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Peddi NC, Muppalla SK, Sreenivasulu H, Vuppalapati S, Komuravelli M, Navab R. Navigating Food Allergies: Advances in Diagnosis and Treatment Strategies. Cureus 2024; 16:e56823. [PMID: 38654770 PMCID: PMC11037442 DOI: 10.7759/cureus.56823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Food allergy is a major health concern worldwide, encompassing both immunologic and non-immunologic reactions. This review thoroughly examines the pathophysiology, clinical manifestations, and treatment options for various types of food allergies. Immunologic food allergies, including IgE-mediated reactions such as oral allergy syndrome and systemic anaphylaxis, pose various diagnostic and management challenges. Non-IgE-mediated reactions such as food protein-induced enterocolitis syndrome, dermatitis herpetiformis, and proctocolitis necessitate individualized patient care. In addition, mixed reactions such as eosinophilic esophagitis and atopic dermatitis complicate the clinical picture. Skin prick tests, serum-specific IgE tests, and oral food challenges are all necessary for accurate food allergy diagnosis. The primary therapeutic options are allergen avoidance, epinephrine-based emergency management, and emerging treatments like immunotherapy. Our review emphasizes the importance of multidisciplinary collaboration and ongoing research in improving our understanding and managing food allergies, promising a brighter future for those affected.
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Affiliation(s)
| | | | | | - Sravya Vuppalapati
- General Physician, PES Institute of Medical Sciences and Research, Kuppam, IND
| | - Myna Komuravelli
- Pediatrics, Chalmeda Anand Rao Institute of Medical Sciences, Hanamkonda, IND
| | - Rahul Navab
- Internal Medicine, PES Institute of Medical Sciences and Research, Kuppam, IND
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El-Hodhod MA, El-Shabrawi MHF, AlBadi A, Hussein A, Almehaidib A, Nasrallah B, AlBassam EM, El Feghali H, Isa HM, Al Saraf K, Sokhn M, Adeli M, Al-Sawi NMM, Hage P, Al-Hammadi S. Consensus statement on the epidemiology, diagnosis, prevention, and management of cow's milk protein allergy in the Middle East: a modified Delphi-based study. World J Pediatr 2021; 17:576-589. [PMID: 34817828 PMCID: PMC8639571 DOI: 10.1007/s12519-021-00476-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study aimed to develop an expert consensus regarding the epidemiology, diagnosis, and management of cow's milk protein allergy (CMPA) in the Middle East. METHODS A three-step modified Delphi method was utilized to develop the consensus. Fifteen specialized pediatricians participated in the development of this consensus. Each statement was considered a consensus if it achieved an agreement level of ≥ 80%. RESULTS The experts agreed that the double-blind placebo-controlled oral challenge test (OCT) should be performed for 2-4 weeks using an amino acid formula (AAF) in formula-fed infants or children with suspected CMPA. Formula-fed infants with confirmed CMPA should be offered a therapeutic formula. The panel stated that an extensively hydrolyzed formula (eHF) is indicated in the absence of red flag signs. At the same time, the AAF is offered for infants with red flag signs, such as severe anaphylactic reactions. The panel agreed that infants on an eHF with resolved symptoms within 2-4 weeks should continue the eHF with particular attention to the growth and nutritional status. On the other hand, an AAF should be considered for infants with persistent symptoms; the AAF should be continued if the symptoms resolve within 2-4 weeks, with particular attention to the growth and nutritional status. In cases with no symptomatic improvements after the introduction of an AAF, other measures should be followed. The panel developed a management algorithm, which achieved an agreement level of 90.9%. CONCLUSION This consensus document combined the best available evidence and clinical experience to optimize the management of CMPA in the Middle East.
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Affiliation(s)
- Moustafa A. El-Hodhod
- grid.7269.a0000 0004 0621 1570Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt ,grid.412319.c0000 0004 1765 2101Faculty of Medicine, October 6 University, Giza, Egypt
| | - Mortada H. F. El-Shabrawi
- grid.7776.10000 0004 0639 9286Faculty of Medicine, Cairo University, Cairo, Egypt ,International Pediatric Association (IPA), Marengo, USA ,International Society of Tropical Pediatrics (ISTP), Manila, Philippines
| | | | | | - Ali Almehaidib
- grid.415310.20000 0001 2191 4301Pediatric Gastroenterology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center Riyadh, Riyadh, Saudi Arabia
| | | | - Ebtsam Mohammed AlBassam
- Nutrition Service Department, King Faisal Specialist and Research Center Riyadh, Riyadh, Saudi Arabia
| | | | - Hasan M. Isa
- grid.416646.70000 0004 0621 3322Pediatric Department, Salmaniya Medical Complex, Manama, Bahrain ,grid.411424.60000 0001 0440 9653Pediatric department, Arabian Gulf University, Manama, Bahrain
| | - Khaled Al Saraf
- Pediatrics Department, Dar Al Shifa Hospital, Kuwait, Kuwait
| | - Maroun Sokhn
- grid.33070.370000 0001 2288 0342Pediatric Gastroenterology, Hepatology, and Nutrition Department, Saint George University Medical Center, University of Balamand, Beirut, Lebanon
| | - Mehdi Adeli
- grid.467063.00000 0004 0397 4222Sidra Medicine, Doha, Qatar
| | | | - Pierre Hage
- grid.33070.370000 0001 2288 0342Pediatric Pulmonology and Allergology, University of Balamand, Beirut, Lebanon
| | - Suleiman Al-Hammadi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, 505055, Dubai, United Arab Emirates.
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Logan K, Du Toit G, Giovannini M, Turcanu V, Lack G. Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance. Annu Rev Cell Dev Biol 2020; 36:511-528. [PMID: 32634325 DOI: 10.1146/annurev-cellbio-100818-125346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.
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Affiliation(s)
- Kirsty Logan
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - George Du Toit
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - Mattia Giovannini
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom; .,Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Victor Turcanu
- School of Immunology and Microbial Sciences and School of Life Course Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
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Acupuncture for Infantile Colic: A Systematic Review of Randomised Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:7526234. [PMID: 30473718 PMCID: PMC6220386 DOI: 10.1155/2018/7526234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/01/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Infantile colic is a common condition causing considerable deterioration in the quality of life of both infants and their parents. Minimal acupuncture, a gentle needling technique without strong muscle stimulation, has primarily been used to treat this condition, but the clinical evidence of its efficacy and safety is yet to be established. The objective of this review was to assess clinical evidence of the safety and efficacy of acupuncture for infantile colic. METHODS To identify studies for inclusion, PubMed, Cochrane Library, Google Scholar, China Knowledge Resource Integrated Database, Wanfang, and Oriental Medicine Advanced Searching Integrated System were searched until January 2017. Only randomised controlled trials of infantile colic in patients aged 0 to 25 weeks, who were treated with acupuncture, were included. To assess the quality, the risk of bias was determined for each study by two authors. The intention was to perform a meta-analysis, but this was not possible in this study due to considerable clinical heterogeneity among the included studies. RESULTS Of the 601 studies identified, only four randomized controlled trials were included in this review. All included studies were conducted in northern European countries. Most studies showed a low risk of bias in most domains. Minimal acupuncture on LI4 or ST36 without strong stimulation was used in all studies. From the narrative analysis, acupuncture appears to be effective in alleviating the symptoms of colic, including crying and feeding and stooling problems, and may have only minor adverse effects. However, clinical evidence could not be confirmed owing to considerable clinical heterogeneity and the small sample sizes of the included studies. CONCLUSION There is currently no conclusive evidence on the safety and efficacy of acupuncture for infantile colic. Rigorous full-scale randomized controlled trials will be necessary in future.
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Abstract
PURPOSE OF REVIEW The paradigm for the primary prevention of peanut allergy was, until recently, strict avoidance of peanut during pregnancy, infancy, and early childhood. However, in countries that had these dietary guidelines, the prevalence of peanut allergy greatly increased in contrast to low prevalence rates of peanut allergy in countries where infant diets included peanut at an early age, suggesting the hypothesis that early introduction of peanut is superior to delayed introduction of peanut as a strategy for the primary prevention of food allergy. This review examines recent high-quality studies that support this hypothesis. RECENT FINDINGS Publication of the Learning Early about Allergy to Peanut interventional trial showed that 17% of children avoiding peanut until 5 years of age developed peanut allergy compared with 3% of children who started eating peanut at ages of 4-11 months. Two birth cohort studies demonstrated that high maternal consumption of peanut during the pregnancy period reduced the risk of peanut allergy in offspring by 50-75%. SUMMARY Recent studies indicate that early introduction of peanut enhances the development of tolerance to peanut, reducing the risk of childhood peanut allergy.
