Prediction of clinical manifestations of food allergy in sensitization to the β-parvalbumin allergen of salmon (Sal s 1)

Background: In the last few decades, along with the lifestyle changes and the development of diagnostic procedures, food allergies have become a serious public health problem. In addition to health problems, they also lead to deterioration of the quality of life of both patients and their families. The aim of the study was to determine the frequency of clinical manifestations in preschoolers suffering from food allergies Methods and Objectives: Cross-sectional study was performed in kindergarten "Dr Simo Milošević" Total number of children aged 2-6 years included in the study was 4123. Data on the type of food allergy and clinical manifestations were used. Symptoms were divided according to respiratory symptoms, contact allergies, allergies on the skin, lips, and gastrointestinal, diarrhea Study instrument was questionnaire for parents. Descriptive and analytical statistics methods were used in statistical data processing. Statistical data processing was done in the SPSS Windows version 25 software package. Results: Out of the total number of children who participated in the research, 41 had a food allergy. Out of the total number of children with allergies, most of the symptoms were related to changes in the skin, 53.7%, followed by changes in the lips, 22%, and diarrhea, 17.1%. Only 7.3% of children with food allergies had an anaphylactic manifestation of allergy. Conclusions: The obtained data show a high frequency of clinical manifestations of food allergies, indicating the importance of early detection of food allergies.

Summary. The prevalence of food allergy is increasing, especially among children. The clinical manifestations of food allergy are different, they depend on the mechanisms of pathogenesis. There is a need to improve diagnostic criteria and early diagnosis of gastrointestinal manifestations of food allergy. Objective. Evaluation of gastrointestinal manifestations in children with food allergies. Materials and methods. Clinical and anamnestic data of 29 children (12 girls, 17 boys) with gastrointestinal manifestations and food allergy were analyzed. Results. Most often, gastrointestinal manifestations of food allergies were found in children aged 4 to 7 years (55.17%, 16/29). Epigastric pain (62.07%, 18/29), meteorism (24.14%, 7/29), undecorated stool with undigested food particles and mucus (27.59%, 8/29%) were most common among children with food allergies. The onset of gastrointestinal intolerance by the age of 6 months was in 44.8% (13/29) of children, 76.9% (10/13) of whom were exclusively breastfed. The first gastrointestinal manifestations after the introduction of supplementary feeding were in 20.69% (6/29); 10.34% (3/29) of patients had gastrointestinal complaints from 3 years of age, and 6.9% (2/29) of patients from 7 years of age. Gastrointestinal disorders as the first manifestation of allergic "march" was observed in 20.69% (6/29%) of patients. IgE-mediated food allergy was found in 72.41% (21/29) of the examined children: immediate gastrointestinal hypersensitivity - 65.51% (19/29); oral allergic syndrome - 6.89% (2/29). Non-IgE-mediated food allergy is represented by protein-induced enterocolitis and proctosigmoiditis in 27.58% (8/29) of children. Conclusions. Clinical symptoms of gastrointestinal manifestations of food allergy in children depend on the immunological mechanisms of its occurrence, it should be taken into during of diagnostic. Gastrointestinal food allergy should be diagnosed in time to prevent the evolution and progression of allergic "march". Therefore, it is necessary to develop and search methods and markers for timely diagnosis of these conditions.

Background: Inherited epidermolysis bullosa (EB) refers to a group of rare inherited disorders characterized by severe damage of skin and in most patients — the gastrointestinal mucosa, what leads to a violation of skin and mucosal barrier properties in relation to allergens. However, the issues of food sensitization and food allergy in this category of patients have not been studied, and the study of this problem is important.Aim: To evaluate the clinical manifestations of food allergy (FA) and IgE-response to food proteins in children with EB.Methods: 82 patients with EB aged from 2 months to 16 years were entered this open non-randomized observational prospective study, including 20 patients with simple form of EB and 62 patients with dystrophic form of EB. We analyzed allergic history and clinical manifestations of the FA in all the patients. Every patient in this study underwent of determination of the concentration of total serum IgE and specific serum IgE to the most important food allergens, as well as to mixtures of household allergens in some cases (UniCAP System, Phadia AB). Results: Skin lesion in patients with EB masks allergic skin manifestations, causing a hypodiagnosis of the FA in this category of patients, which in turn leads to erroneous organization of nutritional support. FA (clinical manifestations) was identified in 20.7% of children with EB (in 10% of cases with simple form of EB and in 24.2% — in patients with dystrophic form of EB). Products containing cow’s milk protein, cereals, and eggs were identified as etiologic factors of FA in most cases. In the group of children with comorbidity FA and EB high and very high levels of total IgE (1000 kUA / l) were detected most frequently. The main cause-significant allergens are cow’s milk proteins, cereals, eggs. Conclusions: Comorbidity with FA is high in patients with dystrophic form of EB. The main cause-significant allergens are cow’s milk proteins, cereals, eggs.

