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Kubota K, Nagakura KI, Ejiri Y, Sato S, Ebisawa M, Yanagida N. Natural history of cow's milk allergy in children aged 6-12 years. Pediatr Allergy Immunol 2023; 34:e14064. [PMID: 38146113 DOI: 10.1111/pai.14064] [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: 07/26/2023] [Revised: 10/29/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Approximately 50%-90% of children with immediate-type cow's milk allergy (CMA) acquire tolerance by pre-school age. We aimed to investigate the acquisition rate of CMA tolerance in children aged 6-12 years. METHODS We included children with CMA who persisted until the age of 6. Tolerance was defined as passing an oral food challenge with 200 mL of unheated cow's milk (CM) or consuming 200 mL of CM without symptoms, whereas persistent CMA was defined as fulfilling neither of these criteria by 12 years old. Children receiving oral immunotherapy (OIT) were excluded from the primary analysis. Risk factors associated with persistent CMA were assessed using Cox regression analysis. RESULTS Of 80 included children, 30 (38%) had previous CM anaphylaxis, and 40 (50%) had eliminated CM completely from their diet. The median CM-specific immunoglobulin E (sIgE) level at 6 years old was 12.0 kUA /L. Tolerance was acquired by 25 (31%) and 46 (58%) children by the age of 9 and 12 years, respectively. At baseline, persistent CMA was associated with higher CM-sIgE levels (hazard ratio 2.29, 95% confidence interval 1.41-3.73, optimal cutoff level 12.7 kUA /L), previous CM anaphylaxis (2.07, 1.06-4.02), and complete CM elimination (3.12, 1.46-6.67). No children with CMA who had all three risk factors (n = 14) acquired tolerance. CONCLUSION Except for OIT patients, more than half of children with CMA at 6 years old acquired tolerance by 12 years old. Children with CMA who have the risk factors are less likely to acquire tolerance.
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Affiliation(s)
- Kei Kubota
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Pediatrics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken-Ichi Nagakura
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Ejiri
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Sakura Sato
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Noriyuki Yanagida
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
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Packi K, Rudek A, Matysiak J, Klimczak S, Matuszewska E, Rzetecka N, Matysiak J. Food Allergies and Parasites in Children. Foods 2023; 12:2465. [PMID: 37444203 DOI: 10.3390/foods12132465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The dynamically growing incidence of food allergies forces the scientific community to develop new methods for their diagnosis, differentiation, and effective treatment. Parasitoses appear much less frequently in the scientific literature, as well as among the presumed causes of numerous conditions. The similarity of inflammatory mechanisms in allergies and parasitosis necessitates a revision of current diagnostic standards. A lack of specificity and the coincidence of symptoms at an early stage of disease can lead to misdiagnosis. In this paper, we attempted to perform a comparative analysis of the similarities and differences in symptoms for these two types of diseases. We described the molecular mechanisms and metabolic pathways of food allergy and parasitosis. We presented the available research methods and directions of ongoing studies aimed at implementing precise medical techniques for differential diagnosis. We discussed the allergenic properties of certain parasite proteins, using the example of myofibrillar tropomyosins from the nematode Anisakis simplex. The literature in the fields of allergology and parasitology leads to the conclusion that it is reasonable to run parallel allergological and parasitological diagnostics in patients with non-specific symptoms. This approach will facilitate accurate and early diagnosis and implementation of effective therapy.
