Adverse reactions to food: the female dominance - A secondary publication and update

Time trends in the epidemiology of food allergy in England: an observational analysis of Clinical Practice Research Datalink data

BACKGROUND

Estimates for the prevalence of food allergy vary widely, with a paucity of data for adults. The aim of this analysis was to report trends in the incidence and prevalence of food allergy in England, using a national primary care dataset.

METHODS

We analysed data from Clinical Practice Research Datalink between 1998 and 2018, with linked data to relevant hospital encounters in England. The main outcomes were incidence and prevalence of food allergy, according to three definitions of food allergy: possible food allergy, probable food allergy, and probable food allergy with adrenaline autoinjectors prescription. We also evaluated the difference in proportion of patients prescribed adrenaline autoinjectors by English Index of Multiple Deprivation (IMD), age, and by previous food anaphylaxis, and explored differences in patient encounters (general practice vs emergency department setting).

FINDINGS

7 627 607 individuals in the dataset were eligible for inclusion, of whom 150 018 (median age 19 years [IQR 4-34]; 82 614 [55·1%] female and 67 404 [44·9%] male) had a possible food allergy. 121 706 met diagnostic criteria for probable food allergy, of whom 38 288 were prescribed adrenaline autoinjectors. Estimated incidence of probable food allergy doubled between 2008 and 2018, from 75·8 individuals per 100 000 person-years (95% CI 73·7-77·9) in 2008 to 159·5 (156·6-162·3) individuals per 100 000 person-years in 2018. Prevalence increased from 0·4% (23 399 of 6 432 383) to 1·1% (82 262 of 7 627 607) over the same period and was highest in children under 5 years (11 951 [4·0%] of 296 406 in 2018) with lower prevalence in school-aged children (from 11 353 [2·4%] of 473 597 in 2018 for children aged 5-9 years to 6896 [1·7%] of 404 525 for those aged 15-19 years) and adults (42 848 [0·7%] of 5 992 454 in 2018). In those with previous food anaphylaxis, only 2321 (58·3%) of 3980 (975 [64·0%] of 1524 children and young people and 1346 [54·8%] of 2456 adults) had a prescription for adrenaline autoinjector. Adrenaline autoinjectors prescription was less common in those resident in more deprived areas (according to IMD). In the analysis of health-care encounters, 488 604 (97·1%) of 503 198 visits recorded for food allergy occurred in primary care, with 115 655 (88·4%) of 130 832 patients managed exclusively in primary care.

INTERPRETATION

These estimates indicate an important and increasing burden of food allergy in England. Our findings that most patients with food allergy are managed outside the hospital system, with low rates of adrenaline autoinjector prescription in those with previous anaphylaxis, highlight a need to better support those working in primary care to ensure optimal management of patients with food allergy.

FUNDING

UK Food Standards Agency and UK Medical Research Council.

Does sourdough bread provide clinically relevant health benefits?

During the last decade, scientific interest in and consumer attention to sourdough fermentation in bread making has increased. On the one hand, this technology may favorably impact product quality, including flavor and shelf-life of bakery products; on the other hand, some cereal components, especially in wheat and rye, which are known to cause adverse reactions in a small subset of the population, can be partially modified or degraded. The latter potentially reduces their harmful effects, but depends strongly on the composition of sourdough microbiota, processing conditions and the resulting acidification. Tolerability, nutritional composition, potential health effects and consumer acceptance of sourdough bread are often suggested to be superior compared to yeast-leavened bread. However, the advantages of sourdough fermentation claimed in many publications rely mostly on data from chemical and in vitro analyzes, which raises questions about the actual impact on human nutrition. This review focuses on grain components, which may cause adverse effects in humans and the effect of sourdough microbiota on their structure, quantity and biological properties. Furthermore, presumed benefits of secondary metabolites and reduction of contaminants are discussed. The benefits claimed deriving from in vitro and in vivo experiments will be evaluated across a broader spectrum in terms of clinically relevant effects on human health. Accordingly, this critical review aims to contribute to a better understanding of the extent to which sourdough bread may result in measurable health benefits in humans.

Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry

BACKGROUND

Food is one of the most common elicitors of anaphylaxis, with an increasing incidence over recent years.

OBJECTIVES

To characterize elicitor-specific phenotypes and identify factors enhancing the risk or severity of food-induced anaphylaxis (FIA).

METHODS

We analyzed data from the European Anaphylaxis Registry applying an age- and sex-matched analysis of associations (Cramer's V) for single food triggers and calculated odds ratios (ORs) for severe FIA.

RESULTS

We identified 3,427 cases of confirmed FIA showing an age-dependent elicitor ranking (for children: peanut, cow's milk, cashew, and hen's egg; and for adults: wheat flour, shellfish, hazelnut, and soy). The age- and sex-matched analysis revealed defined symptom patterns for wheat and cashew. Wheat-induced anaphylaxis was more frequently associated with cardiovascular symptoms (75.7%; Cramer's V = 0.28) and cashew-induced anaphylaxis with gastrointestinal symptoms (73.9%; Cramer's V = 0.20). Furthermore, concomitant atopic dermatitis was slightly associated with anaphylaxis to hen's egg (Cramer's V = 0.19) and exercise was strongly associated with anaphylaxis to wheat (Cramer's V = 0.56). Additional factors influencing the severity were alcohol intake in wheat anaphylaxis (OR = 3.23; CI, 1.31-8.83) and exercise in peanut anaphylaxis (OR = 1.78; CI, 1.09-2.95).

CONCLUSIONS

Our data show that FIA is age-dependent. In adults, the range of elicitors inducing FIA is broader. For some elicitors, the severity of FIA seems to be related to the elicitor. These data require confirmation in future studies considering a clear differentiation between augmentation and risk factors in FIA.