The article presents modern data on the epidemiology, etiology and clinical manifestations of food allergies in children. Evidence-based approaches to diagnosis, including differential, treatment, and prevention of food allergies in children are shown. Patient management tactics and algorithms are presented in detail. The guidelines are based on all available up-to-date data on food allergies. The material is based on the methodological guideline for the management of patients with food allergies previously developed by expert specialists of the Union of Pediatricians of Russia in 2021.

Comparative Study of Food Allergies in Children from China, India, and Russia: The EuroPrevall-INCO Surveys

Adult patients with atopic bronchial asthma are susceptible to food allergy, in more than one third of cases, while asthma is a risk factor for severe life-threatening factors. The aim of the study was to determine the prevalence and relationship of food allergies with atopic bronchial asthma in adults living in Chelyabinsk. Materials and methods. An analysis of 313 outpatient case histories of patients with atopic bronchial asthma over the age of 18 was performed. Results. The presence of food allergy was a factor in the earlier onset of atopic bronchial asthma, which is consistent with the concept of comorbidity of these diseases. Patients with seasonal allergic rhinitis and pollen sensitization have an increased risk of developing food allergies (OR – 2.075 [1.27- 3.39]), p=0,004. The overall incidence of oral allergic syndrome among all patients with atopic asthma and plant sensitization was 33% [28; 37]. Plant products (fruits, honey, nuts) were the cause of food allergic reactions in 87% [80; 92] of adult cases. The main clinical manifestations were: oral allergic syndrome, urticaria, angioedema, shortness of breath. Sensitization to pollen of trees, grasses and weeds approximately equally increases the risk of developing an oral allergic syndrome, upon sensitization to tree pollen (OR – 3.08 [2.32-4.25]), to grass pollen (OR – 3.5 [2.23-5.61]), to weed pollen (OR – 2.86 [2.02-4.03]). The combination of several types of pollen sensitization increases by 4 times the risk of developing oral allergic syndrome to a wide range of foods. Conclusion. Data on the causes and clinical manifestations of food allergies in combination with bronchial asthma have been obtained. The notion of a significant risk of developing dangerous clinical manifestations of food allergy in patients with atopic bronchial asthma will make it possible to reasonably prescribe emergency drugs for independent use.

Non-malignant diseases of the upper gastrointestinal tract (UGIT) involving the mucosa exhibit significant heterogeneity in clinical manifestations, age, gender, and geography. It is known that the prevalence of H. pylori infection has been declining in recent years, while the incidence of allergic diseases has been steadily increasing. Numerous experimental studies have demonstrated that H. pylori eradication increases the risk of developing allergic pathology. However, scientific opinions on this issue are conflicting, necessitating further analysis. The objective of this study was to determine the possible relationship between food allergies and the clinical and endoscopic features of upper gastrointestinal diseases with mucosal lesions in children. Clinical characteristics of patients and study methods. The study included 64 children aged 7 to 17 years with upper gastrointestinal diseases with mucosal lesions, recurrent over a period of 2 years or more. All children had a comorbid condition— atopic dermatitis (AD) associated with food allergy (FA). Patients underwent a clinical examination, including an analysis of complaints, medical and life history, clinical and laboratory parameters, esophagogastroduodenoscopy (EGD) of the upper gastrointestinal tract using an Olympus EVIS EXERA GIF-Q160 video gastroscope, including collection and analysis of biopsy material, a rapid urease test of the biopsy specimen using specialized biochemical test systems for the presence of Helicobacter pylori, and determination of IgG and IgA antibodies to H. pylori in the blood using an enzyme-linked immunosorbent assay. If a fungal infection of the gastrointestinal tract was suspected, circulating Candida antigen was determined using the detection of Candida mannan antigen in serum/plasma using an enzyme-linked immunosorbent assay (Platelia Candida mannan antigen). Results. A significant correlation was established between the incidence of erosive gastritis and the severity of AD associated with PA. Nineteen patients (29.69 %) had Candida-infected gastrointestinal tract infections, while 15 (23.44 %) had fungal-infected adenomatous gastritis. A significant association was found between mycotic infection of the gastrointestinal tract and the incidence of antral, erosive, and pangastritis gastritis, duodenal ulcers, and bulbitis. Analysis of EGDS data revealed endoscopic features of mucosal lesions in gastrointestinal tract infections complicated by Candida infection, which were similar to those seen in Helicobacter pylori infections. Conclusions. The incidence of erosive gastritis is directly proportional to the severity of adenomatous gastritis associated with pancreatic ulcers. Upper gastrointestinal tract lesions: the development of antral and erosive gastritis, pangastritis, duodenal bulb ulcers, and bulbitis may be accompanied by a mycotic infection in the absence of clinical manifestations of food allergy. Endoscopic features of the mucosal condition in upper gastrointestinal tract diseases complicated by candidal infection are morphologically similar to those seen in Helicobacter pylori lesions. Given the endoscopic signs of mucosal lesions in upper gastrointestinal tract diseases complicated by microbiota imbalances, Helicobacter pylori, or Candida infections, it is advisable to include associated probiotics in the complex therapy of upper gastrointestinal tract diseases with concomitant food allergies.