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Affiliation(s)
- Kacper Packi
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 60-806 Poznan, Poland
- AllerGen Center of Personalized Medicine, 97-300 Piotrkow Trybunalski, Poland
| | - Alicja Rudek
- AllerGen Center of Personalized Medicine, 97-300 Piotrkow Trybunalski, Poland
| | - Joanna Matysiak
- Faculty of Health Sciences, Calisia University-Kalisz, 62-800 Kalisz, Poland
| | - Sylwia Klimczak
- AllerGen Center of Personalized Medicine, 97-300 Piotrkow Trybunalski, Poland
- Department of Nucleic Acid Biochemistry, Medical University of Lodz, 92-213 Lodz, Poland
| | - Eliza Matuszewska
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Natalia Rzetecka
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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Hansen MM, Nissen SP, Halken S, Høst A. The natural course of cow's milk allergy and the development of atopic diseases into adulthood. Pediatr Allergy Immunol 2021; 32:727-733. [PMID: 33350002 DOI: 10.1111/pai.13440] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies have investigated the natural course of cow's milk allergy (CMA) and development of atopic diseases into adolescence. Studies with long-term follow-up into adulthood are lacking. The aim of this study was to investigate (a) the natural course of CMA in a 1-year birth cohort of Danish children from birth until 15 and 26 years of age and (b) the development of atopic diseases in a group of children with CMA (group A) compared to a random sample of 276 children from the same birth cohort (group B). METHODS A birth cohort of 1749 newborns was investigated prospectively for the development of CMA and atopic diseases. During the first year of life and at 18 months and 3, 5, 10, 15, and 26 years of age, questionnaire-based interviews, physical examination, skin prick tests, and specific IgE testing, and from 10 years also spirometry, were carried out. RESULTS Thirty-nine (2.2%) were diagnosed with CMA. The recovery rate was 87%, 92%, and 97% at 3, 5, and 26 years of age. Compared to group B, group A had significantly (P < .05) higher prevalence of asthma and rhinoconjunctivitis at 15 years of age, and at 26 years of age, group A had significantly higher prevalence of asthma and atopic dermatitis. The follow-up rate was 85% (A) and 70% (B). CONCLUSION CMA has a good prognosis regarding recovery rate. However, CMA, especially IgE-mediated, in early childhood predicts a high prevalence of atopic diseases into adulthood.
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Affiliation(s)
- Michaela M Hansen
- University of Southern Denmark, Odense, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Arne Høst
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Kaczmarski M, Citko D, Wasilewska J. The prevalence of IgE-dependent sensitizations to selected trophoallergens and airborne allergens in the population of children and adolescents of the north-eastern region of Poland. Postepy Dermatol Alergol 2020; 37:790-795. [PMID: 33240022 PMCID: PMC7675079 DOI: 10.5114/ada.2020.100490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/27/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Good evidence has been provided over the last three to four decades that the prevalence of allergic diseases has been increasing in many developed countries worldwide. Recent data suggest that this increase may now be levelling off. AIM Retrospective analysis of the prevalence of IgE-dependent sensitization and changes in selected environmental allergens in the population of children and adolescents in the north-eastern region of Poland in the years 1998-2012. MATERIAL AND METHODS Skin prick testing (SPT) with selected food allergens (trophoallergens) and airborne allergens was used to evaluate the sensitization process of patients recruited to the study in the years 1998-2012. A positive result of sensitization was defined when the patient had at least one positive skin prick test with the allergen studied. The skin prick tests were done after written consent had been obtained from the parents. RESULTS The retrospective study included children and adolescents aged up to 18 years with a suspicion of an allergic disease, referred to the regional tertiary medical centre for further diagnosis. A total of 6577 patients were studied, including 1556 (23.7%) in 1998, 1473 (22.4%) in 2003, 1690 (25.7%) in 2008, and 1858 (28.2%) in 2012. Sensitization to at least one allergen was observed in 39.0% of the examined children (regardless of the allergen type), of which 8.1% were sensitized to food allergens only, 23.9% to airborne allergens only, and 7.0% simultaneously to food and airborne allergens. During the 14-year study period, an increase was noted in the percentage of the sensitized children from 35.3% at baseline to 40.4% when the study was completed. The percentage of those sensitized to food allergens increased from 10.5% (1998) to 20.1% (2012). The percentage of children sensitized to airborne allergens remained unchanged at the level of 28.2% in 1998 and 27.2% in 2012. CONCLUSIONS Measurement of skin prick test reactivity to different allergens is a useful and commonly used method in epidemiological studies for the assessment of allergic sensitization and changes in selected populations. The obtained results confirmed the need for systematic epidemiological research into allergic sensitization and allergic diseases among children and adolescents in Poland.
