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Poole A, Song Y, Brown H, Hart PH, Zhang G(B. Cellular and molecular mechanisms of vitamin D in food allergy. J Cell Mol Med 2018; 22:3270-3277. [PMID: 29577619 PMCID: PMC6010899 DOI: 10.1111/jcmm.13607] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/18/2018] [Indexed: 12/19/2022] Open
Abstract
Food allergies are becoming increasingly prevalent, especially in young children. Epidemiological evidence from the past decade suggests a role of vitamin D in food allergy pathogenesis. Links have been made between variations in sunlight exposure, latitude, birth season and vitamin D status with food allergy risk. Despite the heightened interest in vitamin D in food allergies, it remains unclear by which exact mechanism(s) it acts. An understanding of the roles vitamin D plays within the immune system at the cellular and genetic levels, as well as the interplay between the microbiome and vitamin D, will provide insight into the importance of the vitamin in food allergies. Here, we discuss the effect of vitamin D on immune cell maturation, differentiation and function; microbiome; genetic and epigenetic regulation (eg DNA methylation); and how these processes are implicated in food allergies.
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Affiliation(s)
- Ashlyn Poole
- School of Public HealthCurtin UniversityBentleyWAAustralia
| | - Yong Song
- School of Public HealthCurtin UniversityBentleyWAAustralia
- Centre for Genetic Origins of Health and DiseaseThe University of Western Australia and Curtin UniversityCrawleyWAAustralia
| | - Helen Brown
- School of Public HealthCurtin UniversityBentleyWAAustralia
| | - Prue H. Hart
- Telethon Kids InstituteThe University of Western AustraliaCrawleyWAAustralia
| | - Guicheng (Brad) Zhang
- School of Public HealthCurtin UniversityBentleyWAAustralia
- Centre for Genetic Origins of Health and DiseaseThe University of Western Australia and Curtin UniversityCrawleyWAAustralia
- Telethon Kids InstituteThe University of Western AustraliaCrawleyWAAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityBentleyWAAustralia
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Asthma and Allergy "Epidemic" and the Role of Vitamin D Deficiency. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 996:169-183. [PMID: 29124699 DOI: 10.1007/978-3-319-56017-5_14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increase in asthma and allergies prevalence that has been recorded in many countries during the last decades, and the reemergence of vitamin D (VD) deficiency in many populations worldwide, renders fairly plausible the assumption of an underlying association between these two conditions and justifies the research effort invented in this issue. Indeed, there is growing body of evidence from epidemiological, laboratory, and clinical studies, suggesting that such an association does exist. The hypothesis of low levels of VD leading to compromised fetal programming and impairment of various immune functions involved in asthma and allergic disorders, stands as the most credible explanation of this presumed association. However, the evidence is not yet definite and there are some conflicting results among studies. As a consequence, no safe conclusions can be drawn yet, and more research is required in order to fully clarify the involvement of VD deficiency in the pathogenesis of asthma and allergies, and decide if VD has a role to play in the prevention and therapy of these disorders.
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Speakman S, Kool B, Sinclair J, Fitzharris P. Paediatric food-induced anaphylaxis hospital presentations in New Zealand. J Paediatr Child Health 2018; 54:254-259. [PMID: 28885749 DOI: 10.1111/jpc.13705] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 02/06/2023]
Abstract
AIM Globally, rates of paediatric food-induced anaphylaxis (FIA) are increasing. Little data is available regarding the epidemiology of FIA among New Zealand (NZ) children. This study investigated the incidence of paediatric (0-14 years) FIA hospital presentations in NZ over a 10-year period. METHODS Ministry of Health public hospital discharge data from 2006 to 2015 were analysed using FIA-related International Classification of Diseases codes (T78.0 - anaphylactic shock due to adverse food reaction and T78.2 - anaphylactic shock unspecified and free text qualifier) to identify acute hospital presentations. RESULTS The overall annualised FIA hospital presentation rate was 16.2 per 100 000 children. Subgroup analysis indicated a significantly higher rate in males (19.1/100 000) than in females (13.1/100 000), and among children aged less than 2 years of age (50.5/100 000) compared with older children. Rates among Asian and Pacific children were higher than Māori and NZ European children. In 67.7% of cases, a single specific allergen was suggested by the information provided; among these cases, nuts (48%), specifically peanuts (26%), were the most commonly reported allergen, followed by cow's milk (21%). Time trend analysis showed a 2.8-fold increase in the overall annualised rate for the 10-year period. CONCLUSION These findings are consistent with other international studies indicating increasing rates of FIA in children. These data will provide information for a review of NZ paediatric allergy services to ensure current international standards with regard to the equitable delivery of timely, appropriate and accessible care are being met. Reasons for differences by gender, age and ethnicity require further investigation.
