1
|
Røisgård S, Nopp A, Lindam A, Nilsson CA, West CE. Basophil allergen threshold sensitivity to casein (casein-specific CD-sens) predicts allergic reactions at a milk challenge in most but not all patients. Immun Inflamm Dis 2024; 12:e1265. [PMID: 38722265 PMCID: PMC11080960 DOI: 10.1002/iid3.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The basophil activation test is an emerging clinical tool in the diagnosis of cow's milk allergy (CMA). The aim was to assess the association between the basophil allergen threshold sensitivity to the major milk protein casein (casein-specific CD-sens), the levels of milk- and casein-specific Immunoglobulin E antibodies (IgE-ab), and the severity of allergic reactions at milk challenges. METHODS We enrolled 34 patients aged 5-15 (median 9) years who underwent a double-blind placebo-controlled milk-challenge (DBPCMC) as screening before inclusion in an oral immunotherapy study for CMA. The severity of the allergic reaction at the DBPCMC was graded using Sampson's severity score. Venous blood was drawn before the DBPCMC. Milk- and casein-specific IgE-ab were analyzed. Following in vitro stimulation of basophils with casein, casein-specific CD-sens, was determined. RESULTS Thirty-three patients completed the DBPCMC. There were strong correlations between casein-specific CD-sens and IgE-ab to milk (rs = 0.682, p < .001), and between casein-specific CD-sens and IgE-ab to casein (rs = 0.823, p < .001). There was a correlation between the severity of the allergic reaction and casein-specific CD-sens level (rs = 0.395, p = .041) and an inverse correlation between casein-specific CD-sens level and the cumulative dose of milk protein to which the patient reacted at the DBPCMC (rs = -0.418, p = .027). Among the 30 patients with an allergic reaction at the DBPCMC, 67% had positive casein-specific CD-sens, 23% had negative casein-specific CD-sens, and 10% were declared non-responders. CONCLUSION Two thirds of those reacting at the DBPMC had positive casein-specific CD-sens, but reactions also occurred despite negative casein-specific CD-sens. The association between casein-specific CD-sens and the severity of the allergic reaction and cumulative dose of milk protein, respectively, was moderate.
Collapse
Affiliation(s)
- Solveig Røisgård
- Department of Clinical SciencesPediatrics, Umeå UniversityUmeåSweden
| | - Anna Nopp
- Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Sachs Children and Youth HospitalSödersjukhusetStockholmSweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development ÖstersundUmeå UniversityUmeåSweden
| | | | - Caroline A. Nilsson
- Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Sachs Children and Youth HospitalSödersjukhusetStockholmSweden
| | - Christina E. West
- Department of Clinical SciencesPediatrics, Umeå UniversityUmeåSweden
| |
Collapse
|
2
|
Strisciuglio C, Vitale A, Perna F, Garziano F, Dolce P, Vitale S, Micillo T, Oglio F, Del Giudice MM, Matarese G, Gianfrani C. Bifidobacteria modulate immune response in pediatric patients with cow's milk protein allergy. Pediatr Res 2023; 94:1111-1118. [PMID: 36959319 DOI: 10.1038/s41390-023-02534-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND In children with an allergy to cow's milk proteins (CMA), the altered composition of intestinal microbiota influences the immune tolerance to milk proteins (CMP). This study aims to investigate the effect of probiotics on the phenotype and activation status of peripheral basophils and lymphocytes in a pediatric CMA cohort. METHODS CMA children underwent 45 days of treatment with Bifidobacteria. The basophil degranulation and the immune phenotype of B cells, T helper cells, and regulatory T cells were analyzed in peripheral blood at diagnosis (T0), after a 45-day probiotic treatment (T1), and 45 days after the probiotic wash-out (T2). RESULTS We observed in probiotic-treated CMA patients a decrease in naive T lymphocytes. Among the CD3+ cell subsets, both naive and activated CD4+ cells resulted markedly reduced after taking probiotics, with the lowest percentages at T2. A decreased basophil degranulation was observed in response to all analyzed CMP at T1 compared to T0. CONCLUSIONS The probiotic treatment resulted in a decrease of circulating naive and activated CD4+ T cells, as well as degranulating basophils. These data suggest that the Bifidobacteria could have a beneficial effect in the modulation of oral tolerance to CMP. TRIAL REGISTRATION ISRCTN69069358. URL of registration: https://www.isrctn.com/ISRCTN69069358 . IMPACT Probiotic treatment with Bifidobacteria induces a reduction of both naive and activated circulating CD4+ T cells in pediatric patients with cow's milk allergy (CMA). The probiotic supplementation induces a decreased basophil degranulation. The immunological tolerance persists even after 45 days of the probiotic wash-out. Bifidobacteria in vivo supplementation down-modulates the activation of innate and adaptive immunity in pediatric patients with cow's milk allergy. Bifidobacteria contribute to the development of immune tolerance in CMA patients.
