|
1
|
Smith HG, Nimmagadda S, Gupta RS, Warren CM. Food allergen introduction practices and parent/caregiver attitudes based on family history of food allergy. FRONTIERS IN ALLERGY 2025; 6:1562667. [PMID: 40176928 PMCID: PMC11961653 DOI: 10.3389/falgy.2025.1562667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 02/28/2025] [Indexed: 04/05/2025] Open
Abstract
Background The National Institute of Allergy and Infectious Disease (NIAID) addendum guidelines for primary prevention of peanut allergy1 provide recommendations regarding peanut introduction, and a recent consensus statement highlighted the importance of timely introduction of other commonly allergenic solids, and the role of family history as a risk factor.2ObjectiveTo determine whether children in households with a food allergic parent/caregiver or sibling have different rates of being fed commonly allergenic solids during the first year of life than children lacking this family history. Methods A pretested survey was administered between January-February 2021 to a U.S. sample of 3,062 parents/caregivers of children born since the NIAID Addendum guidelines. Survey-weighted chi-square statistics and logistic regression models tested the independence of key variables across strata of interest before and after covariate adjustment. Results Peanut, almond, shellfish, and other tree nuts are more likely to be introduced to children with one or more food-allergic caregivers. Respondents with food-allergic parents (39.3%) and siblings with FA (35.8%) were more familiar with the 2017 NIAID guidelines compared to parents (12.9%) and siblings without FA (12.7%). Conclusion Findings suggest that respondents with food-allergic parents and siblings are more likely to have many of the most prevalent allergens introduced at younger ages, which could be due to knowledge related to the NIAID-sponsored guidelines and other national guidance, but that even among these higher-risk families overall rates of "early" introduction during infancy still remain relatively low.
Collapse
Affiliation(s)
- Hunter G. Smith
- Department of Pediatrics, Lurie Children’s Hospital of Chicago and Northwestern McGaw Pediatrics Residency, Chicago, IL, United States
| | - Sai Nimmagadda
- Center for Food Allergy and Asthma Research Northwestern Feinberg School of Medicine & Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Ruchi S. Gupta
- Center for Food Allergy and Asthma Research Northwestern Feinberg School of Medicine & Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Christopher M. Warren
- Center for Food Allergy and Asthma Research Northwestern Feinberg School of Medicine & Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| |
Collapse
|
|
2
|
Isa HM, Abdulnabi MJ, Naser NS, Lahmda FN, AlAnsari NM, Isa ZH, Mohamed AM. Clinical, laboratory, and therapeutic differences between immunoglobulin E-mediated and non-immunoglobulin E-mediated cow’s milk protein allergy in children. World J Clin Pediatr 2025; 14:100386. [DOI: 10.5409/wjcp.v14.i1.100386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 10/08/2024] [Accepted: 11/12/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Although breast milk is ideal for newborns, in some cases, it is replaced with cow’s milk, which contains proteins that increase the risk of cow’s milk protein allergy (CMPA).
AIM To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E (IgE)- and non-IgE-mediated CMPA.
METHODS This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex, Bahrain, between 2014 and 2022, and assessed CMPA prevalence. Clinical presentations, laboratory findings, dietary modifications, and outcomes were compared between children with IgE-mediated and non-IgE-mediated CMPA. Categorical variables were compared using Fisher’s exact test or Pearson’s χ2 test, whereas continuous variables were compared using Student’s t-test or the Mann-Whitney U test.
RESULTS Of 8332 patients, 6022 (72.3%) adhered to their appointment. Of them, 618 (10.3%) were suggested of having CMPA and 595 (96.3%) were included; CMPA prevalence was 2%. Most patients were Bahraini (93.8%) and males (55.3%). Non-IgE-mediated type accounted for 77.3% cases and IgE-mediated type, 22.7%. IgE-mediated CMPA presented more in boys (P = 0.030), and later in life (5.1 months ± 4.5 months vs 4.2 months ± 4.2 months, P = 0.016, 95%CI: 0.08-1.73), had more associated diseases (P < 0.001); and presented with more cutaneous (P = 0.024) and respiratory (P = 0.003) manifestations, severe symptoms [rash/dry skin (P = 0.031), facial swelling/angioedema (P = 0.003), failure to thrive (P = 0.013), apparent life-threatening event (P < 0.001)], and positive physical findings (P = 0.002) than non-IgE-mediated CMPA. Most patients were exclusively fed cow milk formula (50.3%). The amino acid-based formula (AAF) was most prescribed (60.5%) with no difference between the two types (P = 0.173). Although breastfeeding was recommended to 49.6%, only 8.2% were exclusively breastfed. IgE-mediated CMPA was associated with a longer follow-up duration than non-IgE-mediated CMPA (17.3 months ± 14.0 months vs 13.5 months ± 13.4 months, P = 0.005, 95%CI: 1.1-6.3).
CONCLUSION This study revealed a high CMPA prevalence with clinical differences between both types that can influence treatment. AAF was most prescribed, while breastfeeding with dietary modification is rarely applied.
Collapse
Affiliation(s)
- Hasan M Isa
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
- Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
| | - Marwa J Abdulnabi
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Nawra S Naser
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Fatema N Lahmda
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Noor M AlAnsari
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Zahra H Isa
- Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Afaf M Mohamed
- Public Health Directorate, Ministry of Health, Manama 26671, Bahrain
| |
Collapse
|
|
3
|
Arnau‐Soler A, Tremblay BL, Sun Y, Madore A, Simard M, Kersten ETG, Ghauri A, Marenholz I, Eiwegger T, Simons E, Chan ES, Nadeau K, Sampath V, Mazer BD, Elliott S, Hampson C, Soller L, Sandford A, Begin P, Hui J, Wilken BF, Gerdts J, Bourkas A, Ellis AK, Vasileva D, Clarke A, Eslami A, Ben‐Shoshan M, Martino D, Daley D, Koppelman GH, Laprise C, Lee Y, Asai Y. Food Allergy Genetics and Epigenetics: A Review of Genome-Wide Association Studies. Allergy 2025; 80:106-131. [PMID: 39698764 PMCID: PMC11724255 DOI: 10.1111/all.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 10/12/2024] [Accepted: 11/26/2024] [Indexed: 12/20/2024]
Abstract
In this review, we provide an overview of food allergy genetics and epigenetics aimed at clinicians and researchers. This includes a brief review of the current understanding of genetic and epigenetic mechanisms, inheritance of food allergy, as well as a discussion of advantages and limitations of the different types of studies in genetic research. We specifically focus on the results of genome-wide association studies in food allergy, which have identified 16 genetic variants that reach genome-wide significance, many of which overlap with other allergic diseases, including asthma, atopic dermatitis, and allergic rhinitis. Identified genes for food allergy are mainly involved in epithelial barrier function (e.g., FLG, SERPINB7) and immune function (e.g., HLA, IL4). Epigenome-wide significant findings at 32 loci are also summarized as well as 14 additional loci with significance at a false discovery of < 1 × 10-4. Integration of epigenetic and genetic data is discussed in the context of disease mechanisms, many of which are shared with other allergic diseases. The potential utility of genetic and epigenetic discoveries is deliberated. In the future, genetic and epigenetic markers may offer ways to predict the presence or absence of clinical IgE-mediated food allergy among sensitized individuals, likelihood of development of natural tolerance, and response to immunotherapy.
Collapse
Affiliation(s)
- Aleix Arnau‐Soler
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC)BerlinGermany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität Zu BerlinBerlinGermany
- Experimental and Clinical Research Center, a Joint Cooperation of Max Delbruck Center for Molecular Medicine and Charité—Universitätsmedizin BerlinBerlinGermany
- German Center for Child and Adolescent Health (DZKJ)BerlinGermany
| | - Bénédicte L. Tremblay
- Département Des Sciences FondamentalesUniversité du Québec à ChicoutimiSaguenayQuebecCanada
| | - Yidan Sun
- Department of Pediatric Pulmonology and Pediatric AllergologyUniversity Medical Center Groningen, Beatrix Children's Hospital, University of GroningenGroningenthe Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC)Groningenthe Netherlands
| | - Anne‐Marie Madore
- Département Des Sciences FondamentalesUniversité du Québec à ChicoutimiSaguenayQuebecCanada
| | - Mathieu Simard
- Département Des Sciences FondamentalesUniversité du Québec à ChicoutimiSaguenayQuebecCanada
| | - Elin T. G. Kersten
- Department of Pediatric Pulmonology and Pediatric AllergologyUniversity Medical Center Groningen, Beatrix Children's Hospital, University of GroningenGroningenthe Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC)Groningenthe Netherlands
| | - Ahla Ghauri
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC)BerlinGermany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität Zu BerlinBerlinGermany
- Experimental and Clinical Research Center, a Joint Cooperation of Max Delbruck Center for Molecular Medicine and Charité—Universitätsmedizin BerlinBerlinGermany
- German Center for Child and Adolescent Health (DZKJ)BerlinGermany
| | - Ingo Marenholz
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC)BerlinGermany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität Zu BerlinBerlinGermany
- Experimental and Clinical Research Center, a Joint Cooperation of Max Delbruck Center for Molecular Medicine and Charité—Universitätsmedizin BerlinBerlinGermany
| | - Thomas Eiwegger
- Translational Medicine Program, Research InstituteHospital for Sick ChildrenTorontoOntarioCanada
- Department of Immunology, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Karl Landsteiner University of Health SciencesKrems an der DonauAustria
- Department of Pediatric and Adolescent MedicineUniversity Hospital St. PöltenSt. PöltenAustria
- Department of Paediatrics, Division of Clinical Immunology and Allergy, Food Allergy and Anaphylaxis Program, the Hospital for Sick ChildrenThe University of TorontoTorontoOntarioCanada
| | - Elinor Simons
- Section of Allergy & Clinical Immunology, Department of Pediatrics & Child Health, University of ManitobaChildren's Hospital Research InstituteWinnipegManitobaCanada
| | - Edmond S. Chan
- Division of Allergy, Department of PediatricsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kari Nadeau
- Department of Environmental StudiesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Vanitha Sampath
- Department of Environmental StudiesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Bruce D. Mazer
- Research Institute of the McGill University Health CentreMontrealQuebecCanada
| | - Susan Elliott
- Department of Geography and Environmental ManagementUniversity of WaterlooWaterlooOntarioCanada
| | | | - Lianne Soller
- Division of Allergy, Department of PediatricsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Andrew Sandford
- Department of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung InnovationVancouverBritish ColumbiaCanada
| | - Philippe Begin
- Department of Pediatrics, Service of Allergy and Clinical ImmunologyCentre Hospitalier Universitaire Sainte‐JustineMontréalQuébecCanada
- Department of Medicine, Service of Allergy and Clinical ImmunologyCentre Hospitalier de l'Université de MontréalMontréalQuébecCanada
| | - Jennie Hui
- School of Population HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Bethany F. Wilken
- School of Medicine, Department of MedicineQueen's UniversityKingstonOntarioCanada
| | | | - Adrienn Bourkas
- School of Medicine, Department of MedicineQueen's UniversityKingstonOntarioCanada
| | - Anne K. Ellis
- Division of Allergy & Immunology, Department of MedicineQueen's UniversityKingstonOntarioCanada
| | - Denitsa Vasileva
- Department of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung InnovationVancouverBritish ColumbiaCanada
| | - Ann Clarke
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Aida Eslami
- Département de médecine Sociale et préventive, Faculté de médecineUniversité LavalQuebecCanada
| | - Moshe Ben‐Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montréal Children's HospitalMcGill University Health CentreMontréalQuebecCanada
| | - David Martino
- Wal‐Yan Respiratory Research CentreTelethon Kids InstitutePerthAustralia
| | - Denise Daley
- Department of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
- Centre for Heart Lung InnovationVancouverBritish ColumbiaCanada
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric AllergologyUniversity Medical Center Groningen, Beatrix Children's Hospital, University of GroningenGroningenthe Netherlands
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC)Groningenthe Netherlands
| | - Catherine Laprise
- Département Des Sciences FondamentalesUniversité du Québec à ChicoutimiSaguenayQuebecCanada
| | - Young‐Ae Lee
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC)BerlinGermany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt‐Universität Zu BerlinBerlinGermany
- Experimental and Clinical Research Center, a Joint Cooperation of Max Delbruck Center for Molecular Medicine and Charité—Universitätsmedizin BerlinBerlinGermany
- German Center for Child and Adolescent Health (DZKJ)BerlinGermany
| | - Yuka Asai
- Division of Dermatology, Department of MedicineQueen's UniversityKingstonOntarioCanada
| |
Collapse
|
|
4
|
Ma J, Palmer DJ, Geddes D, Lai CT, Rea A, Prescott SL, D'Vaz N, Stinson LF. Maternal Allergic Disease Phenotype and Infant Birth Season Influence the Human Milk Microbiome. Allergy 2024. [PMID: 39723602 DOI: 10.1111/all.16442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 10/11/2024] [Accepted: 11/19/2024] [Indexed: 12/28/2024]
Abstract
Early infancy is a critical period for immune development. In addition to being the primary food source during early infancy, human milk also provides multiple bioactive components that shape the infant gut microbiome and immune system and provides a constant source of exposure to maternal microbiota. Given the potential interplay between allergic diseases and the human microbiome, this study aimed to characterise the milk microbiome of allergic mothers. Full-length 16S rRNA gene sequencing was performed on milk samples collected at 3 and 6 months postpartum from 196 women with allergic disease. Multivariate linear mixed models were constructed to identify the maternal, infant, and environmental determinants of the milk microbiome. Human milk microbiome composition and beta diversity varied over time (PERMANOVA R2 = 0.011, p = 0.011). The season of infant birth emerged as the strongest determinant of the microbiome community structure (PERMANOVA R2 = 0.014, p = 0.011) with impacts on five of the most abundant taxa. The milk microbiome also varied according to the type of maternal allergic disease (allergic rhinitis, asthma, atopic dermatitis, and food allergy). Additionally, infant formula exposure reduced the relative abundance of several typical oral taxa in milk. In conclusion, the milk microbiome of allergic mothers was strongly shaped by the season of infant birth, maternal allergic disease phenotype, and infant feeding mode. Maternal allergic disease history and infant season of birth should therefore be considered in future studies of infant and maternal microbiota. Trial Registration: ClinicalTrials.gov identifier: ACTRN12606000281594.