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Wollmann E, Hamsten C, Sibanda E, Ochome M, Focke-Tejkl M, Asarnoj A, Önell A, Lilja G, Gallerano D, Lupinek C, Thalhamer T, Weiss R, Thalhamer J, Wickman M, Valenta R, van Hage M. Natural clinical tolerance to peanut in African patients is caused by poor allergenic activity of peanut IgE. Allergy 2015; 70:638-52. [PMID: 25683061 DOI: 10.1111/all.12592] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Africa, peanuts are frequently consumed, but severe allergic reactions are rare. We investigated immunological patterns of clinical tolerance to peanut in peanut-sensitized but asymptomatic patients from central Africa compared to peanut-allergic and peanut-sensitized but asymptomatic patients from Sweden. METHODS Sera from allergic patients (n = 54) from Zimbabwe sensitized to peanut but without allergic symptoms to peanut, and sera from peanut-allergic (n = 25) and peanut-sensitized but asymptomatic (n = 25) patients from Sweden were analyzed toward peanut allergen components (Ara h 1-3, 6, 8-9) and other allergen molecules from important allergen sources using microarray. IgE to Ara h 2 peptide epitopes was analyzed, and allergenic activity was assessed by basophil activation assay. RESULTS Forty-six percent of the African and all peanut-allergic Swedish patients showed IgE toward one of the highly allergenic peanut allergens (Ara h 1-3, 6, 9). However, 48% of the African patients had IgE to cross-reactive carbohydrate determinants (CCDs) with low allergenic activity and 60% of the Swedish asymptomatic patients had IgE against the PR protein Ara h 8. IgG and IgG4 specificities and levels could not discriminate between the African asymptomatic and Swedish peanut-allergic patients. Asymptomatic patients almost lacked IgE to Ara h 2 peptides, which were recognized by peanut-allergic patients. Peanut IgE from peanut asymptomatic patients showed poor allergenic activity compared with IgE from peanut-allergic patients. CONCLUSIONS Natural clinical tolerance to peanut in the African patients can be caused by IgE to low allergenic peanut components and by poor allergenic activity of peanut-specific IgE.
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Affiliation(s)
- E. Wollmann
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - C. Hamsten
- Department of Medicine Solna; Clinical Immunology and Allergy Unit; Karolinska Institutet and University Hospital; Stockholm Sweden
- Center for Inflammatory Diseases; Karolinska Institutet; Stockholm Sweden
| | - E. Sibanda
- University of Zimbabwe Medical School; Harare Zimbabwe
| | - M. Ochome
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - M. Focke-Tejkl
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - A. Asarnoj
- Department of Medicine Solna; Clinical Immunology and Allergy Unit; Karolinska Institutet and University Hospital; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Stockholm Sweden
| | - A. Önell
- Thermo Fisher Scientific ImmunoDiagnostics; Uppsala Sweden
| | - G. Lilja
- Department of Pediatrics; Sachs' Children's Hospital; Stockholm Sweden
| | - D. Gallerano
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - C. Lupinek
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - T. Thalhamer
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - R. Weiss
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - J. Thalhamer
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - M. Wickman
- Department of Pediatrics; Sachs' Children's Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - M. van Hage
- Department of Medicine Solna; Clinical Immunology and Allergy Unit; Karolinska Institutet and University Hospital; Stockholm Sweden
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Abstract
Food allergy is defined as an adverse immune response towards food proteins or as a form of a food intolerance associated with a hypersensitive immune response. It should also be reproducible by a double-blind placebo-controlled food challenge. Many reported that food reactions are not allergic but are intolerances. Food allergy often presents to clinicians as a symptom complex. This review focuses on the clinical spectrum and manifestations of various forms of food allergies. According to clinical presentations and allergy testing, there are three types of food allergy: IgE mediated, mixed (IgE/Non-IgE), and non-IgE mediated (cellular, delayed type hypersensitivity). Recent advances in food allergy in early childhood have highlighted increasing recognition of a spectrum of delayed-onset non-IgE-mediated manifestation of food allergy. Common presentations of food allergy in infancy including atopic eczema, infantile colic, and gastroesophageal reflux. These clinical observations are frequently associated with food hypersensitivity and respond to dietary elimination. Non-IgE-mediated food allergy includes a wide range of diseases, from atopic dermatitis to food protein-induced enterocolitis and from eosinophilic esophagitis to celiac disease. The most common food allergies in children include milk, egg, soy, wheat, peanut, treenut, fish, and shellfish. Milk and egg allergies are usually outgrown, but peanut and treenut allergy tends to persist. The prevalence of food allergy in infancy is increasing and may affect up to 15-20 % of infants. The alarming rate of increase calls for a public health approach in the prevention and treatment of food allergy in children.
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Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM. Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database Syst Rev 2014; 2014:CD008550. [PMID: 25419906 PMCID: PMC8947620 DOI: 10.1002/14651858.cd008550.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux (GOR) is a common disorder, characterised by regurgitation of gastric contents into the oesophagus. GOR is a very common presentation in infancy in both primary and secondary care settings. GOR can affect approximately 50% of infants younger than three months old (Nelson 1997). The natural history of GOR in infancy is generally that of a functional, self-limiting condition that improves with age; < 5% of children with vomiting or regurgitation continue to have symptoms after infancy (Martin 2002). Older children and children with co-existing medical conditions can have a more protracted course. The definition of gastro-oesophageal reflux disease (GORD) and its precise distinction from GOR are debated, but consensus guidelines from the North American Society of Gastroenterology, Hepatology and Nutrition (NASPGHAN-ESPGHAN guidelines 2009) define GORD as 'troublesome symptoms or complications of GOR.' OBJECTIVES This Cochrane review aims to provide a robust analysis of currently available pharmacological interventions used to treat children with GOR by assessing all outcomes indicating benefit or harm. SEARCH METHODS We sought to identify relevant published trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 5), MEDLINE and EMBASE (1966 to 2014), the Centralised Information Service for Complementary Medicine (CISCOM), the Institute for Scientific Information (ISI) Science Citation Index (on BIDS-UK General Science Index) and the ISI Web of Science. We also searched for ongoing trials in the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com).Reference lists from trials selected by electronic searching were handsearched for relevant paediatric studies on medical treatment of children with gastro-oesophageal reflux, as were published abstracts from conference proceedings (published in Gut and Gastroenterology) and reviews published over the past five years.No language restrictions were applied. SELECTION CRITERIA Abstracts were reviewed by two review authors, and relevant RCTs on study participants (birth to 16 years) with GOR receiving a pharmacological treatment were selected. Subgroup analysis was considered for children up to 12 months of age, and for children 12 months to 16 years of age, and for those with neurological impairment. DATA COLLECTION AND ANALYSIS Trials were critically appraised and data collected by two review authors. Risk of bias was assessed. Meta-analysis data were independently extracted by two review authors, and suitable outcome data were analysed using RevMan. MAIN RESULTS A total of 24 studies (1201 participants) contributed data to the review. The review authors had several concerns regarding the studies. Pharmaceutical company support for manuscript preparation was a common feature; also, because common endpoints were lacking, study populations were heterogenous and variations in study design were noted, individual drug meta-analysis was not possible.Moderate-quality evidence from individual studies suggests that proton pump inhibitors (PPIs) can reduce GOR symptoms in children with confirmed erosive oesophagitis. It was not possible to demonstrate statistical superiority of one PPI agent over another.Some evidence indicates that H₂antagonists are effective in treating children with GORD. Methodological differences precluded performance of meta-analysis on individual agents or on these agents as a class, in comparison with placebo or head-to-head versus PPIs, and additional studies are required.RCT evidence is insufficient to permit assessment of the efficacy of prokinetics. Given the diversity of study designs and the heterogeneity of outcomes, it was not possible to perform a meta-analysis of the efficacy of domperidone.In younger children, the largest RCT of 80 children (one to 18 months of age) with GOR showed no evidence of improvement in symptoms and 24-hour pH probe, but improvement in symptoms and reflux index was noted in a subgroup treated with domperidone and co-magaldrox(Maalox(®) ). In another RCT of 17 children, after eight weeks of therapy. 33% of participants treated with domperidone noted an improvement in symptoms (P value was not significant). In neonates, the evidence is even weaker; one RCT of 26 neonates treated with domperidone over 24 hours showed that although reflux frequency was significantly increased, reflux duration was significantly improved.Diversity of RCT evidence was found regarding efficacy of compound alginate preparations(Gaviscon Infant(®) ) in infants, although as a result of these studies, Gaviscon Infant(®) was changed to become aluminium-free and has been assessed in its current form in only two studies since 1999. Given the diversity of study designs and the heterogeneity of outcomes, as well as the evolution in formulation, it was not possible to perform a meta-analysis on the efficacy of Gaviscon Infant(®) . Moderate evidence indicates that Gaviscon Infant(®) improves symptoms in infants, including those with functional reflux; the largest study of the current formulation showed improvement in symptom control but was limited by length of follow-up.No serious side effects were reported.No RCTs on pharmacological treatments for children with neurodisability were identified. AUTHORS' CONCLUSIONS Moderate evidence was found to support the use of PPIs, along with some evidence to support the use of H₂ antagonists in older children with GORD, based on improvement in symptom scores, pH indices and endoscopic/histological appearances. However, lack of independent placebo-controlled and head-to-head trials makes conclusions as to relative efficacy difficult to determine. Further RCTs are recommended. No robust RCT evidence is available to support the use of domperidone, and further studies on prokinetics are recommended, including assessments of erythromycin.Pharmacological treatment of infants with reflux symptoms is problematic, as many infants have GOR, and little correlation has been noted between reported symptoms and endoscopic and pH findings. Better evidence has been found to support the use of PPIs in infants with GORD, but heterogeneity in outcomes and in study design impairs interpretation of placebo-controlled data regarding efficacy. Some evidence is available to support the use of Gaviscon Infant(®) , but further studies with longer follow-up times are recommended. Studies of omeprazole and lansoprazole in infants with functional GOR have demonstrated variable benefit, probably because of differences in inclusion criteria.No robust RCT evidence has been found regarding treatment of preterm babies with GOR/GORD or children with neurodisabilities. Initiation of RCTs with common endpoints is recommended, given the frequency of treatment and the use of multiple antireflux agents in these children.
