had these dietary guidelines, the prevalence of peanut allergy greatly increased in contrast to low prevalence rates of peanut allergy in countries where infant diets included peanut at an early age, suggesting the hypothesis that early introduction of peanut is superior to delayed introduction of peanut as a strategy for the primary prevention of food allergy. This review examines recent high-quality studies that support this hypothesis. RECENT FINDINGS Publication of the Learning Early about Allergy to Peanut interventional trial showed that 17% of children avoiding peanut until 5 years of age developed peanut allergy compared with 3% of children who started eating peanut at ages of 4-11 months. Two birth cohort studies demonstrated that high maternal consumption of peanut during the pregnancy period reduced the risk of peanut allergy in offspring by 50-75%. SUMMARY Recent studies indicate that early introduction of peanut enhances the development of tolerance to peanut, reducing the risk of childhood peanut allergy.
Collapse
|
22
|
Mondoulet L, Dioszeghy V, Thébault C, Benhamou PH, Dupont C. Epicutaneous immunotherapy for food allergy as a novel pathway for oral tolerance induction. Immunotherapy 2015; 7:1293-305. [PMID: 26584421 DOI: 10.2217/imt.15.86] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Epicutaneous immunotherapy is a developing technique, aiming at desensitizing patients with food allergy with less risks that oral ingestion or injection could generate. Several clinical trials have been performed and are currently running, in milk and peanut allergy, assessing the safety of the technique and its efficacy. Preclinical models indicate a major role in the mechanisms of desensitization, for example, Tregs and epigenetic modifications.
Collapse
Affiliation(s)
- Lucie Mondoulet
- DBV Technologies, Green Square, 80/84 rue des Meuniers, Bagneux, France
| | - Vincent Dioszeghy
- DBV Technologies, Green Square, 80/84 rue des Meuniers, Bagneux, France
| | - Claude Thébault
- DBV Technologies, Green Square, 80/84 rue des Meuniers, Bagneux, France
| | | | - Christophe Dupont
- Université Paris Descartes - Hôpital Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France
| |
Collapse
|
23
|
Oral Food Challenges: The Design must Reflect the Clinical Question. Curr Allergy Asthma Rep 2015; 15:51. [PMID: 26183500 DOI: 10.1007/s11882-015-0549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Oral food challenges are the gold-standard diagnostic investigation for diagnosing food allergy. They allow a subject to consume an age-appropriate portion of allergenic food under surveillance to assess whether a reproducible immune-mediated adverse response is demonstrated. The specific design of food challenge must closely reflect the anticipated management step being considered. In clinical practice, food challenges are most commonly used to investigate the subject's status of allergy or tolerance to a food. However, other characteristics of food allergy are increasingly being investigated through recent studies. In particular, studies investigating food allergy prevention strategies, the impact of oral immunotherapy on subjects' threshold for allergic reactions and also their potential acquisition of long-term tolerance each utilize differing designs of oral food challenges to investigate their specific hypothesis. We examine how oral food challenges may be designed to assess specific characteristics of the food allergic response.
Collapse
|
24
|
Graham F, Bégin P, Paradis L, Des Roches A. Prenatal and/or Breastfeeding Food Exposures and Risk of Food Allergies in the Offspring. Curr Nutr Rep 2015. [DOI: 10.1007/s13668-015-0126-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
25
|
Kulis M, Wright BL, Jones SM, Burks AW. Diagnosis, management, and investigational therapies for food allergies. Gastroenterology 2015; 148:1132-42. [PMID: 25633563 PMCID: PMC4793977 DOI: 10.1053/j.gastro.2015.01.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/15/2015] [Accepted: 01/20/2015] [Indexed: 12/14/2022]
Abstract
Food allergies have increased in prevalence over the past 20 years, now becoming an important public health concern. Although there are no therapies currently available for routine clinical care, recent reports have indicated that immunotherapies targeting the mucosal immune system may be effective. Oral immunotherapy is conducted by administering small, increasing amounts of food allergen; it has shown promise for desensitizing individuals with peanut, egg, or milk allergies. Sublingual immunotherapy also desensitizes allergic patients to foods-2 major studies have examined the effects of sublingual immunotherapy in subjects with peanut allergies. We review the complex nature of IgE-mediated food allergies and the therapies being evaluated in clinical trials. We focus on the diagnosis and management of food allergies and investigational therapies.
Collapse
Affiliation(s)
- Mike Kulis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Benjamin L. Wright
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Stacie M. Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas
| | - A. Wesley Burks
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
26
|
Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015; 372:803-13. [PMID: 25705822 PMCID: PMC4416404 DOI: 10.1056/nejmoa1414850] [Citation(s) in RCA: 1321] [Impact Index Per Article: 146.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy. METHODS We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test--one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age. RESULTS Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy. CONCLUSIONS The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.).