The credibility of dietary advice formulated by ChatGPT: Robo-diets for people with food allergies

The introduction of ChatGPT has sparked enormous public interest in large language (deep-learning) models, which have been sophisticated enough to perform well on a variety of tasks. One way people are using these models is to construct diets. The prompts often include food restrictions that are an obligatory part of everyday life for millions of people worldwide. The aim of this study was to investigate the safety and accuracy of 56 diets, constructed for hypothetical individuals who are allergic to food allergens. Four levels, corresponding to the "baseline" ability of ChatGPT without prompting for specifics, as well as its ability to prepare appropriate diets when an individual has an adverse food reaction to two allergens or solicits a low-calorie diet, were defined. Findings from our study demonstrated that ChatGPT, although generally accurate, has the potential to produce harmful diets. More common errors involve inaccuracies in portions or calories of food, meals, or diets. We discuss here how the accuracy of large language models could be increased and the trade-offs involved. We propose that prompting for elimination diets can serve as one way to assess differences between such models.

Food Allergy Characteristics Associated With Coexisting Eosinophilic Esophagitis in FARE Registry Participants

BACKGROUND

Eosinophilic esophagitis (EoE) can coexist in individuals with food allergy.

OBJECTIVE

To evaluate the characteristics of food-allergic patients with and without coexisting EoE using a large food allergy patient registry.

METHODS

Data were derived from 2 Food Allergy Research & Education, Inc, Patient Registry surveys. A series of multivariable regression models were used to evaluate associations between demographic, comorbidity, and food allergy characteristics and the likelihood of reporting EoE.

RESULTS

Five percent (n = 309) of registry participants (n = 6074; ages <1 year->80 years, mean, 20.20 ± 15.37 years) reported having EoE. The odds of having EoE were significantly greater in male participants (adjusted odds ratio [aOR], 1.3; 95% CI, 1.04-1.72) and those with comorbid asthma (aOR, 2.0; 95% CI, 1.55-2.49), allergic rhinitis (aOR, 1.8; 95% CI, 1.37-2.22), oral allergy syndrome (aOR, 2.8; 95% CI, 2.09-3.70), food protein-induced enterocolitis syndrome (aOR, 2.5; 95% CI, 1.34-4.84), and hyper-IgE syndrome (aOR, 7.6; 95% CI, 2.93-19.92), though not atopic dermatitis (aOR, 1.3; 95% CI, 0.99-1.59), when adjusting for demographics (sex, age, race, ethnicity, and geographic location). Those with a greater number of food allergies (aOR, 1.3; 95% CI, 1.23-1.32), more frequent food-related allergic reactions (aOR, 1.2; 95% CI, 1.11-1.24), previous anaphylaxis (aOR, 1.5; 95% CI, 1.15-1.83), and health care utilization for food-related allergic reactions (aOR, 1.3; 95% CI, 1.01-1.67)-specifically intensive care unit admission (aOR, 1.2; 95% CI, 1.07-1.33)-were more likely to have EoE after controlling for demographics. However, no significant difference in ever using epinephrine for food-related allergic reactions was detected.

CONCLUSIONS

These self-reported data showed that coexisting EoE is associated with an increased number of food allergies, food-related allergic reactions per year, and measures of reaction severity, calling attention to the likely increased health care needs of food-allergic patients with EoE.

Food allergies and allergens in Lebanon: Characterization and perceptions toward labeling

Background

Food allergy is a life-threatening medical condition of public health concern. The aim of our study was to characterize food allergies, in terms of sources, symptoms, severity, and history, as well as to assess the knowledge, practices, and attitudes towards food allergens and allergies, in addition to food allergen labeling, in Lebanon.

Methods

For this, 1100 participants filled over the phone a comprehensive valid questionnaire composed of 41 questions.

Results

Fruits were reported as top food allergens (29.6%), while itching and rash were the most reported symptoms (9.6% and 8.0%, respectively). In terms of knowledge, participants scored on average 67.9 ± 16.2%. Participants who identified as females, below 35 years, highly educated, and from health backgrounds had a significantly higher score (p < 0.05), while area of residence did not have any significant effect (p > 0.05). Participants who are medically diagnosed with allergies and those with health background were found to check the ingredients list and read nutritional claims significantly more frequently than those from a non-health background and who are non-medically diagnosed, respectively, while females were found to check ingredients list and read nutritional claims significantly more frequently (p < 0.05). The majority reported that ingredients are easy to understand (63.2%) and simple to read (61.3%), while allergic individuals agreed that the font size of the ingredients list is not big enough (56.8%) and that E-code numbers are not understood (68.7%). The majority considered it "important" to have the label writings larger and bolded (85.7%), to use simple language (95.5%), to place allergen warning (82.2%), and to use a striking allergen symbol (93.5%).

Conclusions

Our results emphasize the need for national awareness campaigns to improve knowledge and practices, and to lobby policymakers for appropriate management of food allergies and allergens in Lebanon.

IgE Mediated Wheat Allergy Associated with Resistant and Severe Forms of Allergic Conjunctivitis

Objective:

This study aimed to determine the prevalence and criteria of wheat allergy (WA) among patients with resistant allergic conjunctivitis (AC).

Methods:

A prospective comparative study was conducted on 100 patients with resistant AC. Skin prick-tests (SPTs), total and sIgE against a panel of inhalant and food allergens were performed in all patients’ sera. They were divided into 2 groups according to skin prick test (SPT) and specific IgE (sIgE) level, namely the wheat sensitive group (WSG) and wheat tolerant group (WTG). Total ocular symptom scores (TOSS) and 4-point sign scales were correlated for both groups.