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Affiliation(s)
- Mark Tighe
- Poole Hospital NHS Foundation TrustDepartment of PaediatricsLongfleet RoadPooleDorsetUKBH15 2JB
| | - Nadeem A Afzal
- University Hospital Southampton NHS Foundation TrustChild HealthTremona RoadSouthamptonHampshireUKSO16 6YD
| | - Amanda Bevan
- University Hospital Southampton NHS Foundation TrustDepartment of PharmacyTremona RoadSouthamptonHampshireUK
| | - Andrew Hayen
- University of TechnologyFaculty of HealthUltimoNSWAustralia2007
| | - Alasdair Munro
- Poole Hospital NHS Foundation TrustDepartment of PaediatricsLongfleet RoadPooleDorsetUKBH15 2JB
| | - R Mark Beattie
- University Hospital Southampton NHS Foundation TrustChild HealthTremona RoadSouthamptonHampshireUKSO16 6YD
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Dairy food at the first occasion of eating is important for total dairy food intake for Australian children. Nutrients 2014; 6:3878-94. [PMID: 25251295 PMCID: PMC4179193 DOI: 10.3390/nu6093878] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/04/2014] [Accepted: 09/05/2014] [Indexed: 12/04/2022] Open
Abstract
The cross-sectional 2007 Australian National Children’s Nutrition and Physical Activity Survey collected detailed dietary information from a representative sample of more than 4400 children by 24-h dietary recall. Dairy food intake by Australian children is substantially lower than recommendations, and decreases as a percentage of energy intake as children grow older. Children aged 2 to 16 years are, on average, 2.3 times more likely to have a dairy food at the first daily occasion of eating, than at the second occasion. For children who consumed any dairy food at the first occasion of eating, the total daily intake of dairy foods was 129% (95% CI 120%–138%) greater than for children who did not consume a dairy food at the first occasion of eating. Their dairy food intake for the rest of the day following the first occasion of eating was also greater by 29% (95% CI 21%–37%). Younger age group, male sex, location of eating being at home or in a residence and starting the first occasion of eating from 6 a.m. to 9 a.m. are all jointly associated with having a dairy food at the first occasion of eating. A simple strategy to increase Australian children’s intake from the dairy and alternatives food group may be to make sure that the first occasion of eating each day includes a dairy food or a nutritional equivalent.
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Affiliation(s)
- Gideon Lack
- King's College London, King's Health Partners, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, UK; Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Subrahmanya NK, Patel KS, Kori VK, Shrikrishna R. Role of Kasahara Dashemani Vati in Kasa and Vyadhikshamatva in children with special reference to recurrent respiratory tract infections. Ayu 2014; 34:281-7. [PMID: 24501524 PMCID: PMC3902595 DOI: 10.4103/0974-8520.123124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The present single-centered randomized control trial (RCT) was carried out with the prime aim of assessing the effect of Kasahara Dashemani Vati (trial drug) on Kasa and Vyadhikshamatva in the children suffering from recurrent respiratory tract infections and comparing it with the efficacy of Indukanta Vati. The clinical trial included 40 patients belonging to age group of 3-12 years. The drugs were administered in a daily dose fixed as per “Clark's Rule” along with honey for duration of 60 days. The effect of treatment on the signs and symptoms of Kasa was assessed on the 15th day, whereas the effect on Vyadhikshamatva was assessed on the 60th day. The patients were under follow-up for a period of 60 days after completing the treatment course for evaluation of any recurrence. Effect of the therapy on the individual signs and symptoms of Kasa, laboratory parameters, immunoglobulin (Ig) biomarkers, status of Atura Bala, and prevention of recurrence during follow-up period were the parameters used to assess the overall effect of therapy. The observed data were subjected to appropriate statistical analysis for testing the statistical significance. Kasahara Dashemani provided relief in all symptoms of Kasa irrespective of Doshic involvement and on the parameters of Atura Bala. All the changes were statistically highly significant. The control group also showed similar effects which were statistically highly significant. The trial group was found to have a direct influence on serum Ig status. No patient has reported any adverse drug reactions during the treatment and follow-up periods.
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Affiliation(s)
- Nayan Kumar Subrahmanya
- Assistant Professor, Department of Kaumarabhritya, SDM College of Ayurveda and Hospital, Hassan, Karnataka, India
| | - Kalpana Shanthibhai Patel
- Associate professor and Head, Department of Kaumarabhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved university, Jamnagar, Gujarat, India
| | - Virendra Kumar Kori
- Assistant Professor, Department of Kaumarabhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved university, Jamnagar, Gujarat, India
| | - Rajagopala Shrikrishna
- Assistant Professor, Department of Kaumarabhritya, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved university, Jamnagar, Gujarat, India
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Hon KLE, Poon TCW, Pong NHH, Wong YHK, Leung SS, Chow CM, Leung TF. Specific IgG and IgA of common foods in Chinese children with eczema: friend or foe. J DERMATOL TREAT 2013; 25:462-6. [PMID: 24237254 DOI: 10.3109/09546634.2013.848262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Specific immunoglobulins G and A (IgG and IgA) for common food items have been extensively measured as surrogate markers of food allergy, and dietary avoidance based on the test results advocated. AIM We reviewed the prevalence of specific food IgG and IgA in children with eczema and evaluated outcome of dietary avoidance in these children. METHODS Specific immunoglobulins of 96 food items were measured for 30 consecutive atopic dermatitis (AD) patients and disease severity [SCORing atopic dermatitis (SCORAD) and Nottingham eczema severity score (NESS)], Children Dermatology Life Quality Index (CDLQI), skin hydration (SH), transepidermal water loss (TEWL), topical corticosteroid and oral antihistamine usage were evaluated. Twenty seven of these patients received dietary avoidance advice based on IgG and IgA data. General acceptability of treatment (GAT) was documented at the end of 3 months. RESULTS There were generally no correlations among levels of IgG or IgA of the 96 food items and disease severity, quality of life, SH or TEWL. Two-third patients reported very good or good and one-third reported fair or poor GAT following dietary avoidance advice. There was no difference in any clinical parameters between the two groups following dietary avoidance. Patient with lower sunflower seed IgA (p = 0.043), casein IgG (p = 0.041), milk IgG (p = 0.037) or whey IgG (p = 0.014) had improved SCORAD and objective SCORAD following dietary advice. CONCLUSION Children with AD are sensitized to many food allergens via IgG and IgA mechanisms. Levels of food IgG or IgA do not seem to correlate with any clinical parameters in AD. Subjectively, two third of patients accepted dietary manipulations as very good or good for their AD. Objectively, dietary avoidance had few clinical effects on the clinical parameters. Sensitization should not be generalized to mean allergy to common food.
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Affiliation(s)
- Kam Lun E Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
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13
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Martorell A, Alonso E, Boné J, Echeverría L, López M, Martín F, Nevot S, Plaza A. Position document: IgE-mediated allergy to egg protein. Allergol Immunopathol (Madr) 2013; 41:320-36. [PMID: 23830306 DOI: 10.1016/j.aller.2013.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 03/25/2013] [Indexed: 11/25/2022]
Abstract
Egg is the food that most often causes allergy in young Spanish children, with an incidence of 2.4-2.6% in the first 2 years of life. The prevalence of sensitisation and allergy to egg is greater in children with allergy to cow's milk and in those suffering atopic dermatitis. The protein component from egg white is the cause of the allergic response in child. The major allergens in egg white are ovomucoid and ovalbumin. Most of the allergic reactions affect the skin, followed by gastrointestinal and respiratory systems. Egg allergy is one of the most common causes of severe anaphylaxis. The diagnosis of egg allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which represents the gold standard for confirming the diagnosis. The treatment of egg allergy is based on the avoidance of egg protein intake. A subgroup of egg-allergic patients are tolerant to cooked egg. In these cases, only uncooked egg must necessarily be avoided. Maintaining a diet with strict egg avoidance is difficult, and transgressions are relatively common. The patient, family, and school environment should receive education and training in the avoidance of egg and in the management of possible allergic reactions. With an avoidance diet, up to 15-20% of children will remain allergic and the severity of the reactions will increase over the years. In these more severe cases of egg-allergy, it becomes more difficult to adhere to the avoidance diet over the years, with a significant decrease in patient quality of life. Oral tolerance induction can be regarded as a therapeutic option for IgE-mediated egg allergy. The anti-IgE, omalizumab, might become another genuine therapeutic option for food allergy, not only to prevent allergic reactions after a contact with egg, but also as a complementary treatment to oral tolerance induction for egg allergy, with the purpose of reducing adverse reactions. The administration of influenza vaccine to children with egg allergy is safe in children that do not manifest severe reactions after egg intake, and in children who tolerate cooked egg. The triple viral vaccine (MMR) can be given to egg-allergic children in their usual vaccination centre, with no added risk. Different medicinal products can be formulated with egg proteins, and therefore should be avoided in children with egg allergy.
