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Yazici D, Suer H, Bulbuloglu CN, Guzar E, Koçak E, Nemutlu E, Buyuktiryaki B, Sackesen C. Development of a low allergenic product for patients with milk allergy and assessment of its specific IgE reactivity. Pediatr Allergy Immunol 2024; 35:e14174. [PMID: 38899602 DOI: 10.1111/pai.14174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/10/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Milk oral immunotherapy is the riskiest and most unpredictable form of oral immunotherapy. We aimed to produce a low allergenic product than conventional once baked-cake/muffin, to develop indirect in-house ELISA to check the tolerance status with milk products and evaluate IgE reactivity of patients' sera via western blotting (WB) and indirect in-house ELISA. METHOD A low allergenic product named biscotti-twice baked-cake was developed, and the total protein concentration was determined. The protein content was studied by SDS-PAGE and proteomics. Milk-specific IgE (sIgE) binding assays were performed by WB and indirect in-house ELISA by using patients' sera. RESULTS Casein band intensity was observed to be lower in the biscotti-twice baked-cake than in the once baked-cake (p = .014). Proteomics analysis and αS1-casein measurement showed that the lowest intensity of casein was found in biscotti. The low binding capacity of milk sIgE to biscotti compared with once baked-cake was shown by WB (p = .0012) and by indirect in-house ELISA (p = .0001). In the ROC analysis, the area under the curve (AUC) of the in-house ELISA IgE was comparable with Uni-CAP milk and casein sIgE. The AUC of the in-house ELISA IgE for cake (0.96) and biscotti (1) was slightly better than Uni-CAP milk sIgE (0.94; 0.97) and casein sIgE (0.96; 0.97), respectively. CONCLUSION The low allergenicity of the newly developed low allergenic product "biscotti-twice baked-cake" has been demonstrated by in vitro experiments. Biscotti could be a safe treatment option than once baked-cake/muffin in patients who are reactive to once baked-milk products.
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Affiliation(s)
- Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
| | - Hande Suer
- Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
- Graduate School of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cemre Naz Bulbuloglu
- Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
| | - Elif Guzar
- Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
| | - Engin Koçak
- Department of Analytical Chemistry, Faculty of Gulhane Pharmacy, Health Sciences University, Ankara, Turkey
| | - Emirhan Nemutlu
- Department of Analytical Chemistry, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Betul Buyuktiryaki
- Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
- Division of Pediatric Allergy, School of Medicine, Koc University, Istanbul, Turkey
| | - Cansin Sackesen
- Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, Istanbul, Turkey
- Division of Pediatric Allergy, School of Medicine, Koc University, Istanbul, Turkey
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Braun C, Coutier L, Bégin P, Nosbaum A. Skin-centered strategies in food allergy prevention. Pediatr Allergy Immunol 2024; 35:e14130. [PMID: 38693814 DOI: 10.1111/pai.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024]
Abstract
While the early introduction of food allergens in the infant diet has been shown to be effective at preventing the development of food allergy (FA), its implementation in real life has been associated with various challenges. Interventions aimed at correcting skin barrier dysfunction have been explored in recent decades as a distinct or complementary mean to prevent allergic sensitization through the skin and subsequent development of FA. Studies assessing the application of emollient from birth have yielded conflicting results, and meta-analyses have demonstrated either no effect or only a slight positive effect on FA prevention. However, a careful review of the clinical trials reveals that different emollients were used, which may have explained some of the discrepancies between study results. Emollient application protocols also varied widely between studies. While firm conclusions cannot be drawn with regard to their overall efficacy at preventing FA, the available data provide valuable insight into the characteristics that could be associated with a more effective intervention. Namely, successful trials tended to use emollients with an acidic pH of 5.5, applied over the entire body, and combined with topical corticosteroids in affected areas. Consensus on the optimal strategy to restore skin barrier function could help improve the homogeneity and clinical relevance of future trials on this topic. In the meantime, clinicians should avoid products associated with worse outcomes.
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Affiliation(s)
- Camille Braun
- Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Pneumology, Allergy, Cystic Fibrosis, Hôpital Femme Mère Enfant, Bron, France
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, Lyon, France
| | - Laurianne Coutier
- Department of Pediatrics, Pneumology, Allergy, Cystic Fibrosis, Hôpital Femme Mère Enfant, Bron, France
- INSERM U1028 CNRS UMR 5292, Université Lyon 1, Lyon, France
| | - Philippe Bégin
- Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Medicine, Section of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Audrey Nosbaum
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, Lyon, France
- Department of Allergy and Clinical Immunology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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3
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Turkalj M, Miletić Gospić A, Višekruna Džidić I, Banić I. Food Allergen Immunotherapy in the Treatment of Patients with IgE-Mediated Food Allergy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:121. [PMID: 38256382 PMCID: PMC10820435 DOI: 10.3390/medicina60010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
The prevalence of allergic diseases, including food allergy, is increasing, especially in developed countries. Implementation of an elimination diet is not a sufficient therapeutic strategy in patients with food allergy, whose quality of life is significantly impaired. In recent years, new effective therapeutic strategies have been developed, such as the application of oral, sublingual, and epicutaneous immunotherapy. Oral immunotherapy is the most often applied strategy because of its effectiveness and ease of application, with an acceptable safety profile. The effectiveness of oral immunotherapy in patients with egg, cow's milk, and peanut allergy has been proven both in terms of raising of the threshold and the development of tolerance, and in some patients, the development of sustainable unresponsiveness. Although oral immunotherapy is an effective treatment for food allergy, several limitations, including a long duration and a significant rate of reported adverse events, reduces its success. Therefore, new therapeutic options, such as treatment with biologicals, either as combinations with food allergen immunotherapy or as monotherapy with the aim of improving the efficacy and safety of treatment, are being investigated.
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Affiliation(s)
- Mirjana Turkalj
- Srebrnjak Children’s Hospital, HR-10000 Zagreb, Croatia; (M.T.); (I.V.D.); (I.B.)
- Faculty of Medicine, J.J. Strossmayer University of Osijek, HR-31000 Osijek, Croatia
- School of Medicine, Catholic University of Croatia, HR-10000 Zagreb, Croatia
| | | | | | - Ivana Banić
- Srebrnjak Children’s Hospital, HR-10000 Zagreb, Croatia; (M.T.); (I.V.D.); (I.B.)