Collapse
Affiliation(s)
- George Du Toit
- From the Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London and Guy's and St. Thomas' National Health Service Foundation Trust, London (G.D.T., S.R., A.F.S., H.A.B., M.B., M.F., V.T., G.L.), and the University of Southampton and National Institute for Health Research Respiratory Biomedical Research Unit, Southampton and David Hide Centre, Newport, Isle of Wight (G.R.) - both in the United Kingdom; the Division of Hematology-Oncology, Department of Medicine (P.H.S.), and the Immune Tolerance Network (D.P.), University of California, San Francisco, San Francisco; Rho Federal Systems Division, Chapel Hill, NC (H.T.B., M.L.S.); and the National Institute of Allergy and Infectious Diseases, Bethesda, MD (M.G.L., M.P.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Koplin JJ, Allen KJ. Early Introduction of Foods for Food Allergy Prevention. CURRENT TREATMENT OPTIONS IN ALLERGY 2014. [DOI: 10.1007/s40521-014-0017-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Kumar S, Sharma A, Neelabh, Singh G, Verma AK, Roy R, Gupta R, Misra A, Tripathi A, Ansari KM, Das M, Shanker R, Dwivedi PD. Allergenic responses of green gram (Vigna radiata L. Millsp) proteins can be vitiated by induction of oral tolerance due to single acute dose in BALB/c mice. Food Res Int 2014. [DOI: 10.1016/j.foodres.2014.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
29
|
White BL, Shi X, Burk CM, Kulis M, Burks AW, Sanders TH, Davis JP. Strategies to Mitigate Peanut Allergy: Production, Processing, Utilization, and Immunotherapy Considerations. Annu Rev Food Sci Technol 2014; 5:155-76. [DOI: 10.1146/annurev-food-030713-092443] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Peanut (Arachis hypogaea L.) is an important crop grown worldwide for food and edible oil. The surge of peanut allergy in the past 25 years has profoundly impacted both affected individuals and the peanut and related food industries. In response, several strategies to mitigate peanut allergy have emerged to reduce/eliminate the allergenicity of peanuts or to better treat peanut-allergic individuals. In this review, we give an overview of peanut allergy, with a focus on peanut proteins, including the impact of thermal processing on peanut protein structure and detection in food matrices. We discuss several strategies currently being investigated to mitigate peanut allergy, including genetic engineering, novel processing strategies, and immunotherapy in terms of mechanisms, recent research, and limitations. All strategies are discussed with considerations for both peanut-allergic individuals and the numerous industries/government agencies involved throughout peanut production and utilization.
Collapse
Affiliation(s)
- Brittany L. White
- Market Quality and Handling Research Unit, Agricultural Research Service, US Department of Agriculture and
| | - Xiaolei Shi
- Department of Food, Bioprocessing and Nutrition Sciences at North Carolina State University, Raleigh, North Carolina 27695;, , ,
| | - Caitlin M. Burk
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;, ,
| | - Michael Kulis
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;, ,
| | - A. Wesley Burks
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599;, ,
| | - Timothy H. Sanders
- Market Quality and Handling Research Unit, Agricultural Research Service, US Department of Agriculture and
| | - Jack P. Davis
- Market Quality and Handling Research Unit, Agricultural Research Service, US Department of Agriculture and
- Department of Food, Bioprocessing and Nutrition Sciences at North Carolina State University, Raleigh, North Carolina 27695;, , ,
| |
Collapse
|
30
|
Netting M, Makrides M, Gold M, Quinn P, Penttila I. Heated allergens and induction of tolerance in food allergic children. Nutrients 2013; 5:2028-46. [PMID: 23739144 PMCID: PMC3725491 DOI: 10.3390/nu5062028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 01/25/2023] Open
Abstract
Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow's milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow's milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow's milk and egg allergy.
Collapse
Affiliation(s)
- Merryn Netting
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
| | - Maria Makrides
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
| | - Michael Gold
- Children’s Youth and Women’s Health Network, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.G.); (P.Q.)
| | - Patrick Quinn
- Children’s Youth and Women’s Health Network, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.G.); (P.Q.)
| | - Irmeli Penttila
- Women’s and Children’s Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia; E-Mails: (M.N.); (M.M.)
| |
Collapse
|
31
|
Chan SMH, Dumitru C, Turcanu V. Molecular diagnosis of peanut allergy. Expert Rev Mol Diagn 2013; 12:879-91. [PMID: 23249205 DOI: 10.1586/erm.12.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peanut allergy prevalence has increased in developed countries over the last few decades in the frame of the allergy epidemics, currently affecting 1-2% of children. While less frequent in developing countries, its prevalence is rising as these countries adopt a more westernized lifestyle. There is no curative treatment for peanut allergy at present so patient management relies on peanut avoidance, which requires an accurate diagnosis. Recent progress in peanut allergy diagnosis was made with the introduction of component resolved diagnosis that allows the assessment of IgE specific to individual peanut allergens. Component-resolved diagnosis needs to be interpreted in the context of clinical data but overall increases the diagnostic accuracy, as described in the typical cases that we present. Novel diagnostic tools have been proposed recently, such as the basophil activation test, mRNA expression and resonance magnetic evaluation of biomarkers.
