The significance of allergic contact urticaria to milk in children with cow's milk allergy

Ameliorative Effects of Ginger on Allergic Diseases: An Updated Review

The hypersensitivity reaction of the immune system to harmless environmental substances causes allergic diseases. Today, about 22%-30% of the world's population suffers from allergic diseases. Since the probability of change in the genetic structure during the past decades of lives is very low, genetic disorders cannot be blamed for causing allergic diseases. Thus, factors such as air pollution, climate change, change in diet, increased antibiotics consumption, change in the gut microbiome, migration toward urban areas, and increase in airborne allergens should be considered as the main causes of the spread and increase in allergic diseases. Methods of preventing contact with allergens, drug treatment, and allergen-specific immunotherapy are used to treat allergic diseases. In recent years, the therapeutic efficacy of herbal compounds has been significantly investigated by the scientific community, because these compounds have very few side effects. Ginger is one of the plant compounds that have anti-inflammatory, antioxidant, and immunomodulatory properties. The ameliorative effects of this plant on allergic diseases have been identified. Therefore, the aim of this short review is to summarize the knowledge, which is available about the ameliorative properties of the compounds found in the ginger plant that can reduce the clinical symptoms of allergic diseases. The hypersensitivity reaction of the immune system to harmless environmental substances causes allergic diseases. Today, about 22%-30% of the world's population suffers from allergic diseases. Since the probability of change in the genetic structure during the past decades of lives is very low, genetic disorders cannot be blamed for causing allergic diseases. Thus, factors such as air pollution, climate change, change in diet, increase in antibiotic consumption, change in the gut microbiome, migration toward urban areas, and increase in airborne allergens should be considered as the main causes of the spread and increase in allergic diseases. Methods of preventing contact with allergens, drug treatment, and allergen-specific immunotherapy are used to treat allergic diseases. In recent years, the therapeutic efficacy of herbal compounds has been significantly investigated by the scientific community, because these compounds have very few side effects. Ginger is one of the plant compounds that have antiinflammatory, antioxidant, and immunomodulatory properties. The ameliorative effects of this plant on allergic diseases have been identified. Therefore, the aim of this short review is to summarize the knowledge, which is available about the ameliorative properties of the compounds found in the ginger plant that can reduce the clinical symptoms of allergic diseases.

Characterization of the potential allergenicity of enzymatically hydrolyzed casein in Balb/c mouse model

Bovine casein is a major allergen present in cow milk to induce anaphylaxis. In this study, the potential allergenicity of enzymatically hydrolyzed casein (HC) was evaluated based on in vitro and in vivo. The results showed that Alcalase and Protamex treatment (AT, PT) reduced the potential allergenicity of CN, with the greatest reductions of 68.25% and 50.75%, respectively. In addition, in vivo results showed that HC effectively alleviated allergic response symptoms of Balb/c mice; a significant tendency toward decreased serum IgG1 and mast cell tryptase levels was observed, accompanied by a decrease of Th2-associated IL-4, IL-5, and IL-13 and an increase of IFN-γ levels in spleen. Moreover, the inflammation of the lung, jejunum, and ileum was remarkably ameliorated. The findings indicated that HC induced a shift toward Th1 response and maintained the Th1/Th2 immune balance. Importantly, our results provide the basis for the production of hypoallergenic dairy products.

Oral food challenge in children with contact urticaria in reaction to cow's milk

OBJECTIVE

To evaluate the relationship between the occurrence of contact urticaria in reaction to cow's milk in infants and the diagnosis of cow's milk allergy (CMA) established by supervised oral food challenge.

METHODS

In this cross-sectional study, we identified 184 children who had undergone 221 oral food challenge (OFC) at a CMA reference center between July 2015 and August 2019. Of these, 23 (12.5%) had a history of contact urticaria to cow's milk and underwent a total of 30 OFC. Baked cow's milk OFC were excluded, and 21 children were included in the study. All data from clinical history and allergy tests (serum-specific IgE dosages and skin prick test [SPT] with reconstituted cow's milk formula) were recorded on standardized forms. The challenge was conducted with reconstituted cow's milk formula in increasing volumes every 15-20 min.

RESULTS

24 OFC were performed; 13/24 (54.2%) for diagnostic purpose and 11/24 (45.8%) to evaluate cow's milk tolerance. Allergy tests were positive in 14 patients (87.5%). Positive oral challenge outcomes were identified in 7/24. One patient had a late flare of atopic dermatitis and five children presented with immediate urticaria (two generalized urticaria and three perioral urticaria). The median papule diameter was 6.5 mm in patients with a positive OFC and 3.75 mm in the negative group (P = 0.02).

CONCLUSION

The occurrence of contact urticaria might be the only manifestation among infants sensitized to cow's milk with tolerance to oral ingestion. Reactions due to oral challenge were related to a larger wheal diameter on the SPT.

Allergic disorders and their risk factors in primary Sjögren's syndrome

Objective

This study aimed to evaluate the prevalence of allergic disorders in patients with primary Sjögren's syndrome (pSS), compare it with that of patients with rheumatoid arthritis (RA), and examine the risk factors in patients with pSS.