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Parisi CAS, Smaldini PL, Gervasoni ME, Maspero JF, Docena GH. Hypersensitivity reactions to the Sabin vaccine in children with cow's milk allergy. Clin Exp Allergy 2013; 43:249-54. [DOI: 10.1111/cea.12059] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 08/14/2012] [Accepted: 09/18/2012] [Indexed: 01/09/2023]
Affiliation(s)
- C. A. S. Parisi
- Sección de Alergia Pediátrica; Servicio de Clínica Pediátrica; Sección Alergia Adultos; Servicio de Clínica Médica; Hospital Italiano de Buenos Aires; Buenos Aires; Argentina
| | - P. L. Smaldini
- Laboratorio de Investigaciones del Sistema Inmune; Facultad de Ciencias Exactas; Universidad Nacional de La Plata; La Plata; Argentina
| | - M. E. Gervasoni
- Hospital de Niños Víctor J Vilela; Servicio de Alergia e Inmunología; Rosario; Argentina
| | | | - G. H. Docena
- Laboratorio de Investigaciones del Sistema Inmune; Facultad de Ciencias Exactas; Universidad Nacional de La Plata; La Plata; Argentina
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15
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Lee AH, Kim KE, Lee KE, Kim SH, Wang TW, Kim KW, Kwak TK. Prevalence of food allergy and perceptions on food allergen labeling in school foodservice among Korean students. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.3.227] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Ah-Hyun Lee
- Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Eun Lee
- Department of Food and Nutrition, College of Natural Sciences, Seoul Women's University, Seoul, Korea
| | | | - Tae-Whan Wang
- Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics and Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Tong-Kyung Kwak
- Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, Korea
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16
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Srivastava KD, Bardina L, Sampson HA, Li XM. Efficacy and immunological actions of FAHF-2 in a murine model of multiple food allergies. Ann Allergy Asthma Immunol 2012; 108:351-358.e1. [PMID: 22541407 DOI: 10.1016/j.anai.2012.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Food Allergy Herbal Formula-2 (FAHF-2) prevents anaphylaxis in a murine model of peanut allergy. Multiple food allergies (MFA) are common and associated with a higher risk of anaphylaxis. No well-characterized murine model of sensitization to multiple food allergens exists, and no satisfactory therapy for MFA is currently available. OBJECTIVE To determine the effect of FAHF-2 in a murine model of MFA. METHODS C3H/HeJ mice were orally sensitized to peanut, codfish, and egg concurrently. Oral FAHF-2 treatment commenced 1 day after completing sensitization and continued daily for 7 weeks. Mice were subsequently orally challenged with each allergen. RESULTS Antibodies in sera from mice simultaneously sensitized with peanut, codfish, and egg recognized major allergens of all 3 foods, demonstrating sensitization to multiple unrelated food allergens (MFA mice). Sham-treated MFA mice exhibited anaphylactic symptoms accompanied by elevation of plasma histamine and hypothermia. In contrast, FAHF-2-treated MFA mice showed no anaphylactic symptoms, normal body temperature, and histamine levels after challenge with each allergen. Protection was accompanied by reduction in allergen-specific immunoglobulin E levels. Allergen-stimulated Th2 cytokine interleukin-4 and interleukin-13 production levels decreased, whereas the Th1 cytokine interferon-γ levels were elevated in cultured splenocytes and mesenteric lymph node cells in FAHF-2-treated mice. CONCLUSION We established the first murine model of MFA. FAHF-2 prevents peanut, egg, and fish-induced anaphylactic reactions in this model, suggesting that FAHF-2 may have potential for treating human MFA.
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Affiliation(s)
- Kamal D Srivastava
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine,One Gustave L. Levy Place, New York, NY 10029-6574, USA
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17
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Lack G. Update on risk factors for food allergy. J Allergy Clin Immunol 2012; 129:1187-97. [DOI: 10.1016/j.jaci.2012.02.036] [Citation(s) in RCA: 304] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/20/2012] [Accepted: 02/23/2012] [Indexed: 12/11/2022]
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18
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Jain P, Kant S, Mishra R. Perception of dietary food items as food allergens in asthmatic individuals in north Indian population. J Am Coll Nutr 2012; 30:274-83. [PMID: 21917708 DOI: 10.1080/07315724.2011.10719970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The role of food allergy in asthma is well recognized but is poorly quantified. The aim of the present study was to document perceived food items as allergens and to determine their association with age, sex, socioeconomic status (SES), family history of asthma, smoking history, duration of illness, and total serum immunoglobulin (Ig)E. METHODS A total of 261 clinically and spirometrically diagnosed patients with asthma were included in this study on an accrual basis. Of these, 237 patients thought that their asthma became aggravated after consumption of at least 1 food item. The perceived food item allergy and its association with age, sex, SES, family history of asthma, smoking history, duration of illness, and total serum IgE were assessed using a detailed, open-ended questionnaire. RESULTS Food items were perceived as main allergens by 90% (237/261) of responders. Sixty-five percent (154/237) of patients who perceived at least 1 food item as an allergen had high total serum IgE levels. Of 22 suspected food items, 16 were significantly (p < 0.05) associated with at least 1 of the 6 study parameters. CONCLUSION Food items play a major role as food allergens on the basis of perception in asthmatic individuals. Some suspected food items are significantly associated with the demographic profile of asthmatic individuals.
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Affiliation(s)
- Priyanka Jain
- Department of Pulmonary Medicine, Chhatrapati Shahuji Medical University, Lucknow, Uttar Pradesh, INDIA
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19
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Kim J, Lee J, Seo WH, Han Y, Ahn K, Lee SI. Changes in Major Peanut Allergens Under Different pH Conditions. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 4:157-60. [PMID: 22548209 PMCID: PMC3328733 DOI: 10.4168/aair.2012.4.3.157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/01/2011] [Indexed: 11/20/2022]
Abstract
Regional dietary habits and cooking methods affect the prevalence of specific food allergies; therefore, we determined the effects of various pH conditions on major peanut allergens. Peanut kernels were soaked overnight in commercial vinegar (pH 2.3) or acetic acid solutions at pH 1.0, 3.0, or 5.0. Protein extracts from the sera of seven patients with peanut-specific IgE levels >15 kUA/L were analyzed by SDS-PAGE and immunolabeling. A densitometer was used to quantify and compare the allergenicity of each protein. The density of Ara h 1 was reduced by treatment with pH 1.0, 3.0, or 5.0 acetic acid, or commercial vinegar. Ara h 2 remained largely unchanged after treatment with pH 5.0 acetic acid, and was decreased following treatment with pH 1.0, 2.3, or 3.0 acetic acid. Ara h 3 and Ara h 6 appeared as a thick band after treatment with pH 1.0 acetic acid and commercial vinegar. IgE-binding intensities to Ara h 1, Ara h 2, and Ara h 3 were significantly reduced after treatment with pH 1.0 acetic acid or commercial vinegar. These data suggest that treatment with acetic acid at various pH values affects peanut allergenicity and may explain the low prevalence of peanut allergy in Korea.
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Affiliation(s)
- Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Abstract
PURPOSE OF REVIEW Cow's milk is a leading cause of food allergy especially in infants and children. 'Diagnosis and Rationale for Action against Cow's Milk Allergy' published by the World Allergy Organization has underlined that there is not enough information concerning geographical trends in cow's milk allergy (CMA) in children or adults. Experts from Australia, Asia, North America, Latin America, the Middle East and Europe have gathered together in a 2-day meeting in order to present various regional approaches to CMA. This report is a summary of the information that was presented at this meeting. RECENT FINDINGS Even though there seems to be uniformity concerning the diagnosis and treatment of CMA, the diagnostic approach to CMA shows variations among different regions. Common concerns were inadequate applications of challenge tests for the diagnosis and inadequate supply of the cow's milk substitute formulas. SUMMARY CMA is a global challenge and collaboration of the national and international scientific communities is essential to produce and update practical guidelines for CMA.