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Affiliation(s)
- Sophie Speakman
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bridget Kool
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jan Sinclair
- Starship Paediatric Immunology and Allergy, Starship Children's Health, Auckland, New Zealand
| | - Penny Fitzharris
- Immunology Department, Auckland City Hospital, Auckland, New Zealand
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Hsu JC, Chang SM, Lu CY. Geographic Variations and Time Trends in Cancer Treatments in Taiwan. BMC Public Health 2017; 18:89. [PMID: 28768504 PMCID: PMC5541736 DOI: 10.1186/s12889-017-4615-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 07/20/2017] [Indexed: 01/25/2023] Open
Abstract
Background Targeted therapies have become important treatment options for cancer care in many countries. This study aimed to examine recent trends in utilization of antineoplastic drugs, particularly the use of targeted therapies for treatment of cancer, by geographic region in Taiwan (northern, midwestern, southern, and eastern regions and the outer islands). Methods This was a retrospective observational study of antineoplastic agents using 2009-2012 quarterly claims data from Taiwan’s National Health Insurance Research Database. Yearly market shares by prescription volume and costs for targeted therapies among total antineoplastic agents by region were estimated. We used multivariate regression model and ANOVA to examine variations in utilization of targeted therapies between geographic regions and used ARIMA models to estimate longitudinal trends. Results Population-adjusted use and costs of antineoplastic drugs (including targeted therapies) were highest in the southern region of Taiwan and lowest in the outer islands. We found a 4-fold difference in use of antineoplastic drugs and a 49-fold difference in use of targeted therapies between regions if the outer islands were included. There were minimal differences in use of antineoplastic drugs between other regions with about a 2-fold difference in use of targeted therapies. Without considering the outer islands, the market share by prescription volume and costs of targeted therapies increased almost 2-fold (1.84-1.90) and 1.5-fold (1.26-1.61) respectively between 2009 and 2012. Furthermore, region was not significantly associated with use of antineoplastic agents or use of targeted therapies after adjusting for confounders. Region was associated with costs of antineoplastic agents but it was not associated with costs of targeted therapies after confounding adjustments. Conclusions Use of antineoplastic drugs overall and use of targeted therapies for treatment of cancer varied somewhat between regions in Taiwan; use was notably low in the outer islands. Strategies might be needed to ensure access to cancer care in each region as economic burden of cancer care increase due to growing use of targeted therapies.
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Affiliation(s)
- Jason C Hsu
- School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan, 70101, Taiwan.
| | - Sheng-Mao Chang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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5
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Molloy J, Koplin JJ, Allen KJ, Tang MLK, Collier F, Carlin JB, Saffery R, Burgner D, Ranganathan S, Dwyer T, Ward AC, Moreno-Betancur M, Clarke M, Ponsonby AL, Vuillermin P. Vitamin D insufficiency in the first 6 months of infancy and challenge-proven IgE-mediated food allergy at 1 year of age: a case-cohort study. Allergy 2017; 72:1222-1231. [PMID: 28042676 DOI: 10.1111/all.13122] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ecological evidence suggests vitamin D insufficiency (VDI) due to lower ambient ultraviolet radiation (UVR) exposure may be a risk factor for IgE-mediated food allergy. However, there are no studies relating directly measured VDI during early infancy to subsequent challenge-proven food allergy. OBJECTIVE To prospectively investigate the association between VDI during infancy and challenge-proven food allergy at 1 year. METHODS In a birth cohort (n = 1074), we used a case-cohort design to compare 25-hydroxyvitamin D3 (25(OH)D3 ) levels among infants with food allergy vs a random subcohort (n = 274). The primary exposures were VDI (25(OH)D3 <50 nM) at birth and 6 months of age. Ambient UVR and time in the sun were combined to estimate UVR exposure dose. IgE-mediated food allergy status at 1 year was determined by formal challenge. Binomial regression was used to examine associations between VDI, UVR exposure dose and food allergy and investigate potential confounding. RESULTS Within the random subcohort, VDI was present in 45% (105/233) of newborns and 24% (55/227) of infants at 6 months. Food allergy prevalence at 1 year was 7.7% (61/786), and 6.5% (53/808) were egg-allergic. There was no evidence of an association between VDI at either birth (aRR 1.25, 95% CI 0.70-2.22) or 6 months (aRR 0.93, 95% CI 0.41-2.14) and food allergy at 1 year. CONCLUSIONS There was no evidence that VDI during the first 6 months of infancy is a risk factor for food allergy at 1 year of age. These findings primarily relate to egg allergy, and larger studies are required.