Collapse
Affiliation(s)
- Jie Ma
- School of Molecular Sciences, The University of Western Australia, Crawley, WA, Australia
- ABREAST Network, Perth, WA, Australia
- UWA Centre for Human Lactation Research and Translation, Perth, WA, Australia
| | - Debra J Palmer
- ABREAST Network, Perth, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Donna Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, WA, Australia
- ABREAST Network, Perth, WA, Australia
- UWA Centre for Human Lactation Research and Translation, Perth, WA, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, WA, Australia
- ABREAST Network, Perth, WA, Australia
- UWA Centre for Human Lactation Research and Translation, Perth, WA, Australia
| | - Alethea Rea
- Mathematics and Statistics, Harry Butler Institute, Murdoch University, Murdoch, WA, Australia
| | - Susan L Prescott
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Nova Institute for Health, Baltimore, Maryland, USA
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nina D'Vaz
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Lisa F Stinson
- School of Molecular Sciences, The University of Western Australia, Crawley, WA, Australia
- ABREAST Network, Perth, WA, Australia
- UWA Centre for Human Lactation Research and Translation, Perth, WA, Australia
| |
Collapse
|
|
5
|
Krejner-Bienias A, Łyżwa K, Krupa-Łaska A, Zielińska J, Kulus M, Grzela K. Peanut Allergy in Children-Is Prevention Better than Cure? Nutrients 2024; 16:3237. [PMID: 39408205 PMCID: PMC11478115 DOI: 10.3390/nu16193237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/16/2024] [Accepted: 09/23/2024] [Indexed: 10/20/2024] Open
Abstract
Peanut allergy, one of the most frequently occurring allergies, usually starts in childhood and rarely subsides-often persisting throughout adult life. Accidental exposure to peanuts can often result in adverse reactions ranging from mild to life-threatening, such as anaphylactic shock. Historically, food avoidance and the use of rescue drugs have remained a fundamental management mechanism for dealing with food allergy. However, prevention of adverse reactions to food allergy is playing an increasing role. This is possible through the early introduction of peanuts into the diet, especially in infants at risk of this allergy. In recent years, specific immunotherapy has been used to develop desensitisation and, in some patients, tolerance-defined as a persistent state of clinical non-reactivity to the allergen after therapy is finished. The aim of this article is to summarise the current state of knowledge on the prevention and treatment of peanut allergy, with a focus on clinical trials, current guidelines, and recent experimental studies. This review may be particularly useful for paediatricians and general practitioners.
Collapse
Affiliation(s)
| | | | | | | | | | - Katarzyna Grzela
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| |
Collapse
|
|
6
|
Lee HY, Nazmul T, Lan J, Oyoshi MK. Maternal influences on offspring food allergy. Immunol Rev 2024; 326:130-150. [PMID: 39275992 PMCID: PMC11867100 DOI: 10.1111/imr.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2024]
Abstract
The prevalence of allergies has been globally escalating. While allergies could appear at any age, they often develop in early life. However, the significant knowledge gap in the field is the mechanisms by which allergies affect certain people but not others. Investigating early factors and events in neonatal life that have a lasting impact on determining the susceptibilities of children to develop allergies is a significant area of the investigation as it promotes the understanding of neonatal immune system that mediates tolerance versus allergies. This review focuses on the research over the recent 10 years regarding the potential maternal factors that influence offspring allergies with a view to food allergy, a potentially life-threatening cause of anaphylaxis. The role of breast milk, maternal diet, maternal antibodies, and microbiota that have been suggested as key maternal factors regulating offspring allergies are discussed here. We also suggest future research area to expand our knowledge of maternal-offspring interactions on the pathogenesis of food allergy.
Collapse
Affiliation(s)
- Hwa Yeong Lee
- Division of Pediatric Allergy, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Charlestown, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Tanuza Nazmul
- Division of Pediatric Allergy, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Charlestown, MA
| | - Jinggang Lan
- Division of Pediatric Allergy, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Charlestown, MA
| | - Michiko K. Oyoshi
- Division of Pediatric Allergy, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Charlestown, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
7
|
Alibrahim I, AlSulami M, Alotaibi T, Alotaibi R, Bahareth E, Abulreish I, Alsuruji S, Khojah I, Goronfolah L, Rayes H, Bukhari A, Khojah A. Prevalence of Parent-Reported Food Allergies Among Children in Saudi Arabia. Nutrients 2024; 16:2693. [PMID: 39203829 PMCID: PMC11356889 DOI: 10.3390/nu16162693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/28/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Food allergy (FA) is an immune-mediated hypersensitivity to foods, significantly contributing to childhood morbidity and mortality. This study aimed to assess the prevalence, characteristics, and influencing factors of parent-reported FAs among children in Saudi Arabia. (2) Methods: This cross-sectional study utilized a validated parental questionnaire distributed across all regions of Saudi Arabia. Data from 2130 participants were collected and analyzed using SPSS v. 26 and Prism software v. 10.3.0. (3) Results: Parent-reported FA prevalence was 15.2%. Egg was the most common allergen (6.2%), followed by tree nuts (4.1%), peanuts (4.0%), milk (3.8%), and sesame (3.2%). Significant geographical variations were observed, with the western region having the highest burden (p < 0.001). Older children had higher rates of shellfish and fish allergies. Parental allergies and co-existing asthma/drug allergies were positively associated with childhood FAs. (4) Conclusions: This study highlights a substantial burden of parent-reported FAs in Saudi Arabia, with regional variations in food allergen distribution. Parental allergies and co-existing allergic conditions may influence FA risk.
Collapse
Affiliation(s)
- Ibrahim Alibrahim
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Maria AlSulami
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Turki Alotaibi
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Ruba Alotaibi
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Elaf Bahareth
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Inam Abulreish
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Sumayyah Alsuruji
- College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (I.A.); (M.A.); (T.A.); (R.A.); (E.B.); (I.A.); (S.A.)
| | - Imad Khojah
- Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Loie Goronfolah
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia;
| | - Husni Rayes
- Department of Pediatrics, Makkah Maternity and Children Hospital, Makkah 24246, Saudi Arabia;
| | - Ameera Bukhari
- College of Science, Taif University, Taif 21944, Saudi Arabia;
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| |
Collapse
|
|
8
|
Iglesia EGA, Fleischer DM, Abrams EM. Health Promotion of Early and Sustained Allergenic Food Introduction for the Prevention of Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1670-1683.e9. [PMID: 38796104 DOI: 10.1016/j.jaip.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Observational studies and landmark randomized control trials support early and sustained allergenic food introduction in infancy as an effective preventive strategy against food allergy development. Despite a consensus regarding the intended goals of early and sustained allergenic food introduction, there have been myriad policy recommendations among health authorities in how to achieve both individual and population-level health outcomes for food allergy prevention. This clinical management review provides an overview on the data that informs early and sustained allergenic food introduction strategies, suggestions on how to advise allergenic food introduction, principles of prevention programs as they relate to food allergy prevention, and health promotion and systems-level challenges that impede achievement of food allergy prevention goals.
Collapse
Affiliation(s)
- Edward G A Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David M Fleischer
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
|
9
|
Mendonca CE, Andreae DA. Food Allergy. Med Clin North Am 2024; 108:655-670. [PMID: 38816109 DOI: 10.1016/j.mcna.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Food allergy is a growing health problem affecting both pediatric and adult patients. Food allergies are often immunoglobulin E (IgE) mediated but other food-induced non-IgE-mediated diseases exist. Diagnosis of food allergy relies on the combination of clinical and reaction history, skin and IgE testing as well as oral food challenges. Although oral immunotherapy has been able to achieve sustained unresponsiveness in some patients, no cure for food allergies has been found to date. Avoidance of the inciting food as well as availability of epinephrine autoinjectors remains the mainstay of treatment.
Collapse
Affiliation(s)
- Chelsea Elizabeth Mendonca
- Department of Family and Community Medicine, Baylor College of Medicine, 1100 West 34th Street, Houston, TX 77018, USA.
| | - Doerthe A Andreae
- Division of Allergy and Immunology, Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA
| |
Collapse
|
|
10
|
Yang F, Zhou C, Li L, Wang X, Wang B, Hu Y, Zhang Y, Chen C, Li J, Yu X. A nomogram for predicting food allergy in infants with feeding problems and malnutrition. J Pediatr Gastroenterol Nutr 2024; 78:1161-1170. [PMID: 38374772 DOI: 10.1002/jpn3.12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND OBJECTIVE As oral food challenge (OFC) cannot be performed routinely in the general outpatient, this study aimed to construct a nomogram to predict the odds of food allergy in infants with idiopathic feeding problems and malnutrition. METHODS From August 2018 to December 2021, 289 infants (median age, 6 months; P25-P75, 4-8) with idiopathic feeding problems and malnutrition were enrolled from seven hospitals in Shanghai, China. Food allergy was defined as a positive response to a skin prick test or OFC, with gastrointestinal, dermatologic, or respiratory symptom improvement after 4 weeks of avoidance of the suspected food. Demographic characteristics, Cow's Milk-related Symptom Scores (CoMiSS), and blood eosinophil amounts were evaluated for their associations with food allergy. Multivariable logistic regression analysis was used to identify variables to develop a nomogram model with the bootstrapped-concordance index as an assessment metric. RESULTS Totally 249 of 289 infants had food allergy (86.2%). After logistic regression analysis, the feeding pattern (odds ratio [OR] = 5.28, 95% confidence interval [CI]: 2.13-13.09), a family history of allergy (OR = 1.79, 95% CI: 0.71-4.51), CoMiSS (OR = 1.45, 95% CI: 1.19-1.77), and eosinophil percentage (OR = 1.33, 95% CI: 1.11-1.60) were used to develop the model, which had a good performance with an area under the curve of 0.868 (95% CI: 0.792-0.944) and a bootstrapped-concordance index of 0.868. CONCLUSION Food allergy is common in infants with idiopathic feeding problems and malnutrition. The developed nomogram may help identify infants with food allergy for further diagnosis.