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21
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Bossios A, Theodoropoulou M, Mondoulet L, Rigby NM, Papadopoulos NG, Bernard H, Adel-Patient K, Wal JM, Mills CE, Papageorgiou P. Effect of simulated gastro-duodenal digestion on the allergenic reactivity of beta-lactoglobulin. Clin Transl Allergy 2011; 1:6. [PMID: 22410304 PMCID: PMC3339358 DOI: 10.1186/2045-7022-1-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 08/09/2011] [Indexed: 02/02/2023] Open
Abstract
Background Cow's milk (CM) allergy affects about 2% of infants. The allergenicity of dietary proteins, including those from CM, has been related to their digestibility although the generality of the link and its causality remains to be demonstrated. In this study we use an in vitro digestion system, to investigate the digestibility of β-lactoglobulin (blg) during gastrointestinal transit and to assess the impact of this process on blg allergenic reactivity in CM allergic children. Methods Blg digesta were prepared using an in vitro digestion protocol simulating either gastric digestion alone or followed by duodenal digestion with or without phosphatidylcholine (PC). Biochemical analysis of blg digesta was performed by SDS-PAGE and their concentration was measured by a sandwich ELISA. Assessment of their allergenic reactivity was done in vitro by EAST inhibition, specific basophil activation (basotest) and lymphocyte proliferation (PCNA-flow cytometry) assays using sera and cells from patients allergic to blg and in vivo by skin prick testing (SPT) of these patients. Results Blg was only broken down to smaller peptides after gastro-duodenal digestion although a sizeable amount of intact protein still remained. Digestion did not modify the IgE binding capacity of blg except for gastro-duodenal digestion performed in the absence of PC. These results are consistent with the quantity of intact blg remaining in the digesta. Overall both gastric and gastroduodenal digestion enhanced activation of sensitized basophils and proliferation of sensitized lymphocytes by blg. However, there was a tendency towards reduction in mean diameter of SPT following digestion, the PC alone during phase 1 digestion causing a significant increase in mean diameter. Conclusions Digestion did not reduce the allergenic reactivity of blg to a clinically insignificant extent, PC inhibiting digestion and thereby protecting blg allergenic reactivity. SPT reactivity was reduced compared to blg immunoreactivity in in vitro tests.
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Affiliation(s)
- Apostolos Bossios
- Athens University, P. & A. Kyriakou Children's Hospital, Athens, Greece.,Krefting Research Centre, Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Theodoropoulou
- Athens University, P. & A. Kyriakou Children's Hospital, Athens, Greece.,Thessaly University Hospital, Larissa, Greece
| | - Lucie Mondoulet
- Lab d'Immuno-Allergie Alimentaire, INRA-CEA, Saclay, France.,DBV Technologies, 92220, Bagneux, France
| | - Neil M Rigby
- Institute of Food Research, Norwich Research Park, Colney NR4 7UA UK
| | | | - Hervé Bernard
- Lab d'Immuno-Allergie Alimentaire, INRA-CEA, Saclay, France
| | | | | | - Clare En Mills
- Institute of Food Research, Norwich Research Park, Colney NR4 7UA UK
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22
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Yavuz ST, Sahiner UM, Sekerel BE, Tuncer A, Kalayci O, Sackesen C. Anaphylactic reactions to measles-mumps-rubella vaccine in three children with allergies to hen's egg and cow's milk. Acta Paediatr 2011; 100:e94-6. [PMID: 21244488 DOI: 10.1111/j.1651-2227.2011.02165.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Allergies to hen's egg and cow's milk are the most frequent food allergies in infancy and childhood. Current guidelines recommend safe administration of measles-mumps-rubella (MMR) vaccine in egg allergic patients. METHODS We present three cases of anaphylaxis that we encountered after MMR vaccination in children sensitized to hen's egg and cow's milk. RESULTS Even though MMR vaccine is generally known to be safe in children with egg allergy, there may still be isolated cases of anaphylaxis. CONCLUSION Therefore, we recommend that all children not only those who were sensitized to foods should receive the MMR vaccination in a setting that is equipped to deal with anaphylactic reactions. As stated by WHO in immunization safety surveillance, 'Each vaccinator must have an emergency kit with adrenaline, and be familiar with its dosage and administration'.
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Affiliation(s)
- Suleyman Tolga Yavuz
- Pediatric Allergy and Asthma Unit, Hacettepe University, School of Medicine, Ankara, Turkey
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23
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Arisawa T, Arisawa S, Yokoi T, Kuroda M, Hirata I, Nakano H. Endoscopic and histological features of the large intestine in patients with atopic dermatitis. J Clin Biochem Nutr 2011; 40:24-30. [PMID: 18437210 PMCID: PMC2291501 DOI: 10.3164/jcbn.40.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 07/16/2006] [Indexed: 11/22/2022] Open
Abstract
Although atopic dermatitis is known to be closely associated with food antigens, the actual changes in the gastrointestinal tract have not been clarified. The aim of this study was to investigate the macroscopic and histological features of the large intestine in patients with atopic dermatitis. We studied 15 outpatients who had generalized atopic dermatitis. Eight non-dermatitis subjects of a similar age without inflammatory bowel disease were also enrolled as controls. Total colonoscopy, pathological evaluation of biopsy specimens, and detection of Candida albicans were performed in all subjects. Four patients were re-examined after 6 months of treatment with an antifungal drug. Among the 15 patients with atopic dermatitis, 4 patients had melanosis coli. On pathological examinations, prominent infiltration of eosinophils and fragmentation of granulocyte nuclei were observed. There were no changes after an antifungal therapy. In the patients with melanosis coli, lipofuscin deposits were observed in the lamina propria. Candida albicans was not detected in any of the subjects. In conclusion, patients with atopic dermatitis may have a predisposition to develop chronic inflammation of the large intestine.
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Affiliation(s)
- Tomiyasu Arisawa
- Department of Gastroenterology, Fujita Health University, School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
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24
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Abstract
Food allergy is a recognized public health concern, for which preventative strategies are required. Although an intervention that adequately protects against the development of food allergy has still to be identified, limited benefits have been shown for the prevention of related allergic conditions such as eczema, and to a lesser extent asthma and rhinitis; these benefits are usually limited to at-risk populations. Prevention strategies need to be tested using randomized controlled study designs that account for the numerous methodological challenges, safety concerns, and necessary ethical limitations.
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Affiliation(s)
- George Du Toit
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' National Health Service Foundation Trust, Medical Research Council, London, UK.
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25
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Hon KLE, Chan IHS, Chow CM, Wang SS, Lam CWK, Ng PC, Leung TF. Specific IgE of common foods in Chinese children with eczema. Pediatr Allergy Immunol 2011; 22:50-3. [PMID: 20609136 DOI: 10.1111/j.1399-3038.2010.01031.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Food atopy is important but inadequately studied among children with atopic dermatitis (AD). We evaluated whether any association existed between AD severity, quality of life, total IgE, eosinophil counts, and the number of food items sensitized. Specific IgE of ten common food items was measured for a group of consecutive AD patients (n=85) enrolled during a randomized trial and correlated the findings with eczema severity. Twenty-four patients (28%) were negative for any of the ten common food items. The most commonly sensitized foods were shrimp (54%), egg white (43%), wheat (42%), and peanut (41%). Atopy to beef as a protein and orange as a fruit were least common among the food items studied, even among patients positive for 8-9 IgE items. Patients with severe AD (objective SCORAD>40) were more likely to be positive for at least one of the food items (Yates corrected p=0.024 for ≥1 food-specific IgE in severe vs. moderate AD, OR 3.42 and 95% CI 1.15-10.32); and for at least seven of the food items (p=0.001 for ≥7 food-specific IgE vs. nil with OR 11.67 and 95% CI 2.29-67.77), respectively. The Spearman coefficients between the number of positive food-specific IgE and total SCORAD, objective SCORAD, area of AD involvement, Children's Dermatology Life Quality Index (CDLQI), total IgE levels, and eosinophil counts were 0.42 (p<0.001), 0.45 (p<0.001), 0.50 (p<0.001), 0.17 (p=0.116), 0.80 (p<0.001), and 0.22 (p=0.043), respectively. Specific IgE levels for beef correlated with all the other food-specific IgE levels, including cow's milk (ρ=0.061, p<0.001) and soy (ρ=0.70, p<0.001). The number of common food items sensitized correlated with disease severity, extent, and total IgE levels. IgE sensitization to beef protein is unlikely in the majority of children with AD, but its serum IgE level is associated with disease severity and risk of sensitization to other foods.