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Affiliation(s)
- Maciej Kaczmarski
- Department of Paediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Bialystok, Poland
| | - Dorota Citko
- Department of Statistics and Medical Informatics, Medical University of Bialystok, Bialystok, Poland
| | - Jolanta Wasilewska
- Department of Paediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Bialystok, Poland
- Centre for Paediatrics, Allergology, Psychodietetics and Treatment of Somatic Diseases in Children with Autism, Bialystok, Poland
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Roth-Walter F, Afify SM, Pacios LF, Blokhuis BR, Redegeld F, Regner A, Petje LM, Fiocchi A, Untersmayr E, Dvorak Z, Hufnagl K, Pali-Schöll I, Jensen-Jarolim E. Cow's milk protein β-lactoglobulin confers resilience against allergy by targeting complexed iron into immune cells. J Allergy Clin Immunol 2020; 147:321-334.e4. [PMID: 32485264 DOI: 10.1016/j.jaci.2020.05.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Beta-lactoglobulin (BLG) is a bovine lipocalin in milk with an innate defense function. The circumstances under which BLG is associated with tolerance of or allergy to milk are not understood. OBJECTIVE Our aims were to assess the capacity of ligand-free apoBLG versus loaded BLG (holoBLG) to protect mice against allergy by using an iron-quercetin complex as an exemplary ligand and to study the molecular mechanisms of this protection. METHODS Binding of iron-quercetin to BLG was modeled and confirmed by spectroscopy and docking calculations. Serum IgE binding to apoBLG and holoBLG in children allergic to milk and children tolerant of milk was assessed. Mice were intranasally treated with apoBLG versus holoBLG and analyzed immunologically after systemic challenge. Aryl hydrocarbon receptor (AhR) activation was evaluated with reporter cells and Cyp1A1 expression. Treated human PBMCs and human mast cells were assessed by fluorescence-activated cell sorting and degranulation, respectively. RESULTS Modeling predicted masking of major IgE and T-cell epitopes of BLG by ligand binding. In line with this modeling, IgE binding in children allergic to milk was reduced toward holoBLG, which also impaired degranulation of mast cells. In mice, only treatments with holoBLG prevented allergic sensitization and anaphylaxis, while sustaining regulatory T cells. BLG facilitated quercetin-dependent AhR activation and, downstream of AhR, lung Cyp1A1 expression. HoloBLG shuttled iron into monocytic cells and impaired their antigen presentation. CONCLUSION The cargo of holoBLG is decisive in preventing allergy in vivo. BLG without cargo acted as an allergen in vivo and further primed human mast cells for degranulation in an antigen-independent fashion. Our data provide a mechanistic explanation why the same proteins can act either as tolerogens or as allergens.