Collapse
Affiliation(s)
- Fan Yang
- Department of Developmental and Behavioral Pediatrics, Shanghai Jiao Tong University, Shanghai, China
| | - Chunyan Zhou
- Translational Medicine Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Luanluan Li
- Department of Developmental and Behavioral Pediatrics, Shanghai Jiao Tong University, Shanghai, China
| | - Xirui Wang
- Department of Developmental and Behavioral Pediatrics, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University, Shanghai, China
| | - Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Chen
- Department of Developmental and Behavioral Pediatrics, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Li
- Department of Developmental and Behavioral Pediatrics, Shanghai Jiao Tong University, Shanghai, China
| | - Xiandan Yu
- Department of Developmental and Behavioral Pediatrics, Shanghai Jiao Tong University, Shanghai, China
- State Environmental Protection Key Laboratory of Environmental Health Impact Assessment of Emerging Contaminants, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
|
11
|
侯 林, 马 紫, 晁 爽, 李 中, 张 宇, 刘 毅, 张 俊, 武 文, 黄山 雅, 刘 捷. [Risk factors for cow's milk protein allergy in infants: a multicenter prospective nested case-control study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:230-235. [PMID: 38557373 PMCID: PMC10986379 DOI: 10.7499/j.issn.1008-8830.2309105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/29/2023] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To explore the risk factors associated with cow's milk protein allergy (CMPA) in infants. METHODS This study was a multicenter prospective nested case-control study conducted in seven medical centers in Beijing, China. Infants aged 0-12 months were included, with 200 cases of CMPA infants and 799 control infants without CMPA. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for the occurrence of CMPA. RESULTS Univariate logistic regression analysis showed that preterm birth, low birth weight, birth from the first pregnancy, firstborn, spring birth, summer birth, mixed/artificial feeding, and parental history of allergic diseases were associated with an increased risk of CMPA in infants (P<0.05). Multivariate logistic regression analysis revealed that firstborn (OR=1.89, 95%CI: 1.14-3.13), spring birth (OR=3.42, 95%CI: 1.70-6.58), summer birth (OR=2.29, 95%CI: 1.22-4.27), mixed/artificial feeding (OR=1.57, 95%CI: 1.10-2.26), parental history of allergies (OR=2.13, 95%CI: 1.51-3.02), and both parents having allergies (OR=3.15, 95%CI: 1.78-5.56) were risk factors for CMPA in infants (P<0.05). CONCLUSIONS Firstborn, spring birth, summer birth, mixed/artificial feeding, and a family history of allergies are associated with an increased risk of CMPA in infants.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - 文艳 武
- 北京华信医院（清华大学第一附属医院）儿科北京100016
| | | | | |
Collapse
|
|
12
|
Anagnostou A. Shared decision-making in food allergy: Navigating an exciting era. Ann Allergy Asthma Immunol 2024; 132:313-320. [PMID: 37742794 DOI: 10.1016/j.anai.2023.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is increasingly used in food allergy. We review its use in the areas of prevention, diagnosis, and management. DATA SOURCES PubMed and online SDM resources. STUDY SELECTIONS Studies and reviews relevant to SDM and areas in food allergy that decision-making may be applied were selected for discussion. RESULTS Food allergy represents an area with multiple opportunities for SDM. Patients, on one hand, need to obtain the necessary information and understanding of existing options from the allergist. The allergist, on the other hand, needs to understand "where the patient is coming from," their needs, preferences, and values, so that jointly they can reach a decision that is responsive to these. Benefits of SDM include a better understanding of disease by patients, improved compliance with medication, better health outcomes, decreased health care costs, and improved ability of patients to manage their disease and make informed choices. CONCLUSION In food allergy prevention, diagnosis, and management, multiple preference-sensitive options exist for patients where SDM may be used during allergy consultations, alongside decision aids. Decision aids are tools that assist and support patients during the SDM process, by supplementing the patient-physician interaction.
Collapse
Affiliation(s)
- Aikaterini Anagnostou
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Division of Allergy, Immunology & Retrovirology, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
|
13
|
Lee ECK, Trogen B, Brady K, Ford LS, Wang J. The Natural History and Risk Factors for the Development of Food Allergies in Children and Adults. Curr Allergy Asthma Rep 2024; 24:121-131. [PMID: 38416390 PMCID: PMC10960768 DOI: 10.1007/s11882-024-01131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This narrative review explores food allergy prevalence and natural history stratified by life stages, especially in context of evolving knowledge over the last few decades. RECENT FINDINGS The prevalence of food allergy remains highest in early childhood with common food triggers being cow's milk, soy, hen's egg, wheat, peanut, tree nuts, sesame, fish, and shellfish. This correlates with certain risk factors especially pertinent in the postnatal period which appear to predispose an individual to developing a food allergy. Some allergies (such as milk and egg) were previously thought to be easily outgrown in early life; however, recent studies suggest increasing rates of persistence of these allergies into young adulthood; the reason behind this is unknown. Despite this, there is also evidence demonstrating that food allergies can be outgrown in adolescents and adults. An understanding of the paradigm shifts in the natural history of food allergy allows clinicians to provide updated, age-appropriate, and tailored advice for patients on the management and prognosis of food allergy.
Collapse
Affiliation(s)
- Eric C K Lee
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Brit Trogen
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kathryn Brady
- Department of Pediatrics, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, USA
| | - Lara S Ford
- The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
- Sydney Medical School, The University of Sydney, The University of Sydney, NSW, 2006, Australia.
| | - Julie Wang
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
|
14
|
Iglesia EGA, Kwan M, Virkud YV, Iweala OI. Management of Food Allergies and Food-Related Anaphylaxis. JAMA 2024; 331:510-521. [PMID: 38349368 PMCID: PMC11060332 DOI: 10.1001/jama.2023.26857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Importance An estimated 7.6% of children and 10.8% of adults have IgE-mediated food-protein allergies in the US. IgE-mediated food allergies may cause anaphylaxis and death. A delayed, IgE-mediated allergic response to the food-carbohydrate galactose-α-1,3-galactose (alpha-gal) in mammalian meat affects an estimated 96 000 to 450 000 individuals in the US and is currently a leading cause of food-related anaphylaxis in adults. Observations In the US, 9 foods account for more than 90% of IgE-mediated food allergies-crustacean shellfish, dairy, peanut, tree nuts, fin fish, egg, wheat, soy, and sesame. Peanut is the leading food-related cause of fatal and near-fatal anaphylaxis in the US, followed by tree nuts and shellfish. The fatality rate from anaphylaxis due to food in the US is estimated to be 0.04 per million per year. Alpha-gal syndrome, which is associated with tick bites, is a rising cause of IgE-mediated food anaphylaxis. The seroprevalence of sensitization to alpha-gal ranges from 20% to 31% in the southeastern US. Self-injectable epinephrine is the first-line treatment for food-related anaphylaxis. The cornerstone of IgE-food allergy management is avoidance of the culprit food allergen. There are emerging immunotherapies to desensitize to one or more foods, with one current US Food and Drug Administration-approved oral immunotherapy product for treatment of peanut allergy. Conclusions and Relevance IgE-mediated food allergies, including delayed IgE-mediated allergic responses to red meat in alpha-gal syndrome, are common in the US, and may cause anaphylaxis and rarely, death. IgE-mediated anaphylaxis to food requires prompt treatment with epinephrine injection. Both food-protein allergy and alpha-gal syndrome management require avoiding allergenic foods, whereas alpha-gal syndrome also requires avoiding tick bites.
Collapse
Affiliation(s)
- Edward G A Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mildred Kwan
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Yamini V Virkud
- University of North Carolina Food Allergy Initiative, Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Onyinye I Iweala
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
- University of North Carolina Food Allergy Initiative, Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| |
Collapse
|
|
15
|
Vandenplas Y, Broekaert I, Domellöf M, Indrio F, Lapillonne A, Pienar C, Ribes-Koninckx C, Shamir R, Szajewska H, Thapar N, Thomassen RA, Verduci E, West C. An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy. J Pediatr Gastroenterol Nutr 2024; 78:386-413. [PMID: 38374567 DOI: 10.1097/mpg.0000000000003897] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 0 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis, and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion, or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost, and quality of life.
Collapse
Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Ilse Broekaert
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Magnus Domellöf
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker-Enfants Malades Hospital, Paris University, Paris, France
- CNRC, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Corina Pienar
- Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Carmen Ribes-Koninckx
- Gastroenterology and Hepatology & Instituto de Investigacion Sanitaria, La Fe University Hospital, Valencia, Spain
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rut Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Christina West
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| |
Collapse
|
|
16
|
Pratelli G, Tamburini B, Badami GD, Lo Pizzo M, De Blasio A, Carlisi D, Di Liberto D. Cow's Milk: A Benefit for Human Health? Omics Tools and Precision Nutrition for Lactose Intolerance Management. Nutrients 2024; 16:320. [PMID: 38276558 PMCID: PMC10819418 DOI: 10.3390/nu16020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Cow's milk (CM) is a healthy food consumed worldwide by individuals of all ages. Unfortunately, "lactase-deficient" individuals cannot digest milk's main carbohydrate, lactose, depriving themselves of highly beneficial milk proteins like casein, lactoalbumin, and lactoglobulin due to lactose intolerance (LI), while other individuals develop allergies specifically against these proteins (CMPA). The management of these conditions differs, and an inappropriate diagnosis or treatment may have significant implications for the patients, especially if they are infants or very young children, resulting in unnecessary dietary restrictions or avoidable adverse reactions. Omics technologies play a pivotal role in elucidating the intricate interactions between nutrients and the human body, spanning from genetic factors to the microbiota profile and metabolites. This comprehensive approach enables the precise delineation and identification of distinct cohorts of individuals with specific dietary requirements, so that tailored nutrition strategies can be developed. This is what is called personalized nutrition or precision nutrition (PN), the area of nutrition that focuses on the effects of nutrients on the genome, proteome, and metabolome, promoting well-being and health, preventing diseases, reducing chronic disease incidence, and increasing life expectancy. Here, we report the opinion of the scientific community proposing to replace the "one size fits all" approach with tailor-made nutrition programs, designed by integrating nutrigenomic data together with clinical parameters and microbiota profiles, taking into account the individual lactose tolerance threshold and needs in terms of specific nutrients intake. This customized approach could help LI patients to improve their quality of life, overcoming depression or anxiety often resulting from the individual perception of this condition as different from a normal state.
Collapse
Affiliation(s)
- Giovanni Pratelli
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (G.P.); (D.C.)
| | - Bartolo Tamburini
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo, 90127 Palermo, Italy;
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP Paolo Giaccone, 90127 Palermo, Italy; (G.D.B.); (M.L.P.)
| | - Giusto Davide Badami
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP Paolo Giaccone, 90127 Palermo, Italy; (G.D.B.); (M.L.P.)
| | - Marianna Lo Pizzo
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AOUP Paolo Giaccone, 90127 Palermo, Italy; (G.D.B.); (M.L.P.)
| | - Anna De Blasio
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), Laboratory of Biochemistry, University of Palermo, 90127 Palermo, Italy;
| | - Daniela Carlisi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (G.P.); (D.C.)
| | - Diana Di Liberto
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), Institute of Biochemistry, University of Palermo, 90127 Palermo, Italy; (G.P.); (D.C.)
| |
Collapse
|
|
17
|
Del Refugio Morfin Maciel BM, Álvarez Castelló M. [Risk factors for food allergy]. REVISTA ALERGIA MÉXICO 2023; 70:214-221. [PMID: 38506859 DOI: 10.29262/ram.v70i4.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
Allergy is the result of genetic and environmental interactions, including time, route, and dose of food exposure in susceptible patients. Risk factors can be: 1) genetic and 2) environmental, and these, in turn, are divided into prenatal, perinatal and postnatal. Food allergy appears frequently and depends on multiple risk factors (genetic and environmental), which in turn are divided into: prenatal, natal and postnatal factors; They participate in the expression of the disease and clinical intervention is not possible in all cases.
Collapse
Affiliation(s)
- Blanca María Del Refugio Morfin Maciel
- Alergóloga Pediatra, Instituto Nacional de Pediatría; Académico numerario de la Academia Mexicana de Pediatría; Maestría en Ciencias Mé-dicas, Universidad Nacional Autónoma de México Alergóloga, Hospital San Ángel Inn Chapultepec, Ciudad de
| | - Mirta Álvarez Castelló
- Doctor en Ciencias médicas, Especialista en Medicina General Integral y Alergología; Hospital Universitario General Calixto García; Investigadora Titular; Profesora auxiliar
| |
Collapse
|
|
18
|
Ansotegui Zubeldia IJ, Fiocchi A. [Introduction to food allergy]. REVISTA ALERGIA MÉXICO 2023; 70:208-210. [PMID: 38506857 DOI: 10.29262/ram.v70i4.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
Food allergy is a common chronic disorder that affects infants, children, adolescents, and adults. The prevalence of food allergy has increased in recent decades throughout the world, not limited to Western countries. Since there is no treatment, this focuses on avoiding allergens, in addition to educating patients and caregivers in the emergency treatment of acute reactions, for example: application of epinephrine. Studies suggest that accidental reactions occur in about 45% of children with food allergies each year, although most reactions are mild or moderate in severity. Hospital admissions for food anaphylaxis vary from 4 to 20 per 100,000 inhabitants; Deaths are rare, with an estimated incidence of 0.03 to 0.3 per million people with food allergy. Death from food anaphylaxis is rare and appears to have remained stable, possibly due to increases in food allergen labeling, diagnostic services, rates of intramuscular epinephrine prescription, and awareness of food allergies. Omalizumab is a drug approved for several disorders (chronic hives or difficult asthma) and may help reduce symptoms associated with food allergy. The relative importance of alternative technologies, management strategies and policies for food allergy varies from one region to another, due to differences in the epidemiology, education, socioeconomic well-being, and cultural preferences of the population.