Collapse
Affiliation(s)
- Caterina Strisciuglio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Alessandra Vitale
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Perna
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Federica Garziano
- U.O.C Clinical Biochemistry, A.O.R.N. Ospedale dei Colli, Naples, Italy
| | - Pasquale Dolce
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Serena Vitale
- Institute of Biochemistry and Cell Biology, CNR, Naples, Italy
| | - Teresa Micillo
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Franca Oglio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Matarese
- Department of Molecular Medicine and Biotechnology Science, University of Naples "Federico II", Naples, Italy
| | | |
Collapse
|
3
|
Briceno Noriega D, Teodorowicz M, Savelkoul H, Ruinemans-Koerts J. The Basophil Activation Test for Clinical Management of Food Allergies: Recent Advances and Future Directions. J Asthma Allergy 2021; 14:1335-1348. [PMID: 34754200 PMCID: PMC8572092 DOI: 10.2147/jaa.s237759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
The basophil activation test (BAT) is an ex vivo functional assay that measures by flow cytometry the degree of basophil degranulation after stimulation with an allergen. In recent years, there has been an increased interest in the diagnostic value of the BAT as it has the potential to mimic the clinical phenotype of sIgE sensitized patients, in contrast to allergen-specific IgE levels. This diagnostic potential would be of particular interest for food allergies present early in life such as peanut, cow’s milk and eggs, which require an expensive, time-consuming and patient unfriendly oral food challenge (OFC) for diagnosis. However, routine applications of the BAT for clinical use are not yet feasible due to the lack of standardized protocols and large clinical validation studies. This review will summarize the current data regarding the application of the BAT in food allergy (FA) for cow’s milk, egg and peanut, being the most common causes of FA in children. Additionally, it will discuss the hurdles for widespread clinical use of the BAT and possible future directions for this diagnostic procedure.
Collapse
Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Malgorzata Teodorowicz
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Huub Savelkoul
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Janneke Ruinemans-Koerts
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands.,Laboratory of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, the Netherlands
| |
Collapse
|
4
|
Eberlein B. Basophil Activation as Marker of Clinically Relevant Allergy and Therapy Outcome. Front Immunol 2020; 11:1815. [PMID: 32973757 PMCID: PMC7472882 DOI: 10.3389/fimmu.2020.01815] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023] Open
Abstract
For some years now the basophil activation test (BAT) using flow cytometry has emerged as a powerful tool and sensitive marker that can be used to detect clinically relevant allergies, provide information on the severity of an allergic reaction, and monitor therapies. Compared to other in vitro diagnostic tests, BAT seems to have a better informative value in terms of clinical relevance. In general, the BAT can be used for the diagnosis of the most common forms of IgE-mediated allergy such as hymenoptera venom allergy, inhalant allergy, food allergy, and drug allergy. Various basophil markers and parameters have been established which, depending on the trigger of the respective allergy, can provide information on the clinical relevance of sensitization, on the development of natural tolerance, on trigger thresholds, and on the severity of the allergic reaction. The BAT also serves as a suitable follow-up instrument for various therapeutic approaches such as specific immunotherapy, desensitization protocols, or use of anti-IgE-antibodies for the various diseases. Quality controls for routine use, standardization, and automatization are expected to expand the range of applications for the above-mentioned indications.