Results:

Ten patients out of 100 with IgE-mediated resistant AC were wheat sensitive, and the other 90 were wheat tolerant patients. WSG included patients of significantly younger age. Positive family history of atopy was proven in 100% of WSG vs. 67% of WTG. A significantly higher frequency of multiorgan allergy was detected in 100% of WSG vs. 20% in WTG (P = 0.0001). Thirty (30%) of WSG had associated allergic rhinitis (AR) and bronchial asthma (BA). Another 30% had an associated AR only, 10% had an associated BA only, and another 20% had an associated skin allergy. TOSS, 4- point sign scale, and total IgE level were significantly higher in WSG.

Conclusion:

This study provides novel evidence that wheat allergy is responsible for some severe forms of AC.

Prevalence, clinical presentation, and associated atopic diseases of pediatric fruit and vegetable allergy: A population-based study

BACKGROUND

In children, fruit and vegetable allergies are often overlooked compared with well-known allergies such as those to eggs, milk, and shellfish. Therefore, this study aimed to analyze fruit and vegetable allergies in children, including prevalence, types of food allergens, clinical presentation, management, and associated comorbid atopic diseases.

METHODS

In 2012, a nationwide, cross-sectional, random sampling questionnaire-based survey for common fruit and vegetable allergies was conducted in Taiwan. Information regarding these plant food allergies was collected. Physicians diagnosed food allergies according to the descriptions of convincing symptoms. Enrolled questionnaires were reviewed by expert pediatricians.

RESULTS

A total of 9,982 valid questionnaires were analyzed. The overall prevalence of fruit and vegetable allergies was 5.6% (n = 560) and 3.0% (n = 304), respectively. The most common fruit allergen was mango, followed by kiwifruit, whereas taro and bamboo shoot were the most common vegetable allergens. Meanwhile, most allergic symptoms were of the mucocutaneous tissue, followed by the upper airway and gastrointestinal tract. Most only required avoidance of allergens and not medical treatment. Children with fruit or vegetable allergies had a higher percentage of comorbid atopic dermatitis, allergic rhinitis, and asthma than those without food allergies; additionally, the proportion of comorbid atopic diseases was similar between fruit and vegetable allergies and shellfish allergy. One child developed anaphylaxis due to a corn allergy.

CONCLUSIONS

Fruits and vegetables are common food allergens in Taiwanese children who present with diverse and potentially severe symptoms. Children with plant food allergies had a percentage of comorbid atopic diseases similar to that of shellfish allergy, the most common allergen. These findings indicate the importance of considering fruit and vegetable allergies in children.

Understanding sex differences in the allergic immune response to food

Food allergies are of great public health concern due to their rising prevalence. Our understanding of how the immune system reacts to food remains incomplete. Allergic responses vary between individuals with food allergies. This variability could be caused by genetic, environmental, hormonal, or metabolic factors that impact immune responses mounted against allergens found in foods. Peanut (PN) allergy is one of the most severe and persistent of food allergies, warranting examination into how sensitization occurs to drive IgE-mediated allergic reactions. In recent years, much has been learned about the mechanisms behind the initiation of IgE-mediated food allergies, but additional questions remain. One unresolved issue is whether sex hormones impact the development of food allergies. Sex differences are known to exist in other allergic diseases, so this poses the question about whether the same phenomenon is occurring in food allergies. Studies show that females exhibit a higher prevalence of atopic conditions, such as allergic asthma and eczema, relative to males. Discovering such sex differences in allergic diseases provide a basis for investigating the mechanisms of how hormones influence the development of IgE-mediated reactions to foods. Analysis of existing food allergy demographics found that they occur more frequently in male children and adult females, which is comparable to allergic asthma. This paper reviews existing allergic mechanisms, sensitization routes, as well as how sex hormones may play a role in how the immune system reacts to common food allergens such as PN.

[Self-reported prevalence of fructan food hypersensitivity in university students from the State of Mexico]

OBJECTIVE

To determine the self-reported prevalence of fructans food hypersensitivity in a sample of Mexican university students and to investigate the most frequent symptoms, the related foods involved, risk factors and gastrointestinal function status.

METHODS

A cross-sectional, descriptive study was conducted in a convenience sample of 412 university students aged from 18 to 35 years. Data were collected about their personal and family history of gastrointestinal diseases, the presence of symptoms after consumption of certain foods, and the severity of their symptoms.

RESULTS

The prevalence of fructans food hypersensitivity was 31.1 %; it was higher in women than in men. The most frequent gastrointestinal symptoms were bloating and flatulence. The most frequent extra-intestinal symptoms were fatigue and stress. The food groups related to the occurrence of symptoms were legumes, vegetables, and fruits. Significant association was found between female sex, personal and family history of gastrointestinal diseases and the presence of fructans food hypersensitivity (p < 0.05). Most individuals with fructans food hypersensitivity had mild gastrointestinal dysfunction (67.2 %).

CONCLUSIONS

FFH is a common condition, it was found in one third of university students and occurs mainly in women. More research and diffusion about this pathology is required.

Adverse reactions to BNT162b2 mRNA COVID-19 vaccine in medical staff with a history of allergy

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) vaccination is progressing globally. Several adverse reactions have been reported with vaccination against COVID-19. It is unknown whether adverse reactions to COVID-19 vaccination are severe in individuals with allergies.

METHODS

We administered the COVID-19 vaccine to the medical staff at Yamagata University Hospital from March to August 2021. Subsequently, we conducted an online questionnaire-based survey to investigate the presence of allergy and adverse reactions after vaccination and examine the association between allergy and adverse reactions after immunization.