Collapse
Affiliation(s)
- Ignacio Javier Ansotegui Zubeldia
- Director Médico Ejecutivo, Expresidente de la Organización Mundial de Alergia (WAO). Jefe del Departamento de Alergia e Inmunología, Hospital Quironsalud, Bizkaia, Bilbao,
| | - Alessandro Fiocchi
- Director responsable de la S.C. de Pediatría, Hospital Materno Infantil Macedonio Melloni, Milán, Italia. Director del Departamento Materno Infantil, Hospital Fatebenefratelli-Ophthalmic de Milán, Italia. Profesor adjunto de la Escuela de Es-pecialización en Pediatría III, Universidad de Milán y Consejero de la Sociedad Italiana de Pediatría, Sección Lombarda. Pediatric Hospital Bambino Gesú IRCCS Allergy division, Roma, Italia
| |
Collapse
|
|
19
|
Rao S, Chen X, Ou OY, Chair SY, Chien WT, Liu G, Waye MMY. A Positive Causal Effect of Shrimp Allergy on Major Depressive Disorder Mediated by Allergy- and Immune-Related Pathways in the East Asian Population. Nutrients 2023; 16:79. [PMID: 38201909 PMCID: PMC10780813 DOI: 10.3390/nu16010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Observational studies have implied a potential correlation between allergic diseases and major depressive disorder (MDD). However, the relationship is still inconclusive as it is likely to be interfered with by substantial confounding factors and potential reverse causality. The present study aimed to investigate causal correlation of the two diseases by a Mendelian randomization (MR) study and further elucidate the underlying molecular mechanisms. METHODS With the biggest summary datasets of a genome-wide association study (GWAS) in the East Asian population, we conducted a two-sample, bidirectional MR study to assess the causal correlation between shrimp allergy (SA) and MDD. Subsequently, we identified the pleiotropic genes' susceptibility to the two diseases at whole-genome and tissue-specific levels, respectively. Enriched GO sets and KEGG pathways were also discovered to elucidate the potential underlying mechanisms. RESULTS With the most suitable MR method, SA was identified as a causal risk factor for MDD based on three different groups of independent genetic instruments, respectively (p < 2.81 × 10-2). In contrast, we did not observe a significant causal effect of MDD on SA. The GWAS-pairwise program successfully identified seven pleiotropic genetic variants (PPA3 > 0.8), indicating that the two diseases indeed have a shared genetic basis. At a whole-genome level, the MAGMA program identified 44 pleiotropic genes, which were enriched in allergy-related pathways, such as antigen processing and presentation pathway (p = 1.46 × 10-2). In brain-specific tissue, the S-MultiXcan program found 17 pleiotropic genes that were significantly enriched in immune-related pathways and GO sets, including asthma-related pathway, T-cell activation-related, and major histocompatibility complex protein-related GO sets. Regarding whole-blood tissue, the program identified six pleiotropic genes that are significantly enriched in tolerance induction-related GO sets. CONCLUSIONS The present study for the first time indicated a significant causal effect of SA on the occurrence of MDD, but the reverse was not true. Enrichment analyses of pleiotropic genes at whole-genome and tissue-specific levels implied the involvement of allergy and immune-related pathways in the shared genetic mechanism of the two diseases. Elucidating the causal effect and the acting direction may be beneficial in reducing the incidence rate of MDD for the massive group of SA patients in the East Asian region.
Collapse
Affiliation(s)
- Shitao Rao
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350122, China; (S.R.); (X.C.)
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaotong Chen
- Department of Bioinformatics, Fujian Key Laboratory of Medical Bioinformatics, Institute of Precision Medicine, School of Medical Technology and Engineering, Fujian Medical University, Fuzhou 350122, China; (S.R.); (X.C.)
| | - Olivia Yanlai Ou
- Department of Psychology, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Sek Ying Chair
- Croucher Laboratory for Human Genomics, Asia-Pacific Genomic and Genetic Nursing Centre, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; (S.Y.C.); (W.T.C.)
| | - Wai Tong Chien
- Croucher Laboratory for Human Genomics, Asia-Pacific Genomic and Genetic Nursing Centre, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; (S.Y.C.); (W.T.C.)
| | - Guangming Liu
- College of Ocean Food and Biological Engineering, Xiamen Key Laboratory of Marine Functional Food, Fujian Provincial Engineering Technology Research Center of Marine Functional Food, Jimei University, Xiamen 361021, China
| | - Mary Miu Yee Waye
- Croucher Laboratory for Human Genomics, Asia-Pacific Genomic and Genetic Nursing Centre, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; (S.Y.C.); (W.T.C.)
| |
Collapse
|
|
20
|
Belmabrouk S, Abdelhedi R, Bougacha F, Bouzid F, Gargouri H, Ayadi I, Abdelmoula NB, Abdelmoula B, Abdellaoui N, BenMarzoug R, Triki N, Torjmen M, Kharrat M, Jmaiel M, Kharrat N, Rebai A. Prevalence of self-reported food allergy in Tunisia: General trends and probabilistic modeling. World Allergy Organ J 2023; 16:100813. [PMID: 37811397 PMCID: PMC10558849 DOI: 10.1016/j.waojou.2023.100813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Food allergy (FA) has become a major public health concern affecting millions of children and adults worldwide. In Tunisia, published data on FA are scarce. Methods This study, was intended to fill the gap and estimate the frequency of allergy to different foods in the Sfax region, Tunisia, within self-reported FA. One hundred twenty-five (125) children (56% males, 1-17 years old), and 306 adults (17% males, 18-70 years old) were interviewed using a bilingual questionnaire. Results The number of self-reported food allergens in this sample was 105; allergens were clustered in 8 foods: fruits, seafood, eggs, milk and dairy, cereals, nuts, vegetables, and peanuts. Cutaneous reactions were the most frequent symptoms, in both children and adults. About 40% of children and 30% of adults had a family history of FA. About 81% of adults and 38% of children are allergic to at least 1 non-food allergen. The most prevalent food allergen was the fruit group in both adults and children, followed by seafood. Most food allergies were mutually exclusive and 90% of individuals have a single FA. The relationship between self-declared FA was modeled using a Bayesian network graphical model in order to estimate conditional probabilities of each FA when other FA is present. Conclusions Our findings suggest that the prevalence of self-reported FA in Tunisia depends on dietary habits and food availability since the most frequent allergens are from foods that are highly consumed by the Tunisian population.
Collapse
Affiliation(s)
- Sabrine Belmabrouk
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| | - Rania Abdelhedi
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| | - Fadia Bougacha
- National Institute of Statistics, 70, Ech-cham Road, P.O Box 265 CEDEX. Tunis, Tunisia
| | - Fériel Bouzid
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| | - Héla Gargouri
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| | - Imen Ayadi
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
- Faculty of Sciences of Sfax, La Soukra Road km 4 - BP 1171-3000, Sfax, Tunisia
| | - Nouha Bouayed Abdelmoula
- Genomics of Signalopathies at The Service of Medicine, Medical University of Sfax, Majida Boulila Road, Tunisia
| | - Balkiss Abdelmoula
- Genomics of Signalopathies at The Service of Medicine, Medical University of Sfax, Majida Boulila Road, Tunisia
| | - Nawel Abdellaoui
- Genomics of Signalopathies at The Service of Medicine, Medical University of Sfax, Majida Boulila Road, Tunisia
| | - Riadh BenMarzoug
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| | - Nersrine Triki
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| | - Mouna Torjmen
- ReDCAD, National Engineering School of Sfax, La Soukra Road km4, 3038, Sfax, Tunisia
| | - Mohamed Kharrat
- Faculty of Sciences of Sfax, La Soukra Road km 4 - BP 1171-3000, Sfax, Tunisia
| | - Mohamed Jmaiel
- ReDCAD, National Engineering School of Sfax, La Soukra Road km4, 3038, Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| | - Ahmed Rebai
- Laboratory of Screening Cellular and Molecular Process, Center of Biotechnology of Sfax, Sidi Mansour Road km 7, P.O Box 1177, 3018, Sfax, Tunisia
| |
Collapse
|
|
21
|
Su KW, Yan DC, Ou LS, Lin LL, Wu CY, Huang SJ, Yao TC, Yeh KW, Huang JL. Rising prevalence of food allergies in Taiwan: An epidemiological study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:863-870. [PMID: 37169610 DOI: 10.1016/j.jmii.2023.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 03/12/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Food allergies are becoming more prevalent globally. The purpose of this study was to investigate the epidemiology of food allergies in Taiwan. METHODS In 2017, a food allergy questionnaire was administered to 6-7-year-old children, 13-14-year-old adolescents, and their parents in Taipei. The results were compared to those from a previous survey conducted in 2004. RESULTS A total of 16,200 questionnaires were completed, revealing a rise in the prevalence of food allergies from 7.7% to 10.4% in the pediatric group and from 6.4% to 12.5% in the adult group. Peanut allergies also increased to 1.1%. Shrimp and crabs were the most common allergens, with urticaria being the most common symptom. Shortness of breath or wheezing occurred in 10% of individuals, while 2.1% experienced syncope or shock, and 0.1% were admitted to an intensive care unit. Personal history of allergic rhinitis and atopic dermatitis, as well as family histories of food allergies, were risk factors for food allergy in 6-7-year-old children. In the 13-14-year-old group, personal history of asthma, allergic rhinitis, or atopic dermatitis, recent use of acetaminophen, and living with dogs were risk factors. Females, personal histories of asthma, allergic rhinitis, atopic dermatitis, and moist and damp at home were risk factors in adults. Breastfeeding was a protective factor in 6-7-year-old children. CONCLUSION The increasing prevalence of food allergies, including peanut allergies, in Taiwan warrants attention from physicians to provide appropriate care and education to patients with food allergies. The protective effect of breastfeeding against food allergies shall be emphasized.
Collapse
Affiliation(s)
- Kuan-Wen Su
- Department of Pediatrics, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Dah-Chin Yan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Liang-Shiou Ou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Li-Lun Lin
- Department of Pediatrics, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chao-Yi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Jung Huang
- Department of Pediatrics, Jen-Ai Hospital, Taichung, Taiwan
| | - Tsung-Chieh Yao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Jing-Long Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Pediatrics, New Taipei Municipal TuCheng Hospital, New Taipei, Taiwan.
| |
Collapse
|
|
22
|
Keet C, Sicherer SH, Bunyavanich S, Visness C, Fulkerson PC, Togias A, Davidson W, Perry S, Hamrah S, Calatroni A, Robinson K, Dunaway L, Davis CM, Anvari S, Leong-Kee SM, Hershey GK, DeFranco E, Devonshire A, Kim H, Joseph C, Davidson B, Strong NK, Tsuang AJ, Groetch M, Wang J, Dantzer J, Mudd K, Aina A, Shreffler W, Yuan Q, Simmons V, Leung DY, Hui-Beckman J, Ramos JA, Chinthrajah S, Winn V, Sindher T, Jones SM, Manning NA, Scurlock AM, Kim E, Stuebe A, Gern JE, Singh AM, Krupp J, Wood RA. The SunBEAm birth cohort: Protocol design. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100124. [PMID: 37771674 PMCID: PMC10509956 DOI: 10.1016/j.jacig.2023.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 09/30/2023]
Abstract
Background Food allergy (FA) and atopic dermatitis (AD) are common conditions that often present in the first year of life. Identification of underlying mechanisms and environmental determinants of FA and AD is essential to develop and implement effective prevention and treatment strategies. Objectives: We sought to describe the design of the Systems Biology of Early Atopy (SunBEAm) birth cohort. Methods Funded by the National Institute of Allergy and Infectious Diseases (NIAID) and administered through the Consortium for Food Allergy Research (CoFAR), SunBEAm is a US population-based, multicenter birth cohort that enrolls pregnant mothers, fathers, and their newborns and follows them to 3 years. Questionnaire and biosampling strategies were developed to apply a systems biology approach to identify environmental, immunologic, and multiomic determinants of AD, FA, and other allergic outcomes. Results Enrollment is currently underway. On the basis of an estimated FA prevalence of 6%, the enrollment goal is 2500 infants. AD is defined on the basis of questionnaire and assessment, and FA is defined by an algorithm combining history and testing. Although any FA will be recorded, we focus on the diagnosis of egg, milk, and peanut at 5 months, adding wheat, soy, cashew, hazelnut, walnut, codfish, shrimp, and sesame starting at 12 months. Sampling includes blood, hair, stool, dust, water, tape strips, skin swabs, nasal secretions, nasal swabs, saliva, urine, functional aspects of the skin, and maternal breast milk and vaginal swabs. Conclusions The SunBEAm birth cohort will provide a rich repository of data and specimens to interrogate mechanisms and determinants of early allergic outcomes, with an emphasis on FA, AD, and systems biology.