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Affiliation(s)
- J. Molloy
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - J. J. Koplin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - M. L. K. Tang
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; Royal Children's Hospital; Parkville VIC Australia
| | - F. Collier
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - J. B. Carlin
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Epidemiology and Biostatistics; The University of Melbourne; Carlton VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
| | - R. Saffery
- Murdoch Childrens Research Institute; Parkville VIC Australia
| | - D. Burgner
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Paediatrics; Monash University; Clayton VIC Australia
| | - S. Ranganathan
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; University of Melbourne; Parkville VIC Australia
- Department of Respiratory Medicine; Royal Children's Hospital; Parkville VIC Australia
| | - T. Dwyer
- The George Institute for Global Health; University of Oxford; Oxford UK
| | - A. C. Ward
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
| | - M. Moreno-Betancur
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne VIC Australia
| | - M. Clarke
- Biological and Molecular Mass Spectrometry Facility; Centre for Microscopy, Characterisation and Analysis; University of Western Australia; Perth Western Australia 6009
| | - A. L. Ponsonby
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
| | - P. Vuillermin
- School of Medicine; Deakin University; Waurn Ponds VIC Australia
- Child Health Research Unit; Barwon Health; Geelong VIC Australia
- Murdoch Childrens Research Institute; Parkville VIC Australia
- Centre for Food and Allergy Research; Parkville VIC Australia
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Grimshaw K, Logan K, O'Donovan S, Kiely M, Patient K, van Bilsen J, Beyer K, Campbell DE, Garcia-Larsen V, Grabenhenrich L, Lack G, Mills C, Wal JM, Roberts G. Modifying the infant's diet to prevent food allergy. Arch Dis Child 2017; 102:179-186. [PMID: 27530541 DOI: 10.1136/archdischild-2015-309770] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 07/02/2016] [Accepted: 07/24/2016] [Indexed: 01/03/2023]
Abstract
Recommendations and guidelines on the prevention of food allergy have changed in recent decades. The aim of this review of the current evidence and ongoing studies is to provide a comprehensive and up to date picture of prevention of food allergy for healthcare professionals. The review was undertaken as part of the European Union funded Integrated Approaches to Food Allergy and Allergen Management (iFAAM) study. This is a wide ranging project bringing together expertise across the breadth of food allergy research. Specifically, the review discusses dietary manipulation in food allergy prevention, and covers the possible preventive strategies of allergen avoidance, early allergen introduction, general nutrition and supplements, as well as other strategies, such as prebiotics and probiotics. The review concludes that despite agreement that allergen avoidance strategies should not be undertaken for allergy prevention, there is currently no consensus regarding what actions should be recommended beyond exclusive breastfeeding for the first 4-6 months of life. Recent and upcoming trial results, which are detailed in this review, should help inform the debate and add clarity to the topic.
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Affiliation(s)
- Kate Grimshaw
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kirsty Logan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sinead O'Donovan
- Vitamin D Research Group, School of Food and Nutritional Science, University College Cork, Cork, Ireland
| | - Mairead Kiely
- Vitamin D Research Group, School of Food and Nutritional Science, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | | | | | - Kirsten Beyer
- Charite-Universitatsmedizin Berlin, Department of Paediatric Pneumology & Immunology, Berlin, Germany
| | - Dianne E Campbell
- Department of Allergy and Immunology, Children's Hospital Westmead, Sydney University, Sydney, New South Wales, Australia
| | - Vanessa Garcia-Larsen
- Respiratory Epidemiology, Occupational Medicine and Public Health Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Linus Grabenhenrich
- Charite-Universitatsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Gideon Lack
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, UK
| | - Clare Mills
- Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, The University of Manchester, Manchester, UK
| | | | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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7
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du Toit G, Tsakok T, Lack S, Lack G. Prevention of food allergy. J Allergy Clin Immunol 2016; 137:998-1010. [PMID: 27059727 DOI: 10.1016/j.jaci.2016.02.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 01/21/2023]
Abstract
The past few decades have witnessed an increase in the prevalence of IgE-mediated food allergy (FA). For prevention strategies to be effective, we need to understand the causative factors underpinning this rise. Genetic factors are clearly important in the development of FA, but given the dramatic increase in prevalence over a short period of human evolution, it is unlikely that FA arises through germline genetic changes alone. A plausible hypothesis is that 1 or more environmental exposures, or lack thereof, induce epigenetic changes that result in interruption of the default immunologic state of tolerance. Strategies for the prevention of FA might include primary prevention, which seeks to prevent the onset of IgE sensitization; secondary prevention, which seeks to interrupt the development of FA in IgE-sensitized children; and tertiary prevention, which seeks to reduce the expression of end-organ allergic disease in children with established FA. This review emphasizes the prevention of IgE-mediated FA through dietary manipulation, among other strategies; in particular, we focus on recent interventional studies in this field.