RESULTS

Responses were collected from 1586 to 1306 participants after the first and second administration of the BNT162b2 mRNA COVID-19 vaccine, respectively. Adverse reactions included injection site pain, injection site swelling, fever, fatigue or malaise, headache, chills, nausea, muscle pain outside the injection site, and arthralgia. The frequency of some adverse reactions and their severity were higher, and the duration of symptoms was longer in participants with allergies than in those without allergies. Although several participants visited the emergency room for treatment after the first and second vaccinations, no participant was diagnosed with anaphylaxis.

CONCLUSIONS

This study suggests that the frequency and severity of adverse reactions after injection of BNT162b2 mRNA COVID-19 vaccine were higher in individuals with allergy; however, no severe adverse reactions such as anaphylaxis or death were observed. These results indicate that individuals with allergic histories may tolerate the BNT162b2 mRNA COVID-19 vaccine.

Allergic reactions to the Ad26.COV2.S vaccine in South Africa

Background

The Janssen-Ad26.COV2.S vaccine is authorized for use in several countries, with more than 30 million doses administered. Mild and severe allergic adverse events following immunization (AEFI) have been reported.

Objective

We sought to detail allergic reactions reported during the Sisonke phase 3B study in South Africa.

Methods

A single dose of the Ad26.COV2.S vaccine was administered to 4,77,234 South African health care workers between February 17 and May 17, 2021. Monitoring of adverse events used a combination of passive reporting and active case finding. Telephonic contact was attempted for all adverse events reported as "allergy." Anaphylaxis adjudication was performed using the Brighton Collaboration and National Institute of Allergy and Infectious Disease case definitions.

Results

Only 251 (0.052%) patients reported any allergic-type reaction (<1 in 2000), with 4 cases of adjudicated anaphylaxis (Brighton Collaboration level 1, n = 3) (prevalence of 8.4 per million doses). All anaphylaxis cases had a previous history of drug or vaccine-associated anaphylaxis. Cutaneous allergic reactions were the commonest nonanaphylatic reactions and included self-limiting, transient/localized rashes requiring no health care contact (n = 92) or isolated urticaria and/or angioedema (n = 70; median onset, 48 [interquartile range, 11.5-120] hours postvaccination) that necessitated health care contact (81%), antihistamine (63%), and/or systemic/topical corticosteroid (16%). All immediate (including adjudicated anaphylaxis) and most delayed AEFI (65 of 69) cases resolved completely.

Conclusions

Allergic AEFI are rare following a single dose of Ad26.COV, with complete resolution in all cases of anaphylaxis. Although rare, isolated, delayed-onset urticaria and/or angioedema was the commonest allergic AEFI requiring treatment, with nearly half occurring in participants without known atopic disease.

Sex-specific associations of human milk long-chain polyunsaturated fatty acids and infant allergic conditions

BACKGROUND

Polyunsaturated fatty acids (PUFAs) may influence immune development. We examined the association of PUFAs in human milk with food sensitization and atopic dermatitis among breastfed infants.

METHODS

In a selected subgroup of 1109 mother-infant dyads from the CHILD Cohort Study, human milk was analyzed by gas-liquid chromatography to quantify PUFAs including arachidonic acid (ARA) and docosahexaenoic acid (DHA). At 1 year of age, food sensitization was determined by skin-prick testing for egg, peanut, cow's milk, and soybean, and atopic dermatitis was diagnosed by pediatricians. Logistic regression analyses controlled for breastfeeding exclusivity, family history of atopy, and other potential confounders.

RESULTS

Overall, 184 infants (17%) were sensitized to one or more food allergens and 160 (14%) had atopic dermatitis. Sex-specific associations were observed between these conditions and milk PUFAs. Girls receiving human milk with lower proportions of DHA had lower odds of food sensitization (aOR 0.35; 95% CI 0.12, 0.99 for lowest vs highest quintile), and a clear dose-dependent association was observed for the ARA/DHA ratio (aOR 2.98; 95% CI 1.10, 8.06 for lowest vs highest quintile). These associations were not seen in boys. Similar sex-specific tendencies were observed for atopic dermatitis.

CONCLUSIONS

Human milk PUFA proportions and their ratios are associated with infant atopic conditions in a sex-specific manner. In female infants, a higher ratio of ARA/DHA may reduce the risk of food sensitization and atopic dermatitis. Further research is needed to determine the underlying mechanisms and clinical relevance of this sex-specific association.

Histamine Intolerance-The More We Know the Less We Know. A Review

The intake of food may be an initiator of adverse reactions. Food intolerance is an abnormal non-immunological response of the organism to the ingestion of food or its components in a dosage normally tolerated. Despite the fact that food intolerance is spread throughout the world, its diagnosing is still difficult. Histamine intolerance (HIT) is the term for that type of food intolerance which includes a set of undesirable reactions as a result of accumulated or ingested histamine. Manifestations may be caused by various pathophysiological mechanisms or a combination of them. The problem with a "diagnosis" of HIT is precisely the inconstancy and variety of the manifestations in the same individual following similar stimuli. The diagnosing of HIT therefore requires a complex time-demanding multidisciplinary approach, including the systematic elimination of disorders with a similar manifestation of symptoms. Among therapeutic approaches, the gold standard is a low-histamine diet. A good response to such a diet is considered to be confirmation of HIT. Alongside the dietary measures, DAO supplementation supporting the degradation of ingested histamine may be considered as subsidiary treatment for individuals with intestinal DAO deficiency. If antihistamines are indicated, the treatment should be conscious and time-limited, while 2nd or 3rd generation of H1 antihistamines should take precedence.

Gender differences in food allergy depend on the PPAR γ/NF-κB in the intestines of mice

AIMS

Epidemiology shows that gender affects the incidence of food allergy. However, there is a lack of evidence of gender differences in food allergies and little is known about the mechanisms. The aim of this study was to excavate potential reasons for gender differences in food allergy based on estrogen.