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4
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Upton JEM, Lanser BJ, Bird JA, Nowak-Węgrzyn A. Baked Milk and Baked Egg Survey: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2335-2344.e4. [PMID: 37236351 DOI: 10.1016/j.jaip.2023.04.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 05/28/2023]
Abstract
Most milk- and egg-allergic children can tolerate milk and egg in baked forms. Some allergists have extended the use of baked milk (BM) and baked egg (BE) to advocating for the stepwise introduction of small amounts of BM and BE to children who are reactive to larger amounts of BM and BE. Little is known about the practice of introducing BM and BE and existing barriers to this approach. The purpose of this study was to gather a current assessment of the implementation of BM and BE oral food challenges and diets for milk- and egg-allergic children. We conducted an electronic survey of North American Academy of Allergy, Asthma & Immunology members offering BM and BE introduction in 2021. The response rate was 10.1% of distributed surveys (72 of 711). Surveyed allergists had a similar approach to both BM and BE introduction. Demographic features of time in practice and region of practice were significantly associated with the odds of introducing BM and BE. A wide variety of tests and clinical features guided decisions. Some allergists determined BM and BE to be appropriate for home introduction and offered this for BM and BE more often than other foods. The use of BM and BE as a food for oral immunotherapy was endorsed by almost half of respondents. Less time in practice was the most significant factor associated with offering this approach. Published recipes were used and written information was widely provided to patients by most allergists. The wide practice variabilities reveal a need for more structured guidance about oral food challenges, in-office versus home procedures, and patient education.
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Affiliation(s)
- Julia E M Upton
- Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Bruce J Lanser
- Department of Pediatrics, Division of Allergy and Clinical Immunology, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - J Andrew Bird
- Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anna Nowak-Węgrzyn
- Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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5
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Ham SL, Lee TH, Kim KJ, Kim JH, Hwang SJ, Lee SH, Yu JS, Kim KH, Lee HJ, Lee W, Kim CS. Discovery and Biosynthesis of Imidazolium Antibiotics from the Probiotic Bacillus licheniformis. JOURNAL OF NATURAL PRODUCTS 2023; 86:850-859. [PMID: 36921254 DOI: 10.1021/acs.jnatprod.2c01032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Antibiotic resistance is one of the world's most urgent public health problems, and novel antibiotics to kill drug-resistant bacteria are needed. Natural product-derived small molecules have been the major source of new antibiotics. Here we describe a family of antibacterial metabolites isolated from a probiotic bacterium, Bacillus licheniformis. A cross-streaking assay followed by activity-guided isolation yielded a novel antibacterial metabolite, bacillimidazole G, which possesses a rare imidazolium ring in the structure, showing MIC values of 0.7-2.6 μg/mL against human pathogenic Gram-positive and Gram-negative bacteria including methicillin-resistant Staphylococcus aureus (MRSA) and a lipopolysaccharide (LPS)-lacking Acinetobacter baumannii ΔlpxC. Bacillimidazole G also lowered MICs of colistin, a Gram-negative antibiotic, up to 8-fold against wild-type Escherichia coli MG1655 and A. baumannii. We propose a biosynthetic pathway to the characterized metabolites based on precursor-feeding studies, a chemical biological approach, biomimetic total synthesis, and a biosynthetic gene knockout method.
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Affiliation(s)
- Song Lim Ham
- Department of Biopharmaceutical Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Tae Hyun Lee
- Department of Biopharmaceutical Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Kyung Jun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Jung Ha Kim
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Su Jung Hwang
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Sun Ho Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Jae Sik Yu
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
- Department of Integrative Biological Sciences and Industry, Sejong University, Seoul 05006, Republic of Korea
| | - Ki Hyun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Hyo-Jong Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Wonsik Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Chung Sub Kim
- Department of Biopharmaceutical Convergence, Sungkyunkwan University, Suwon 16419, Republic of Korea
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
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Maryniak NZ, Stage MH, Ballegaard AR, Sancho AI, Hansen EB, Bøgh KL. Camel Milk Cannot Prevent the Development of Cow's Milk Allergy-A Study in Brown Norway Rats. Mol Nutr Food Res 2023; 67:e2200359. [PMID: 36415026 PMCID: PMC10078016 DOI: 10.1002/mnfr.202200359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/20/2022] [Indexed: 11/24/2022]
Abstract
SCOPE Currently there are no specific recommendations for the use of any particular infant formula in the prevention of cow's milk allergy (CMA). Recently, there has been an increasing interest in alternative infant formulas based on milk proteins from other sources than the cow, including milk from other mammalians such as goat, sheep, donkey, horse, and camel. Whereas these have been studied for their usability in CMA management, there are no studies of their CMA preventive capacity. Thus, the aim of this study is to evaluate whether camel milk can prevent CMA and vice versa. METHODS AND RESULTS The capacity of camel milk in preventing CMA and vice versa is evaluated in a well-established prophylactic Brown Norway rat model. IgG1, IgE, and IgA responses, allergy elicitation, intestinal and mLN gene expression, and protein uptake are analyzed. The study demonstrates that camel and cow's milk in general has an insignificant cross-preventive capacity. Yet, whereas cow's milk is shown to have a low transient capacity to prevent sensitization and clinically active camel milk allergy, camel milk does not show this effect for CMA. CONCLUSIONS This study suggests that due to lack of cross-tolerance camel milk cannot be used for CMA prevention.
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Affiliation(s)
| | - Mette Halkjær Stage
- National Food InstituteTechnical University of DenmarkKgs. LyngbyDK‐2800Denmark
| | | | - Ana Isabel Sancho
- National Food InstituteTechnical University of DenmarkKgs. LyngbyDK‐2800Denmark
| | - Egon Bech Hansen
- National Food InstituteTechnical University of DenmarkKgs. LyngbyDK‐2800Denmark
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7
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Reese I, Dölle-Bierke S, Kugler C, Schäfer C, Schnadt S, Ziegert M. Ernährungstherapie bei Nahrungsmittelallergien. ALLERGO JOURNAL 2022. [DOI: 10.1007/s15007-022-5606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Elghoudi A, Narchi H. Food allergy in children—the current status and the way forward. World J Clin Pediatr 2022; 11:253-269. [PMID: 35663006 PMCID: PMC9134150 DOI: 10.5409/wjcp.v11.i3.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Food allergy in children is a major health concern, and its prevalence is rising. It is often over-diagnosed by parents, resulting occasionally in unnecessary exclusion of some important food. It also causes stress, anxiety, and even depression in parents and affects the family’s quality of life. Current diagnostic tests are useful when interpreted in the context of the clinical history, although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations. Although the oral food challenge is the current gold standard for making the diagnosis, it is only available to a small number of patients because of its requirement in time and medical personnel. New diagnostic methods have recently emerged, such as the Component Resolved Diagnostics and the Basophil Activation Test, but their use is still limited, and the latter lacks standardisation. Currently, there is no definite treatment available to induce life-long natural tolerance and cure for food allergy. Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food, usually taken by accident. New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy. If standardised and widely implemented, this may result in decreasing the prevalence of food allergy.