Collapse
Affiliation(s)
- Susan M H Chan
- King's College London, King's Health Partners, MRC and Asthma-UK Centre in Allergic Mechanisms of Asthma, Department of Asthma, Allergy and Respiratory Science, Guy's Hospital, London, SE1 9RT, UK
| | | | | |
Collapse
|
32
|
Kulis M, Gorentla B, Burks AW, Zhong XP. Type B CpG oligodeoxynucleotides induce Th1 responses to peanut antigens: modulation of sensitization and utility in a truncated immunotherapy regimen in mice. Mol Nutr Food Res 2013; 57:906-15. [PMID: 23386314 DOI: 10.1002/mnfr.201200410] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 12/14/2022]
Abstract
SCOPE Peanut allergy stems from a Th2-biased immune response to peanut allergens leading to IgE production and allergic reactions upon ingestion. METHODS AND RESULTS A model of peanut allergy in C3H/HeJ mice was used to assess whether type A, B, or C CpG oligodeoxynucleotide (ODN) molecules would be effective in: (i) a prophylactic approach to prevent peanut allergy when administered simultaneously with a Th2-skewing adjuvant, and (ii) a therapeutic model to allow for shortened immunotherapy. Type B ODNs were extremely effective in inhibiting anaphylaxis in the sensitization protocol as evidenced by differences in symptom scores, body temperature, and mouse mast cell protease 1 release compared to sham treatment. In the therapeutic model, co-administration of type B ODN plus peanut proteins was highly effective in reducing anaphylactic reactions in mice with established peanut allergy. The therapeutic effect was accompanied by an increase in IFN-γ and peanut-IgG2a, without a significant decrease in peanut IgE or IL-4 responses. CONCLUSION CpG ODNs, especially type B, were highly effective in inducing Th1 responses in mice undergoing induction of peanut allergy, as well as in mice undergoing therapy for established peanut allergy. Interestingly, the IgE response was not significantly altered, suggesting that IgG antibodies may be enough to prevent peanut-induced anaphylaxis.
Collapse
Affiliation(s)
- Mike Kulis
- Department of Pediatric Allergy and Immunology, Duke University Medical Center, Durham, NC 27599, USA.
| | | | | | | |
Collapse
|
33
|
Thang CL, Boye JI, Zhao X. Low doses of allergen and probiotic supplementation separately or in combination alleviate allergic reactions to cow β-lactoglobulin in mice. J Nutr 2013; 143:136-41. [PMID: 23236021 DOI: 10.3945/jn.112.169466] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Probiotic supplementation and oral tolerance induction can reduce certain types of food allergy. The objectives of this study were to investigate the allergy-reducing effects of probiotics (VSL#3) and/or oral tolerance induction via low doses of an allergen supplementation in β-lactoglobulin (BLG)-sensitized mice. Three-week-old, male BALB/c mice were divided into 6 groups (n = 8/group): sham-sensitized negative control (CTL-), BLG-sensitized positive control (CTL+), oral tolerance-induced and BLG-sensitized group (OT), probiotic-supplemented OT group (OTP), probiotic-supplemented CTL- (PRO), and probiotic-supplemented and BLG-sensitized (PROC) groups. Mice were i.p. sensitized with BLG and alum and then orally challenged with BLG. Immunological responses were assessed by monitoring hypersensitivity scores and measuring levels of BLG-specific serum Igs, total serum IgE and fecal IgA, and cytokines from serum and spleen lysates. Hypersensitivity scores were significantly lower in the PROC (2.00 ± 0.53), OT (0.75 ± 0.46), and OTP mice (1.00 ± 0.53) than in the CTL+ mice (2.63 ± 0.52) as were BLG-specific serum IgE concentrations (34.3 ± 10, 0.442 ± 0.36, 3.54 ± 3.5, and 78.5 ± 8.7 μg/L for PROC, OT, OTP, and CTL+, respectively). Our results suggest that supplementation of VSL#3 suppressed the allergic reaction mainly through increased intestinal secretary IgA (sIgA) in PROC mice, and oral tolerance offered allergen-specific protective effects to BLG-induced allergy, probably through CD4+CD25+ regulatory T cell-mediated active suppression. In OTP mice, probiotics did not induce a further reduction of hypersensitivity score compared with OT mice but may provide additional protection to unforeseen nonspecific challenges through increased intestinal sIgA.