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Affiliation(s)
- George du Toit
- King's College London, King's Health Partners, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, and the Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Teresa Tsakok
- King's College London and St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Lack
- Imperial College London, London, United Kingdom
| | - Gideon Lack
- King's College London, King's Health Partners, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, and the Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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9
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Kool B, Chandra D, Fitzharris P. Adult food-induced anaphylaxis hospital presentations in New Zealand. Postgrad Med J 2016; 92:640-644. [DOI: 10.1136/postgradmedj-2015-133530] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 03/01/2016] [Accepted: 03/18/2016] [Indexed: 11/04/2022]
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10
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Allen KJ, Koplin JJ. Prospects for Prevention of Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:215-20. [DOI: 10.1016/j.jaip.2015.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 12/21/2022]
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Abstract
Australia has reported the highest rates of food allergy, using the gold standard, oral food challenge. This phenomenon, which appears linked to the "modern lifestyle" and has coincided with the explosion of the new diseases of affluence in the 21st century, dubbed "affluenza," has spurred a multitude of theories and academic investigations. This review focuses on potentially modifiable lifestyle factors for the prevention of food allergy and presents the first data to emerge in the Australian context that centers around the dual allergen exposure hypothesis, the vitamin D hypothesis, and the hygiene hypothesis.
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Affiliation(s)
- Katrina J Allen
- Centre of Food and Allergy Research, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne 3052, Australia; Department of Allergy and Clinical Immunology, The Royal Children's Hospital, Melbourne 3052, Australia; Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne 3052, Australia; Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, Melbourne 3052, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
| | - Jennifer J Koplin
- Centre of Food and Allergy Research, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne 3052, Australia; Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, Melbourne 3052, Australia
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12
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Koplin JJ, Suaini NHA, Vuillermin P, Ellis JA, Panjari M, Ponsonby AL, Peters RL, Matheson MC, Martino D, Dang T, Osborne NJ, Martin P, Lowe A, Gurrin LC, Tang MLK, Wake M, Dwyer T, Hopper J, Dharmage SC, Allen KJ. Polymorphisms affecting vitamin D-binding protein modify the relationship between serum vitamin D (25[OH]D3) and food allergy. J Allergy Clin Immunol 2015; 137:500-506.e4. [PMID: 26260969 DOI: 10.1016/j.jaci.2015.05.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/17/2015] [Accepted: 05/14/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is evolving evidence that vitamin D insufficiency may contribute to food allergy, but findings vary between populations. Lower vitamin D-binding protein (DBP) levels increase the biological availability of serum vitamin D. Genetic polymorphisms explain almost 80% of the variation in binding protein levels. OBJECTIVE We sought to investigate whether polymorphisms that lower the DBP could compensate for adverse effects of low serum vitamin D on food allergy risk. METHODS From a population-based cohort study (n = 5276) we investigated the association between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and food allergy at age 1 year (338 challenge-proven food-allergic and 269 control participants) and age 2 years (55 participants with persistent and 50 participants with resolved food allergy). 25(OH)D3 levels were measured using liquid chromatography-tandem mass spectrometry and adjusted for season of blood draw. Analyses were stratified by genotype at rs7041 as a proxy marker of DBP levels (low, the GT/TT genotype; high, the GG genotype). RESULTS Low serum 25(OH)D3 level (≤50 nM/L) at age 1 years was associated with food allergy, particularly among infants with the GG genotype (odds ratio [OR], 6.0; 95% CI, 0.9-38.9) but not in those with GT/TT genotypes (OR, 0.7; 95% CI, 0.2-2.0; P interaction = .014). Maternal antenatal vitamin D supplementation was associated with less food allergy, particularly in infants with the GT/TT genotype (OR, 0.10; 95% CI, 0.03-0.41). Persistent vitamin D insufficiency increased the likelihood of persistent food allergy (OR, 12.6; 95% CI, 1.5-106.6), particularly in those with the GG genotype. CONCLUSIONS Polymorphisms associated with lower DBP level attenuated the association between low serum 25(OH)D3 level and food allergy, consistent with greater vitamin D bioavailability in those with a lower DBP level. This increases the biological plausibility of a role for vitamin D in the development of food allergy.
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Affiliation(s)
- Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Noor H A Suaini
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Peter Vuillermin
- Murdoch Childrens Research Institute, Parkville, Australia; Child Health Research Unit, Barwon Health and Deakin University, Geelong, Australia
| | - Justine A Ellis
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Mary Panjari
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Rachel L Peters
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Melanie C Matheson
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - David Martino
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Thanh Dang
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom
| | - Pamela Martin
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Adrian Lowe
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Lyle C Gurrin
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Mimi L K Tang
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Centre for Community Child Health, Royal Children's Hospital, Parkville, Australia
| | - Terry Dwyer
- Murdoch Childrens Research Institute, Parkville, Australia
| | - John Hopper
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Shyamali C Dharmage
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; School of Inflammation and Repair, University of Manchester, Manchester, United Kingdom.