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Affiliation(s)
- Ahmed Elghoudi
- Paediatric Department, Sheikh Khalifa Medical City, Abu Dhabi NA, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
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9
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Nagendran S, Patel N, Turner PJ. Oral immunotherapy for food allergy in children: is it worth it? Expert Rev Clin Immunol 2022; 18:363-376. [PMID: 35285356 DOI: 10.1080/1744666x.2022.2053675] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Oral immunotherapy (OIT) is effective at inducing desensitization in food-allergic individuals, and is a valid therapeutic option for those allergic to peanut, cow's milk and egg. However, there is a high rate of dose-related adverse events, and at least one fatality to OIT has been reported. AREAS COVERED We provide an update on the broader framework of issues which will impact on the availability and uptake of OIT. EXPERT OPINION The need for standardized products remains controversial. A licensed product exists for peanut-OIT, but OIT can also be safely achieved using peanut-containing foods at much lower cost. For other allergens, OIT can only be done with non-pharma products - something which has been done safely for over 2 decades. There is a need to develop personalized protocols for OIT, particularly for the 20% of patients unable to tolerate standard OIT. Cost-effectiveness is dependent on improved quality of life, but evidence for this is currently lacking, and is a key evidence gap. OIT is likely to be cost-effective, particularly if noncommercial products are used. There may be a trade-off: in patients with lower reaction thresholds, a commercial product may be needed for initial updosing, until a level of desensitization is achieved when they can be switched to natural food products.
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Affiliation(s)
| | - Nandinee Patel
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Paul J Turner
- National Heart & Lung Institute, Imperial College London, London, UK
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10
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Assessment of egg and milk allergies among Indians by revalidating a food allergy predictive model. World Allergy Organ J 2022; 15:100639. [PMID: 35399818 PMCID: PMC8956949 DOI: 10.1016/j.waojou.2022.100639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 12/24/2022] Open
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Leech SC, Ewan PW, Skypala IJ, Brathwaite N, Erlewyn-Lajeunesse M, Heath S, Ball H, James P, Murphy K, Clark AT. BSACI 2021 guideline for the management of egg allergy. Clin Exp Allergy 2021; 51:1262-1278. [PMID: 34586690 DOI: 10.1111/cea.14009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 12/19/2022]
Abstract
This guideline advises on the management of patients with egg allergy. Most commonly egg allergy presents in infancy, with a prevalence of approximately 2% in children and 0.1% in adults. A clear clinical history will confirm the diagnosis in most cases. Investigation by measuring egg-specific IgE (by skin prick testing or specific IgE assay) is useful in moderate-severe cases or where there is diagnostic uncertainty. Following an acute allergic reaction, egg avoidance advice should be provided. Egg allergy usually resolves, and reintroduction can be achieved at home if reactions have been mild and there is no asthma. Patients with a history of severe reactions or asthma should have reintroduction guided by a specialist. All children with egg allergy should receive the MMR vaccine. Most adults and children with egg allergy can receive the influenza vaccine in primary care, unless they have had anaphylaxis to egg requiring intensive care support. Yellow Fever vaccines should only be considered in egg-allergic patients under the guidance of an allergy specialist. This guideline was prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and is intended for allergists and others with a special interest in allergy. The recommendations are evidence based. Where evidence was lacking, consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, diagnosis, treatment, prognosis and co-morbid associations.
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Affiliation(s)
- Susan C Leech
- Department of Child Health, Kings College Hospital, London, UK
| | - Pamela W Ewan
- Allergy Clinic, NHS Foundation Trust, Cambridge University, Cambridge, UK
| | | | - Nicola Brathwaite
- Department of Child Health, Kings College Hospital, London, UK.,Department of Child Health, Kings College Hospital, London, UK
| | | | - Sarah Heath
- Department of Child Health, Kings College Hospital, London, UK
| | - Heidi Ball
- University Hospitals Leicester, Leicester, UK
| | - Polly James
- Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Murphy
- Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew T Clark
- Allergy Clinic, NHS Foundation Trust, Cambridge University, Cambridge, UK
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Esty B, Maciag MC, Bartnikas LM, Petty CR, MacGinnitie AJ, Sheehan WJ, Phipatanakul W. Predicting outcomes of baked egg and baked milk oral food challenges by using a ratio of food-specific IgE to total IgE. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1750-1752.e1. [PMID: 33217611 DOI: 10.1016/j.jaip.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/02/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Brittany Esty
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Michelle C Maciag
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Carter R Petty
- Biostatistics and Research Design Core, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Andrew J MacGinnitie
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - William J Sheehan
- Division of Allergy and Immunology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
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Vilar LK, Rolins Neto PR, Abdo MA, Cheik MFA, Afonso CPES, Segundo GRS. Baked egg tolerance: is it possible to predict? JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Baked egg tolerance: is it possible to predict? J Pediatr (Rio J) 2020; 96:725-731. [PMID: 31513760 PMCID: PMC9432010 DOI: 10.1016/j.jped.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/09/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the frequency of baked egg tolerance in IgE-mediated egg allergy patients through the oral food challenge and to assess the tolerance predictability of different skin prick tests, as well as specific serum IgE measurement to egg proteins. METHODS In this cross-sectional study, 42 patients with a diagnosis of egg allergy were submitted to different skin prick tests with egg (in natura, boiled, muffin, ovalbumin, and ovomucoid), and specific IgE to egg white, ovalbumin, and ovomucoid; as well as to the oral food challenge with food containing egg, extensively baked in a wheat matrix. RESULTS Of the total, 66.6% of patients tolerated the ingestion of egg-containing foods in the oral food challenge. A comparative analysis with positive and negative oral food challenge found no significant differences regarding age, gender, other food allergies, or even specific skin prick tests and IgE values between the groups. CONCLUSIONS The study demonstrated an elevated frequency of baked egg food-tolerant individuals among egg allergy patients. None of the tested markers, skin prick tests, or specific IgE, were shown to be good predictors for identifying baked egg-tolerant patients. The oral food challenge with egg baked in a matrix is central to demonstrate tolerance and the early introduction of baked foods, improving patients' and families' quality of life and nutrient intake.