Collapse
Affiliation(s)
- Cin L Thang
- Department of Animal Science, Macdonald Campus, McGill University, Ste Anne de Bellevue, Quebec, Canada
| | | | | |
Collapse
|
34
|
A molecular insight of CTLA-4 in food allergy. Immunol Lett 2013; 149:101-9. [DOI: 10.1016/j.imlet.2012.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 12/06/2012] [Indexed: 12/31/2022]
|
35
|
Mondoulet L, Dioszeghy V, Puteaux E, Ligouis M, Dhelft V, Letourneur F, Dupont C, Benhamou PH. Intact skin and not stripped skin is crucial for the safety and efficacy of peanut epicutaneous immunotherapy (EPIT) in mice. Clin Transl Allergy 2012; 2:22. [PMID: 23140259 PMCID: PMC3542018 DOI: 10.1186/2045-7022-2-22] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/08/2012] [Indexed: 01/14/2023] Open
Abstract
Background Epicutaneous immunotherapy (EPIT) on intact skin with an epicutaneous delivery system has already been used in preclinical and clinical studies. In epicutaneous vaccination and immunotherapy, the stripping of skin before application of the allergen is suggested to facilitate the passage of allergen through immune cells. Objectives The aim of this study was to compare the immunological response induced by EPIT performed on intact and stripped skin in a mouse model of peanut allergy. Methods After oral sensitization with peanut and cholera toxin, BALB/c mice were epicutaneously treated using an epicutaneous delivery system (Viaskin® (DBV Technologies, Paris) applied either on intact skin or on stripped skin. Following EPIT, mice received an exclusive oral peanut regimen, aimed at triggering esophageal and jejunal lesions. We assessed eosinophil infiltration by histology, mRNA expression in the esophagus, antibody levels and peripheral T-cell response. Results EPIT on intact skin significantly reduced Th2 immunological response (IgE response and splenocyte secretion of Th2 cytokines) as well as esophageal eosinophilia (2.7 ± 0.9, compared to Sham 19.9 ± 1.5, p < 0.01), mRNA expression of Th2 cytokines in tissue and intestinal villus sub-atrophia (2.9 ± 0.2 vs Sham, 2.1 ± 0.2, p < 0.05). By contrast, EPIT on stripped skin reinforced Th2 systemic immunological response as well as eosinophil infiltration (26.8 ± 15.1), mRNA expression of Th2 cytokines and duodenal villus/crypt-ratio (2.4 ± 0.3). Conclusions Epicutaneous allergen-specific immunotherapy needs the integrity of superficial layers of the stratum corneum to warranty safety of treatment and to induce a tolerogenic profile of the immune response.
Collapse
|
36
|
Kim J, Lee JY, Han Y, Ahn K. Significance of Ara h 2 in clinical reactivity and effect of cooking methods on allergenicity. Ann Allergy Asthma Immunol 2012; 110:34-8. [PMID: 23244656 DOI: 10.1016/j.anai.2012.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/19/2012] [Accepted: 10/14/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence and clinical severity of peanut allergy vary between Western countries and Asia. It has been suggested that cooking methods are responsible for this discrepancy. OBJECTIVES To evaluate the specific IgE responses to major peanut allergens in peanut allergic Korean children and to examine the influence of different cooking methods on peanut proteins. METHODS Raw peanut protein extracts were immunolabeled with serum samples from 42 children with a level of peanut specific IgE of 15 kUA/L or higher to detect specific binding to Ara h 1, Ara h 2, and Ara h 3. Clinical severity scores were assessed on a scale of 0 to 5. Protein extracts from boiled, roasted, fried, and pickled peanuts were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting with pooled serum samples from 7 patients. RESULTS Most patients' serum samples reacted with Ara h 1 (76.2%) and Ara h 3 (78.6%) from raw peanuts, whereas only 53.0% of patients had specific IgE against Ara h 2. IgE binding to Ara h 2 was more prevalent in patients with more severe reaction than in those with mild reactions. IgE binding to Ara h 2 was increased by roasting, but there was significantly less IgE binding after vinegar treatment. CONCLUSION Our results suggest that Ara h 2 is an important allergen to predict clinical symptoms but less prevalent in Korean children than in Western children. This finding may be attributed in part to different cooking methods and dietary habits among regions.