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13
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Rueter K, Siafarikas A, Prescott SL, Palmer DJ. In uteroand postnatal vitamin D exposure and allergy risk. Expert Opin Drug Saf 2014; 13:1601-11. [DOI: 10.1517/14740338.2014.961913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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14
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Hoyos-Bachiloglu R, Morales PS, Cerda J, Talesnik E, González G, Camargo CA, Borzutzky A. Higher latitude and lower solar radiation influence on anaphylaxis in Chilean children. Pediatr Allergy Immunol 2014; 25:338-43. [PMID: 24628618 PMCID: PMC4069239 DOI: 10.1111/pai.12211] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies suggest an association between higher latitude, a proxy of vitamin D (VD) status, and allergic diseases. Chile provides an ideal setting to study this association due to its latitude span and high rates of VD deficiency in southern regions. The aim of this study is to explore the associations of latitude and solar radiation with anaphylaxis admission rates. METHODS We reviewed anaphylaxis admissions in Chile's hospital discharge database between 2001 and 2010 and investigated associations with latitude and solar radiation. RESULTS 2316 anaphylaxis admissions were registered. Median age of patients was 41 yr; 53% were female. National anaphylaxis admission rate was 1.41 per 100,000 persons per year. We observed a strong north-south increasing gradient of anaphylaxis admissions (β 0.04, p = 0.01), with increasing rates south of latitude 34°S. A significant association was also observed between solar radiation and anaphylaxis admissions (β -0.11, p = 0.009). Latitude was associated with food-induced (β 0.05, p = 0.02), but not drug-induced (β -0.002, p = 0.27), anaphylaxis. The association between latitude and food-induced anaphylaxis was significant in children (β 0.01, p = 0.006), but not adults (β 0.003, p = 0.16). Anaphylaxis admissions were not associated with regional sociodemographic factors like poverty, rurality, educational level, ethnicity, or physician density. CONCLUSIONS Anaphylaxis admission rates in Chile are highest at higher latitudes and lower solar radiation, used as proxies of VD status. The associations appear driven by food-induced anaphylaxis. Our data support a possible role of VD deficiency as an etiological factor in the high anaphylaxis admission rates found in southern Chile.
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Affiliation(s)
- Rodrigo Hoyos-Bachiloglu
- Immunology, Allergy and Rheumatology Unit, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Food allergy: the perspectives of prevention using vitamin D. Curr Opin Allergy Clin Immunol 2014; 13:287-92. [PMID: 23549154 DOI: 10.1097/aci.0b013e328360ed9c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW We reviewed the scientific publications in the last 2 years on the connections between vitamin D and food allergy, and endeavor to focus on the possible indications for supplementation in order to prevent allergies. RECENT FINDINGS Ecological studies have suggested a possible relationship between sun exposure and atopic diseases such as asthma, atopic dermatitis and anaphylaxis. However, no direct evaluation of vitamin D status has been performed. Recent studies evaluating the relationship with vitamin D levels at birth or during pregnancy have shown conflicting results with the lower levels of vitamin D associated with eczema, the higher with increased food allergy prevalence. SUMMARY Although the role of vitamin D in extraskeletal function is certainly intriguing and must not be underestimated, at the moment there is a lack of consistent data addressing the topic of vitamin D supplementation in the prevention of food allergies. However, in light of the vast amount of literature regarding the mechanisms connected with atopic diseases, an evaluation of serum levels of vitamin D and eventually supplementation must be considered as a further opportunity to understand and treat atopic diseases. In this regard, well designed trials on vitamin D supplementation to prevent food allergies are urgently needed.
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Borzutzky A, Camargo CA. Role of vitamin D in the pathogenesis and treatment of atopic dermatitis. Expert Rev Clin Immunol 2014; 9:751-60. [DOI: 10.1586/1744666x.2013.816493] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Food allergy is a growing worldwide epidemic that adversely effects up to 10% of the population. Causes and risk factors remain unclear and diagnostic methods are imprecise. There is currently no accepted treatment for food allergy. Therefore, there is an imminent need for greater understanding of food allergies, revised diagnostics and development of safe, effective therapies. Oral immunotherapy provides a particularly promising avenue, but is still highly experimental and not ready for clinical use.