Collapse
Affiliation(s)
- Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technische Universität München, Munich, Germany
| |
Collapse
|
5
|
Ruinemans-Koerts J, Schmidt-Hieltjes Y, Jansen A, Savelkoul HF, Plaisier A, van Setten P. The Basophil Activation Test reduces the need for a food challenge test in children suspected of IgE-mediated cow's milk allergy. Clin Exp Allergy 2018; 49:350-356. [DOI: 10.1111/cea.13307] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 12/28/2022]
Affiliation(s)
| | - Yvonne Schmidt-Hieltjes
- Department of Clinical Chemistry and Haematology; Rijnstate Hospital; Arnhem The Netherlands
| | - Ad Jansen
- Department of Otorhinolaryngology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Huub F.J. Savelkoul
- Cell Biology and Immunology Group; Wageningen University& Research; Wageningen The Netherlands
| | - Annejet Plaisier
- Department of Paediatrics; Rijnstate Hospital; Arnhem The Netherlands
| | - Petra van Setten
- Department of Paediatrics; Rijnstate Hospital; Arnhem The Netherlands
| |
Collapse
|
6
|
Inuo C, Tanaka K, Suzuki S, Nakajima Y, Yamawaki K, Tsuge I, Urisu A, Kondo Y. Oral Immunotherapy Using Partially Hydrolyzed Formula for Cow's Milk Protein Allergy: A Randomized, Controlled Trial. Int Arch Allergy Immunol 2018; 177:259-268. [PMID: 30134240 DOI: 10.1159/000490804] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partially hydrolyzed cow's milk protein-based formula (pHF) possesses low allergenicity. Here, we investigate the safety and efficacy of oral immunotherapy using pHF for children with cow's milk protein allergy (CMPA). OBJECTIVES A randomized, double-blind, controlled single-center trial was conducted to evaluate the efficacy and safety of pHF oral immunotherapy in children with CMPA. METHODS Participants were randomized into double-blind pHF-pHF and extensively hydrolyzed cow's milk protein-based formula (eHF)-pHF groups. During this phase, the pHF-pHF group received pHF and the eHF-pHF group received eHF. During the open phase, all participants received pHF. The primary end point was a change in thresholds between baseline and the end of the first phase. Secondary end points were changes in thresholds between baseline and the end of the second phase, and casein-specific immunoglobulin (Ig)E, IgG4, and basophil activation. RESULTS Twenty-five children, aged 1-9 years, were randomized into pHF-pHF and eHF-pHF groups. The threshold between baseline and the end of the first phase was significantly elevated in the pHF-pHF group (p = 0.048), but not in the eHF-pHF group. The threshold between other phases did not change significantly in either group. There were significant decreases in casein-specific IgE antibody levels between baseline and the second phase in the eHF-pHF group (p = 0.014). No participants suffered systemic allergic reactions requiring adrenaline or systemic corticosteroids after receiving the formulas. CONCLUSIONS The results of this trial suggest that, in children with CMPA, tolerance to cow's milk might be safely enhanced by intake of pHF, relative to that of eHF.
Collapse
Affiliation(s)
- Chisato Inuo
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan.,Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan.,Department of Allergy, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kenichi Tanaka
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Satoko Suzuki
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Yoichi Nakajima
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kazuo Yamawaki
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Ikuya Tsuge
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Atsuo Urisu
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| | - Yasuto Kondo
- Department of Pediatrics, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
| |
Collapse
|
7
|
Sabogal-Cuadro P, Zakzuk J. Prueba de activación de basófilos: aspectos técnicos, metodológicos y su utilidad clínica. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n3.61820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La prueba de activación de basófilos (PAB) se considera una técnica confiable y segura para el diagnóstico de problemas alérgicos.Objetivo. Profundizar en el estado del arte de la PAB y su utilidad clínica.Materiales y métodos. Se realizó una revisión narrativa de la literatura mediante la búsqueda electrónica en las bases de datos y metabuscadores Ovid Medline, Google Scholar y PubMed, sin limitar la búsqueda por fecha, idioma o tipo de artículo. Se buscaron artículos sobre los detalles técnicos de la PAB y su utilidad clínica en el manejo de las enfermedades alérgicas.Resultados. De los marcadores de activación, CD63 ha sido el más estudiado y es el que mejor representa un evento de degranulación anafiláctica, mientras que CD203c es representativo de varias formas de degranulación. La superioridad de uno sobre otro como prueba diagnóstica depende del problema alérgico estudiado. En cuanto a los métodos de detección de basófilos, su selección con un único marcador, CCR3, se propone como una opción con buena relación de costo-efectividad.Conclusiones. La PAB es una herramienta prometedora para evaluar en clínica las reacciones alérgicas de forma segura. Es necesario una mayor estandarización de protocolos para obtener resultados más reproducibles.