MAIN METHODS

Female and male BALB/c mice sensitized with ovalbumin (OVA) were established to analyze the difference in food allergy. The systemic anaphylactic, including OVA-specific IgE, OVA-specific IgG, histamine, and cytokines, was assessed using an enzyme-linked immunosorbent assay (ELISA). ELISA also detected the estradiol in serum. Western blotting and immunofluorescence were used to detect the estrogen receptor. Peroxisome proliferator-activated receptor gamma (PPARγ) implicated in immune homeostasis and nuclear factor kappa-B (NF-κB) were determined by western blotting. Immunohistochemistry and hematoxylin-eosin (H&E) staining were used to detect zonula occludens-1 (ZO-1), tryptase, forkhead box protein P3 (Foxp3), and intestinal morphology, respectively.

KEY FINDINGS

Female mice were more vulnerable to food allergy. Female mice treated with OVA did exhibit more serious systemic anaphylaxis than male mice. We observed increased levels of estradiol in serum, estrogen receptor, NF-κB, and decreased levels of PPAR γ in female mice. Furthermore, the intestinal mucosal integrity and intestinal permeability were more impaired in female mice treated with OVA than male mice.

SIGNIFICANCE

Clarify the mechanism of gender differences in food allergies can provide targets in female mice and provide personalized diagnosis, management, and treatment of food allergy for female mice.

Characteristics and associated morbidities of young adults with misconceived food allergy: A cross-sectional study

BACKGROUND

Many patients with self-reported food allergy are not allergic but suffer from similar burdens. We aimed to characterize young adults with misconceived food allergy.

METHODS

A cross-sectional study of individuals (n = 12,592) aged 17-18 years, recruited to the Israel Defense Forces (IDF) at a single urban-area recruitment center over a six month-period. All participants underwent a comprehensive medical and psychological evaluation. Cognitive tests were performed and a Combined Intellectual-Education score assigned. Participants who reported food elimination due to allergy were skin-tested and underwent oral food challenges, when indicated. The characteristics, psychological evaluation and cognitive tests of individuals with no reported food allergy (n = 12,444), misconceived food allergy (n = 64) and true food allergy (n = 84) were compared.

FINDINGS

The prevalence of atopic co-morbidities was higher in recruits reporting compared to those not reporting food allergy while the rate of other co-morbidities was comparable. Anxiety disorder was diagnosed significantly more in individuals who reported food allergy (4·1%) compared to those who did not (1·7%) (p = 0·04). Further analysis revealed that this diagnosis was concentrated in individuals with misconceived (8/64, 12·5%) compared to true food allergy (2/84, 2·4%), (p = 0·02). Patients with misconceived food allergy were mostly of female sex, had lower Combined Intellectual-Education scores compared to patients with true (p = 0·001) and no reported food allergy (p = 0·01), and required the longest mean evaluation time (147·6 ± 109·4 days).

INTERPRETATION

Patients with misconceived food allergy have higher rates of anxiety disorder and are often from a lower educational level and of female sex. Medical and educational attention is required to improve care of this specific population.

FUNDING

The research reported in this publication was supported by the Israel Defense Forces (IDF) Medical Corps and Directorate of Defense Research & Development, Israeli Ministry of Defense (IMOD DDR&D).

Applications of Mouse Models to the Study of Food Allergy

Mouse models of allergic disease offer numerous advantages when compared to the models of other animals. However, selection of appropriate mouse models is critical to advance the field of food allergy by revealing mechanisms of allergy and for testing novel therapeutic approaches. All current mouse models for food allergy have weaknesses that may limit their applicability to human disease. Aspects such as the genetic predisposition to allergy or tolerance from the strain of mouse used, allergen dose, route of exposure (oral, intranasal, intraperitoneal, or epicutaneous), damage of the epithelial barrier, use of adjuvants, food matrix effects, or composition of the microbiota should be considered prior to the selection of a specific murine model and contemplated according to the intended purpose of the study. This chapter reviews our current knowledge on the application of mouse models to food allergy research and the variables that may influence the successful development of each type of model.

Food allergies and allergens: Characterization and perceptions among diagnosed food allergic individuals in Lebanon

Background

The aim of our study was to assess the knowledge, practices, and attitudes towards food allergens and allergies among diagnosed food allergic individuals in Lebanon.

Methods

Seventy diagnosed participants were recruited after reaching out to all the allergists of the country. They completed in person or over the phone a comprehensive valid questionnaire composed of 49 questions.

Results

Wheat was reported as top food allergen (15.7%), while itchy skin and rash were the most reported symptoms (71.4% and 68.6%, respectively). Only 34 (48.6%) of participants indicated they carry medications, 58 (70.7%) were diagnosed using blood test, and 22 (31.4%) stated that they are very knowledgeable on the topic. In terms of knowledge, participants scored on average 84.2 ± 11.5%. In terms of best practices, participants scored on average 47.8 ± 28.3%. Having a health related educational background increased significantly (p < 0.05) both knowledge and best practices scores, while age and gender did not have an effect.

Conclusions

Our results highlight the importance of organizing ongoing educational initiatives and emphasize the need to lobby policy makers to making allergen-warning labels obligatory in the country.

Gender aspects in food allergy

PURPOSE OF REVIEW

The difference of food allergy prevalence between male and female individuals is well documented and should have more impact for personalized diagnosis and management. Although in younger age male sex dominates, in adults more women are affected by food allergies. This sex disparity diminishes again around menopause, underlining the influence of sex hormones, but in addition, also metabolic gender-specific factors and differences in microbiome composition might contribute to the different expression of food allergy in the two genders. The sex-dependent and gender-dependent influence on development of food allergy, disease severity, as well as on social, dietary and neuropsychological factors in studies mainly published within past 18 months are discussed in this review.