Collapse
Affiliation(s)
- Corinne Keet
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Patricia C. Fulkerson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Wendy Davidson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Susan Perry
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sanaz Hamrah
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | - Lars Dunaway
- Rho Inc, Federal Research Operations, Durham, NC
| | - Carla M. Davis
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Susan M. Leong-Kee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex
| | | | | | | | | | | | | | | | | | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Dantzer
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kim Mudd
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Abimbola Aina
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Qian Yuan
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | - Virginia Simmons
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | | | | | | | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Virginia Winn
- Division Maternal Fetal Medicine and Obstetrics, Stanford University, Palo Alto, Calif
| | - Tina Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Stacie M. Jones
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | | | - Amy M. Scurlock
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | - Edwin Kim
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wis
| | | | - Jennifer Krupp
- Maternal and Fetal Medicine, Obstetrics and Gynecology, SSM Health, Madison, Wis
| | - Robert A. Wood
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| |
Collapse
|
|
23
|
Gorzkiewicz M, Łoś-Rycharska E, Gawryjołek J, Gołębiewski M, Krogulska A, Grzybowski T. The methylation profile of IL4, IL5, IL10, IFNG and FOXP3 associated with environmental exposures differed between Polish infants with the food allergy and/or atopic dermatitis and without the disease. Front Immunol 2023; 14:1209190. [PMID: 37520545 PMCID: PMC10373304 DOI: 10.3389/fimmu.2023.1209190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Objectives Epigenetic dynamics has been indicated to play a role in allergy development. The environmental stimuli have been shown to influence the methylation processes. This study investigated the differences in CpGs methylation rate of immune-attached genes between healthy and allergic infants. The research was aimed at finding evidence for the impact of environmental factors on methylation-based regulation of immunological processes in early childhood. Methods The analysis of methylation level of CpGs in the IL4, IL5, IL10, IFNG and FOXP3 genes was performed using high resolution melt real time PCR technology. DNA was isolated from whole blood of Polish healthy and allergic infants, with food allergy and/or atopic dermatitis, aged under six months. Results The significantly lower methylation level of FOXP3 among allergic infants compared to healthy ones was reported. Additional differences in methylation rates were found, when combining with environmental factors. In different studied groups, negative correlations between age and the IL10 and FOXP3 methylation were detected, and positive - in the case of IL4. Among infants with different allergy symptoms, the decrease in methylation level of IFNG, IL10, IL4 and FOXP3 associated with passive smoke exposure was observed. Complications during pregnancy were linked to different pattern of the IFNG, IL5, IL4 and IL10 methylation depending on allergy status. The IFNG and IL5 methylation rates were higher among exclusively breastfed infants with atopic dermatitis compared to the non-breastfed. A decrease in the IFNG methylation was noted among allergic patients fed exclusively with milk formula. In different study groups, a negative correlation between IFNG, IL5 methylation and maternal BMI or IL5 methylation and weight was noted. Some positive correlations between methylation rate of IL10 and child's weight were found. A higher methylation of IL4 was positively correlated with the number of family members with allergy. Conclusion The FOXP3 methylation in allergic infants was lower than in the healthy ones. The methylation profile of IL4, IL5, IL10, IFNG and FOXP3 associated with environmental exposures differed between the studied groups. The results offer insights into epigenetic regulation of immunological response in early childhood.
Collapse
Affiliation(s)
- Marta Gorzkiewicz
- Department of Forensic Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Ewa Łoś-Rycharska
- Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Julia Gawryjołek
- Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Marcin Gołębiewski
- Department of Plant Physiology and Biotechnology, Nicolaus Copernicus University in Toruń, Toruń, Poland
- Interdisciplinary Centre of Modern Technologies, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Aneta Krogulska
- Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Tomasz Grzybowski
- Department of Forensic Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| |
Collapse
|
|
24
|
Devonshire A, Gautam Y, Johansson E, Mersha TB. Multi-omics profiling approach in food allergy. World Allergy Organ J 2023; 16:100777. [PMID: 37214173 PMCID: PMC10199264 DOI: 10.1016/j.waojou.2023.100777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
The prevalence of food allergy (FA) among children is increasing, affecting nearly 8% of children, and FA is the most common cause of anaphylaxis and anaphylaxis-related emergency department visits in children. Importantly, FA is a complex, multi-system, multifactorial disease mediated by food-specific immunoglobulin E (IgE) and type 2 immune responses and involving environmental and genetic factors and gene-environment interactions. Early exposure to external and internal environmental factors largely influences the development of immune responses to allergens. Genetic factors and gene-environment interactions have established roles in the FA pathophysiology. To improve diagnosis and identification of FA therapeutic targets, high-throughput omics approaches have emerged and been applied over the past decades to screen for potential FA biomarkers, such as genes, transcripts, proteins, and metabolites. In this article, we provide an overview of the current status of FA omics studies, namely genomic, transcriptomic, epigenomic, proteomic, exposomic, and metabolomic. The current development of multi-omics integration of FA studies is also briefly discussed. As individual omics technologies only provide limited information on the multi-system biological processes of FA, integration of population-based multi-omics data and clinical data may lead to robust biomarker discovery that could translate into advances in disease management and clinical care and ultimately lead to precision medicine approaches.
Collapse
Affiliation(s)
- Ashley Devonshire
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yadu Gautam
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elisabet Johansson
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tesfaye B. Mersha
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
|
25
|
Abstract
Food allergy is a growing health problem affecting both pediatric and adult patients. Food allergies are often immunoglobulin E (IgE) mediated but other food-induced non-IgE-mediated diseases exist. Diagnosis of food allergy relies on the combination of clinical and reaction history, skin and IgE testing as well as oral food challenges. Although oral immunotherapy has been able to achieve sustained unresponsiveness in some patients, no cure for food allergies has been found to date. Avoidance of the inciting food as well as availability of epinephrine autoinjectors remains the mainstay of treatment.
Collapse
|
|
26
|
Koplin JJ, McWilliam V, Soriano VX, Peters RL. Early peanut introduction: To test or not to test? Ann Allergy Asthma Immunol 2023; 130:565-570. [PMID: 36791959 DOI: 10.1016/j.anai.2023.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To review recent evidence and international guidelines on early peanut introduction for preventing peanut allergy and provide an update on the status of the debate around testing before early peanut introduction. DATA SOURCES Review of published literature documenting: infant feeding guidelines; impact of early peanut introduction on peanut allergy; risk factors for peanut allergy; and impact of early peanut introduction guidelines on infant feeding practices and allergy. STUDY SELECTION We used a narrative approach and present both pro and con arguments for testing before peanut introduction. Data from randomized controlled trials and post-hoc analyses of these trials and observational studies were included. RESULTS Allergy prevention guidelines around the world now consistently recommend introducing peanut into an infant's diet before 12 months of age for countries with high peanut allergy prevalence. In the US, guidelines recently shifted away from recommending allergy testing before introduction for those at risk of peanut allergy. There is evidence primarily from Australia that recommending early introduction without prior testing is safe and effective in increasing early peanut introduction for both high and low-risk infants, although the subsequent reduction in peanut allergy prevalence at the population level was less than expected. CONCLUSION Current evidence supports recommending early peanut introduction without routinely testing for peanut allergy. If testing is offered, this should be based on shared decision making between families and practitioners and only be undertaken where there is provision for rapid access to definitive diagnosis including oral food challenges.
Collapse
Affiliation(s)
- Jennifer J Koplin
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
| | - Vicki McWilliam
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Rachel L Peters
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
|
27
|
Muacevic A, Adler JR, Alsalmi S, Althomali M, Alsofyani R, Alkhudaydi F, Osman M. Prevalence of Parent-Reported Food Allergies and Associated Risk Predictors Among Children in Saudi Arabia. Cureus 2023; 15:e33974. [PMID: 36820112 PMCID: PMC9938726 DOI: 10.7759/cureus.33974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The worldwide prevalence of food allergies has been increasing recently. Due to limited data on food allergy (FA) in Saudi Arabia, this study was conducted to estimate the prevalence and risk factors of parent-reported food allergies and clinical manifestations in children in Taif, Saudi Arabia. METHODOLOGY A cross-sectional questionnaire-based observational study was conducted from July 2019 to December 2020. A total of 508 parents of school children (aged five to eight years) responded to the questions based on the child's health and food allergies. RESULTS FA (16.1%) was observed as the most common type of allergy among children. The prevalence of other atopic diseases was estimated at 30.5%. The most common allergy-causing foods were eggs (4.9%), peanuts (2.7%), and sesame (2.5%). Rash, itching without rash, and vomiting were the most common FA symptoms. The presence of childhood eczema (p< 0.0001), allergic rhinitis (p= 0.005), and the father's history of allergy (p= 0.005) were all significant and independent predictors/risk factors for FA among the studied children. CONCLUSION We noted substantial parents' concern with food allergies among children in Saudi Arabia, which necessitates the establishment of effective diagnosis and treatment strategies and primary prevention initiatives.
Collapse
|
|
28
|
Pezeshki PS, Nowroozi A, Razi S, Rezaei N. Asthma and Allergy. Clin Immunol 2023. [DOI: 10.1016/b978-0-12-818006-8.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
|
29
|
Tursi AR, Saba NK, Dunham D, Manohar M, Peters RL, Saffery R, Koplin JJ, Nadeau KC, Neeland MR, Andorf S. Mass cytometry analysis of blood from peanut-sensitized tolerant and clinically allergic infants. Sci Data 2022; 9:738. [PMID: 36456584 PMCID: PMC9715645 DOI: 10.1038/s41597-022-01861-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
IgE-mediated food allergies in infants are a significant health concern, with peanut allergy being of particular interest due to its prevalence and severity. Among individuals who produce peanut-specific IgE some experience no adverse reaction on peanut consumption. This asymptomatic phenotype is known as sensitized tolerance. To elucidate the immune environment of peanut sensitized tolerant and clinically allergic one-year-olds, high-dimensional mass cytometry was conducted as part of the HealthNuts study. The resulting data includes peripheral blood mononuclear cells from 36 participants encompassing non-allergic, peanut sensitized with tolerance, and clinically peanut allergic infants. The raw mass cytometry data is described here and freely available for reuse through the Immunology Database and Analysis Portal (ImmPort). Additional allergy information and serum vitamin D levels of the participants were measured and are also included in the data upload. These high-dimensional mass cytometry data, when combined with clinical information, offer a broad immune profile of peanut allergic and sensitized tolerant infants.
Collapse
Affiliation(s)
- Amanda R Tursi
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicholas K Saba
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Diane Dunham
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA, USA
| | - Monali Manohar
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA, USA
| | - Rachel L Peters
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy & Asthma Research, Stanford University, Stanford, CA, USA
| | - Melanie R Neeland
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
| | - Sandra Andorf
- Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Divisions of Allergy and Immunology and of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| |
Collapse
|
|
30
|
Islam N, Chu DK. What is causing the rise in food allergy? A narrative review of risk factors for the development of food allergy in infants and children. FRONTIERS IN ALLERGY 2022; 3:1037596. [PMID: 36506645 PMCID: PMC9731156 DOI: 10.3389/falgy.2022.1037596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nazmul Islam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, ON, Canada
| | - Derek K. Chu
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, ON, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada
| |
Collapse
|
|
31
|
How a Family History of Allergic Diseases Influences Food Allergy in Children: The Japan Environment and Children's Study. Nutrients 2022; 14:nu14204323. [PMID: 36297007 PMCID: PMC9606927 DOI: 10.3390/nu14204323] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
The influence of family allergic history on food allergy in offspring in Japan is unknown. We analyzed data from a nationwide birth cohort study using logistic regression models to examine the associations of maternal, paternal, and both parental histories of allergic diseases (food allergy, atopic dermatitis, asthma, and rhinitis) with their child’s food allergy at 1.5 and 3 years of age. This analysis included 69,379 singleton full-term mothers and 37,179 fathers and their children. All parental histories of allergic diseases showed significant positive associations with their child’s food allergy. When both parents had a history of allergic diseases, the adjusted odds ratio (aOR) tended to be higher than when either parent had allergic diseases (p for trend < 0.0001). The highest aOR was detected when both parents had food allergy (2.60; 95% confidential interval, 1.58−4.27), and the aOR was 1.71 when either parent had food allergy (95% confidential interval, 1.54−1.91). The aORs were attenuated but still had significant positive associations after adjusting for the child’s atopic dermatitis, a risk factor for allergy development. In conclusion, all parental allergic diseases were significantly positively associated with their child’s food allergy. The effect of family history showed a stepwise increase in risk from either parent to both parents, and the highest risk of allergic disease was a parental history of food allergy.