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Stockhammer D, Katelaris CH, Simpson MD, Vanniasinkam T. Parent perceptions in managing children with food allergy: An Australian perspective. World Allergy Organ J 2020; 13:100468. [PMID: 33133333 PMCID: PMC7578552 DOI: 10.1016/j.waojou.2020.100468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Food allergy affects up to 10% of Australian children, and living with food allergic children can be challenging for parents. This study explored parental perceptions and knowledge as they navigate a new reality of keeping their child safe. METHODS Parents of children with food allergies completed an online food allergy survey in 2015. Questions explored health knowledge, skills, and attitudes (KSAs) as well as quality of life (QoL) through the inclusion of the Food Allergy Quality of Life - Parental Burden instrument (FAQL-PB). Notification of the survey included advertisements to more than 700 randomly selected Australia-wide preschools, 44 allergy specialists, and Allergy & Anaphylaxis Australia. Responses were tabulated and analysed. RESULTS Of the 400 participants who logged on, 357 commenced the survey and 318 finished. Questionnaire analysis showed that 44.1% of parents (n = 135) hesitated to use an adrenaline auto-injector and may be influenced by a classification system where symptom severity is not universally understood. While 79% would sign up to a national Anaphylaxis Registry, intention to participate in clinical trials using vaccines was disclosed by only 56%. Allergen labelling and community acceptance continue to be the most challenging aspects of managing a food allergy, and 50% of parents reported that food allergy played a role in choosing a preschool or primary school. Overall, quality of life for participants was influenced more by gender (male) and age of the child than where they lived - capital city or regional location; however, regional participants were more frustrated over lack of appreciation relating to the seriousness of food allergy (p = 0.010). CONCLUSION Results highlight the need for educational strategies for both the food allergy community and public, particularly in regional areas, since there is a perceived lack of appreciation as to the seriousness of food allergy. Educational resources and relevant networks are required to support parents and caregivers in the management of children with food allergy.
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Key Words
- ABC, Australian Broadcasting Corporation
- ANOVA, Analysis of variance
- CA, California
- FAQL-PB
- FAQL-PB, Food Allergy Quality of Life – Parental Burden
- Food allergy
- GP/GPs, General Practitioner(s)
- KSA, Knowledge, Skills, Attitudes
- LOC, Locus of control
- NSW, New South Wales, Australia
- NVivo Pro, NVivo Pro, QSR International Pty Ltd
- PAF, Principal Axis Factoring
- PRIME7, Prime Television Australia
- Parental burden
- QoL, Quality of Life
- Quality of life
- SPSS/IBM SPSS Statistics, IBM Statistical Package for the Social Sciences
- VIC, Victoria, Australia
- WIN Television, WIN Corporation Australia
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Affiliation(s)
- Debbi Stockhammer
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
| | | | | | - Thiru Vanniasinkam
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
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Abstract
Although the gold standard for diagnosis of immunoglobulin E (IgE)-mediated food allergy is an oral food challenge, clinically relevant biomarkers of IgE sensitization, including serum-specific IgE and skin prick testing, can aid in diagnosis. Clinically useful values have been defined for individual foods. More recently, specific IgE to particular protein components has provided additional diagnostic value. In summary, food allergy diagnostics to evaluate IgE sensitization are clinically useful and continue to evolve to improve evaluation of IgE-mediated food allergies.
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Affiliation(s)
- Nicole A LaHood
- Allergy and Immunology, Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA, USA
| | - Sarita U Patil
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA, USA; Food Allergy Center, Massachusetts General Hospital for Children, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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17
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Sirin Kose S, Asilsoy S, Uzuner N, Karaman O, Anal O. Outcomes of Baked Milk and Egg Challenge in Cow's Milk and Hen's Egg Allergy: Can Tolerance Be Predicted with Allergen-Specific IgE and Prick-to-Prick Test? Int Arch Allergy Immunol 2019; 180:264-273. [PMID: 31597156 DOI: 10.1159/000502957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adding baked food into the diets of patients with cow's milk allergy (MA) and hen's egg allergy (EA) has several benefits. OBJECTIVE We aimed to determine baked and unbaked food tolerance and evaluate the effectiveness of laboratory findings on the prediction of baked and unbaked food tolerance in patients with MA and EA. METHODS Clinical outcomes of the patients with MA and EA who had been exposed to oral food challenge with baked food were retrospectively analyzed. RESULTS Ninety-one patients were evaluated. The median age of the study group was 22 months. Forty-nine and 42 patients had IgE-mediated MA and EA, respectively. While all patients with EA tolerated baked egg, 24.5% patients with MA could not tolerate baked cow's milk (BM). In patients with MA, BM tolerance showed negative association with milk-specific IgE, skin prick test (SPT), and prick-to-prick test (PTP), and the PTP was the most significant parameter (sensitivity 83.8%, specificity 91.7% for PTP ≤7 mm). Negative association was seen between milk-specific IgE, SPT, PTP, and unbaked milk (UBM) tolerance, and PTP was the most significant parameter (sensitivity 100%, specificity 55% for PTP ≤4 mm). In patients with EA, at the end of 6 months of baked hen's egg (BE) consumption, scrambled egg tolerance showed negative association with egg white-specific IgE level, egg white SPT and PTP. Egg white PTP was the most significant parameter (sensitivity 82.4%, specificity 96.0% for PTP ≤5 mm). CONCLUSION Specific-IgE, SPT, and PTP should be kept in mind as parameters that can be used to predict tolerance to BM and BE for patients with MA and EA.
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Affiliation(s)
- Seda Sirin Kose
- Department of Pediatric Immunology and Allergy, Dokuz Eylul University, Izmir, Turkey,
| | - Suna Asilsoy
- Department of Pediatric Immunology and Allergy, Dokuz Eylul University, Izmir, Turkey
| | - Nevin Uzuner
- Department of Pediatric Immunology and Allergy, Dokuz Eylul University, Izmir, Turkey
| | - Ozkan Karaman
- Department of Pediatric Immunology and Allergy, Dokuz Eylul University, Izmir, Turkey
| | - Ozden Anal
- Department of Pediatric Immunology and Allergy, Dokuz Eylul University, Izmir, Turkey
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18
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Chen M, Sutherland A, Birrueta G, Laubach S, Leonard S, Peters B, Schulten V. Analysis of Allergen-Specific T Cell and IgE Reactivity to Different Preparations of Cow's Milk-Containing Food Extracts. Cells 2019; 8:E667. [PMID: 31269726 PMCID: PMC6679079 DOI: 10.3390/cells8070667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND cow's milk allergy (CM) is among the most common food allergies in young children and is often outgrown by adulthood. Prior to developing a tolerance to CM, a majority of CM-allergic children may tolerate extensively-heated CM. This study aims to characterize the IgE- and T cell-reactivity to unheated CM and the progressively more heated CM-containing foods. METHODS CM-containing food extracts from muffin, baked cheese, custard and raw, pasteurized CM commercial extract were tested for skin prick test reactivity, IgE binding and T cell reactivity as assessed by IL-5 and IFNγ production. RESULTS the skin prick test (SPT) reactivity was significantly decreased to muffin extract compared to raw, pasteurized CM. Both IgE- and T-cell reactivity were readily detectable against food extracts from all forms of CM. Western blot analysis of IgE reactivity revealed variability between extracts that was protein-specific. T cell-reactivity was detected against all four extracts with no significant difference in IL-5 or IFNγ production between them. CONCLUSION our data indicate that despite reduced clinical reactivity, extracts from heated CM-containing foods retain immunogenicity when tested in vitro, particularly at the T cell level.