Methods

We retrospectively examined the records of patients diagnosed with pSS and RA who regularly visited our department between 2010 and 2020. Allergic disorders included drug allergy, food allergy, allergic contact dermatitis (ACD), allergic rhinitis (AR)/allergic conjunctivitis (AC), and asthma.

Results

Patients with pSS (292 patients) had a higher prevalence of food allergy, drug allergy, and AR/AC than those with RA (413 patients). The multivariate analysis revealed that patients with pSS who had drug allergy had a higher prevalence of food allergy, higher eosinophil levels, and higher positivity rates of anti-SS-related antigen A (SSA) antibodies than those without drug allergy; those with food allergy had a higher rate of ACD than those without food allergy and vice versa; those with AR/AC had a higher rate of ACD and asthma and higher eosinophil levels than those without AR/AC; those with asthma had a higher rate of AR/AC than those without asthma.

Conclusions

Patients with pSS had a higher prevalence of allergic disorders than those with RA. Among patients with pSS, the risk factors for drug allergy were food allergy, higher eosinophil levels, and positivity for anti-SSA antibodies, the risk factor for food allergy was ACD and vice versa, the risk factors for AR/AC were ACD, asthma, and high eosinophil levels, and the risk factor for asthma was AR/AC.

Successful management of chronic urticaria and food allergies in a pediatric population using integrative traditional Chinese medicine therapy: a case series

BACKGROUND

Food allergy is becoming increasingly common among the pediatric population. Despite strict avoidance of food allergens, a subgroup of sensitive individuals still develops frequent, persistent, and difficult to treat hives (FPDTH) for which there is no curative therapy. Although these cases are rare, these patients are in most need of therapy.

CASE PRESENTATIONS

This is a retrospective review of 3 pediatric patients with highly sensitive food allergies who initially presented with hives daily or every other day, or multiple times a day, but achieved marked remission after traditional Chinese medicine (TCM) therapies. Patient 1 (P1) is a 5-year-old who has experienced 140 reactions in his lifetime. Reactions were mostly hives with 4 episodes of anaphylaxis. P1 had used Prednisone 20 times, had an Epinephrine injection 4 times, and had 3 emergency room (ER) visits. Patient 2 (P2) is a 12-year-old who had experienced hives since age 3. Despite daily antihistamine use, P2 had > 730 reactions in his lifetime at the time of presentation including 2 episodes of anaphylaxis. He had been prescribed prednisone 4 times, an Epinephrine injection 2 times, and had 1 ER visit. Patient 3 (P3) is a 20-month-old girl who had experienced > 120 reactions including 1 episode of anaphylaxis. She was on daily desonide and frequently used an antihistamine, yet still had required a course of prednisone once, an Epinephrine injection once, and had 1 ER visit to manage her reaction. After presenting to our clinic, patients received internal and external TCM treatments, including herbal baths and creams (Remedy A-D) as basic remedies to reduce food reactions, including but not limited to frequent hives. Within 7-9 months of TCM treatment, remarkably all patients had complete remission of atopic symptoms. All three patients also experienced an improvement in other conditions including food intolerance, diarrhea, anxiety, eczema, and environmental allergies. After 1 year of treatment, all three patients had reductions in food-specific IgE levels that had been previously elevated, and additionally, P1 and P3, who initially had high total IgE levels, experienced a marked decrease in total IgE levels as well. All three patients continued to introduce foods into their diet that they previously had reactions to, and all 3 patients remain symptom-free.

CONCLUSIONS

Three pediatric patients with a known history of multiple food sensitivities and physician-diagnosed food allergies that presented with FPDTH underwent a TCM regimen and experienced dramatic improvement in symptoms and reduction in their IgE levels. This regimen appears to be effective in FPDTH population although a further study in a controlled clinical setting is required.

Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update - III - Cow's milk allergens and mechanisms triggering immune activation

Background

The immunopathogenesis of cow's milk protein allergy (CMPA) is based on different mechanisms related to immune recognition of protein epitopes, which are affected by industrial processing.

Purpose

The purpose of this WAO DRACMA paper is to: (i) give a comprehensive overview of milk protein allergens, (ii) to review their immunogenicity and allergenicity in the context of industrial processing, and (iii) to review the milk-related immune mechanisms triggering IgE-mediated immediate type hypersensitivity reactions, mixed reactions and non-IgE mediated hypersensitivities.

Results

The main cow’s milk allergens – α-lactalbumin, β-lactoglobulin, serum albumin, caseins, bovine serum albumins, and others – may determine allergic reactions through a range of mechanisms. All marketed milk and milk products have undergone industrial processing that involves heating, filtration, and defatting. Milk processing results in structural changes of immunomodulatory proteins, leads to a loss of lipophilic compounds in the matrix, and hence to a higher allergenicity of industrially processed milk products. Thereby, the tolerogenic capacity of raw farm milk, associated with the whey proteins α-lactalbumin and β-lactoglobulin and their lipophilic ligands, is lost.