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Affiliation(s)
- Franziska Roth-Walter
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria; Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
| | - Sheriene Moussa Afify
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria; Laboratory Medicine and Immunology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Luis F Pacios
- Biotechnology Department, ETSIAAB, Center for Plant Biotechnology and Genomics, CBGP (UPM-INIA), Technical University of Madrid, Madrid, Spain
| | - Bart R Blokhuis
- Faculty of Science, Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Frank Redegeld
- Faculty of Science, Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andreas Regner
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Lisa-Marie Petje
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | | | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Zdenek Dvorak
- Department of Cell Biology and Genetics, Faculty of Science, Palacky University, Olomouc, Czech Republic
| | - Karin Hufnagl
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria; Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Isabella Pali-Schöll
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria; Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Erika Jensen-Jarolim
- The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria; Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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Guest JF, Weidlich D, Kaczmarski M, Jarocka-Cyrta E, Kobelska-Dubiel N, Krauze A, Sakowska-Maliszewska I, Zawadzka-Krajewska A. Relative cost-effectiveness of using an extensively hydrolyzed casein formula containing the probiotic Lactobacillus rhamnosus GG in managing infants with cow's milk allergy in Poland. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:307-16. [PMID: 27418845 PMCID: PMC4934487 DOI: 10.2147/ceor.s105748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To estimate the cost-effectiveness of using an extensively hydrolyzed casein formula (eHCF) containing the probiotic Lactobacillus rhamnosus GG (eHCF + LGG; Nutramigen LGG) as an initial treatment for cow’s milk allergy compared with eHCF alone and amino acid formulas (AAF) in Poland from the perspective of the Polish National Health Fund (Narodowy Fundusz Zdrowia [NFZ]) and parents. Methods Decision modeling was used to estimate the probability of cow’s milk allergic infants developing tolerance to cow’s milk by 18 months. The model also estimated the cost to the NFZ and parents (Polish Zloty [PLN] at 2013–2014 prices) for managing infants over 18 months after starting one of the formulas as well as the relative cost-effectiveness of each of the formulas. Results The probability of developing tolerance to cow’s milk by 18 months was higher among infants who were fed eHCF + LGG (0.82) compared with those fed eHCF alone (0.53) or an AAF (0.22). An infant who is initially managed with eHCF + LGG is expected to consume fewer health care resources than infants managed with the other formulas. Hence, the estimated total health care cost incurred by the NFZ for initially feeding infants with eHCF + LGG (PLN 5,693) was less than that of feeding infants with eHCF alone (PLN 7,749) or an AAF (PLN 24,333). However, the total cost incurred by parents for initially feeding infants with an AAF (PLN 815) was marginally less than that of feeding with eHCF + LGG (PLN 993), which was less than that of feeding with eHCF alone (PLN 1,226). Conclusion Using eHCF + LGG instead of eHCF alone or an AAF for first-line management of newly diagnosed infants with cow’s milk allergy affords a cost-effective use of NFZ-funded resources, since it improves outcome for less cost. Whether eHCF + LGG would be viewed as being cost-effective by parents is dependent on their willingness to pay an additional cost for additional tolerance acquisition to cow’s milk.
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Affiliation(s)
- Julian F Guest
- Catalyst Health Economics Consultants, Northwood, Middlesex; Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Diana Weidlich
- Catalyst Health Economics Consultants, Northwood, Middlesex
| | - Maciej Kaczmarski
- Department of Pediatrics, Gastroenterology, and Allergology, Medical University of Bialystok, Białystok
| | - Elzbieta Jarocka-Cyrta
- Uniwersytet Warmińsko-Mazurski, Wydział Nauk Medycznych, Katedra Pediatrii Klinicznej, Olsztyn
| | - Natalia Kobelska-Dubiel
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, Poznań
| | | | | | - Anna Zawadzka-Krajewska
- Department of Pediatric Pneumonology and Allergology, Medical University of Warsaw, Warsaw, Poland
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Kaczmarski M, Bartuzi Z. Wybrane aspekty epidemiologiczne alergii pokarmowej wieku dziecięco-młodzieżowego i dorosłego. ALERGOLOGIA POLSKA-POLISH JOURNAL OF ALLERGOLOGY 2016. [DOI: 10.1016/j.alergo.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Savage J, Sicherer S, Wood R. The Natural History of Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:196-203; quiz 204. [DOI: 10.1016/j.jaip.2015.11.024] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023]
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Lee J, Choi EJ, Park SY, Jeon GY, Jang JY, Oh YJ, Lim SK, Kwon MS, Kim TW, Lee JH, Park HW, Kim HJ, Kang JS, Jeon JT, Choi HJ. High-pressure processing of milk alleviates atopic dermatitis in DNCB-induced Balb/c mice. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13594-015-0239-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Ganaha Y, Kobayashi M, Asikin Y, Gushiken T, Shinjo S. The Relationship Between the Status of Unnecessary Accommodations Being Made to Unconfirmed Food Allergy Students and the Presence or Absence of a Doctor's Diagnosis. CHILDREN (BASEL, SWITZERLAND) 2015; 2:228-43. [PMID: 27417361 PMCID: PMC4928759 DOI: 10.3390/children2020228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/08/2015] [Accepted: 05/18/2015] [Indexed: 11/23/2022]
Abstract
The present study investigated the current state of unnecessary children food allergy accommodation and the medical efforts to confirm the existence of food allergies in school lunch service kitchens in Okinawa, Japan, including kitchens accommodating food allergy students by requiring medical documentation at the start and during provisions being made (Double Diagnosis), requiring medical documentation at the start only (Single Diagnosis), and with no medical documentation (Non-Diagnosis). Unnecessary accommodations are being made to unconfirmed food allergy students, wherein the more medical consultation was required, the lower the food allergy incident rate was and the more food allergens were diagnosed (Non-Diagnosis > Single Diagnosis > Double Diagnosis). This study suggests the possibility that unconfirmed food allergy students may be receiving unnecessary food allergy accommodations per school lunches, and the number of unnecessary food allergy provisions being made could be reduced by requiring medical documentation at the start and during these provisions.