Collapse
|
|
32
|
Idrose NS, Lodge CJ, Peters RL, Douglass JA, Koplin JJ, Lowe AJ, Perrett KP, Tang MLK, Newbigin EJ, Abramson MJ, Erbas B, Vicendese D, Dharmage SC. The role of short-term grass pollen exposure in food skin-prick test reactivity, food allergy, and eczema flares in children. Pediatr Allergy Immunol 2022; 33:e13862. [PMID: 36282135 PMCID: PMC9828461 DOI: 10.1111/pai.13862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/13/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND While the relationship between pollen and respiratory allergies is well-documented, the role of short-term pollen exposure in food allergy and eczema flares has not previously been explored. We aimed to investigate these associations in a population-based sample of children. METHODS We investigated 1- (n = 1108) and 6-year-old (n = 675) children in the grass pollen season from the HealthNuts cohort. Grass pollen concentrations were considered on the day of testing (lag 0), up to three days before (lag 1-lag 3) and cumulatively (lag 0-3). Associations between grass pollen and food skin-prick test reactivity (SPT ≥ 2 mm at age 1 year and ≥ 3 mm at age 6 years), eczema flares, challenge-confirmed food allergy, reaction threshold to oral food challenges (OFC), and serum food-specific IgE levels were analyzed using either logistic or quantile regression models. Atopy and family history of allergic disease were considered as potent effect modifiers. RESULTS Grass pollen at lag 0-3 (every 20 grains/m3 increase) was associated with an up to 1.2-fold increased odds of food SPT reactivity and eczema flares in 6-year-olds. In 1-year-olds, the associations were only observed for peanut in those with a family history of food allergy. Increasing grass pollen concentrations were associated with a lower reaction threshold to OFC and higher serum IgE levels in peanut-allergic 1-year-olds only. CONCLUSION Increasing grass pollen concentration was associated with increased risk of food SPT reactivity and eczema flares in children. The associations in peanut-allergic infants may be related to immune activation and/or peanut and grass pollen cross-reactivity leading to a lower reaction threshold.
Collapse
Affiliation(s)
- Nur Sabrina Idrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia
| | - Jo A Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ed J Newbigin
- School of Biosciences, The University of Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Don Vicendese
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
|
33
|
Eapen AA, Ridley E, Sitarik AR, Joseph C, Nageotte C, Misiak R, Ownby D, Johnson C, Zoratti E, Kim H. Race is a modifier between parental allergy and food allergy in offspring. Pediatr Allergy Immunol 2022; 33:e13840. [PMID: 36003044 PMCID: PMC10278087 DOI: 10.1111/pai.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/16/2022] [Accepted: 08/09/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Amy A Eapen
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - Erica Ridley
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - Alexandra R Sitarik
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Christine Joseph
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Christian Nageotte
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - Rana Misiak
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - Dennis Ownby
- Department of Pediatrics, Augusta University, Augusta, Georgia
| | - Christine Johnson
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Edward Zoratti
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA
| | - Haejin Kim
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Michigan, USA
| |
Collapse
|
|
34
|
Vandenplas Y, Bajerova K, Dupont C, Eigenmann P, Kuitunen M, Meyer R, Ribes-Koninckx C, Salvatore S, Shamir R, Szajewska H. The Cow's Milk Related Symptom Score: The 2022 Update. Nutrients 2022; 14:nu14132682. [PMID: 35807862 PMCID: PMC9268587 DOI: 10.3390/nu14132682] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
CoMiSS® was developed 7 years ago to increase the awareness of health care professionals towards the possibility that symptoms presented by infants could be related to cow’s milk. While CoMiSS was conceived mostly on theoretical concepts, data is now available from 25 clinical trials. Based on this extensive research using the tool since 2015, we aim to propose an updated CoMiSS. The evidence was reviewed, debated and discussed by 10 experts, of whom seven were part of the original group. The panel concluded that the cut-off previously proposed to indicate the likelihood that symptoms may be cow’s milk related should be lowered from ≥12 to ≥10. Data in healthy infants > 6 months are missing. Since the Brussels Infant and Toddlers Stool Scale (BITSS) was recently developed for non-toilet trained children, the Bristol Stool Scale was changed to the BITSS without changing the impact of stool characteristics on CoMiSS. Overall, CoMiSS raises awareness that symptoms might be cow’s milk related. New studies are needed to determine if the change in cut-off and other small adaptions improve its sensitivity and specificity. Data for CoMiSS is still needed in presumed healthy infants between 6 and 12 months old. There may also be regional differences in CoMiSS, in healthy infants as well as in those with cow’s milk allergy. Finally, we emphasize that CoMiSS is an awareness tool and not a diagnostic test.
Collapse
Affiliation(s)
- Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan 101, 1090 Brussels, Belgium
- Correspondence: ; Tel.: +32-475748794
| | - Katerina Bajerova
- Department of Pediatrics, University Hospital Brno and Masaryk’s University, 625 00 Brno, Czech Republic;
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk´s University, 625 00 Brno, Czech Republic
| | - Christophe Dupont
- Ramsay Group, France et Clinique Marcel Sembat, Paris Descartes University, Boulogne-Billancourt, 75004 Paris, France;
| | - Philippe Eigenmann
- Pediatric Allergy Unit, University Hospitals of Geneva, 1205 Geneva, Switzerland;
| | - Mikael Kuitunen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland;
| | - Rosan Meyer
- Department Paediatrics, Imperial College London, London SW7 2BX, UK;
- Department Dietetics, Winchester University, Winchester SO23 4NR, UK
- Department Medicine, KU Leuven, 3001 Leuven, Belgium
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology, La Fe University Hospital, Instituto de Iinvestigacion Sanitaria La FE Valencia, 46026 Valencia, Spain;
| | - Silvia Salvatore
- Department of Paediatrics, University of Insubria, 21100 Varese, Italy;
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Lea and Arieh Pickel for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel;
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, 02-014 Warsaw, Poland;
| |
Collapse
|
|
35
|
Palmer DJ, Sullivan TR, Campbell DE, Nanan R, Gold MS, Hsu PS, Netting MJ, McWilliam V, Koplin JJ, Perrett KP, Quinn P, O'Sullivan M, Prescott SL, Grivell R, Makrides M. PrEggNut Study: protocol for a randomised controlled trial investigating the effect of a maternal diet rich in eggs and peanuts from <23 weeks' gestation during pregnancy to 4 months' lactation on infant IgE-mediated egg and peanut allergy outcomes. BMJ Open 2022; 12:e056925. [PMID: 35697444 PMCID: PMC9196184 DOI: 10.1136/bmjopen-2021-056925] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Clinical studies supported by immunological data indicate early life intervention strategies to be promising in reducing the growing global burden of food allergies. The events that predispose to food allergy, including the induction of allergen-specific immune responses, appear to be initiated early in development. Early exposure to food allergens in utero and via breast milk is likely to be important in initiating oral tolerance. We aim to determine the effectiveness of higher maternal food allergen consumption during pregnancy and lactation on infant food allergy outcomes. METHODS AND ANALYSIS This is a multisite, parallel, two-arm (1:1 allocation), single-blinded (outcome assessors, statistical analyst and investigators), randomised controlled trial. Pregnant women (<23 weeks' gestation) whose (unborn) infants have at least two biological family members (mother, father or siblings) with medically diagnosed allergic disease are eligible to participate. After obtaining written informed consent, pregnant women are randomised to either a high egg and peanut diet (at least 6 eggs and 60 peanuts per week) or standard (low) egg and peanut diet (no more than 3 eggs and 30 peanuts per week). The women are asked to follow their allocated diet from <23 weeks' gestation to 4 months' lactation. The primary outcome is food challenge proven IgE-mediated egg and/or peanut allergy in the infants at 12 months of age. Key secondary outcomes include infant sensitisation to egg and/or peanut and infant eczema. Our target sample size is 2136 women. Analyses will be performed on an intention-to-treat basis according to a pre-specified statistical analysis plan. ETHICS AND DISSEMINATION Ethical approval has been granted from the Women's and Children's Health Network Human Research Ethics Committee (approval number HREC/18/WCHN/42). Trial results will be presented at scientific conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12618000937213.
Collapse
Affiliation(s)
- Debra J Palmer
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Dianne E Campbell
- Discipline of Child and Adolescent Health, The University of Sydney, Lidcombe, New South Wales, Australia
- Department of Allergy and Immunology; and Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ralph Nanan
- Charles Perkins Center, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael S Gold
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Peter S Hsu
- Discipline of Child and Adolescent Health, The University of Sydney, Lidcombe, New South Wales, Australia
- Department of Allergy and Immunology; and Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Merryn J Netting
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Department of Nutrition, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Vicki McWilliam
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Allergy and Immunology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsten P Perrett
- Department of Allergy and Immunology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Quinn
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Michael O'Sullivan
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Immunology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Susan L Prescott
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Immunology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Rosalie Grivell
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
|
36
|
Susanto NH, Lowe AJ, Salim A, Koplin JJ, Tang MLK, Suaini NHA, Ponsonby AL, Allen KJ, Dharmage SC, Erbas B. Associations between grass pollen exposures in utero and in early life with food allergy in 12-month-old infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:712-722. [PMID: 32677468 DOI: 10.1080/09603123.2020.1793920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
Birth during pollen seasons may influence food allergy risk but no study has assessed pollen exposure. Using the HealthNuts population-based cohort of 5276 infants, we assessed grass pollen exposures, in utero and up to the first 6 months of life, on hen's egg, sesame and peanut allergy outcomes at 12 months. Cumulative pollen exposure in the first 7 days of life increased risk of peanut sensitization aMOR (adjusted multinomial odds ratio) = 1.21 (95% CI: 1.01-1.44). Exposure between first 4-6 months of life increased risk of hen's egg aMOR = 1.02 (95% CI: 1.004-1.04) and sensitization to all foods aMOR = 1.02 (95% CI: 1.003-1.04). Grass pollen exposure was associated with food challenge diagnosed food allergy, but only among infants with a maternal history of food allergy. Exposure to grass pollen in the intrauterine period and infancy may be important but more studies are needed to replicate these findings.
Collapse
Affiliation(s)
- Nugroho Harry Susanto
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta, Indonesia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Agus Salim
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Jennifer J Koplin
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Mimi L K Tang
- The Murdoch Children's Research Institute, Parkville, Australia
- The Department of Paediatrics, University of Melbourne, Parkville, Australia
- The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Noor H A Suaini
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Anne-Louise Ponsonby
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- The Murdoch Children's Research Institute, Parkville, Australia
| | - Katrina J Allen
- The Murdoch Children's Research Institute, Parkville, Australia
- The Department of Paediatrics, University of Melbourne, Parkville, Australia
- The Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
- The Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
|
37
|
Jiao L, Su CW, Cao T, Zheng S, Walker WA, Shi HN. Maternal Influences and Intervention Strategies on the Development of Food Allergy in Offspring. Front Immunol 2022; 13:817062. [PMID: 35281070 PMCID: PMC8904425 DOI: 10.3389/fimmu.2022.817062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
Food allergies and other immune-mediated diseases have become serious health concerns amongst infants and children in developed and developing countries. The absence of available cures limits disease management to allergen avoidance and symptomatic treatments. Research has suggested that the presence of maternal food allergies may expose the offspring to genetic predisposition, making them more susceptible to allergen sensitization. The following review has focused on epidemiologic studies regarding maternal influences of proneness to develop food allergy in offspring. The search strategy was "food allergy OR maternal effects OR offspring OR prevention". A systematically search from PubMed/MEDLINE, Science Direct and Google Scholar was conducted. Specifically, it discussed the effects of maternal immunity, microbiota, breastfeeding, genotype and allergy exposure on the development of food allergy in offspring. In addition, several commonly utilized prenatal and postpartum strategies to reduce food allergy proneness were presented, including early diagnosis of high-risk infants and various dietary interventions.