Collapse
Affiliation(s)
- Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
37
|
Torres-Borrego J, Moreno-Solís G, Molina-Terán AB. Diet for the prevention of asthma and allergies in early childhood: much ado about something? Allergol Immunopathol (Madr) 2012; 40:244-52. [PMID: 22425606 DOI: 10.1016/j.aller.2011.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 12/19/2011] [Indexed: 12/28/2022]
Abstract
In the last decades there has been an increase in allergic disease throughout the world, particularly in children. Attempts have been made to identify the causes of this "allergy epidemic" in environmental changes and changes in population hygiene, lifestyle, socioeconomic level, and eating habits that would exert epigenetic effects. Dietetic hypotheses have been mainly focussed in long-chain polyunsaturated fatty acids, vitamin D, antioxidants, Mediterranean diet, and fruits, vegetables and fish consumption. Although the data suggest a certain association between diet and the development of asthma/allergy, there is no evidence that diet has an impact upon the prevalence of such diseases after early infancy. If indeed there is such an impact, it is likely to be confined to the prenatal period and the first months of life - when it is still possible to modulate the development of the respiratory, digestive and immune systems. Thus, once the most appropriate preventive measures have been defined, these should be implemented during pregnancy and lactation. The existing scientific evidence is unable to recommend any primary preventive measure in the general population or in different population subgroups. Special or restrictive diets in pregnant or nursing women are not indicated. Exclusive breastfeeding for six months is questioned, since solid foods should begin to be introduced at around four months of age. Once the atopic process has started, no nutritional strategies have been found to be effective as secondary or tertiary preventive measures. Longitudinal studies in cohorts of pregnant women or newborn infants could help clarify these issues.
Collapse
Affiliation(s)
- Javier Torres-Borrego
- Pediatric Allergy and Pneumology Unit, Pediatrics Clinical Management Unit, Reina Sofía Children's University Hospital, Córdoba, Spain.
| | | | | |
Collapse
|
38
|
Zhou XL, Zhao XD. Specific oral tolerance induction for the treatment of food allergy. Shijie Huaren Xiaohua Zazhi 2012; 20:1433-1438. [DOI: 10.11569/wcjd.v20.i16.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The morbidity of food allergy in children has a tendency to increase these years. Double-blind placebo-controlled food challenge (DBPCFC) is the gold standard for the diagnosis of food allergy, and the standard treatment for food allergy is strict food avoidance. However, long-time strict food avoidance is difficult in everyday life, and may lead to malnutrition and even can increase the risk for developing severe anaphylaxis after accidental ingestion. Specific oral tolerance induction (SOTI) is a new and possible way to treat food allergy, which is performed by limited ingestion of the allergen to make the body become unresponsive to it. However, the effectiveness, safety and economic benefit are still controversial, because of the deficiency of DBPCFC. Our paper will introduce the methods and mechanism of SOTI, compare it with traditional treatments for food allergy, and discuss the possibility of clinical use of SOTI.
Collapse
|
39
|
Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol 2012; 129:1187-97. [DOI: 10.1016/j.jaci.2012.02.036] [Citation(s) in RCA: 304] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/20/2012] [Accepted: 02/23/2012] [Indexed: 12/11/2022]
|
40
|
Chan SMH, Turcanu V, Stephens AC, Fox AT, Grieve AP, Lack G. Cutaneous lymphocyte antigen and α4β7 T-lymphocyte responses are associated with peanut allergy and tolerance in children. Allergy 2012; 67:336-42. [PMID: 22423373 DOI: 10.1111/j.1398-9995.2011.02765.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unclear whether the initial route of allergen exposure in early life could influence the subsequent development of allergy, with cutaneous sensitization leading to peanut allergy (PA), and tolerance induced by oral exposure. The skin- and gastrointestinal (GI)-homing markers, cutaneous lymphocyte antigen (CLA) and α4β7 integrin, are used to determine whether the state of PA correlates with peanut-specific CLA responses, with tolerance associated with predominant α4β7 responses. METHODS CLA+ and α4β7+ memory T cells were isolated and cultured with peanut extract to assess their proliferation. Stimulation indices were compared in peanut allergic and non-allergic (NA) groups, and peanut-specific cytokine production was measured. RESULTS In peanut allergic patients, peanut-specific proliferation predominates in the skin-homing CLA+ subset, whilst peanut-tolerant groups have a mixed CLA/α4β7 response (P = 0.008). Comparison with a control food antigen (ovalbumin) showed that these differences are allergen specific. Cytokine responses showed trends towards Th1 skewing in the GI-homing α4β7+ cells of peanut-tolerant groups and Th2 skewing in the skin-homing CLA+ cells of peanut allergic patients. CONCLUSION The predominance of the CLA+ response to peanut in peanut allergic patients is consistent with the hypothesis that allergic sensitization occurs through the skin. The predominant α4β7+ response in peanut-tolerant groups suggests that allergen exposure through the GI tract induces tolerance.