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Affiliation(s)
- Meng Chen
- Division of Pediatric Allergy & Immunology, Rady Children's Hospital San Diego, University of California, San Diego, CA 92123, USA
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | | | | | - Susan Laubach
- Division of Pediatric Allergy & Immunology, Rady Children's Hospital San Diego, University of California, San Diego, CA 92123, USA
| | - Stephanie Leonard
- Division of Pediatric Allergy & Immunology, Rady Children's Hospital San Diego, University of California, San Diego, CA 92123, USA
| | - Bjoern Peters
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
- La Jolla Institute for Immunology, La Jolla, CA 92037, USA
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19
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Wagenaar L, van Roest M, Kruijssen LJW, Simons PJ, Boon L, Vonk MM, van Esch BCAM, Knippels LMJ, Garssen J, Pieters RHH, Smit JJ. Non-digestible oligosaccharides scFOS/lcFOS facilitate safe subcutaneous immunotherapy for peanut allergy. Clin Mol Allergy 2019; 17:7. [PMID: 30988664 PMCID: PMC6448225 DOI: 10.1186/s12948-019-0111-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 03/26/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Improving the safety of subcutaneous immunotherapy (SCIT) for food allergy is necessary to reduce side effects and achieve long-term tolerance. We determined the effect of dietary supplementation with 1% non-digestible short- and long-chain fructo-oligosaccharides (scFOS/lcFOS) on safety and efficacy of SCIT using a peanut allergy mouse model. METHODS After sensitization, mice received a scFOS/lcFOS or control diet for the rest of the study. To study safety of SCIT, mice were dosed with a single subcutaneous injection of peanut extract (PE) or PBS. To study efficacy, mice were dosed subcutaneously (SCIT, 3 times/week) with PE or PBS for 3 weeks. Hereafter, acute allergic skin responses, anaphylactic shock symptoms and body temperature were assessed. To study the mechanism in vitro, the human IgE receptor (FcεRI)-transfected rat mast cell (RBL) line was sensitized with an oligoclonal pool of chimeric human (chu)IgE antibodies against bovine β-lactoglobulin (BLG) and incubated with the oligosaccharides before exposure to BLG to assess direct the effect on degranulation. RESULTS scFOS/lcFOS reduced anaphylaxis caused by a single PE SCIT dose. scFOS/lcFOS alone also reduced the acute allergic skin response. Moreover, scFOS/lcFOS supplementation resulted in lower MMCP-1 levels in serum after PE SCIT dose compared to control diet, while antibody levels were not affected by the diet. In vitro incubation with scFOS/lcFOS at 0.5% suppressed the degranulation of IgE-sensitized RBL cells. However, dietary supplementation with scFOS/lcFOS did not improve the efficacy of SCIT. CONCLUSIONS We show that scFOS/lcFOS diet improves the safety of SCIT, as evidenced by lower anaphylactic responses without compromising the efficacy in a mouse model for peanut allergy. This effect is likely to result from the suppression of mast cell effector function.
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Affiliation(s)
- Laura Wagenaar
- Department of Immunotoxicology, Faculty of Veterinary Medicine, Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3508 TD Utrecht, The Netherlands
| | - Manon van Roest
- Department of Immunotoxicology, Faculty of Veterinary Medicine, Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3508 TD Utrecht, The Netherlands
| | - Laura J. W. Kruijssen
- Department of Immunotoxicology, Faculty of Veterinary Medicine, Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3508 TD Utrecht, The Netherlands
| | | | | | - Marlotte M. Vonk
- Department of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Immunology, Danone Nutricia Research, Utrecht, The Netherlands
| | - Betty C. A. M. van Esch
- Department of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Immunology, Danone Nutricia Research, Utrecht, The Netherlands
| | - Leon M. J. Knippels
- Department of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Immunology, Danone Nutricia Research, Utrecht, The Netherlands
| | - Johan Garssen
- Department of Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Immunology, Danone Nutricia Research, Utrecht, The Netherlands
| | - Raymond H. H. Pieters
- Department of Immunotoxicology, Faculty of Veterinary Medicine, Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3508 TD Utrecht, The Netherlands
| | - Joost J. Smit
- Department of Immunotoxicology, Faculty of Veterinary Medicine, Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3508 TD Utrecht, The Netherlands
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20
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Induction of sublingual immunotherapy to cow's milk (raw, pasteurized and sterilized) in Balb/c mice sensitized to beta-lactoglobulin. REVUE FRANCAISE D ALLERGOLOGIE 2019. [DOI: 10.1016/j.reval.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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21
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Sackesen C, Altintas DU, Bingol A, Bingol G, Buyuktiryaki B, Demir E, Kansu A, Kuloglu Z, Tamay Z, Sekerel BE. Current Trends in Tolerance Induction in Cow's Milk Allergy: From Passive to Proactive Strategies. Front Pediatr 2019; 7:372. [PMID: 31620408 PMCID: PMC6760011 DOI: 10.3389/fped.2019.00372] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/30/2019] [Indexed: 12/15/2022] Open
Abstract
This review addresses the current strategies of inducing tolerance development in infant and childhood cow's milk protein allergy (CMPA). The change in prevention strategies for CMPA has been emphasized based on the lack of evidence to support the efficacy of food allergen avoidance in infancy and the concept of the dual-allergen-exposure hypothesis, which suggests that allergen exposure through the skin leads to sensitization, whereas early oral consumption of allergenic food protein induces oral tolerance. The new approach is based on the likelihood of early introduction of allergenic foods to the infant's diet to reduce the development of food allergies through oral tolerance induction. The latest treatment guidelines recommend the continuation of breast feeding and the elimination of cow's milk and products from the maternal diet in exclusively breast-fed infants with CMPA, the use of an extensively hydrolyzed infant formula (eHF) with proven efficacy in CMPA as the first elimination diet in formula-fed infants with CMPA and the use of amino acid-based formula (AAF) in severe cases, such as anaphylaxis, enteropathy, eosinophilic esophagitis, and food protein-induced enterocolitis syndrome (FPIES), as well as cases of multiple system involvement, multiple food allergies, and intolerance to extensively hydrolyzed formula (eHF). In conclusion, this paper presents the current knowledge on tolerance development in infants and children with CMPA to increase the awareness of the clinicians concerning the new approaches in CMPA treatment Tolerance development is considered a relatively new concept in CMPA, inducing a shift in interventions in CMPA from a passive (avoidance of responsible allergen) toward a proactive (tolerance induction) strategy.