Collapse
Affiliation(s)
- Lefei Jiao
- School of Marine Sciences, Ningbo University, Ningbo, China
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Chien-Wen Su
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Tinglan Cao
- Laboratory for Lipid Medicine and Technology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Shasha Zheng
- Department of Nutrition, California Baptist University, Riverside, CA, United States
| | - W. Allan Walker
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| | - Hai Ning Shi
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States
| |
Collapse
|
|
38
|
Quake AZ, Liu TA, D’Souza R, Jackson KG, Woch M, Tetteh A, Sampath V, Nadeau KC, Sindher S, Chinthrajah RS, Cao S. Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study. Nutrients 2022; 14:nu14040737. [PMID: 35215387 PMCID: PMC8879339 DOI: 10.3390/nu14040737] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 01/09/2023] Open
Abstract
The incidence and prevalence of food allergy (FA) is increasing. While several studies have established the safety and efficacy of early introduction of single allergens in infants for the prevention of FA, the exact dose, frequency, and number of allergens that can be safely introduced to infants, particularly in those at high or low risk of atopy, are still unclear. This 1-year pilot study evaluated the safety of the early introduction of single foods (milk, egg, or peanut) vs. two foods (milk/egg, egg/peanut, milk/peanut) vs. multiple foods (milk/egg/peanut/cashew/almond/shrimp/walnut/wheat/salmon/hazelnut at low, medium, or high doses) vs. no early introduction in 180 infants between 4-6 months of age. At the end of the study, they were evaluated for plasma biomarkers associated with food reactivity via standardized blood tests. Two to four years after the start of the study, participants were evaluated by standardized food challenges. The serving sizes for the single, double, and low dose mixtures were 300 mg total protein per day. The serving sizes for the medium and high dose mixtures were 900 mg and 3000 mg total protein, respectively. Equal parts of each protein were used for double or mixture foods. All infants were breastfed until at least six months of age. The results demonstrate that infants at either high or low risk for atopy were able to tolerate the early introduction of multiple allergenic foods with no increases in any safety issues, including eczema, FA, or food protein induced enterocolitis. The mixtures of foods at either low, medium, or high doses demonstrated trends for improvement in food challenge reactivity and plasma biomarkers compared to single and double food introductions. The results of this study suggest that the early introduction of foods, particularly simultaneous mixtures of many allergenic foods, may be safe and efficacious for preventing FA and can occur safely. These results need to be confirmed by larger randomized controlled studies.
Collapse
|
|
39
|
Che D, Yu L, Guo Y, Ke HJ, Liu C, Wu JL. Correlation between vitamin D levels and bone metabolism in children with cow's milk allergy. J Int Med Res 2022; 50:3000605211066071. [PMID: 34994215 PMCID: PMC8753241 DOI: 10.1177/03000605211066071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Research is limited regarding biochemical markers of bone metabolism among children with cow’s milk protein allergy (CMPA). We aimed to determine differences in vitamin D and bone metabolism markers between infants with CMPA and healthy infants and explore relationships between these in a cross-sectional study. Methods In total, we included 41 children diagnosed with CMPA and under systematic medical and nutritional care at our center, and 50 healthy children as a control group. We reviewed demographic and clinical characteristics and measured serum biomarkers. Results We found that serum 25-hydroxyvitamin D (25(OH)D) levels among infants in the CMPA group were significantly lower than those in the control group, and levels of bone-specific alkaline phosphatase (BALP), serum phosphorus, and serum calcitonin were reduced. Pearson correlation analysis showed that serum 25(OH)D concentrations in the CMPA group were negatively correlated with parathyroid hormone but not significantly correlated with calcitonin and BALP. Logistic regression showed that CMPA was a risk factor for vitamin D deficiency. Conclusions Our study indicated that CMPA was associated with disturbances in bone metabolism. Levels of vitamin D in children with CMPA were lower than those in healthy children. CMPA was a risk factor for vitamin D deficiency.
Collapse
Affiliation(s)
- Di Che
- Department of Children's Health Care, 90405Guangdong Women and Children Hospital, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Li Yu
- Department of Children's Health Care, 90405Guangdong Women and Children Hospital, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yong Guo
- Department of Children's Health Care, 90405Guangdong Women and Children Hospital, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hai-Jin Ke
- Department of Children's Health Care, 90405Guangdong Women and Children Hospital, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cui Liu
- Department of Children's Health Care, 90405Guangdong Women and Children Hospital, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jie-Ling Wu
- Department of Children's Health Care, 90405Guangdong Women and Children Hospital, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
|
40
|
Yang X, Zhou C, Guo C, Wang J, Chen I, Wen SW, Krewski D, Yue L, Xie RH. The prevalence of food allergy in cesarean-born children aged 0-3 years: A systematic review and meta-analysis of cohort studies. Front Pediatr 2022; 10:1044954. [PMID: 36733768 PMCID: PMC9887154 DOI: 10.3389/fped.2022.1044954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Previous studies reported a higher risk of food allergy for cesarean-born children than vaginal-born children. This study aims to systematically compare the prevalence of food allergy among cesarean-born and vaginal-born children aged 0-3 years. METHODS Three English and two Chinese databases were searched using terms related to food allergies and cesarean sections. Cohort studies that reported the prevalence of food allergy in cesarean-born and vaginal-born children aged 0-3 years were included. Two reviewers performed study selection, quality assessment, and data extraction. The pooled prevalence of food allergy in cesarean-born and vaginal-born children was compared by meta-analysis. RESULTS Nine eligible studies, with 9,650 cesarean-born children and 20,418 vaginal-born children aged 0-3 years, were included. Of them, 645 cesarean-born children and 991 vaginal-born children were identified as having food allergies. The pooled prevalence of food allergy was higher in cesarean-born children (7.8%) than in vaginal-born children (5.9%). Cesarean section was associated with an increased risk of food allergy [odds ratio (OR): 1.45; 95% confidence interval (CI): 1.03-2.05] and cow's milk allergy (OR: 3.31; 95% CI: 1.98-5.53). Additionally, cesarean-born children with a parental history of allergy had an increased risk of food allergy (OR: 2.60; 95% CI: 1.28-5.27). CONCLUSION This study suggests that cesarean sections was associated with an increased risk of food and cow's milk allergies in children aged 0-3 years. Cesarean-born children with a parental history of allergy demonstrated a higher risk for food allergy than did vaginal-born children. These results indicate that caregivers should be aware of the risks of food allergies in cesarean-born children, reducing the risk of potentially fatal allergic events. Further research is needed to identify the specific factors affecting food allergies in young children. SYSTEMATIC REVIEW REGISTRATION http://www.crd.york.ac.uk/prospero, identifier: International Prospective Register of Systematic Reviews (NO. CRD42019140748).
Collapse
Affiliation(s)
- Xiaoxian Yang
- School of Health and Nursing, Wuxi Taihu University, Wuxi, China
| | - Chuhui Zhou
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Chentao Guo
- Department of Epidemiology, Xishan Center for Disease Control and Prevention, Wuxi, China
| | - Jie Wang
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,School of Nursing, Southern Medical University, Guangzhou, China
| | - Innie Chen
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shi Wu Wen
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel Krewski
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.,McLaughlin Centre for Population Health Risk Assessment, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.,Risk Science International, Ottawa, ON, Canada
| | - Liqun Yue
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ri-Hua Xie
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China.,The Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
|
41
|
Fang H, Ma Z, Chen L, Xian R, Wang J, Chen J, Li H, Hu Y. Trends in the contributions of atopic family history to pediatric food sensitization and allergy. Front Pediatr 2022; 10:967930. [PMID: 36568419 PMCID: PMC9768553 DOI: 10.3389/fped.2022.967930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Family history of atopic diseases (FHA) contributes to food allergy (FA). But little is known whether FHA primarily increases IgE-mediated, non-IgE-mediated FA, or both. And the trends in the contributions of FHA to food sensitization (FS) and FA remain unclear. We aim to clarify the associations among FHA, FS and FA and to understand the trends in the contributions of FHA to FS and FA. METHODS We used chi-square test and mediating effect model to analyze the associations among FHA, FS and FA through comparisons between two cross-sectional investigations on FA in children under 2 years old in 2009 and 2019. RESULTS In 2009 and 2019, the positive FHA proportion tended to be increasing without significance (28.9% to 31.6%, P = 0.39). Subgroup analysis showed the FS rate in FA group decreased significantly (37/39 to 44/62, P = 0.003). In 2009, the FS rate and FA prevalence were higher in FHA (+) group than in FHA (-) group (26% vs. 14.7%, P = 0.008 and 15% vs. 7.7%, P = 0.03), and FS had a complete mediating effect on the association between FHA and FA (Z = 2.54, P = 0.011), but the results lost significance in 2019. CONCLUSIONS The association between FHA and FA was completely mediated by FS, which means FHA mainly increases IgE-mediated FA. And the contributions of FHA to FS and FA tended to be stabilized or even diminished, which means FHA alone could no longer be enough to screen high-risk children.
Collapse
Affiliation(s)
- Heping Fang
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Zhuoying Ma
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Lin Chen
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Ruoling Xian
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Juan Wang
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Jing Chen
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Haiqi Li
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| | - Yan Hu
- Department of Child Health Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Chongqing, China
| |
Collapse
|
|
42
|
Tokura Y, Hayano S. Subtypes of atopic dermatitis: From phenotype to endotype. Allergol Int 2022; 71:14-24. [PMID: 34344611 DOI: 10.1016/j.alit.2021.07.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Atopic dermatitis (AD) is a heterogenous disorder and can be classified into different types. Stratification of subtypes may enable personalized medicine approaches. AD can be categorized into the IgE-high, extrinsic subtype and the IgE-normal, intrinsic subtype. While extrinsic AD is the major subtype possessing skin barrier impairment (high incidence of filaggrin mutations), intrinsic AD occupies about 20% of AD with female dominance and preserved barrier. Extrinsic AD exhibits protein allergy and food allergy, but intrinsic AD shows metal allergy possibly in association with suprabasin deficiency. In particular, accumulated knowledge of food allergy has more clearly characterized extrinsic AD. European American (EA) and Asian AD subtypes have been also proposed. Asian patients with AD are characterized by a unique blended immune dysregulation and barrier feature phenotype between EA patients with AD and those with psoriasis. In another ethnic study, filaggrin loss-of-function mutations are not prevalent in African American patients with AD, and Th1/Th17 attenuation and Th2/Th22 skewing were seen in these patients. Recent endotype classification provides new insights for AD and other allergic disorders. Endotype is defined as the molecular mechanisms underlying the visible features/phenotype. Endotype repertoire harbors activation of type 2 cytokines, type 1 cytokines, and IL-17/IL-22, impairment of epidermal barrier, and abnormalities of intercellular lipids. Classification of endotype has been attempted with serum markers. These lines of evidence indicate a need for personalized or precision medicine appropriate for each subtype of AD.
Collapse
Affiliation(s)
- Yoshiki Tokura
- Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan; Department of Dermatology, Chutoen General Medical Center, Kakegawa, Japan.
| | - Satoshi Hayano
- Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan; Department of Pediatrics, Chutoen General Medical Center, Kakegawa, Japan
| |
Collapse
|
|
43
|
Abstract
A cross-sectional study compared feeding difficulties in children aged 2-5 years fed a cows' milk elimination diet due to food allergy with a control group on an unrestricted diet. All data were obtained online. Specific questionnaires evaluated three types of feeding difficulties: avoidant eating, picky eating and feeding problems. The median scores of feeding difficulties in the elimination diet (n 146) and control (n 109) groups were, respectively: picky eating (31 v. 27; P = 0·148), avoidant eating (3 v. 3; P = 0·508) and feeding problems (38 v. 34, P = 0·032). Picky eating was more frequent in the elimination diet (35·4 %) than in the controls (23·3 %; P = 0·042), but no difference was observed for avoidant eating (23·9 % v. 20·4 %, P = 0·508) and feeding problems (32·1 % v. 28·4 %, P = 0·541). Picky eating was associated with lower values of weight-for-age z-scores in both groups. Multivariate analyses identified associations of the three feeding difficulties with previous food refusal and/or inappetence in the elimination diet group. Current constipation and anticipatory gagging were associated with feeding difficulties in both groups. In conclusion, children on an elimination diet presented higher frequency of picky eating and higher scores of feeding problems. Picky eating was associated with lower values of weight-for-age z-scores. Food refusal and/or inappetence as clinical manifestations of food allergy were associated with feeding difficulties at the moment of the survey. Current constipation and anticipatory gagging were associated with picky eating, avoidant eating and feeding problems.
