Allergic sensitisation in infants younger than one year of age

A new way forward? Examining the potential of quantitative analysis of IgE datasets

Background

Allergies constitute an important public health problem, and epidemiological data is crucial to developing strategies for its prevention and therapy. Few population-based studies are available for data on allergies and sensitization. However, as these studies are expensive and time-consuming, novel approaches are searched for.

Objectives

A large monocentric IgE dataset was used to analyse quantitative sensitization data in different age and gender groups and compared the results to available epidemiological data.

Methods

A total of 14,370 patients who sought medical care at the Department for Dermatology and Allergology at the Technical University of Munich, Germany was analysed. Total IgE and sensitization measured in specific IgE levels to common food allergens and aeroallergens were compared between females and males, age groups, and the year of testing (2003–2021).

Results

8283 females (57.6%) and 6087 males (42.4%) were tested. The average number of specific IgE tests per patient was 12.3 ± 11.4. Total IgE increased after birth with age and reached a peak between 4–6 years in males and 10–12 years in females. Males had higher specific IgE for all common aeroallergens (house dust mite, birch, mugwort and timothy grass pollen) and food allergens (milk protein, chicken egg white, peanut, wheat flour, cod) except for cat epithelia. Data closely reflected results of population-based studies in the literature.

Conclusion

This study shows that, despite potential patient and test selection bias, the results of the quantitative IgE-dataset analysis closely reflect results of population-based data. Thus, as large cohorts can be examined with a minute amount of effort, this surrogate method appears promising to supplement epidemiology research.

Mycophenolate mofetil use is associated with reduced incidence of food allergy in liver transplanted children

OBJECTIVES

The incidence of food allergy in children following liver transplantation is high and the pathogenesis is still not known. We aimed to identify risk factors for development of food allergies in liver transplant children.

METHODS

107 children and adolescents who underwent liver transplantation from 1999 to 2019 were included. Data were retrospectively collected from medical records included total and specific IgE, eosinophil cationic protein and eosinophil count 12 months after transplantation and at yearly follow up (median follow-up).

RESULTS

24/107 (22%) patients reported clinical food reactions. Median time from transplantation to debut of food allergy was 1.6 (IQR 0.6-3.3) years. Mycophenolate mofetil (MMF) was discontinued in 24/78 patients (31%) due to side effects. Children treated with MMF in addition to tacrolimus one year after transplantation reported less food allergy (12.5% vs. 37.8%, p=0.003) and sensitization to food allergens one year after transplantation (8.9% vs. 17.8%, p=0.02) than those not receiving MMF. Tacrolimus trough levels did not differ between the patients treated with MMF and those who were not. Treatment with MMF two years after transplantation was associated with less food allergy (p=0.001) and food sensitization (p=0.002), also when adjusted for age at transplantation (p=0.006 and p=0.03, respectively) or for use of basilixmab (p=0.015 and p=0.018, respectively). Basiliximab was also associated with less food allergy.

CONCLUSIONS

Use of MMF one and two years after transplantation was associated with less food allergy and sensitization against food allergens. The effect of MMF was not due to reduced trough levels of of tacrolimus. An infographic is available for this article at: https://links.lww.com/MPG/C821.

Extract and molecular-based early infant sensitization and associated factors-A PreventADALL study

BACKGROUND

More knowledge about sensitization patterns in early infancy, including impact of molecular allergology, is needed to help predict future allergy development more accurately.

OBJECTIVE

We aimed to determine the prevalence and patterns of allergic sensitization at 3 months of age, and explore possible associated factors.

METHODS

From the Scandinavian antenatally recruited PreventADALL mother-child cohort, we included 1110 3-month infants with available serum. Sensitization was defined as s-IgE of ≥0.1 kU_A /L by Phadiatop Infant^® (ThermoFisher Scientific) including birch, cat, grass, dog, milk, egg, peanut and wheat. Further ImmunoCAP analyses to ovomucoid, casein, Ara h 1-3, omega-5-gliadin were performed in food extract s-IgE-positive children. Maternal sensitization was defined as s-IgE ≥ 0.35 kU_A /L to Phadiatop^® (inhalant allergen mix) and/or Fx5 (food allergen mix) at 18-week pregnancy.