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Affiliation(s)
- Cansin Sackesen
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Derya Ufuk Altintas
- Division of Pediatric Allergy, Department of Pediatrics, Cukurova University School of Medicine, Adana, Turkey
| | - Aysen Bingol
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gulbin Bingol
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Acibadem University School of Medicine, Istanbul, Turkey
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Esen Demir
- Division of Pediatric Allergy, Department of Pediatrics, Ege University School of Medicine, Izmir, Turkey
| | - Aydan Kansu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Zarife Kuloglu
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Tamay
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Bulent Enis Sekerel
- Division of Pediatric Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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22
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Efron A, Zeldin Y, Gotesdyner L, Stauber T, Maoz Segal R, Binson I, Dinkin M, Dinkowitz L, Shahar D, Deutch M, Yaron M, Nevet A, Reshef A, Agmon-Levin N, Kenett RS, Kidon MI. A Structured Gradual Exposure Protocol to Baked and Heated Milk in the Treatment of Milk Allergy. J Pediatr 2018; 203:204-209.e2. [PMID: 30270168 DOI: 10.1016/j.jpeds.2018.07.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/17/2018] [Accepted: 07/26/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a structured gradual exposure protocol (SGEP) with extensively heated and baked milk in promoting allergy resolution in children with cow milk allergy (CMA). STUDY DESIGN In a case control study, children with CMA aged 1-4 years who were treated with SGEP including extensively heated and baked milk, were compared with children treated with strict avoidance. Data were collected from medical records and from validated telephone questionnaires. Data analysis was performed using a nonparametric Kaplan-Meier and proportional hazard Cox regression model, after evaluation of the adequacy of the case control matching. RESULTS There were 43 children with milk allergy-26 (62%) males with a mean age at intervention of 21 months (range, 12-47 months)-who were treated with SGEP and followed to a mean age of 40 months (range, 20-82 months). The median age at resolution of CMA was compared with a matched group of 67 children treated with strict avoidance at least until 4 years of age or followed until earlier resolution, with a mean age at follow-up of 71 months (range, 11-176 months). The median estimated age at CMA resolution in the SGEP group was 36 months (95% CI, 34.5-49.7) compared with 98 months (95% CI, 82.4-114.1) in controls (P < .001). At last follow-up, 86% of treated children were tolerant to unheated milk proteins vs 52% of controls (P = .003). CONCLUSION A structured protocol with extensively heated and baked milk seems to promote faster resolution of CMA.
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Affiliation(s)
- Adi Efron
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yuri Zeldin
- Clinical Allergy and Immunology, "Goldman" School of Medicine, Ben Gurion University, Beer Sheva, Israel; Clalit Health Services, Tel Aviv, Israel
| | - Leora Gotesdyner
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Stauber
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Ramit Maoz Segal
- Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Danit Shahar
- Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Michal Deutch
- Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Avner Reshef
- Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Nancy Agmon-Levin
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Ron S Kenett
- KPA Group and Institute for Drug Research, School of Pharmacy, Hebrew University, Jerusalem, Israel
| | - Mona I Kidon
- Clinical Allergy and Immunology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Clalit Health Services, Tel Aviv, Israel; Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Allergy and Clinical Immunology Unit, Sheba Medical Center, Tel Hashomer, Israel
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23
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Abstract
Food allergy is defined as an adverse immunologic response to a food protein. Food-related reactions are associated with a broad range of signs and symptoms that may involve any body system, including the skin, gastrointestinal and respiratory tracts, and cardiovascular system. Immunoglobulin E (IgE)-mediated food allergy is a leading cause of anaphylaxis and, therefore, referral to an allergist for timely and appropriate diagnosis and treatment is imperative. Diagnosis entails a careful history and diagnostic tests, such as skin prick tests, serum-specific IgE and, if indicated, an oral food challenge. Once the diagnosis of food allergy is confirmed, strict elimination of the offending food allergen from the diet is generally necessary; however, in the case of cow’s milk and egg allergy, many allergic children are able to eat these foods in their baked form. This article provides an overview of the epidemiology, pathophysiology, diagnosis, and management of IgE-mediated food allergy.
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Affiliation(s)
- Susan Waserman
- 1Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Philippe Bégin
- 2Division of Clinical Immunology and Allergy, Department of Medicine, Université de Montréal, Montreal, QC Canada
| | - Wade Watson
- 3IWK Health Centre, Division of Allergy, Department of Pediatrics, Dalhousie University, Halifax, NS Canada
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24
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Capucilli P, Cianferoni A, Fiedler J, Gober L, Pawlowski N, Ram G, Saltzman R, Spergel JM, Heimall J. Differences in egg and milk food challenge outcomes based on tolerance to the baked form. Ann Allergy Asthma Immunol 2018; 121:580-587. [PMID: 30036581 DOI: 10.1016/j.anai.2018.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 07/12/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Previous studies suggest inclusion of baked egg and milk in the diet of children with egg or cow's milk (CM) allergy might positively affect native tolerance. However, differences in native food reactivity based on historical baked tolerance are not fully understood. OBJECTIVE To assess differences in native egg and CM oral food challenge (OFC) outcomes based on presenting history of tolerance and exposure to these foods in the baked form. METHODS This study is a retrospective review of all egg and CM OFCs at the Children's Hospital of Philadelphia (Philadelphia, Pennsylvania) over 4 years (N = 580). History of baked ingestion was compared with OFC pass rate, eliciting dose, epinephrine use, reaction classification, and recent skin test reaction or specific immunoglobulin E level. RESULTS There were 115 egg- and 70 CM-positive challenge reactions, with most eliciting anaphylaxis. Children tolerating baked egg passed OFC more frequently (75%) compared with children who avoided baked egg (58%; P = .01) or never ingested egg (45%; P < .0001). For positive reactions, children tolerant of baked egg reacted at higher eliciting doses of native egg (median 3.0 g, range 0.125-15.75 g) compared with those avoiding baked egg (median 0.69 g, range 0.13-10.0 g; P = .03) and those with no egg exposure (median 0.88 g, range 0.13-13.88 g; P = .01). Further, epinephrine use was lower in children tolerating baked egg (10%) compared with children avoiding baked egg (22%; P = .02) and compared with children who never ingested egg (32%; P = .0001). These differences were not observed for CM challenges. CONCLUSION Children who historically tolerated baked egg were less sensitive to native egg during OFC compared with children whose baked reactivity was largely unknown.