Collapse
|
8
|
Petroni D, Spergel JM. Eosinophilic esophagitis and symptoms possibly related to eosinophilic esophagitis in oral immunotherapy. Ann Allergy Asthma Immunol 2018; 120:237-240.e4. [PMID: 29397272 DOI: 10.1016/j.anai.2017.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/22/2017] [Accepted: 11/20/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Daniel Petroni
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
9
|
de la Varga Martínez R, Gutiérrez Fernández D, Áñez GA, Foncubierta Fernández A, Andrés García JA, Medina Varo F. Use of the basophil activation test in monitoring clinical tolerance after desensitization to brentuximab vedotin. Ann Allergy Asthma Immunol 2017; 118:745-747. [PMID: 28583265 DOI: 10.1016/j.anai.2017.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/16/2017] [Accepted: 04/18/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Raquel de la Varga Martínez
- Unidad de Investigación, Área de investigación clínica en Inmunología y Reumatología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | | | - Gustavo A Áñez
- UGC de Cirugía Ortopédica, Traumatología y Reumatología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - José A Andrés García
- UGC de Cirugía Ortopédica, Traumatología y Reumatología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Fermín Medina Varo
- UGC de Cirugía Ortopédica, Traumatología y Reumatología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| |
Collapse
|
10
|
Basophil Degranulation Assay. Methods Mol Biol 2017. [PMID: 28315217 DOI: 10.1007/978-1-4939-6925-8_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Basophil degranulation assay has gained importance over the last decade in both diagnosis of food allergy and evaluation of progression of immunotherapy. This assay involves the identification and quantification of the expression of CD63 molecule on basophil membrane. CD63 is a marker of multivesicular bodies that is exposed to cell membrane during the process of degranulation in which the contents of basophil granules are released. This chapter describes the methodology for performing this assay.
Collapse
|
11
|
Depince-Berger AE, Sidi-Yahya K, Jeraiby M, Lambert C. Basophil activation test: Implementation and standardization between systems and between instruments. Cytometry A 2017; 91:261-269. [DOI: 10.1002/cyto.a.23078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/16/2017] [Accepted: 01/30/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - Khaled Sidi-Yahya
- Immunology laboratory/University Hospital Saint-Etienne; FRE-CNRS 3312, 42055 Saint-Etienne Cedex 2 France
| | - Mohammed Jeraiby
- Immunology laboratory/University Hospital Saint-Etienne; FRE-CNRS 3312, 42055 Saint-Etienne Cedex 2 France
| | - Claude Lambert
- Immunology laboratory/University Hospital Saint-Etienne; FRE-CNRS 3312, 42055 Saint-Etienne Cedex 2 France
| |
Collapse
|
12
|
Malakar S. Bioactive food chemicals and gastrointestinal symptoms: a focus of salicylates. J Gastroenterol Hepatol 2017; 32 Suppl 1:73-77. [PMID: 28244660 DOI: 10.1111/jgh.13702] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 12/28/2022]
Abstract
Bioactive food chemicals are substances present in food that are capable of interacting with living cells causing changes in physiological functions. Salicylic acid (SA), a plant hormone involved in plant immune response, is one such bioactive food chemical. Aspirin, a commercially available SA, might play beneficial roles in cardiovascular health and colon cancer. It may also cause urticaria, angioedema, asthma, and gastrointestinal symptoms in SA-sensitive individuals. Dietary SA might exert similar beneficial effects and/or may induce similar symptoms in hypersensitive individuals. Food-related SA sensitivity in relation to gastrointestinal symptoms is not well documented besides a few self-reported questionnaires and the knowledge that low doses of aspirin (equivalent of high dietary intake) can cause gastrointestinal injury. The only direct evidence that suggests benefits of reducing dietary SA was reported in asthmatic individuals. Although SA sensitivity in relation to gut symptoms in susceptible individuals is accepted by clinicians, the detection of this disease remains a challenge because of the complicated nature of dietary challenges and the risk of oral aspirin provocation tests in patients with severe hypersensitivity reactions. Given the non-IgE mediated nature of the disease, in vitro assays like basophil activation may have failed to produce reliable results. However, given the simplicity of this assay, further studies need to be formulated to firmly establish its reliability. Formulation of proper dietary strategies for symptom control is also impossible given the controversial and scant nature of the data on SA content of food. This issue needs to be resolved to formulate proper dietary strategies for effective symptom control.