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Affiliation(s)
- Aleena Syed
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Arunima Kohli
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kari C Nadeau
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, Stanford University School of Medicine, Stanford, CA 94305, USA
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Dijkstra A, Hak E, Janssen F. A systematic review of the application of spatial analysis in pharmacoepidemiologic research. Ann Epidemiol 2013; 23:504-14. [PMID: 23830932 DOI: 10.1016/j.annepidem.2013.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/23/2013] [Accepted: 05/23/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE Although current reviews of the use of spatial analysis in general epidemiologic research illustrate an important and well-established role in exploring and predicting health, its application has not been reviewed in the subspecialty field of pharmacoepidemiology. METHODS We systematically reviewed the scientific literature to assess to what extent spatial analysis has been applied in pharmacoepidemiologic research and explored its potential added value. RESULTS A systematic search in PubMed and Embase/MEDLINE yielded 823 potentially relevant articles; 45 articles met our criteria for review. The studies were reviewed on study objective, applied spatial methods and units of analysis, and author-reported added value of the geographic approach used. Of the 45 included studies, 34 (76%) reported a geographic research objective. Comparative spatial methods were most often used (n = 25; 56%). Eleven studies used spatial statistics (32%); cluster analysis (n = 5) and aggregate data analysis (n = 4) being most common. Mapping was done in 15 studies (33%). The most common added value reported was to aid the planning of health policies and interventions (n = 24; 53%). A minority of pharmacoepidemiologic studies used a geographic approach and the applied methods were less advanced compared with the broader field of epidemiology. CONCLUSIONS Further advancements are needed to incorporate currently available spatial techniques to impact health care planning.
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Affiliation(s)
- Aletta Dijkstra
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE(2)), Department of Pharmacy, University of Groningen, The Netherlands.
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Ben-Shoshan M, Turnbull E, Clarke A. Food allergy: temporal trends and determinants. Curr Allergy Asthma Rep 2013; 12:346-72. [PMID: 22723032 DOI: 10.1007/s11882-012-0274-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This review summarizes studies discussing temporal trends in the prevalence of food allergy as well as potential factors associated with the development of food allergy. In addition, we will address the potential hypotheses accounting for the apparent increase in food allergy prevalence. Studies suggest increased prevalence of food allergy. However, relatively little is known about its pathogenesis. This review aims to assess temporal trends in the prevalence of food allergy and discuss potential genetic, environmental, and demographic determinants. The search strategy examined the medical literature database MEDLINE (using PubMed) for the time period of January 1, 2002 to January 31, 2012. In recent decades, the prevalence of food allergy in general has increased by 0.60 % [95 % confidence interval (CI), 0.59 %-0.61 %] and the prevalence of peanut allergy by 0.027 % (95 % CI, 0.026 %-0.028 %), but it has now likely stabilized in developed countries. Genes, the environment, and demographic characteristics play a role in the pathogenesis of food allergy. Numerous environmental and demographic factors as well as gene-environment interactions may account for this increase in prevalence, but further studies are required to tease out their relative contribution.
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Affiliation(s)
- Moshe Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
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Oktaria V, Dharmage SC, Burgess JA, Simpson JA, Morrison S, Giles GG, Abramson MJ, Walters EH, Matheson MC. Association between latitude and allergic diseases: a longitudinal study from childhood to middle-age. Ann Allergy Asthma Immunol 2013; 110:80-5.e1. [PMID: 23352525 DOI: 10.1016/j.anai.2012.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 09/12/2012] [Accepted: 11/02/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Worldwide variations in allergy prevalence suggest that geographic factors may contribute to asthma. Ecologic studies have suggested that latitude, a marker of UV-B exposure and allergen exposures, may be related to clinical allergies. OBJECTIVE To examine the relationship between latitude or UV-B based on self-reported geolocation and allergic sensitization and disease prevalence in Australia. METHODS The Tasmanian Longitudinal Health Study is a population-based study of respiratory disease spanning childhood to adulthood. The most recent follow-up included a postal survey of 5,729 participants and a clinical substudy of 1,396 participants. Participants' residential addresses were coded for latitude and linked with the UV-B data from satellite-based observations of atmospheric ozone. Multivariable logistic regression analyses were performed to estimate the associations between latitude or UV-B and allergic diseases. RESULTS Most northerly latitude, that is, latitude closest to the Equator, and high current UV-B exposure were associated with increased odds of hay fever, food allergy, and skin sensitization to house dust mites and molds. More northerly latitude and higher UV-B exposure were associated with increased odds of current asthma among atopic individuals contrasting with a reduced odds of current asthma among nonatopic individuals. CONCLUSION This is the first study, to our knowledge, to demonstrate a differential effect of atopic status on the relationship between latitude and current asthma. Our study demonstrates in a genetically and culturally similar group of individuals that geographic factors may a play role in the development of allergic disease.
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Affiliation(s)
- Vicka Oktaria
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Melbourne, Australia
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Mullins RJ, Camargo CA. Latitude, sunlight, vitamin D, and childhood food allergy/anaphylaxis. Curr Allergy Asthma Rep 2013; 12:64-71. [PMID: 22006065 DOI: 10.1007/s11882-011-0230-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Vitamin D is widely known for its role in bone metabolism, but this sterol hormone also has important immunomodulatory properties. Vitamin D is produced by the conversion of D3 in the skin following UVB exposure, or after ingestion of D2 or D3. At the extremes of latitude, there is insufficient UVB intensity in the autumn and winter months for adequate synthesis of vitamin D to occur. Growing evidence implicates vitamin D deficiency in early life in the pathogenesis of nonskeletal disorders (e. g., type 1 diabetes and multiple sclerosis) and, more recently, atopic disorders. Several studies have reported higher rates of food allergy/anaphylaxis or proxy measures at higher absolute latitudes. Although causality remains to be determined, these studies suggest a possible role for sunlight and/or vitamin D in the pathogenesis of food allergy/anaphylaxis.