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Affiliation(s)
- Peter Capucilli
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Antonella Cianferoni
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel Fiedler
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Gober
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas Pawlowski
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gita Ram
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rushani Saltzman
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Leonard SA. Does the amount of egg protein and type of preparation influence tolerability of baked egg products and potential development of regular egg tolerance in egg-allergic children? Ann Allergy Asthma Immunol 2017; 116:381-2. [PMID: 27153736 DOI: 10.1016/j.anai.2016.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/16/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie A Leonard
- Division of Pediatric Allergy & Immunology, University of California, San Diego, Rady Children's Hospital San Diego, San Diego, California.
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26
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Andorf S, Purington N, Block WM, Long AJ, Tupa D, Brittain E, Rudman Spergel A, Desai M, Galli SJ, Nadeau KC, Chinthrajah RS. Anti-IgE treatment with oral immunotherapy in multifood allergic participants: a double-blind, randomised, controlled trial. Lancet Gastroenterol Hepatol 2017; 3:85-94. [PMID: 29242014 PMCID: PMC6944204 DOI: 10.1016/s2468-1253(17)30392-8] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite progress in single food oral immunotherapy (OIT), there is little evidence concerning the safety and efficacy of treating individuals with multiple food (multifood) allergies. We conducted a pilot study testing whether anti-IgE (omalizumab) combined with multifood OIT benefitted multifood allergic patients. METHODS In this blinded, phase 2 clinical trial conducted at Stanford University, 48 participants, aged 4-15 years, with multifood allergies validated by double-blind, placebo-controlled food challenges (DBPCFCs) to their offending foods were block randomized (3:1) to receive multifood OIT to 2-5 foods, together with omalizumab (n=36) or placebo (n=12). Omalizumab or placebo was administered subcutaneously for 16 weeks with OIT starting at week 8; omalizumab or placebo was stopped 20 weeks before exit DBPCFCs (week 36) to determine the primary endpoint: the proportion of participants who passed DBPCFCs to at least 2 of their offending foods. This completed trial is registered with ClinicalTrials.gov, . FINDINGS At week 36, a significantly greater proportion of the omalizumab (30/36, 83%) vs. placebo (4/12, 33%) participants passed DBPCFCs to 2 g protein for ≥ 2 of their offending foods (odds ratio (OR): 10, 95% confidence interval (CI): 1·8, 58·3, P=0·004). The same individuals also tolerated 4 g protein of ≥ 2 foods (secondary endpoint, P=0·004). A greater proportion of omalizumab (13/17, 77%) vs. placebo (0/5, 0%) participants passed a DBPCFC to 2 g protein for ≥ 4 of their offending foods (OR: 33, 95% CI: 1·9, ∞, P=0·01). All participants completed the study. There were no serious or severe (≥ grade 3) adverse events. INTERPRETATION In multifood allergic patients, omalizumab improves the efficacy of multifood OIT and enables safe and rapid desensitization. FUNDING NIH U19 AADCRC and Opportunity Fund, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Simons Foundation, Myra Reinhard Foundation, FARE Center of Excellence, Department of Pathology, and Department of Pediatrics, Stanford University.
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Affiliation(s)
- Sandra Andorf
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Natasha Purington
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Whitney M Block
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew J Long
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Dana Tupa
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Erica Brittain
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | - Manisha Desai
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA; Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen J Galli
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA; Departments of Pathology and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kari C Nadeau
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA
| | - R Sharon Chinthrajah
- Sean N Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, USA.
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27
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Akuete K, Guffey D, Israelsen RB, Broyles JM, Higgins LJ, Green TD, Naimi DR, MacGinnitie AJ, Vitalpur G, Minard CG, Davis CM. Multicenter prevalence of anaphylaxis in clinic-based oral food challenges. Ann Allergy Asthma Immunol 2017; 119:339-348.e1. [PMID: 28890356 DOI: 10.1016/j.anai.2017.07.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although previous single-center studies report the rate of anaphylaxis for oral food challenges (OFCs) as 9% to 11%, little is known regarding the epidemiology of clinical OFCs across multiple centers in the United States. OBJECTIVE To examine the epidemiology, symptoms, and treatment of clinical low-risk OFCs in the nonresearch setting. METHODS Data were obtained from 2008 to 2013 through a physician survey in 5 food allergy centers geographically distributed across the United States. Allergic reaction rates and the association of reaction rates with year, hospital, and demographics were determined using a linear mixed model. Meta-analysis was used to pool the proportion of reactions and anaphylaxis with inverse-variance weights using a random-effects model with exact confidence intervals (CIs). RESULTS A total of 6,377 OFCs were performed, and the pooled estimate of anaphylaxis was 2% (95% CI, 1%-3%). The rate of allergic reactions was 14% (95% CI, 13%-16%) and was consistent during the study period (P = .40). Reaction rates ranged from 13% to 33%. Males reacted 16% more frequently than females (95% CI, 4%-37.5%; P = .04). Foods challenged in 2013 varied geographically, with peanut as the most challenged food in the Northeast, Midwest, and West and egg as the most challenged in the South. CONCLUSION As the largest national survey of allergic reactions of clinical open OFCs in a nonresearch setting in the United States, this study found that performing clinical nonresearch open low-risk OFCs results in few allergic reactions, with 86% of challenges resulting in no reactions and 98% without anaphylaxis.