Collapse
Affiliation(s)
| | - V. Turcanu
- King's College London; King's Health Partners; Asthma-UK Centre in Allergic Mechanisms of Asthma; Department of Asthma, Allergy and Respiratory Science; Guy's Hospital; London; UK
| | - A. C. Stephens
- King's College London; King's Health Partners; Asthma-UK Centre in Allergic Mechanisms of Asthma; Department of Asthma, Allergy and Respiratory Science; Guy's Hospital; London; UK
| | - A. T. Fox
- King's College London; King's Health Partners; Asthma-UK Centre in Allergic Mechanisms of Asthma; Department of Asthma, Allergy and Respiratory Science; Guy's Hospital; London; UK
| | | | - G. Lack
- King's College London; King's Health Partners; Asthma-UK Centre in Allergic Mechanisms of Asthma; Department of Asthma, Allergy and Respiratory Science; Guy's Hospital; London; UK
| |
Collapse
|
41
|
Mondoulet L, Dioszeghy V, Ligouis M, Dhelft V, Puteaux E, Dupont C, Benhamou PH. Epicutaneous Immunotherapy Compared with Sublingual Immunotherapy in Mice Sensitized to Pollen (Phleum pratense). ISRN ALLERGY 2012; 2012:375735. [PMID: 23724241 PMCID: PMC3658791 DOI: 10.5402/2012/375735] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/04/2012] [Indexed: 01/30/2023]
Abstract
Background. The aim of this study was to compare the efficacy of epicutaneous immunotherapy (EPIT) to sublingual immunotherapy (SLIT) in a model of mice sensitized to Phleum pratense pollen. Methods. BALB/c mice were sensitized by sub-cutaneous route to pollen protein extract mixed treated for 8 weeks, using sham, EPIT, or SLIT. Measurements involved the serological response and cytokine profile from reactivated splenocytes, plethysmography after aerosol challenge to pollen, cell, and cytokine contents in the bronchoalveolar lavages (BALs). Results. After immunotherapy, sIgE was significantly decreased in the treated groups compared to sham (P < 0.001), whereas sIgG2a increased with EPIT and SLIT (P < 0.001 and P < 0.005 versus sham). Reactivated splenocytes secreted higher levels of Th2 cytokines with sham (P < 0.01). Penh values were higher in sham than EPIT and SLIT. Eosinophil recruitment in BAL was significantly reduced only by EPIT (P < 0.01). Conclusion. In this model of mice sensitized to pollen, EPIT was at least as efficient as SLIT.
Collapse
|
42
|
Oral administration of allergen extracts from mugwort pollen desensitizes specific allergen-induced allergy in mice. Vaccine 2012; 30:1437-44. [PMID: 22240342 DOI: 10.1016/j.vaccine.2012.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/04/2011] [Accepted: 01/02/2012] [Indexed: 11/23/2022]
Abstract
Clinically, sublingual immunotherapy (SLIT) using allergen extracts effectively alleviates the symptoms of allergic rhinitis and asthma. We hypothesized that oral administration of a high-dose of allergen extracts imitates SLIT, which may prevent IgE-related responses in allergic diseases. In the present study, we investigated the effects of oral administration of allergen extracts from mugwort pollen (MP) on allergen-induced inflammation and airway hyperresponsiveness (AHR) in an allergic mouse model. After administration of MPdrop containing Art v 1 and Art v 4 extracts derived from MP specifically in MP-sensitized mice, the effects of MPdrop on AHR, inflammatory cell accumulation, cytokine production in the bronchoalveolar lavage fluid and lung tissue, and serum IgE and IgG levels were investigated. The results indicated that MPdrop not only prevented the AHR in response to methacholine in a dose-dependent manner but also significantly reduced the total serum and allergen-specific IgE levels. All of the maximal effects were achieved at a dose of 100μg/(kgd) and were comparable to the effects of dexamethasone at a dose of 0.5mg/(kgd). Furthermore, oral administration of MPdrop dose-dependently elevated allergen-specific serum IgG2a levels, reduced total and allergen-specific IgE levels and normalized the imbalance between the Th1 cytokine IL-12 and Th2 cytokines IL-4 and IL-5. Finally, oral administration of MPdrop significantly reduced goblet cell hyperplasia and eosinophilia in the MP-sensitized allergic mouse model. These data suggest that MPdrop effectively improves specific allergen-induced inflammation and AHR in MP-sensitized and -challenged mice and provides the rationale for clinical use of MPdrop in the specific allergen-induced asthma.