Collapse
Affiliation(s)
- Sreepurna Malakar
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Australia
| |
Collapse
|
13
|
Fiocchi A, Dahda L, Dupont C, Campoy C, Fierro V, Nieto A. Cow's milk allergy: towards an update of DRACMA guidelines. World Allergy Organ J 2016; 9:35. [PMID: 27895813 PMCID: PMC5109783 DOI: 10.1186/s40413-016-0125-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2010, the diagnosis and treatment of IgE-mediated CMA were systematized in a GRADE guideline. OBJECTIVES & METHODS After 6 years, the state of the knowledge in diagnosis and treatment of CMA has largely evolved. We summarize here the main advances, and exemplify indicating some specific points: studies aimed at better knowledge of the effects of breastfeeding and the production of new special formulae intended for the treatment of CMA. The literature (PubMed/MEDLINE) was searched using the following algorithms: (1) [milk allergy] AND diagnosis; (2) [milk allergy] AND [formul*] OR [breast*], setting the search engine [6-years] time and [human] limits. The authors drew on their collective clinical experience to restrict retrieved studies to those of relevance to a pediatric allergy practice. RESULTS Several clinical studies did address the possibility to diagnose CMA using new tools in vitro and in vivo, or to diagnose it without any evaluation of sensitization. Some studies also addressed the clinical role of formulae based on milk hydrolysates, soy, or rice hydrolysates in the treatment of CMA. Many studies have elucidated the effects of selective nutrients in breastfed infants on their immunologic and neurologic characteristics. CONCLUSIONS Evidence-based diagnostic criteria should be identified for non-IgE-mediated CMA. Debate is ongoing about the best substitute for infants with CMA. In particular, Hydrolyzed Rice Formulae have been widely assessed in the last six years. In the substitute choice, clinicians should be aware of recent studies that can modify the interpretation of the current recommendations. New systematic reviews and metanalyses are needed to confirm or modify the current DRACMA recommendations.
Collapse
Affiliation(s)
- Alessandro Fiocchi
- Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Lamia Dahda
- Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Christophe Dupont
- Service d’Explorations Fonctionnelles Digestives Pédiatriques, Hôpital Necker, Université Paris-Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Cristina Campoy
- Department of Paediatrics, Centre of Excellence for Paediatric Research EURISTIKOS, School of Medicine, University of Granada, Avda. De Madrid 11, 18012 Granada, Spain
- Department of Paediatrics, University of Granada, Avda. de la Investigación 11, 18016 Granada, Spain
| | - Vincenzo Fierro
- Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City Italy
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy Unit, Children’s Hospital La Fe, Valencia, Spain
| |
Collapse
|
14
|
Chirumbolo S. Basophil activation test in oral desensitization to cow's milk allergy. United European Gastroenterol J 2016; 4:714-715. [PMID: 27733914 DOI: 10.1177/2050640615614793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/13/2015] [Indexed: 01/25/2023] Open
Abstract
The recent paper by Nucera et al., showed that the basophil activation test (BAT) in flow cytometry is able to monitor an acquired tolerance induced by a desensitization treatment in food allergy. The paper by Nucera et al. reported two standpoints in the CD63 response to food allergy and OAT and their large difference in CD63 response before and after suggests for the optimal performance of a CD123/HLADR/CD63 BAT in oral food allergy immunotherapy.
Collapse
Affiliation(s)
- Salvatore Chirumbolo
- Department of Medicine, University of Verona Laboratory of Physiopathology of Obesity, Verona, Italy
| |
Collapse
|
15
|
Guidelines for the use and interpretation of diagnostic methods in adult food allergy. Clin Mol Allergy 2015; 13:27. [PMID: 26441488 PMCID: PMC4593201 DOI: 10.1186/s12948-015-0033-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/15/2015] [Indexed: 12/27/2022] Open
Abstract
Food allergy has an increasing prevalence in the general population and in Italy concerns 8 % of people with allergies. The spectrum of its clinical manifestations ranges from mild symptoms up to potentially fatal anaphylactic shock. A number of patients can be diagnosed easily by the use of first- and second-level procedures (history, skin tests and allergen specific IgE). Patients with complex presentation, such as multiple sensitizations and pollen-food syndromes, frequently require a third-level approach including molecular diagnostics, which enables the design of a component-resolved sensitization profile for each patient. The use of such techniques involves specialists' and experts' skills on the issue to appropriately meet the diagnostic and therapeutic needs of patients. Particularly, educational programs for allergists on the use and interpretation of molecular diagnostics are needed.
Collapse
|