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Affiliation(s)
- Yurika Ganaha
- Faculty of Education, University of the Ryukyus, 1 Senbaru, Nishihara, Okinawa 903-0213, Japan.
| | - Minoru Kobayashi
- Center for Educational Career Enhancement, Kyoto University of Education, 1 Fukakusa-Fujinomori-cho, Fushimi-ku, Kyoto 612-8522, Japan.
| | - Yonathan Asikin
- Faculty of Life Sciences, Swiss German University, Edu Town BSD City, Kav. II.1, Tangerang 15339, Indonesia.
| | - Taichi Gushiken
- Miyakojima Municipal Minami Elementary School, 1068 Shimozato, Hirara, Miyakojima, Okinawa 906-0013, Japan.
| | - Sumie Shinjo
- Okinawa Dietetic Association, 2-23-1 Takushi, Urasoe, Okinawa 901-2112, Japan.
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Abstract
The prevalence of food allergy is rising for unclear reasons, with prevalence estimates in the developed world approaching 10%. Knowledge regarding the natural course of food allergies is important because it can aid the clinician in diagnosing food allergies and in determining when to consider evaluation for food allergy resolution. Many food allergies with onset in early childhood are outgrown later in childhood, although a minority of food allergy persists into adolescence and even adulthood. More research is needed to improve food allergy diagnosis, treatment, and prevention.
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Affiliation(s)
- Jessica Savage
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, 1 Jimmy Fund Way, Smith Building, Room 516c, Boston, MA 02115, USA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, 1 Jimmy Fund Way, Smith Building, Room 626, Boston, MA 02215, USA.
| | - Christina B Johns
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, 1 Jimmy Fund Way, Smith Building, Room 516c, Boston, MA 02115, USA
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The natural history of IgE-mediated food allergy: can skin prick tests and serum-specific IgE predict the resolution of food allergy? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5039-61. [PMID: 24132133 PMCID: PMC3823325 DOI: 10.3390/ijerph10105039] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/16/2013] [Accepted: 10/08/2013] [Indexed: 12/22/2022]
Abstract
IgE-mediated food allergy is a transient condition for some children, however there are few indices to predict when and in whom food allergy will resolve. Skin prick test (SPT) and serum-specific IgE levels (sIgE) are usually monitored in the management of food allergy and are used to predict the development of tolerance or persistence of food allergy. The aim of this article is to review the published literature that investigated the predictive value of SPT and sIgE in development of tolerance in children with a previous diagnosis of peanut, egg and milk allergy. A systematic search identified twenty-six studies, of which most reported SPT or sIgE thresholds which predicted persistent or resolved allergy. However, results were inconsistent between studies. Previous research was hampered by several limitations including the absence of gold standard test to diagnose food allergy or tolerance, biased samples in retrospective audits and lack of systematic protocols for triggering re-challenges. There is a need for population-based, prospective studies that use the gold standard oral food challenge (OFC) to diagnose food allergy at baseline and follow-up to develop SPT and sIgE thresholds that predict the course of food allergy.
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