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Affiliation(s)
- Kam L E Hon
- Departments of Paediatrics Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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Yang Z. Are peanut allergies a concern for using peanut-based formulated foods in developing countries? Food Nutr Bull 2010; 31:S147-53. [PMID: 20715599 DOI: 10.1177/15648265100312s207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peanut allergy is relatively common among children in developed countries and may have severe outcomes, including anaphylaxis. However, few data about peanut allergy in developing countries are available. Meanwhile, formulated foods with peanuts as a major ingredient are being promoted to prevent and control malnutrition in developing countries. OBJECTIVE The objectives of the paper are to review the existing epidemiologic data about peanut allergy, to determine whether the prevalence of peanut allergy is lower in developing countries, and to explore the possible reasons for onset of peanut allergy. METHODS Publications relevant to peanut allergy were searched via Pubmed, and prevalence and etiological factors of peanut allergy were reviewed. RESULTS Data about peanut allergy were scarce in most developing countries. The existing data support the conclusion that peanut allergy is not as common in developing countries as in developed countries and may not be a major concern for programs promoting formulated food containing peanuts for control of malnutrition. However, plans for treatment of individuals with peanut allergy could be incorporated into these formulated food supplementation programs. A few risk factors (late introduction of peanuts to children, peanut processing technology, non-oral peanut exposure, and maternal peanut exposure during pregnancy and lactation) have been hypothesized to be associated with peanut allergy. However, more conclusive data are needed to verify or disprove these hypotheses. CONCLUSIONS Peanut allergy is not as common in developing countries as in developed countries and may not be a major concern for programs promoting formulated food containing peanuts for control of malnutrition. However, more research about prevalence of peanut allergy is warranted in developing countries.
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Affiliation(s)
- Zhenyu Yang
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland.
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28
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Abstract
Food allergy seems to represent a new spectrum of disease that has elicited significant community concern and extended waiting lists for allergists and gastroenterologists alike. The apparent rise in prevalence of IgE-mediated food allergy (and associated risk of anaphylaxis) has been postulated to result from effects of a "modern lifestyle" but as yet clear environmental risk factors have not yet emerged. Family history seems to contribute to risk suggesting that gene-environment interactions will be important for identifying a subpopulation with increased susceptibility to any identified lifestyle effects. Non-IgE-mediated food allergy (including food-induced enteropathies and colitides, eosinophilic esophagitis, and Crohn's disease) with potentially similar environmental triggers resulting in diverse immune dysregulatory mechanisms. The evidence underpinning the putative rise in food allergy is discussed and potential mechanisms of disease explored. Clinical aspects of various food allergic conditions including non-IgE-mediated food allergy are outlined.
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29
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Gerez IFA, Lee BW, van Bever HP, Shek LP. Allergies in Asia: differences in prevalence and management compared with western populations. Expert Rev Clin Immunol 2010; 6:279-89. [PMID: 20402390 DOI: 10.1586/eci.09.82] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There is wide variability in the epidemiology and management of childhood asthma and related atopic diseases globally. Urbanized, affluent Western countries tend to have a higher prevalence of these diseases compared with Asian nations. However, recent studies have shown that the prevalence in Asia is increasing, although the rate of increase has slowed in the more developed Asian cities. Some possible causes for these differences are socioeconomic status, degree of urbanization, rates of infection, healthcare practices and genetic factors. Importantly, there are significant differences in the way asthma and allergic diseases are managed within Asia. This is of great concern because of the health implications, as these diseases are some of the most common chronic conditions that affect both adults and children. This review compares the differences in prevalence and management between Asia and the West, and discusses some of the possible reasons behind these variations.
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Strinnholm A, Brulin C, Lindh V. Experiences of double-blind, placebo-controlled food challenges (DBPCFC): a qualitative analysis of mothers' experiences. J Child Health Care 2010; 14:179-88. [PMID: 20212057 DOI: 10.1177/1367493509359227] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fear and anxiety are recurring problems for parents of food-allergic children. However, no study has described parents' experiences of introducing food to their children after double-blind provocation. Therefore the aim of this study was to investigate mothers' experiences during their child's negative Double-Blind, Placebo-Controlled Food Challenge (DBPCFC) and the following reintroduction of food. Eight mothers were interviewed and a qualitative content analysis displayed two themes and six subthemes. The first theme, 'living with fear of the unknown', included the subthemes of 'fear of losing control', 'having faith even though fear prevails', 'reintroducing despite fear' and 'fear of causing harm'. In the second theme, the mothers described the challenging process of 're-evaluating earlier experiences' through the sub-themes of 'daring to take new challenges' and 'refraining from new challenges'. Our study indicates that the maternal perspective--not only the professional perspective--needs to be taken into account if mothers are to succeed in the challenging process of reintroducing foods.
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Abstract
OBJECTIVE To explore the prevalence of common food and aeroallergens sensitization in early childhood skin diseases. and to compare the pattern of common food and aeroallergens sensitization before and after 6 months among infants with atopic dermatitis (AD). METHODS All skin prick tests (SPTs) performed on children pound18 months of age managed at the pediatric dermatology clinic of an university-affiliated teaching hospital over a 16-month period were examined. RESULTS There was generally no difference in the pattern of sensitization to common food and aeroallergens between AD patients and non-AD young children with miscellaneous dermatological or gastrointestinal conditions. Dust mites were the only common aeroallergens in these patients; whereas egg and peanuts were the common sensitizing food allergens. Cat and dog fur as aeroallergens, soy bean, orange and beef as food allergens were relatively uncommon among the studied subjects. In AD, infants pound 6 months were generally naive to aeroallergens but became sensitized to the D. Pteronyssinus in the next 12 months of age. 80% of these infants were not sensitized to cow's milk and none sensitized to soybean. CONCLUSION Atopic sensitization to common allergens was common in early childhood with or without AD. Majority of young infants were not sensitized to milk, and develop eczema before they show atopy to the milk or soy allergens.
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White EA. Epinephrine administration: an action plan. Nurse Pract 2010; 35:33-39. [PMID: 20164734 DOI: 10.1097/01.npr.0000368906.23323.b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Elisabeth A White
- Bone Health Centre/Calcium Clinics, Division of Endocrinology, Hospital for Sick Children, Toronto, Canada
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Abstract
Food hypersensitivity (FHS) is the umbrella term used for food allergies that involve the immune system and food intolerances that do not involve the immune system. FHS has a huge impact on quality of life and any dietary advice given should aim to minimise this effect. Despite many advances made in diagnosing and managing patients with FHS, the cornerstone of management still remains avoidance of the relevant food. However, a commonly-presenting dilemma in clinical practice is deciding to what extent the food(s) should be avoided. The level of avoidance required is currently based on the type of FHS the patient has, characteristics of the particular food protein and the natural history of the particular FHS. In addition to management of other FHS, management of cow's milk allergy requires the healthcare professional to choose the appropriate formula. Information required by the patient also includes understanding food labels and issues surrounding cross-contamination. In order to ensure that the diet is nutritionally sound, advice should be given about suitable food choices and following a healthy balanced diet, whilst taking into account the dietary restrictions. Practical issues that need to be addressed include going on holiday, travelling and eating away from home. The dietitian plays a crucial role in this process. At present, there are no standardised documents or protocols for the management of FHS and practices differ within and between countries. If adrenaline auto-injectors are prescribed, correct administration should be demonstrated and reviewed on an ongoing basis.
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Ozbek OY, Ozcay F, Avci Z, Haberal A, Haberal M. Food allergy after liver transplantation in children: a prospective study. Pediatr Allergy Immunol 2009; 20:741-7. [PMID: 19239659 DOI: 10.1111/j.1399-3038.2009.00867.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Food allergy has been increasingly reported in children who had orthotopic liver transplantation (OLT). We aimed to conduct a prospective study to investigate the prevalence of sensitizations and food allergy in pediatric OLT recipients. We also aimed to identify potential risk factors. The study group consisted of 28 children (14 male, 14 female, mean age 4.96 +/- 0.76 yrs) who had OLT. Total eosinophil count (TEC), total IgE, and specific IgEs were studied before and 3, 6, 12 months after OLT. Six patients (21%) developed multiple food allergies. Mean age of six patients at OLT who developed food allergy was younger compared to the non-food allergy group (10.2 months vs. 68.9 months, p < 0.05). Food allergy has been developed within 1 yr in 5, and in 20 months in one patient after OLT. All six patients had cow's milk and egg allergy after OLT. Five children developed wheat, one children developed lentil and another one developed peach allergy in addition to cow's milk and egg allergy. Out of six food-allergic patients after OLT, four children developed Epstein-Barr virus (EBV) infection prior to food allergy. Before OLT, TECs and total IgE levels were not differed among food allergic and non-food allergic patients (p > 0.05). Mean of TECs were significantly higher in food allergic group compared to non-food allergic group at each time point after OLT (p < 0.05). Though statistically insignificant, mean of total IgE levels were also higher in the food allergic group (p > 0.05). These findings suggest that food allergy should be considered after OLT in patients who are younger than 1 yr of age, who developed hypereosinophilia, high total IgE levels or EBV viremia.
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Affiliation(s)
- Ozlem Yilmaz Ozbek
- Department of Pediatric Allergy, Baskent University Faculty of Medicine, 06490, Bahcelievler, Ankara, Turkey.