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Affiliation(s)
- Kwei Akuete
- Immunology, Allergy, and Rheumatology Section, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Ryan B Israelsen
- Departments of Internal Medicine and Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John M Broyles
- Departments of Internal Medicine and Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lori Jo Higgins
- Northwest Asthma & Allergy Center, University of Washington School of Medicine, Seattle, Washington
| | - Todd D Green
- Departments of Internal Medicine and Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David R Naimi
- Northwest Asthma & Allergy Center, University of Washington School of Medicine, Seattle, Washington
| | - Andrew J MacGinnitie
- Division of Immunology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Girish Vitalpur
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Carla M Davis
- Immunology, Allergy, and Rheumatology Section, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
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28
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Alvaro M, Escarrer M. Food allergy in childhood: Are we close to having an effective treatment? Allergol Immunopathol (Madr) 2017; 45:313-315. [PMID: 28688477 DOI: 10.1016/j.aller.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 12/22/2022]
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29
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Yanagida N, Sato S, Asaumi T, Ogura K, Borres MP, Ebisawa M. Safety and feasibility of heated egg yolk challenge for children with egg allergies. Pediatr Allergy Immunol 2017; 28:348-354. [PMID: 28211100 DOI: 10.1111/pai.12705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hen's egg allergy is a frequent cause of childhood food allergy. Egg yolk is used in various commonly consumed foods; if children with allergy to hen's egg could eat heated egg yolk, their quality of life (QOL) would improve. No reports exist regarding oral food challenges (OFCs) for heated egg yolk. We aimed to clarify whether pediatric patients allergic to hen's egg could consume heated egg yolk. METHODS Data from pediatric patients who had undergone OFCs for heated egg yolk were evaluated retrospectively. RESULTS Among 919 patients, positive OFC results were obtained in 17.0% of patients; seven presented with severe symptoms. Older age, high specific IgE value for ovomucoid, low total IgE levels, and history of anaphylaxis related to food other than hen's egg were risk factors for positive OFC results. Specific IgE values for egg white, ovomucoid, and egg yolk, indicative of a negative predictive value >95%, were 0.71, 0.41, and 0.17 kUA /l, respectively. A specific IgE to ovomucoid levels of 100 kUA /l predicted heated egg yolk-positive OFCs for 38.3% of patients. Among 763 patients with a negative OFC, seven (0.9%) reacted to heated egg yolk at home, and 756 (99.1%) consumed hen's egg yolk safely. CONCLUSIONS Most pediatric patients allergic to heated hen's egg safely consumed heated egg yolk. Heated egg yolk OFCs rarely provoked severe symptoms and may be recommended for improving the QOL of children with allergy to hen's egg.
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Affiliation(s)
- Noriyuki Yanagida
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Sakura Sato
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - Tomoyuki Asaumi
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Kiyotake Ogura
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
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30
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Du Toit G, Foong RX, Lack G. The role of dietary interventions in the prevention of IgE-mediated food allergy in children. Pediatr Allergy Immunol 2017; 28:222-229. [PMID: 28258631 DOI: 10.1111/pai.12711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 02/06/2023]
Abstract
Over the last 30 years, the prevalence of food allergy has been on the rise and remains a disease that can have a significant impact on the quality of life of children and their families. There are several hypotheses that have been suggested to account for the increasing prevalence, but this review will focus on the impact that dietary factors have on food allergy development. In the past food allergy, prevalence has largely focused on allergen avoidance; however, there is increasing evidence from interventional studies that have shown that early introduction to potential food allergens may have a beneficial role in allergy prevention. This review aims to look at the evidence in support of early introduction of allergens into infant diets to prevent against the development of food allergy.
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Affiliation(s)
- George Du Toit
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ru-Xin Foong
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Institute of Child Health, University College of London, London, UK
| | - Gideon Lack
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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31
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Jensen-Jarolim E, Fiocchi A. World Allergy Organization Journal: the Editors Look Back at 2016. World Allergy Organ J 2017; 10:9. [PMID: 28138353 PMCID: PMC5256576 DOI: 10.1186/s40413-017-0140-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University of Vienna and University of Vienna, Vienna, Austria
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32
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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.
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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
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33
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Wang X, Li LF, Zhao DY, Shen YW. Prevalence and Clinical Features of Atopic Dermatitis in China. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2568301. [PMID: 27957490 PMCID: PMC5124451 DOI: 10.1155/2016/2568301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/25/2016] [Accepted: 10/13/2016] [Indexed: 12/22/2022]
Abstract
Background. The epidemiology of atopic dermatitis (AD) in Chinese outpatients is yet to be clarified. Objectives. To investigate population-based prevalence and clinical features of AD in Chinese outpatients. Methods. A multicenter cross-sectional study was conducted in outpatients with eczema or dermatitis from 39 tertiary hospitals in 15 provinces. Results. This study included 682 patients diagnosed with AD, with the mean age of 28.8 ± 20.1 years and the median course of 5.3 ± 6.9 years. AD patients had more severe itching (30.4% versus 13.8%, p < 0.001) and clinically suspected bacterial infection (21.7% versus 16.1%, p < 0.001) than those of other types of dermatitis. Older patients were more susceptible to have a history of flexion dermatitis (p < 0.001), bacterial infection (p = 0.005), and severe itching (p < 0.001). Outpatients with clinically suspected bacterial infection had 3.53-fold increased risk of AD than those without it (p < 0.001). The morbidity rate of AD in the (20-25°N) region is 2.86 times higher than that in the (40-45°N) region [OR (95% CI): 0.352 (0.241-0.514), p < 0.001]. Conclusions. AD is characterized by unique clinical/demographic features. Bacterial infection and latitude region may have an impact on the incidence of AD in China.
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Affiliation(s)
- Xin Wang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Lin-Feng Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Da-yu Zhao
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yi-wei Shen
- Department of Dermatology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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34
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Du Toit G, Foong RXM, Lack G. Prevention of food allergy - Early dietary interventions. Allergol Int 2016; 65:370-377. [PMID: 27617655 DOI: 10.1016/j.alit.2016.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022] Open
Abstract
The prevalence of food allergy has increased over the last 30 years and remains a disease, which significantly impacts on the quality of life of children and their families. Several hypotheses have been formulated to explain the increasing prevalence; this review will focus on the hypothesis that dietary factors may influence the development of food allergy. Historically, the prevention of food allergy has focused on allergen avoidance. However, recent findings from interventional studies have prompted a shift in the mind set from avoidance to early introduction of potentially allergenic foods. This review aims to facilitate a better understanding of contemporary research studies that make use of early introduction of common allergenic foods into infant diets as a preventative strategy against the development of food allergy.
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35
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Abstract
Baked milk and egg have the potential to act as a form of oral immunotherapy (OIT). Clinical studies have shown that a majority of milk- and egg-allergic children can tolerate these allergens modified in baked form, and immunologic changes reported in subjects ingesting baked milk and egg mirror those seen in food allergy OIT trials. In addition, several studies have indicated that resolution of milk and egg allergies occur sooner in populations regularly ingesting baked milk and egg. Oral food challenges remain the best method for determining tolerability of baked milk and egg since baseline characteristics and diagnostic testing have not been reliable predictors. In this review, we explore the tolerability of baked milk and egg and their potential as OIT treatment for milk and egg allergy.
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