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Abstract
This review highlights the progress made in food allergy (FA) and anaphylaxis research in pediatrics published in the journal Pediatric Allergy and Immunology since 2010. Putative risk factors for FA are as follows: a family history of allergic disease, particularly in the mother, low birth order, season of birth, and severe atopic eczema. Obstetric practices, antibiotic use, and home environment are factors deserving further research. Diagnostic decision levels and component-specific IgE are useful in the diagnosis of FA; however, oral food challenges remain the gold standard and may also be a means to reduce parental anxiety and to improve education. Oral immunotherapy studies show promise in increasing the threshold of reactivity of allergic patients and therefore improving their quality of life. In single-nut-allergic patients, introduction of other nuts allows broadening the diet and thus reducing the psychological impact of allergen avoidance. Nutritional deficiencies are not uncommon in food-allergic children and should be specifically assessed. The prescription of injectable adrenaline is still insufficient and not consistent among practitioners, requiring improved training and implementation of guidelines. Current research into the epidemiology and immunological mechanisms of FA and tolerance will enable us to devise strategies to both prevent and treat food allergies.
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Affiliation(s)
- Alexandra F Santos
- Department of Pediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.
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Neonatal vitamin D status and childhood peanut allergy: a pilot study. Ann Allergy Asthma Immunol 2012; 109:324-8. [PMID: 23062387 DOI: 10.1016/j.anai.2012.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/24/2012] [Accepted: 07/02/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although a number of factors have been proposed to explain the increase in food allergy during the last decade, the possibility that vitamin D status may play a pathogenic role has received recent attention. OBJECTIVE To determine whether lower levels of neonatal 25-hydroxyvitamin D (25[OH]D) would be observed in children with peanut allergy compared with in population controls. METHODS The concentration of 25(OH)D was measured from neonatal dried blood samples by liquid chromatography tandem mass spectrometry. Levels were compared between children with IgE-mediated peanut allergy younger than 72 months assessed during 2008-2011 in a specialist referral clinic in the Australian Capital Territory and population births matched by sex, birth date, and birth location. Odds ratios were calculated for the matched pairs across quintiles of 25(OH)D. RESULTS Neonatal 25(OH)D levels ranged from 8 to 180 nmol/L (median, 66 nmol/L; interquartile range, 46-93 nmol/L); only 4 children (3%) had levels less than 25 nmol/L, and 24 (20.9%) had levels greater than 100 nmol/L. No significant association was found between socioeconomic or clinical factors and 25(OH)D levels. Compared with the reference group (50-74.9 nmol/L), levels of 75 to 99.9 nmol/L were associated with lower risk of peanut allergy (P = .02). No further reduction was found at levels of 100 nmol/L or higher, and the risk of peanut allergy at levels less than 50 nmol/L was not significantly different from the reference group. CONCLUSION The relationship between neonatal 25(OH)D level and childhood peanut allergy was nonlinear, with slightly higher levels (75-99.9 nmol/L) associated with lower risk than those in the reference group (50-74.9 nmol/L). Vitamin D status may be one of many potential factors contributing to childhood peanut allergy pathogenesis.
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Hong X, Wang X. Early life precursors, epigenetics, and the development of food allergy. Semin Immunopathol 2012; 34:655-69. [PMID: 22777545 DOI: 10.1007/s00281-012-0323-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 06/19/2012] [Indexed: 12/21/2022]
Abstract
Food allergy (FA), a major clinical and public health concern worldwide, is caused by a complex interplay of environmental exposures, genetic variants, gene-environment interactions, and epigenetic alterations. This review summarizes recent advances surrounding these key factors, with a particular focus on the potential role of epigenetics in the development of FA. Epidemiologic studies have reported a number of nongenetic factors that may influence the risk of FA, such as timing of food introduction and feeding pattern, diet/nutrition, exposure to environmental tobacco smoking, prematurity and low birth weight, microbial exposure, and race/ethnicity. Current studies on the genetics of FA are mainly conducted using candidate gene approaches, which have linked more than 10 genes to the genetic susceptibility of FA. Studies on gene-environment interactions of FA are very limited. Epigenetic alteration has been proposed as one of the mechanisms to mediate the influence of early life environmental exposures and gene-environment interactions on the development of diseases later in life. The role of epigenetics in the regulation of the immune system and the epigenetic effects of some FA-associated environmental exposures are discussed in this review. There is a particular lack of large-scale prospective birth cohort studies that simultaneously assess the interrelationships of early life exposures, genetic susceptibility, epigenomic alterations, and the development of FA. The identification of these key factors and their independent and joint contributions to FA will allow us to gain important insight into the biological mechanisms by which environmental exposures and genetic susceptibility affect the risk of FA and will provide essential information to develop more effective new paradigms in the diagnosis, prevention, and management of FA.