RECENT FINDINGS

Sex and gender differences likely play a role in food allergy development, for instance via influence on immune cells and mediators, or on the composition of the microbiome, but only few controlled studies on this specific topic are available.

SUMMARY

Future prospective studies need to clearly take into account the sex and gender difference in order to provide personalized diagnosis, management and treatment of food allergy.

Prevalence of IgE-mediated sensitization in patients with suspected food allergic reactions in Jordan

Background

Despite the recognition of food allergies as a significant cause of morbidity and a growing public health burden worldwide, there are no epidemiological studies addressing food sensitization and allergy in Jordan.

Objective

To conduct an epidemiological study that retrospectively analyzes sensitization data from 3463 patients with suspected immunoglobulin E (IgE)‐mediated food allergic reactions who performed specific IgE tests in our laboratories in Jordan.

Methods

Specific IgE (s‐IgE) tests were analyzed for patients who performed enzyme allegro‐sorbent testing based on either self‐reported food allergy or upon physician's request.

Results

2.3% of the analyzed samples were cross‐reactive to carbohydrate determinants. A quarter of the patients were sensitized to one or more food allergens, with males having higher odds of being s‐IgE positive. Furthermore, a higher prevalence of sensitization was seen in infants and children compared with adults. s‐IgE was most frequently found against cow milk (11.2%), pistachio (4.9%), soybean (4.6%), cherry (4.4%), and orange (4.4%). Interestingly, the s‐IgE class distribution profile of pistachio differed from the rest of the top hits being skewed away from the weak class 1 leaning more towards higher IgE classes. Food allergen sensitization was age group‐dependent: milk, tree nuts, and eggs were the main food groups causing sensitization in infants, while it was fruits followed by milk in children and adults.

Conclusions

Our work represents the first epidemiological study addressing food sensitization in Jordan. This study lays a solid foundation for future studies that can help better guide food allergy diagnosis, patient dietary modifications, and food elimination plans, as well as assist decision‐makers in the region to develop national strategies for an efficient and sustainable healthcare system.

Sex and Gender Aspects for Patient Stratification in Allergy Prevention and Treatment

Allergies are rapidly worsening in recent decades, representing the most common immunological diseases. The mechanism of disorders such as asthma, rhinocongiuntivitis, urticaria, atopic dermatitis, food and drug allergies, and anaphylaxis still remain unclear and consequently treatments is mostly still symptomatic and aspecific while developments of new therapies are limited. A growing amount of data in the literature shows us how the prevalence of allergic diseases is different in both sexes and its changes over the course of life. Genes, hormones, environmental and immunological factors affect sex disparities associated with the development and control of allergic diseases, while they more rarely are considered and reported regarding their differences related to social, psychological, cultural, economic, and employment aspects. This review describes the available knowledge on the role of sex and gender in allergies in an attempt to improve the indispensable gender perspective whose potential is still underestimated while it represents a significant turning point in research and the clinic. It will offer insights to stimulate exploration of the many aspects still unknown in this relationship that could ameliorate the preventive, diagnostic, and therapeutic strategies in allergic diseases.

The Eurasian lactase persistence variant LCT-13910 C/T is associated with vitamin D levels in individuals living at high latitude, more so than exposure to sunlight

Rapid selection of a genetic variant that confers continuous life-long lactase production in Europeans (LCT-13910 C/T) has been attributed to the advantages of acquiring nutrients from consuming milk without the disadvantages of lactose malabsorption. Individuals with this genetic lactase persistence (LP) variant generally consume more milk and have been shown to have higher levels of serum vitamin D. Vitamin D is the principal regulator of Ca absorption and its synthesis in skin is dependent on UVB exposure. The primary aim of the present study was to compare serum vitamin D concentrations with LP variant and to control for UVB exposure. Data from over 100 000 individuals living in Norway, a country with low UVB exposure, was retrospectively retrieved for comparison of genetic LP variant, serum 25-hydroxyvitamin D (25(OH)D) concentration and the time of year when serum samples were taken. For comparison, a similar analysis was performed with a natural dairy micronutrient, namely vitamin B₁₂. It was found that individuals with the genetic LP variant had considerably higher levels of serum 25(OH)D (P < 2 × 10^-16, Cohen's d = 0·73) but lower levels of vitamin B₁₂ (P < 2 × 10^-16, Cohen's d = 0·11), compared with genetic lactase non-persistent individuals, even when controlled for seasonality, age and sex. The difference in serum 25(OH)D levels did not diminish in summer months, showing the role of vitamin D in LP variant selection in areas of low UVB irradiation. LP variant selection advantage through acquiring another dairy micronutrient, vitamin B₁₂, was not observed.

Likely questionnaire-diagnosed food allergy in 78, 890 adults from the northern Netherlands

BACKGROUND

It is challenging to define likely food allergy (FA) in large populations which limited the number of large studies regarding risk factors for FA.

OBJECTIVE

We studied the prevalence and characteristics of self-reported FA (s-rFA) in the large, population-based Dutch Lifelines cohort and identified associated risk factors.

METHODS

Likely food allergic cases (LikelyFA) were classified based on questionnaire reported characteristics consistent with FA. Subjects with atypical characteristics were classified as Indeterminate. We investigated 13 potential risk factors for LikelyFA such as birth mode and living on a farm and addressed health-related quality of life (H-RQOL).