Collapse
|
|
44
|
Breathnach A, Geoghegan R, Moylett E. Parental intentions regarding introduction of common food allergens during complimentary feeding. Pediatr Allergy Immunol 2021; 32:1384-1387. [PMID: 33772876 DOI: 10.1111/pai.13512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Edina Moylett
- Academic Department of Paediatrics, NUI Galway, Galway, Ireland
| |
Collapse
|
|
45
|
Pyrhönen K, Kulmala P. Atopic diseases of the parents predict the offspring's atopic sensitization and food allergy. Pediatr Allergy Immunol 2021; 32:859-871. [PMID: 33527507 DOI: 10.1111/pai.13462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In genetic studies and selected study populations, parental atopy has been associated with atopic diseases in offspring. Our aim was to identify the association between parental atopic diseases and the offspring's atopic sensitization and food allergies, and their effect modifications due to the offspring's sex. METHODS The study population (N = 5564) (born between 2001 and 2006) was identified from the population register and live in the province of South Karelia, Finland. Questionnaire-based information on parental atopic diseases was available for 3592 children. The results of skin prick tests, specific IgE tests, and open food challenges (OFC) were collected from patient records. RESULTS By 12 years of age, the cumulative incidence of sensitization to food (14% vs 7%, hazard ratio 2.13; 95% CI 1.68-2.69), animal (10% vs 6%, 1.86; 1.42-2.44), and pollen allergens (12% vs 6%, 2.43; 1.85-3.19), as well as food allergies (positive OFC, 5% vs 2%, 2.28; 1.57-3.33), was higher in the offspring of parents with atopic diseases. The cumulative incidence for pollen sensitization was twofold higher for the female offspring of parents with atopic diseases than those of parents without, while it was almost threefold higher among males. The association between parental pollen allergy and the offspring's pollen sensitization was modified by sex according to additive scale estimates (RERI 1.03; 95% CI 0.13-1.91). CONCLUSION Until adolescence, parental atopic diseases have a relatively strong association with the offspring's, particularly male offspring's, atopic sensitization, and food allergies. A pronounced association was found between parental pollen allergy and the male offspring's pollen sensitization.
Collapse
Affiliation(s)
- Kaisa Pyrhönen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Petri Kulmala
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Biomedicine Research Unit, Medical Microbiology and Immunology, University of Oulu, Oulu, Finland
| |
Collapse
|
|
46
|
Cow's Milk Protein Allergy as a Model of Food Allergies. Nutrients 2021; 13:nu13051525. [PMID: 33946553 PMCID: PMC8147250 DOI: 10.3390/nu13051525] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
Cow's milk allergy (CMA) is one of the most common food allergies in infants, and its prevalence has increased over recent years. In the present paper, we focus on CMA as a model of food allergies in children. Understanding the diagnostic features of CMA is essential in order to manage patients with this disorder, guide the use of an elimination diet, and find the best moment to start an oral food challenge (OFC) and liberalize the diet. To date, no shared tolerance markers for the diagnosis of food allergy have been identified, and OFC remains the gold standard. Recently, oral immunotherapy (OIT) has emerged as a new therapeutic strategy and has changed the natural history of CMA. Before this, patients had to strictly avoid the food allergen, resulting in a decline in quality of life and subsequent nutritional, social, and psychological impairments. Thanks to the introduction of OIT, the passive approach involving rigid exclusion has changed to a proactive one. Both the heterogeneity in the diagnostic process among the studies and the variability of OIT data limit the comprehension of the real epidemiology of CMA, and, consequentially, its natural history. Therefore, well-planned randomized controlled trials are needed to standardize CMA diagnosis, prevention, and treatment strategies.
Collapse
|
|
47
|
Idrose NS, Tham RCA, Lodge CJ, Lowe AJ, Bui D, Perret JL, Vicendese D, Newbigin EJ, Tang MLK, Aldakheel FM, Waidyatillake NT, Douglass JA, Abramson MJ, Walters EH, Erbas B, Dharmage SC. Is short-term exposure to grass pollen adversely associated with lung function and airway inflammation in the community? Allergy 2021; 76:1136-1146. [PMID: 32815173 DOI: 10.1111/all.14566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between grass pollen exposure and early markers of asthma exacerbations such as lung function changes and increase in airway inflammation is limited. We investigated the associations between short-term grass pollen exposure and lung function and airway inflammation in a community-based sample, and whether any such associations were modified by current asthma, current hay fever, pollen sensitization, age, and other environmental factors. METHODS Cross-sectional and short-term analyses of data from the Melbourne Atopy Cohort Study (MACS) participants (n = 936). Lung function was assessed using spirometry. Airway inflammation was assessed by fractional exhaled nitric oxide (FeNO) and exhaled breath condensate pH and nitrogen oxides (NOx). Daily pollen counts were collected using a volumetric spore trap. The associations were examined by linear regression. RESULTS Higher ambient levels of grass pollen 2 days before (lag 2) were associated with lower mid-forced expiratory flow (FEF25%-75% ) and FEV1 /FVC ratio (Coef. [95% CI] = -119 [-226, -11] mL/s and -1.0 [-3.0, -0.03] %, respectively) and also 3 days before (lag 3). Increased levels of grass pollen a day before (lag 1) were associated with increased FeNO (4.35 [-0.1, 8.7] ppb) and also at lag 2. Adverse associations between pollen and multiple outcomes were greater in adults with current asthma, hay fever, and pollen sensitization. CONCLUSION Grass pollen exposure was associated with eosinophilic airway inflammation 1-2 days after exposure and airway obstruction 2-3 days after exposure. Adults and individuals with asthma, hay fever, and pollen sensitization may be at higher risk.
Collapse
Affiliation(s)
- Nur Sabrina Idrose
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
| | - Rachel C. A. Tham
- Mary MacKillop Institute for Health Research Australian Catholic University Melbourne Vic. Australia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
| | - Dinh Bui
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
| | - Don Vicendese
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
- Department of Mathematics and Statistics La Trobe University Bundoora Vic. Australia
| | - Edward J. Newbigin
- School of BioSciences The University of Melbourne Parkville Vic. Australia
| | - Mimi L. K. Tang
- Allergy and Immunology Murdoch Children’s Research Institute Royal Children’s Hospital Melbourne Vic Australia
- Department of Pediatrics University of Melbourne Melbourne Vic. Australia
| | - Fahad M. Aldakheel
- Department of Clinical Laboratory Sciences College of Applied Medical Sciences King Saud University Riyadh Saudi Arabia
| | - Nilakshi T. Waidyatillake
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
| | - Jo A. Douglass
- Department of Clinical Immunology and Allergy Royal Melbourne Hospital Parkville Vic. Australia
- Department of Medicine University of Melbourne Melbourne Vic. Australia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine Monash University Melbourne Vic. Australia
| | - Eugene Haydn Walters
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
- School of Medicine University of Tasmania Hobart Tas Australia
| | - Bircan Erbas
- School of Psychology and Public Health La Trobe University Bundoora Vic. Australia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit Melbourne School of Population and Global Health The University of Melbourne Carlton Vic. Australia
| |
Collapse
|
|
48
|
Keet C, Pistiner M, Plesa M, Szelag D, Shreffler W, Wood R, Dunlop J, Peng R, Dantzer J, Togias A. Age and eczema severity, but not family history, are major risk factors for peanut allergy in infancy. J Allergy Clin Immunol 2021; 147:984-991.e5. [PMID: 33483153 PMCID: PMC8462937 DOI: 10.1016/j.jaci.2020.11.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whether to screen high-risk groups before early peanut introduction is controversial. OBJECTIVE We sought to determine the risk of peanut allergy (PA) before peanut introduction for infants with (1) moderate-severe eczema, (2) another food allergy (FA), and/or (3) a first-degree relative with peanut allergy (FH). METHODS Infants aged 4 to 11 months with no history of peanut ingestion, testing, or reaction and at least 1 of the above risk factors received peanut skin prick test and, depending on skin prick test wheal size, oral food challenge or observed feeding. RESULTS A total of 321 subjects completed the enrollment visit (median age, 7.2 months; 58% males); 78 had eczema only, 11 FA only, 107 FH only, and 125 had multiple risk factors. Overall, 18% of 195 with eczema, 19% of 59 with FA, and 4% of 201 with FH had PA. Only 1% of 115 with FH and no eczema had PA. Among those with eczema, older age (odds ratio [OR], 1.3; 95% CI, 1.04-1.68 per month), higher SCORing Atopic Dermatitis score (OR, 1.19; 95% CI, 1.06-1.34 per 5 points), black (OR, 5.79; 95% CI, 1.92-17.4 compared with white), or Asian race (OR, 6.98; 95% CI, 1.92-25.44) and suspected or diagnosed other FA (OR, 3.98; 95% CI, 1.62-9.80) were associated with PA. CONCLUSIONS PA is common in infants with moderate-severe eczema, whereas FH without eczema is not a major risk factor, suggesting screening only in those with significant eczema. Even within the first year of life, introduction at later ages is associated with a higher risk of PA among those with eczema, supporting introduction of peanut as early as possible.
Collapse
Affiliation(s)
- Corinne Keet
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
| | - Michael Pistiner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Mihaela Plesa
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Daria Szelag
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Wayne Shreffler
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Robert Wood
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Joan Dunlop
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Jennifer Dantzer
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| |
Collapse
|
|
49
|
Maternal awareness to the timing of allergenic food introduction in Saudi infants: A cross-sectional study. Int J Pediatr Adolesc Med 2021; 8:239-245. [PMID: 34401449 PMCID: PMC8356115 DOI: 10.1016/j.ijpam.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/15/2020] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
Background Current guidelines recommend the introduction of allergenic foods as early as 4–6 months of age to decrease the risk of food allergy. However, caregivers’ knowledge about such practices and adherence to them is ambiguous. Objectives The purpose of this study was to evaluate the timing of introduction of potentially allergenic foods into children’s diet and the level of maternal awareness about and degree of compliance with current recommendations. Materials and methods We conducted a cross-sectional study from May 2019 to January 2020 at Imam Mohammad Ibn Saud Islamic University Medical Center, Riyadh, Saudi Arabia. Data were collected through questionnaire-based surveys, and a total of 405 mothers were enrolled in the study. The eligibility criteria included mothers of children between the ages of 12 and 36 months. Results Most mothers in this study had initiated allergenic foods, and the average time of introduction was 9.84 ± 3.16 months for eggs, 14.6 ± 5.78 months for peanuts, and 13.6 ± 5.37 months for fish. Around one-quarter (n = 102, 25.2%) of the children were identified as being in the high-risk group. Most mothers did not know or disagreed that the timing of introducing allergenic foods might help in preventing food allergy, but there was no difference between the risk groups (33.8% and 26.2%, respectively). Moreover, only 18.6% and 13.2% of the high- and low-risk groups, respectively, received correct information from their health care providers (P = .004). Mothers with only one child were less likely to start eggs at an early age (odds ratio [OR] = 0.5 and P = .005). Furthermore, children at a high risk of food allergy were two times more likely to start eggs at an earlier age (OR = 2.12 and P = .003). Conclusion In this study, the allergenic food feeding practices being followed for infants and young children were found to be suboptimal. Parental education level and the number of siblings were identified as potential barriers to the implementation of and adherence to recent guidelines. There is a need for corrective measures to ensure safe and appropriate feeding practices in the Saudi community.
Collapse
|
|
50
|
Current insights into the genetics of food allergy. J Allergy Clin Immunol 2021; 147:15-28. [PMID: 33436162 DOI: 10.1016/j.jaci.2020.10.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022]
Abstract
Food allergy (FA), a growing public health burden in the United States, and familial aggregation studies support strong roles for both genes and environment in FA risk. Deepening our understanding of the molecular and cellular mechanisms driving FAs is paramount to improving its prevention, diagnosis, and clinical management. In this review, we document lessons learned from the genetics of FA that have aided our understanding of these mechanisms. Although current genetic association studies suffer from low power, heterogeneity in definition of FA, and difficulty in our ability to truly disentangle FA from food sensitization (FS) and general atopy genetics, they reveal a set of genetic loci, genes, and variants that continue to implicate the importance of barrier and immune function genes across the atopic march, and FA in particular. The largest reported effects on FA are from MALT1 (odds ratio, 10.99), FLG (average odds ratio, ∼2.9), and HLA (average odds ratio, ∼2.03). The biggest challenge in the field of FA genetics is to elucidate the specific mechanism of action on FA risk and pathogenesis for these loci, and integrative approaches including genetics/genomics with transcriptomics, proteomics, and metabolomics will be critical next steps to translating these genetic insights into practice.
Collapse
|