Collapse
|
43
|
Dupont C. Food allergy: recent advances in pathophysiology and diagnosis. ANNALS OF NUTRITION AND METABOLISM 2011; 59 Suppl 1:8-18. [PMID: 22189252 DOI: 10.1159/000334145] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Approximately 5% of young children and 3-4% of adults exhibit adverse immune responses to foods in westernized countries, with a tendency to increase. The pathophysiology of food allergy (FA) relies on immune reactions triggered by epitopes, i.e. small amino-acid sequences able to bind to antibodies or cells. Some food allergens share specific physicochemical characteristics that allow them to resist digestion, thus enhancing allergenicity. These allergens encounter specialized dendritic cell populations in the gut, which leads to T-cell priming. In case of IgE-mediated allergy, this process triggers the production of allergen-specific IgE by B cells. Tissue-resident reactive cells, including mast cells, then bind IgE, and allergic reactions are elicited when these cells, with adjacent IgE molecules bound to their surface, are re-exposed to allergen. Allergic reactions occurring in the absence of detectable IgE are labeled non-IgE mediated. The abrogation of oral tolerance which leads to FA is likely favored by genetic disposition and environmental factors (e.g. increased hygiene or enhanced allergenicity of some foods). For an accurate diagnosis, complete medical history, laboratory tests and, in most cases, an oral food challenge are needed. Noticeably, the detection of food-specific IgE (sensitization) does not necessarily indicate clinical allergy. Novel diagnostic methods currently under study focus on the immune responses to specific food proteins or epitopes of specific proteins. Food-induced allergic reactions represent a large array of symptoms involving the skin and gastrointestinal and respiratory systems. They can be attributed to IgE-mediated and non-IgE-mediated (cellular) mechanisms and thus differ in their nature, severity and outcome. Outcome also differs according to allergens.
Collapse
Affiliation(s)
- Christophe Dupont
- Gastroentérologie pédiatrique ambulatoire, Allergie alimentaire et Explorations fonctionnelles digestives, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, Paris, France.
| |
Collapse
|
44
|
Prescott S, Nowak-Węgrzyn A. Strategies to prevent or reduce allergic disease. ANNALS OF NUTRITION AND METABOLISM 2011; 59 Suppl 1:28-42. [PMID: 22189254 DOI: 10.1159/000334150] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The need for allergy prevention strategies has never been greater. Surging rates of food allergy and eczema are now adding to the already substantial burden of asthma and respiratory allergic diseases. The parallel rise in many other immune diseases suggests that the developing immune system is highly vulnerable to modern environmental changes. These strong environmental pressures may be one reason why simple allergen avoidance strategies have not been successful. Another more recent strategy to curtail the allergy epidemic has been to identify factors associated with modern lifestyle that may be causally linked with allergic disease, in an attempt to restore more favourable conditions for immune tolerance during early development. More hygienic conditions and disruption of microbial exposure have prompted strategies to restore this balance using probiotic and prebiotic supplements. Modern dietary changes linked with allergic diseases have prompted supplementation studies to assess the preventive merits of specific immunomodulatory dietary nutrients such as polyunsaturated fatty acids. Other nutrients such as antioxidants, folate, and vitamin D are also currently under investigation. Modern environmental pollutants have also been associated with adverse effects on immune development and the risk of disease. While many of these avenues have provided some promise, they have not yet translated into specific recommendations. Current evidence-based guidelines for allergy prevention remain limited to avoidance of cigarette smoke, promotion of breastfeeding and the use of hydrolysed formula when breastfeeding is not possible. Allergen avoidance strategies have been largely removed from most guidelines. It is hoped that a number of ongoing studies will help provide clearer recommendations around the use of probiotics, prebiotics, specific dietary nutrients and the role of early introduction of allergenic foods for the promotion of tolerance. Despite the current uncertainties, prevention remains the best long-term strategy to reduce the growing burden of allergic disease.
Collapse
Affiliation(s)
- Susan Prescott
- School of Paediatrics and Child Health Research, University of Western Australia, Perth, WA 6840, Australia.
| | | |
Collapse
|
45
|
Early oral ovalbumin exposure during maternal milk feeding prevents spontaneous allergic sensitization in allergy-prone rat pups. Clin Dev Immunol 2011; 2012:396232. [PMID: 22203855 PMCID: PMC3235444 DOI: 10.1155/2012/396232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 08/09/2011] [Accepted: 09/08/2011] [Indexed: 12/27/2022]
Abstract
There are conflicting data to support the practice of delaying the introduction of allergenic foods into the infant diet to prevent allergy development. This study investigated immune response development after early oral egg antigen (Ovalbumin; OVA) exposure in a rat pup model. Brown Norway (BN) rat pups were randomly allocated into groups: dam reared (DR), DR pups challenged daily (days 4–13) with oral OVA (DR + OVAc), DR pups challenged intermittently (on day 4, 10, 12, and 13) with oral OVA (DR + OVAi), formula-fed pups (FF), and FF pups challenged daily with oral OVA (FF + OVA). Immune parameters assessed included OVA-specific serum IgE, IgG1, and IgA. Ileal and splenic messenger ribonucleic acid (mRNA) expression of transforming growth factor-beta (TGF-β1), mothers against decapentaplegic (Smad) 2/4/7, and forkhead box P3 (Foxp3) were determined. Ileum was stained for TGF-β1 and Smad4. Results. Feeding OVA daily to DR pups maintained systemic and local gut antibody and immunoregulatory marker mRNA responses. Systemic TGF-β1 was lower in DR + OVAi pups compared to DR and DR + OVAc pups. Feeding OVA to FF pups resulted in significantly greater OVA-specific IgE and IgG1, and lower IgA and TGF-β1 and Smad expression compared to DR pups. Conclusions. Early daily OVA exposure in the presence of maternal milk maintains immune markers associated with a regulated immune response, preventing early allergic sensitization.