RESULTS

Of the 78, 890 subjects, 12.1% had s-rFA of which 4.0% and 8.1% were classified as LikelyFA and Indeterminate, respectively. Younger age, female sex, asthma, eczema and nasal allergy increased the risk of LikelyFA (p-value range <1.00*10-250-1.29*10-7). Living in a small city/large village or suburb during childhood was associated with a higher risk of LikelyFA than living on a farm (p-value = 7.81*10-4 and p = 4.84*10-4, respectively). Subjects classified as Indeterminate more often reported depression and burn-out compared to those without FA (p-value = 1.46*10-4 and p = 8.39*10-13, respectively). No association was found with ethnicity, (duration of) breastfeeding, birth mode and reported eating disorder. Mental and physical component scores measuring H-RQOL were lower in both those classified as LikelyFA and Indeterminate compared to those without FA.

CONCLUSION

The prevalence of s-rFA among adults is considerable and one-third reports characteristics consistent with LikelyFA. Living on a farm decreased the risk of LikelyFA. The association of poorer H-RQOL as well as depression and burn-out with questionable self-perceived FA is striking and a priority for future study.

Role of Food Neophobia and Allergen Content in Food Choices for a Polish Cohort of Young Women

Young women are vulnerable to a number of factors which influence their food choices, including beliefs about food products, or information about nutritional value, while information, that product is free from specific component generates consumer perceptions of its healthfulness. Among the factors which may influence such perception, there is food neophobia (FN). The aim of this study was to determine the influence of FN and information about allergens on the food product choices in the Polish cohort of young women, in the choice experiment when given a model restaurant menu. The web-based choice experiment, in a group of 600 women, aged 18-30 years, with no food allergies diagnosed, was conducted using a mock Italian-style restaurant menu. For 2 starters, 2 soups, 3 main courses and 3 desserts that were included, the allergen content, neophobic potential and perceived lack of healthiness, for a Polish population, were defined. Each respondent randomly received the version containing only a description of dishes, or a description accompanied by the allergens listed. The FN was assessed using the Food Neophobia Scale (FNS). The type of menu (with or without allergens listed) did not influence the choices of dishes. The highest FN level was observed for the women being inhabitants of villages (median of 32). The respondents characterized by a high level of FN less commonly chose dishes characterized by neophobic potential as a starter (Carpaccio), main course (Risotto ai frutti di mare) and dessert (Zabaglione). At the same time, the highest FN level was observed for respondents who chose dishes with no neophobic potential (median of 34.5). However, for allergen content and perceived lack of healthiness, no association with FN was observed, so it may be stated that for neophobic respondents, only neophobic potential is a factor limiting the choice of dishes. It may be concluded that food neophobia in young women may limit the consumption of dishes with unknown food products, and the influence is observed independently of other features of a dish, such as allergen content or perceived healthiness. The problem may appear especially for inhabitants of villages, who are characterized by the highest level of FN.

Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management

Lactose is the main source of calories in milk, an essential nutriedigestion, patients with visceral hypersensitivity nt in infancy and a key part of the diet in populations that maintain the ability to digest this disaccharide in adulthood. Lactase deficiency (LD) is the failure to express the enzyme that hydrolyses lactose into galactose and glucose in the small intestine. The genetic mechanism of lactase persistence in adult Caucasians is mediated by a single C→T nucleotide polymorphism at the LCTbo -13'910 locus on chromosome-2. Lactose malabsorption (LM) refers to any cause of failure to digest and/or absorb lactose in the small intestine. This includes primary genetic and also secondary LD due to infection or other conditions that affect the mucosal integrity of the small bowel. Lactose intolerance (LI) is defined as the onset of abdominal symptoms such as abdominal pain, bloating and diarrhoea after lactose ingestion by an individual with LM. The likelihood of LI depends on the lactose dose, lactase expression and the intestinal microbiome. Independent of lactose digestion, patients with visceral hypersensitivity associated with anxiety or the Irritable Bowel Syndrome (IBS) are at increased risk of the condition. Diagnostic investigations available to diagnose LM and LI include genetic, endoscopic and physiological tests. The association between self-reported LI, objective findings and clinical outcome of dietary intervention is variable. Treatment of LI can include low-lactose diet, lactase supplementation and, potentially, colonic adaptation by prebiotics. The clinical outcome of these treatments is modest, because lactose is just one of a number of poorly absorbed carbohydrates which can cause symptoms by similar mechanisms.

Adverse Reactions to Wheat or Wheat Components

Wheat is an important staple food globally, providing a significant contribution to daily energy, fiber, and micronutrient intake. Observational evidence for health impacts of consuming more whole grains, among which wheat is a major contributor, points to significant risk reduction for diabetes, cardiovascular disease, and colon cancer. However, specific wheat components may also elicit adverse physical reactions in susceptible individuals such as celiac disease (CD) and wheat allergy (WA). Recently, broad coverage in the popular and social media has suggested that wheat consumption leads to a wide range of adverse health effects. This has motivated many consumers to avoid or reduce their consumption of foods that contain wheat/gluten, despite the absence of diagnosed CD or WA, raising questions about underlying mechanisms and possible nocebo effects. However, recent studies did show that some individuals may suffer from adverse reactions in absence of CD and WA. This condition is called non-celiac gluten sensitivity (NCGS) or non-celiac wheat sensitivity (NCWS). In addition to gluten, wheat and derived products contain many other components which may trigger symptoms, including inhibitors of α-amylase and trypsin (ATIs), lectins, and rapidly fermentable carbohydrates (FODMAPs). Furthermore, the way in which foods are being processed, such as the use of yeast or sourdough fermentation, fermentation time and baking conditions, may also affect the presence and bioactivity of these components. The present review systematically describes the characteristics of wheat-related intolerances, including their etiology, prevalence, the components responsible, diagnosis, and strategies to reduce adverse reactions.

Self-reported hypersensitivity and allergy to foods amongst Mexican adolescents: Prevalence and associated factors

BACKGROUND

The prevalence of food allergy is on the rise on a global scale.