RESULTS

Overall 79 (7.3%) infants had specific sensitization, many with low s-IgE-levels (IQR 0.16-0.81 kU_A /L), with 78 being sensitized to food extract allergens; 41 to egg, 27 to milk, 10 to peanut, and 25 to wheat. A total of 62/78 were further analysed, 18 (29%) had s-IgE to ovomucoid, casein, Ara h 1-3 and/or omega-5-gliadin. Eight infants (0.7%) were sensitized to inhalant allergens. Maternal sensitization to food allergens was associated with infant sensitization, odds ratio 3.64 (95% CI 1.53-8.68).

CONCLUSION

Already at 3 months of age, 7% were sensitized to food, mostly without detectable s-IgE to food allergen molecules, and <1% to inhalant allergens. Maternal food sensitization was associated with infants' sensitization.

Virus, allergic sensitisation and cortisol in infant bronchiolitis and risk of early asthma

Background

Acute bronchiolitis during infancy and human rhinovirus (HRV) lower respiratory tract infections increases the risk of asthma in atopic children. We aimed to explore whether specific viruses, allergic sensitisation or cortisol levels during acute bronchiolitis in infancy increase the risk of early asthma, using recurrent wheeze as a proxy.

Methods

In 294 children with a mean (range) age of 4.2 (0–12) months enrolled during hospitalisation for acute infant bronchiolitis, we analysed virus in nasopharyngeal aspirates, serum specific immunoglobulin E against food and inhalant allergens, and salivary morning cortisol. These factors were assessed by regression analyses, adjusted for age, sex and parental atopy, for risk of recurrent wheeze, defined as a minimum of three parentally reported episodes of wheeze at the 2-year follow-up investigation.

Results

At 2 years, children with, compared to without, recurrent wheeze had similar rates of respiratory syncytial virus (RSV) (82.9% versus 81.8%) and HRV (34.9% versus 35.0%) at the acute bronchiolitis, respectively. During infancy, 6.9% of children with and 9.2% of children without recurrent wheeze at 2 years were sensitised to at least one allergen (p=0.5). Neither recurrent wheeze nor incidence rate ratios for the number of wheeze episodes at 2 years were significantly associated with specific viruses, high viral load of RSV or HRV, allergic sensitisation, or morning salivary cortisol level during acute bronchiolitis in infancy.

Conclusion

In children hospitalised with acute infant bronchiolitis, specific viruses, viral load, allergic sensitisation and salivary morning cortisol did not increase the risk of early asthma by 2 years of age.

In infants with acute bronchiolitis, specific viruses including human rhinovirus, viral load and/or allergic sensitisation did not increase the risk of asthma by 2 years of age.http://bit.ly/2tCE9Yd

Prevalence and distribution patterns of allergens among children with asthma and asthma-like symptoms in Shanghai, China

Objective

We aimed to identify the prevalence and distribution patterns of allergens among Chinese children with asthma/asthma-like symptoms (ALS).

Methods

A total of 3479 children with asthma/ALS were enrolled. Skin prick test (SPT) was used to test the allergen-specific IgE. We analysed allergens prevalence and distribution, and its relationship with demographic characteristics.

Results

Aeroallergens prevalence was higher than that of food allergens (p < 10^− 4). Boys had higher aeroallergens prevalence than that in girls (p < 10^− 4). Significant difference of aeroallergens prevalence among cases with different parental allergy history was observed (p < 10^− 4). Age was positively associated with aeroallergens prevalence before the age of 11.5 (P < 10^− 4), particularly before the age of 2.42 (P < 10^− 4). Age was negatively associated with aeroallergens prevalence after the age of 11.5 (P = 0.021). Age was negatively associated with food allergens prevalence before the age of 3.42 (P < 10^− 4). Age was associated with the intensity of dermatophagoides farinae (DF)/house dust mite (HDM) allergens (P < 10^− 4). Age was negatively associated with the intensity of shrimp, and crab allergens before the age of 3.3 and 3.3, respectively (P = 0.012, < 10^− 4). Boys had higher intensity of DF and HDM allergens than that in girls (P < 10^− 4, P < 10^− 4). Significant differences of the intensity of DF and HDM allergens among groups with different parental allergy history were noted (P < 10^− 4, P < 10^− 4).

Conclusions

Boys and parental allergy history were associated with higher prevalence and intenstity of aeroallergens. Age was positively and negatively associated with aeroallergens prevalence before and after the age of 11.5, respectively. Age was negatively associated with food allergens prevalence before the age of 3.42.