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36
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Dupont D, Mandalari G, Molle D, Jardin J, Léonil J, Faulks RM, Wickham MSJ, Clare Mills EN, Mackie AR. Comparative resistance of food proteins to adult and infant in vitro
digestion models. Mol Nutr Food Res 2009; 54:767-80. [DOI: 10.1002/mnfr.200900142] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Allen KJ, Davidson GP, Day AS, Hill DJ, Kemp AS, Peake JE, Prescott SL, Shugg A, Sinn JKH, Heine RG. Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health 2009; 45:481-6. [PMID: 19702611 DOI: 10.1111/j.1440-1754.2009.01546.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cow's milk protein allergy is a condition commonly managed by general practitioners and paediatricians. The diagnosis is usually made in the first 12 months of life. Management of immediate allergic reactions and anaphylaxis includes the prevention of accidental food ingestion and provision of an adrenaline autoinjector, if appropriate. By contrast, the clinical course of delayed food-allergic manifestations is characterised by chronicity, and is often associated with nutritional or behavioural sequelae. Correct diagnosis of these non-IgE-mediated conditions may be delayed due to a lack of reliable diagnostic markers. This review aims to guide clinicians in the: (i) diagnostic evaluation (skin prick testing or measurement of food-specific serum IgE levels; indications for diagnostic challenges for suspected IgE- and non-IgE-mediated food allergy), (ii) dietary treatment, (iii) assessment of response to treatment, (iv) differential diagnosis and further diagnostic work-up in non-responders, (v) follow-up assessment of tolerance development and (vi) recommendations for further referral.
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Affiliation(s)
- Katrina J Allen
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
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38
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Jylhä S, Mäkinen-Kiljunen S, Haahtela T, Söderlund H, Takkinen K, Laukkanen ML. Selection of recombinant IgE antibodies binding the beta-lactoglobulin allergen in a conformation-dependent manner. J Immunol Methods 2009; 350:63-70. [PMID: 19647743 DOI: 10.1016/j.jim.2009.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/26/2009] [Accepted: 07/21/2009] [Indexed: 12/21/2022]
Abstract
Cow's milk allergy (CMA) is a common food allergy, especially among infants and young children. Approximately 85% of milk-allergic children outgrow their allergy by the age of three but the remaining 15% remain allergic. Bovine beta-lactoglobulin (BLG) is one of the major allergens in cow's milk. There is a definite need for the specific and sensitive detection of allergenic substances. Validated methods are obligatory to demonstrate allergen contamination and even fatal hidden allergens and, thus, to prevent life-threatening conditions of allergic persons. In this study, we constructed human IgE scFv libraries from an adult milk-allergic patient and isolated the first recombinant IgE antibodies specific to a food allergen, BLG. The selection of the IgE antibody libraries with two distinct panning procedures resulted in the enrichment of four clones having different BLG-binding profiles; two of the clones recognize the native BLG whereas the other two recognize only the heat-denatured form of BLG. For further characterization, the scFv fragments were converted to Fab fragments with human IgG1 isotype. The D1 Fab fragment, binding native BLG with nanomolar affinity, also partially inhibited serum IgE binding to BLG. These BLG-specific IgE antibodies can be applied for the detection of both native and denatured BLG in cow's milk products and furthermore, for the optimization of manufacturing processes to develop safe hypoallergenic milk products.
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Affiliation(s)
- Sirpa Jylhä
- VTT Technical Research Centre of Finland, P.O. Box 1000, FIN-02044 VTT, Finland
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39
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Du Toit G, Santos A, Roberts G, Fox AT, Smith P, Lack G. The diagnosis of IgE-mediated food allergy in childhood. Pediatr Allergy Immunol 2009; 20:309-19. [PMID: 19538353 DOI: 10.1111/j.1399-3038.2009.00887.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
IgE-mediated food allergy is a common condition in childhood and a recognized public health concern. An accurate diagnosis of food allergy facilitates the avoidance of the allergen - and cross-reactive allergens - and allows for safe dietary expansion. The diagnosis of food allergy relies on a combination of rigorous history, physical examination, allergy tests [skin prick tests (SPT) and/or serum-specific IgE] and oral food challenges. Diagnostic cut-off values for SPT and specific IgE results have improved the diagnosis of food allergy and thereby reduced the need to perform oral food challenges. This clinical case series seeks to highlight a contemporary approach to the diagnosis of food allergy in children strategies.
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Affiliation(s)
- G Du Toit
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
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40
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Du Toit G, Katz Y, Sasieni P, Mesher D, Maleki SJ, Fisher HR, Fox AT, Turcanu V, Amir T, Zadik-Mnuhin G, Cohen A, Livne I, Lack G. Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy. J Allergy Clin Immunol 2008; 122:984-91. [PMID: 19000582 DOI: 10.1016/j.jaci.2008.08.039] [Citation(s) in RCA: 528] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/20/2008] [Accepted: 08/25/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite guidelines recommending avoidance of peanuts during infancy in the United Kingdom (UK), Australia, and, until recently, North America, peanut allergy (PA) continues to increase in these countries. OBJECTIVE We sought to determine the prevalence of PA among Israeli and UK Jewish children and evaluate the relationship of PA to infant and maternal peanut consumption. METHODS A clinically validated questionnaire determined the prevalence of PA among Jewish schoolchildren (5171 in the UK and 5615 in Israel). A second validated questionnaire assessed peanut consumption and weaning in Jewish infants (77 in the UK and 99 in Israel). RESULTS The prevalence of PA in the UK was 1.85%, and the prevalence in Israel was 0.17% (P < .001). Despite accounting for atopy, the adjusted risk ratio for PA between countries was 9.8 (95% CI, 3.1-30.5) in primary school children. Peanut is introduced earlier and is eaten more frequently and in larger quantities in Israel than in the UK. The median monthly consumption of peanut in Israeli infants aged 8 to 14 months is 7.1 g of peanut protein, and it is 0 g in the UK (P < .001). The median number of times peanut is eaten per month was 8 in Israel and 0 in the UK (P < .0001). CONCLUSIONS We demonstrate that Jewish children in the UK have a prevalence of PA that is 10-fold higher than that of Jewish children in Israel. This difference is not accounted for by differences in atopy, social class, genetic background, or peanut allergenicity. Israeli infants consume peanut in high quantities in the first year of life, whereas UK infants avoid peanuts. These findings raise the question of whether early introduction of peanut during infancy, rather than avoidance, will prevent the development of PA.
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Affiliation(s)
- George Du Toit
- King's College London, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Hon KLE, Leung TF, Ching G, Chow CM, Luk V, Ko WSF, Ng PC. Patterns of food and aeroallergen sensitization in childhood eczema. Acta Paediatr 2008; 97:1734-7. [PMID: 18795904 DOI: 10.1111/j.1651-2227.2008.01034.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To compare the patterns of Type 1 sensitization of common food and aeroallergens among infants and older patients with atopic dermatitis (AD). METHODS All skin prick tests (SPTs) performed over a 6-month period were examined, and patients with urticaria were used for comparison. RESULTS Dust mite was the most common aeroallergen and dog dander the least common. Egg white was the most common food allergen and beef the least common. Dust mite and peanut sensitization was more prevalent in AD than in urticaria. Dust mite sensitization was more prevalent in older children than infants with AD. Cow's milk sensitization only occurred in one-tenth of these patients. Prevalence of sensitization to common aeroallergens, but not food allergens, was generally higher in children beyond 5 years of age. CONCLUSION Milk sensitization is far less prevalent than egg white, and the prevalence does not change beyond infancy. There is no significant change in prevalence in many of the common food allergens beyond infancy. Many infants with AD develop eczema before they show atopy to the common food and aeroallergens. The SPT information is useful in reassuring parents of the unlikelihood of severe Type 1 immediate IgE reaction to some of the common food and aeroallergens, so that empirical and multiple food avoidance/restriction can be avoided.
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Affiliation(s)
- Kam-Lun Ellis Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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42
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Abstract
The aim is to determine whether there is a pattern of allergic and immune abnormalities in children with complex medical problems. The authors retrospectively studied a convenience sample of 69 children in a case management program. Of 69 children, 42 underwent immunologic investigations during the selected time frame. Forty (95%) had 1 or more allergic disorder. Cow's milk sensitivity was present in 32 (76%). Abnormal immunoglobulin levels, IgG, IgA, and IgE were found at a greater frequency than in the general pediatric population (P <.005). Lymphocyte subset percentages were decreased for B cells (CD19) and natural killer cells (CD57, CD16/56; P <.05). Presence of a gastrostomy tube, gastroesophageal reflux disease, gastric acid suppression, and chronic constipation were common and failure to thrive, developmental delay, sleep disturbance, and recurrent otitis media were present in the majority. The authors report a higher than expected prevalence of allergic and immune abnormalities in children with complex medical problems.