Collapse
|
46
|
Chen XW, Lau KWK, Yang F, Sun SSM, Fung MC. An adjuvant free mouse model of oral allergenic sensitization to rice seeds protein. BMC Gastroenterol 2011; 11:62. [PMID: 21605393 PMCID: PMC3123647 DOI: 10.1186/1471-230x-11-62] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 05/23/2011] [Indexed: 12/11/2022] Open
Abstract
Background Rice is commonly known as a staple crop consumed worldwide, though with several rice proteins being reported for allergic properties in clinical studies. Thus, there is a growing need for the development of an animal model to better understand the allergenicity of rice proteins and the immunological and pathophysiological mechanisms underlying the development of food allergy. Methods Groups of BALB/c mice were sensitized daily with freshly homogenized rice flour (30 mg or 80 mg) without adjuvant by intragastric gavage. In addition, the mice were challenged with extracted rice flour proteins at several time points intragastrically. Hypersensitivity symptoms in mice were evaluated according to a scoring system. Vascular leakage, ELISA of rice protein-specific IgE, histopathology of small intestine, and passive cutaneous anaphylaxis were conducted on challenged mice. Results An adjuvant free mouse model of rice allergy was established with sensitized mice showing increased scratching behaviors and increased vascular permeability. Rice protein-specific IgE was detected after eighteen days of sensitization and from the fifth challenge onwards. Inflammatory damage to the epithelium in the small intestine of mice was observed beyond one month of sensitization. Passive cutaneous anaphylaxis results confirmed the positive rice allergy in the mouse model. Conclusions We introduced a BALB/c mouse model of rice allergy with simple oral sensitization without the use of adjuvant. This model would serve as a useful tool for further analysis on the immunopathogenic mechanisms of the various rice allergens, for the evaluation of the hypersensitivity of rice or other cereal grains, and to serve as a platform for the development of immunotherapies against rice allergens.
Collapse
Affiliation(s)
- Xiao-Wei Chen
- Biology Program, School of Science Life Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | | | | | | |
Collapse
|
47
|
Abstract
Food allergy is a recognized public health concern, for which preventative strategies are required. Although an intervention that adequately protects against the development of food allergy has still to be identified, limited benefits have been shown for the prevention of related allergic conditions such as eczema, and to a lesser extent asthma and rhinitis; these benefits are usually limited to at-risk populations. Prevention strategies need to be tested using randomized controlled study designs that account for the numerous methodological challenges, safety concerns, and necessary ethical limitations.
Collapse
Affiliation(s)
- George Du Toit
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' National Health Service Foundation Trust, Medical Research Council, London, UK.
| | | |
Collapse
|
48
|
Maureen Rossel G, Magdalena Araya Q. Alergia alimentaria en la infancia. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
49
|
Food allergy – science and policy needs – The UK Food Standards Agency Research Programme. Toxicology 2010; 278:319-25. [DOI: 10.1016/j.tox.2010.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 08/13/2010] [Accepted: 08/14/2010] [Indexed: 11/23/2022]
|
50
|
Ahuja V, Quatchadze M, Ahuja V, Stelter D, Albrecht A, Stahlmann R. Evaluation of biotechnology-derived novel proteins for the risk of food-allergic potential: advances in the development of animal models and future challenges. Arch Toxicol 2010; 84:909-17. [PMID: 20842347 DOI: 10.1007/s00204-010-0582-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Accepted: 08/30/2010] [Indexed: 11/30/2022]
Abstract
Increasing concern from the public about the safety of genetically modified food has made critical to have suitable methods for recognizing associated potential hazards. Hierarchical approaches to allergenicity determination were proposed, and these include evaluation of the structural and sequence homology and serological identity of novel proteins with existing allergens, measuring the resistance to proteolytic digestion and assessment of sensitizing potential using animal models. Allergic individuals have a predisposed (i.e. atopic) genetic background, and a close resemblance to this setup is therefore desirable in animal models, which is possible by using a strain of an animal species that is prone for allergic disorders. So far, none of the animal model has been validated for the purpose of hazard identification in the context of safety assessment. However, the available knowledge suggests that the judicious use of an appropriate animal model could provide important information about the allergic potential of novel proteins. This paper provides an up-to-date review of the progress made in the field of development of in vivo models in this direction and the further goals that have to be achieved.
Collapse
Affiliation(s)
- Varun Ahuja
- In Vivo Pharmacology and Toxicology, BSL Bioservice Scientific Laboratories GmbH, Behringstr. 6/8, Planegg/Munich, 82152, Germany.
| | | | | | | | | | | |
Collapse
|