Conclusion

The spectrum of immunopathogenic mechanisms underlying cow's milk allergy (CMA) is wide. Unprocessed, fresh cow's milk, like human breast milk, contains various tolerogenic factors that are impaired by industrial processing. Further studies focusing on the immunological consequences of milk processing are warranted to understand on a molecular basis to what extent processing procedures make single milk compounds into allergens.

Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

Clinical difference between single subtype and mixed subtype chronic urticaria: A retrospective study

BACKGROUND

The subtypes of chronic urticaria share a common clinical expression, but may show differences phenotypically. Meanwhile, two or more different subtypes of chronic urticaria can coexist in any given patient which may involve different phenotypes.

AIMS

The study aims to compare the two phenotypes in terms of demographics, clinical profile and treatment response.

METHODS

In this retrospective study, 2678 chronic urticaria patients were divided into the single subtype chronic urticaria group and mixed subtype chronic urticaria group as was appropriate.The differences in the clinical features, possible causes, urticaria activity score of seven days, dermatology life quality index score, laboratory investigations and response to treatments were evaluated among the two groups.

RESULTS

An obvious female predominance was detected in chronic urticaria, especially in mixed subtype chronic urticaria patients. Of the 2678 chronic urticaria patients, there were 837(31.25%) mixed subtype chronic urticaria. Chronic spontaneous urticaria combined with symptomatic dermographism was the most common group in the mixed subtype chronic urticaria. Patients with mixed subtype chronic urticaria were more likely to have associated chest tightness/shortness of breath and showed greater urticaria activity. In patients with single subtype chronic urticaria, the positive rate of family history with allergic rhinitis, asthma or urticaria was lower. Based on evaluation of the treatment, control with second-generation antihistamines at licensed doses was achieved in only 38.83% of mixed subtype chronic urticaria patients, compared with 56.32% of patients with single subtype.

LIMITATIONS

First, this study was a single-center design retrospective study. Second, omalizumab treatment was not included. Third, the differences between different subtypes of mixed subtype chronic urticaria were not discussed in detail.

CONCLUSION

This study showed that mixed subtype chronic urticaria had some distinct features. Comprehensive knowledge about it may help us define effective therapeutic strategies and improve symptom control and the quality of life for chronic urticaria patients.

Prognostic accuracy of clinical signs and diagnostic tests in cow's milk allergy in newborns

BACKGROUND

The aim of the study was to explore the correlation between clinical signs and confirmatory tests for cow's milk allergy (CMA) in the neonatal period and their relation to family history and the occurrence of food allergies in the postneonatal period.

METHODS

The medical documentation of 361 newborns with suspected CMA and exclusion of other comorbidities was analyzed. The correlations between clinical signs and methods to confirm CMA [elevated levels of total immunoglobulin E (IgE) and/or specific IgE for cow's milk, improvement after the introduction of a cow's milk-free diet and positive challenge procedure] were studied. In 90 children, the data were additionally analyzed in relation to outcome (at the age of 1-11 years), evaluated by questionnaires, which inquired about signs and symptoms of food allergy, methods of CMA confirmation, and the presence of other food allergies.

RESULTS

There was a positive correlation between exanthema and confirmed CMA in the neonatal period (R = 0.184; p = <0.001; n = 361), and hematochezia and confirmed CMA in the neonatal (R = 0.203; p < 0.001; n = 361) and postneonatal period (R = 0.215; p = 0.042; n = 90). Additional food allergies in the postneonatal period were positively correlated with neonatal CMA (R = 0.275; p = 0.009; n = 90). No correlation was found between a positive family history of food allergies and CMA in the neonatal (R = -0.66; p = 0.398; n = 165) and postneonatal periods (R = 0.00; p = 1.000; n = 116).

CONCLUSION

Neonatal exanthema and hematochezia were the predominant clinical signs in neonates with CMA. Allergies to other food allergens appeared more frequently in children with CMA in the neonatal period. Neonatal CMA did not occur more frequently in families with food allergies.

Characterization of the potential allergenicity of irradiated bovine α-lactalbumin in a BALB/c mouse model

Bovine α-lactalbumin (ALA) is a known food allergen present in milk to induce anaphylaxis. A previous study demonstrated that irradiated ALA (iALA) decreased the IgE-binding properties and weakened the degranulation capacity of basophils in vitro. The present study aimed to further assess the potential allergenicity of iALA in vivo in a BALB/c mouse model. The mice (n = 10/group) were intragastrically sensitized and orally challenged with either iALA or ALA using cholera toxin as adjuvant. In contrast to the ALA group, the iALA group did not show anaphylactic shock symptoms. A tendency toward decreased serum allergen-specific IgG/IgG₁/IgE levels, plasma histamine levels and mast cell protease-1 (mMCP-1) concentrations in the iALA group were also observed, accompanied by a decrease in Th2-related cytokine levels and an increase of IFN-γ production in spleen cell cultures. Moreover, the peritoneal mast cell surface expression of FcεRI and peripheral blood basophil CD200R⁺ expression were decreased by 64.3% and 35.19%, respectively. Conversely, the percentage of CD4⁺CD25⁺Foxp3⁺ regulatory T cells increased in the iALA group. All of these findings indicated that iALA induces a shift toward the Th1 response, which ultimately reduces its potential allergenicity.