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Affiliation(s)
- Anne Kelly
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA
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43
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Abstract
Gastro-oesophageal reflux disease, constipation and colic are among the most common disorders in infancy and early childhood. In at least a subset of infants with these functional disorders, improvement after dietary elimination of specific food proteins has been demonstrated. Gastrointestinal food allergy should therefore be considered in the differential diagnosis of infants presenting with persistent regurgitation, constipation or irritable behaviour, particularly if conventional treatment has not been beneficial. The diagnosis of food protein-induced gastrointestinal motility disorders is hampered by the absence of specific clinical features or useful laboratory markers. Gastrointestinal biopsies before commencing a hypoallergenic diet may provide the most important diagnostic clues. Early recognition is essential for the optimal management of these patients to prevent nutritional sequelae or aversive feeding behaviours. Treatment relies on hypoallergenic formulae, as well as maternal elimination diets in breast-fed infants. Further research is required to better define the pathological mechanisms and diagnostic markers of paediatric allergic gastrointestinal motility disorders. The following article will present three instructive cases followed by discussion of the clinical presentation, diagnosis, treatment and natural history of food allergic motility disorders in infancy and early childhood.
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Affiliation(s)
- Ralf G Heine
- Department of Gastroenterology & Clinical Nutrition Royal Children's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
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44
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Boulay A, Houghton J, Gancheva V, Sterk Y, Strada A, Schlegel-Zawadzka M, Sora B, Sala R, van Ree R, Rowe G. A EuroPrevall review of factors affecting incidence of peanut allergy: priorities for research and policy. Allergy 2008; 63:797-809. [PMID: 18588545 DOI: 10.1111/j.1398-9995.2008.01776.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Peanuts are extensively cultivated around the world, providing a foodstuff that is both cheap to produce and nutritious. However, allergy to peanuts is of growing global concern, particularly given the severity of peanut-allergic reactions, which can include anaphylaxis and death. Consequently, it is important to understand the factors related to the prevalence of peanut allergy in order to inform efforts to ameliorate or pre-empt the condition. In this article we review evidence for the relevance of factors hypothesized to have some association with allergy prevalence, including both genetic and environmental factors. Although our analysis does indicate some empirical support for the importance of a number of factors, the key finding is that there are significant data gaps in the literature that undermine our ability to provide firm conclusions. We highlight these gaps, indicating questions that need to be addressed by future research.
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Affiliation(s)
- A Boulay
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK
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45
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Lee BW, Shek LPC, Gerez IFA, Soh SE, Van Bever HP. Food allergy-lessons from Asia. World Allergy Organ J 2008; 1:129-33. [PMID: 23282480 PMCID: PMC3650988 DOI: 10.1097/wox.0b013e31817b7431] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 04/10/2008] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE : This is a review on published data available on food allergy in East Asia and a discussion on the insights that it offers. METHODS : PubMed searches were made for terms food allergy and anaphylaxis, in combination with Asia. RESULTS : There is a paucity of population-based prevalence studies on food allergy in Asia. Certain unique food allergens, such as buckwheat, chestnuts, chickpeas, bird's nest, and royal jelly, which are consumed extensively by certain Asian populations have resulted in clinical food allergy of little importance in other populations. Crustacean shellfish is of importance in this region relative to other common food allergens. The high consumption of these foods and possibly coupled with cross-reactive tropomyosins from dominant inhalant dust mite and cockroach allergens in this region may explain this phenomenon. In contrast, the prevalence of peanut allergy is relatively low in this region. The reasons for this difference are not apparent. However, this may be a reflection of the general reduced propensity in this region to allergic diseases as seen with asthma. CONCLUSIONS : Further research on food allergy in Asia is warranted because it offers unique opportunities to further our understanding on the influence of population and environment.
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Affiliation(s)
- Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Children's Medical Institute, National University Hospital, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Children's Medical Institute, National University Hospital, Singapore
| | | | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hugo P Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Children's Medical Institute, National University Hospital, Singapore
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Kucukosmanoglu E, Yazi D, Yesil O, Akkoc T, Gezer M, Bakirci N, Bahceciler N, Barlan I. Prevalence of egg sensitization in Turkish infants based on skin prick test. Allergol Immunopathol (Madr) 2008. [DOI: 10.1016/s0301-0546(08)72538-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Hon KLE, Leung TF, Lam MCA, Wong KY, Chow CM, Ko WSF, Fok TF, Leung AKC. Eczema exacerbation and food atopy beyond infancy: how should we advise Chinese parents about dietary history, eczema severity, and skin prick testing? Adv Ther 2007; 24:223-30. [PMID: 17565911 DOI: 10.1007/bf02849889] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Issues related to empirical dietary restriction are important, but they have been inadequately studied among children with atopic dermatitis (AD). To evaluate whether any association exists between food atopy, food avoidance, and AD severity, investigators in the present study reviewed all skin prick tests (SPTs) performed between January 2005 and April 2006 at a pediatric dermatology clinic and correlated findings with history of food avoidance and eczema severity. Only 13% of 114 children with AD had a positive SPT for beef. The most commonly sensitized foods were egg yolk (53%), egg white (42%), shrimp (35%), peanuts (31%), and crab (29%). Disease severity was not associated with prevalence of sensitization to these foods. The investigators concluded that immediate immunoglobulin E reaction to beef, as suggested by positive SPT findings, is unlikely to occur in most children with AD. SPT information may be useful in reassuring parents about the unlikelihood of a severe and immediate reaction to beef. As for other foods, it is sensible to advise parents about specific avoidance strategies only in more severely affected children with a definite history of eczema exacerbation by specific food allergens.
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Affiliation(s)
- Kam-Lun Ellis Hon
- Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital Shatin, Hong Kong SAR, China.
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Walker RB, Conn JA, Davies MJ, Moore VM. Mothers' views on feeding infants around the time of weaning. Public Health Nutr 2007; 9:707-13. [PMID: 16925875 DOI: 10.1079/phn2005915] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo describe women's views about aspects of infants' diets around the time of weaning, making comparisons with national guidelines.DesignA survey of women with a 9-month-old child.SettingAdelaide, South Australia.SubjectsFive hundred and five women who joined a longitudinal study during pregnancy.ResultsSources of information varied, with written material most commonly used (37%). Cows' milk was considered suitable as the main drink for weaned infants by 14% of women. There were divergent views about the suitability of eggs, with many women concerned about allergy. The majority of women (84%) viewed fruit juice as suitable although many qualified their response, often by stating that fruit juice should be diluted. Almost all women considered the amount of sugar mattered, primarily because of tooth decay, and that salt mattered although the reason was often uncertain. It was widely believed (77%) that additives in food could cause health problems, in particular hyperactivity and allergies, and half of the women reported avoiding specific foods because of concerns about allergies. Many women thought that giving their child food that was high in fat would encourage a liking for ‘junk’ food or lead to fatness in adulthood.ConclusionsThere is considerable diversity in the views women express about aspects of infant feeding that have been the subject of guidelines. Further health promotion efforts are needed to achieve greater consistency with recommendations and to address other concerns women have. This will entail greater engagement with parents and shared development of responses.
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Affiliation(s)
- Ruth B Walker
- Department of Public Health, University of Adelaide, Adelaide, South Australia 5005, Australia
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Affiliation(s)
- Roni D Lane
- Primary Children's Medical Center, Department of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT 84158, USA.
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50
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Mansueto P, Montalto G, Pacor ML, Esposito-Pellitteri M, Ditta V, Lo Bianco C, Leto-Barone SM, Di Lorenzo G. Food allergy in gastroenterologic diseases: Review of literature. World J Gastroenterol 2006; 12:7744-52. [PMID: 17203514 PMCID: PMC4087536 DOI: 10.3748/wjg.v12.i48.7744] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Food allergy is a common and increasing problem worldwide. The newly-found knowledge might provide novel experimental strategies, especially for laboratory diagnosis. Approximately 20% of the population alters their diet for a perceived adverse reaction to food, but the application of double-blind placebo-controlled oral food challenge, the “gold standard” for diagnosis of food allergy, shows that questionnaire-based studies overestimate the prevalence of food allergies. The clinical disorders determined by adverse reactions to food can be classified on the basis of immunologic or nonimmunologic mechanisms and the organ system or systems affected. Diagnosis of food allergy is based on clinical history, skin prick tests, and laboratory tests to detect serum-food specific IgE, elimination diets and challenges. The primary therapy for food allergy is to avoid the responsible food. Antihistamines might partially relieve oral allergy syndrome and IgE-mediated skin symptoms, but they do not block systemic reactions. Systemic corticosteroids are generally effective in treating chronic IgE-mediated disorders. Epinephrine is the mainstay of treatment for anaphylaxis. Experimental therapies for IgE-mediated food allergy have been evaluated, such as humanized IgG anti-IgE antibodies and allergen specific immunotherapy.
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Affiliation(s)
- Pasquale Mansueto
- Dipartimento di Medicina Clinica e delle Patologie Emergenti, Via del Vespro n degree 141, Palermo 90127, Italy.
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