OBJECTIVE

To determine the prevalence of food hypersensitivity (FHS) and probable food allergy (PFA), as well as the foods and factors associated with these occurrences.

METHODS

A cross-sectional study was carried out among 1992 adolescents (aged 15-18 years). Each adolescent answered a structured questionnaire. A multivariate analysis was used to identify the association between the variables.

RESULTS

The prevalence of FHS was 10.6% (the most commonly associated foods were shrimp, cow's milk and avocado) and the PFA was 7.8% (shrimp, cow's milk and pecan). The prevalences of oral allergy syndrome, food-associated urticaria and systemic reaction were 4.9%, 3.6% and 1.5%, respectively. The following factors were associated with FHS: personal history of asthma (OR 1.63; 95% CI: 1.11-2.41), allergic rhinitis (OR 2.60; 95% CI: 1.75-3.87), atopic dermatitis (OR 2.07; 95% CI: 1.25-3.43), maternal history of asthma (OR 1.80; 95% CI: 1.02-3.16), atopic dermatitis (OR 6.11; 95% CI: 2.45-15.29), and female sex (OR 1.89; 95% CI: 1.38-2.59). PFA was associated with a personal history of asthma (OR 1.65; 95% CI: 1.06-2.56), allergic rhinitis (OR 2.46; 95% CI: 1.56-3.88), atopic dermatitis (OR 2.02; 95% CI: 1.15-3.54), paternal allergic rhinitis (OR 2.52; 95% CI: 1.15-5.51), maternal atopic dermatitis (OR 7.46; 95% CI: 2.93-19.00), and female sex (OR 1.89; 95% CI: 1.31-2.72).

CONCLUSION

The adverse reactions associated with foods among late adolescents are a frequent occurrence, and the most commonly associated factor is atopy.

Food hypersensitivity-induced chronic gastrointestinal inflammation in a non-human primate model of diet-induced obesity

Experimental non-human primate models of obesity are induced through the introduction of atypically calorically rich diets. Studies in captive-bred macaques show the development of obesity and diabetes with similar complications to humans including eye and kidney diseases, nerve damage associated with pain and blood vessel damage. Diets differ in outcomes and here we document inflammation of the gastrointestinal tract that can be exacerbated through these dietary interventions. Following baseline physiological evaluation of body composition, Southern pigtail macaques were given a high-fat diet (HFD) for three months. This HFD consisted of lard, grains (including gluten), dairy and fructose that was otherwise omitted from a standard macaque diet (Chow). Physiological parameters were then reassessed before animals were reverted back to standard Chow for a further three months (remission). Consumption of the HFD resulted in food-mediated hypersensitivity marked by chronic weight loss, alopecia, malabsorption, protein-losing enteropathy and gross diffuse intestinal villi atrophy and lamina propria hypertrophy. Physiological changes were more highly pronounced in female macaques suggesting sex-specific differences but could be fully reversed through change of diet. Care should be taken in choosing non-human primate HFD diets for creating experimental models of obesity because they can induce severe food-driven chronic inflammation of the gastrointestinal tract that can eventuate to diet-induced chronic wasting and mortality.

Biological and epidemiological evidence of anti-allergic effects of traditional Japanese food ume (Prunus mume)

Japanese apricot (Prunus mume; ume) is a traditional food in Japan that has been shown to have various beneficial health effects. There is some evidence to suggest that ume is also effective against allergic disease. Here, we conducted a cross-sectional epidemiological pilot study to examine the association between ume intake frequency and allergic symptoms including rhinitis in 563 adults (288 men and 275 women) who resided in Wakayama, Japan. After adjusting for age, present illness and medication, women with high ume intake had significantly lower odds ratio (OR) for the presence of symptoms of allergy [OR: 0.49 with 95% confidence interval (CI): 0.25-0.97]. Therefore, we investigated the anti-allergic effect of ume on passive cutaneous anaphylaxis (PCA) reaction in immunoglobulin E (IgE)-sensitized mice. The animal study demonstrated that oral administration of ume extract attenuated the PCA reaction and mast cell degranulation. Furthermore, RBL-2H3 mast cells were used to identify anti-allergic ume compounds. The following ume compounds inhibited IgE-mediated mast cell degranulation: vanillin, syringic acid, protocatechuic aldehyde, lyoniresinol and p-coumaric acid. These results suggested that ume has the potential to inhibit mast cell degranulation and may be associated with reduced risk of allergic symptoms in women.

Immunological Processes Driving IgE Sensitisation and Disease Development in Males and Females

IgE sensitisation has increased significantly over the last decades and is a crucial factor in the development of allergic diseases. IgE antibodies are produced by B cells through the process of antigen presentation by dendritic cells, subsequent differentiation of CD4⁺ Th2 cells, and class switching in B cells. However, many of the factors regulating these processes remain unclear. These processes affect males and females differently, resulting in a significantly higher prevalence of IgE sensitisation in males compared to females from an early age. Before the onset of puberty, this increased prevalence of IgE sensitisation is also associated with a higher prevalence of clinical symptoms in males; however, after puberty, females experience a surge in the incidence of allergic symptoms. This is particularly apparent in allergic asthma, but also in other allergic diseases such as food and contact allergies. This has been partly attributed to the pro- versus anti-allergic effects of female versus male sex hormones; however, it remains unclear how the expression of sex hormones translates IgE sensitisation into clinical symptoms. In this review, we describe the recent epidemiological findings on IgE sensitisation in male and females and discuss recent mechanistic studies casting further light on how the expression of sex hormones may influence the innate and adaptive immune system at mucosal surfaces and how sex hormones may be involved in translating IgE sensitisation into clinical manifestations.