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Affiliation(s)
- Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA.
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Osborne NJ, Ukoumunne OC, Wake M, Allen KJ. Prevalence of eczema and food allergy is associated with latitude in Australia. J Allergy Clin Immunol 2012; 129:865-7. [DOI: 10.1016/j.jaci.2012.01.037] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/19/2011] [Accepted: 01/11/2012] [Indexed: 12/01/2022]
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Mullins RJ, Clark S, Katelaris C, Smith V, Solley G, Camargo CA. Season of birth and childhood food allergy in Australia. Pediatr Allergy Immunol 2011; 22:583-9. [PMID: 21342281 DOI: 10.1111/j.1399-3038.2011.01151.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies suggest a possible role for low ultraviolet radiation exposure and low vitamin D status as a risk factor for food allergy. We hypothesized that children born in autumn/winter months (less sun exposure) might have higher food allergy rates than those born in spring/summer. METHODS We compared IgE-mediated food allergy rates by season of birth in 835 children aged 0-4 yr assessed 1995-2009 in a specialist referral clinic, using population births as controls. To address potential concerns about generalizability, we also examined national prescriptions for adrenaline autoinjectors (2007) and infant hypoallergenic formula (2006-2007). RESULTS Although live births in the general ACT population showed no seasonal pattern (50% autumn/winter vs. 50% spring/summer), autumn/winter births were more common than spring/summer births among food allergy patients (57% vs. 43%; p < 0.001). The same seasonal pattern was observed with peanut (60% vs. 40%; p < 0.001) and egg (58% vs. 42%; p = 0.003). Regional UVR intensity was correlated with relative rate of overall food allergy (β, -1.83; p = 0.05) and peanut allergy (β, -3.27; p = 0.01). National data showed that autumn/winter births also were more common among children prescribed EpiPens (54% vs. 46%; p < 0.001) and infant hypoallergenic formula (54% vs. 46%; p < 0.001). CONCLUSIONS The significantly higher rates of food allergy in children born autumn/winter (compared to spring/summer), the relationship between relative food allergy rates and monthly UVR, combined with national adrenaline autoinjector and infant hypoallergenic formula prescription data, suggest that ultraviolet light exposure/vitamin D status may be one of many potential factors contributing to childhood food allergy pathogenesis.
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Mullins RJ, Camargo Jr CA. Shining a light on vitamin D and its impact on the developing immune system. Clin Exp Allergy 2011; 41:766-8. [DOI: 10.1111/j.1365-2222.2011.03742.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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.
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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.
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Mullins RJ, Clark S, Camargo CA. Socio-economic status, geographic remoteness and childhood food allergy and anaphylaxis in Australia. Clin Exp Allergy 2010; 40:1523-32. [DOI: 10.1111/j.1365-2222.2010.03573.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vassallo MF, Banerji A, Rudders SA, Clark S, Mullins RJ, Camargo CA. Season of birth and food allergy in children. Ann Allergy Asthma Immunol 2010; 104:307-13. [PMID: 20408340 DOI: 10.1016/j.anai.2010.01.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of food allergy is rising, and etiologic factors remain uncertain. Evidence implicates a role for vitamin D in the development of atopic diseases. Based on seasonal patterns of UV-B exposure (and consequent vitamin D status), we hypothesized that patients with food allergy are more often born in fall or winter. OBJECTIVE To investigate whether season of birth is associated with food allergy. METHODS We performed a multicenter medical record review of all patients presenting to 3 Boston emergency departments (EDs) for food-related acute allergic reactions between January 1, 2001, and December 31, 2006. Months of birth in patients with food allergy were compared with that of patients visiting the ED for reasons other than food allergy. RESULTS We studied 1002 patients with food allergy. Of younger children with food allergy (age < 5 years), but not older children or adults, 41% were born in spring or summer compared with 59% in fall or winter (P = .002). This approximately 40:60 ratio differed from birth season in children treated in the ED for non-food allergy reasons (P = .002). Children younger than 5 years born in fall or winter had a 53% higher odds of food allergy compared with controls. This finding was independent of the suspected triggering food and allergic comorbidities. CONCLUSIONS Food allergy is more common in Boston children born in the fall and winter seasons. We propose that these findings are mediated by seasonal differences in UV-B exposure. These results add support to the hypothesis that seasonal fluctuations in sunlight and perhaps vitamin D may be involved in the pathogenesis of food allergy.
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Affiliation(s)
- Milo F Vassallo
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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