Despite modern achievements in child allergology, the question of evaluating tolerance formation and defining the safest time for expanding the child’s ration after an eliminatory diet remains open. This article contains the results of the authors’ own investigation concerning the practical meaning of specific immunoglobulins (sIg) class G4 as tolerance formation markers at food allergies in children. Thus, it has been found that high levels of sIgG4 are not only a favourable prognostic factor for light manifestations of food allergy, but also an index of a tolerance formation. The prevalence of high food allergy sIgG4 was statistically significantly higher in early age children from the comparison group than in patients with food allergy. Thus the authors suggest that the production of sIgG4 is a normal physiological process which hinders the development of hypersensitivity, while high levels of sIgG4 are evidence for the child’s immune system “contacting” this or that product. Clinical tolerance formation predictors define lighter clinical manifestations of food allergies, a non IgE-mediated form of food allergy and the retention of breastfeeding.

Induction and suppression of allergic diarrhea and systemic anaphylaxis in a murine model of food allergy

Aim: To study the prevalence of food allergy to fish, crustaceans and molluscs in different age groups of children and to assess the frequency of detection of certain clinical manifestations of food allergy in the examined patients. Materials and methods. The study examined 318 children aged one to 18 years with manifestations of food allergy to fish, crustaceans and molluscs. The diagnosis of food allergy and other allergic conditions was made according to the EAACI criteria. Sensitisation to fish, crustacean and mollusc allergens was established when the levels of specific IgE to allergen extracts or molecules presented in the ALEX2 test system (Macro Array Diagnostics GmbH, Austria) were above 0.3 kUA/L. Results. Among the examined children, allergy to fish was most common (p<0.05) in 182 (57.2%) patients, and somewhat less common to crustaceans and molluscs in 103 (32.2%); combined sensitisation to fish, crustaceans and molluscs was found only in 33 (10.4%) children. The most common symptoms of allergy to fish, crustaceans and shellfish were nausea in 82.1-100% of children and vomiting in 42.3-100% of patients. Urticaria and angioedema were more frequently observed in children with food allergy to fish - in 33.3-90.7% of patients, less frequently in children with allergy to crustaceans and molluscs - in 18.8-36.4% of patients. Anaphylaxis was more frequently detected in patients with combined seafood sensitisation - in 21.2% of cases, compared with allergy to fish (8.8%) or crustaceans and molluscs (2.9%). Conclusion. The analysis of literature data and our own studies indicates certain age and regional peculiarities of the clinical course of allergy in sensitisation to fish, crustacean and mollusc allergens. Given the possible development of seafood sensitisation in children from the first years of life, it is worth continuing to study the further clinical course of food allergy and the peculiarities of immunological reactivity, which is necessary to develop optimal treatment and prevention measures and recommendations for such patients.

A couple of decades ago, the diagnostic search for the cause of blood eosinophilia concerned, mainly, the three major allergic diseases (bronchial asthma, allergic rhinitis, atopic dermatitis), or parasitic invasion. In recent years, more and more complex clinical syndromes, from reactive (secondary) eosinophilia to eosinophilic leukemia are increasingly considered by the doctors of different specialties. The aim of our work was to present a clinical case of secondary eosinophilia in a child with minimal clinical manifestations. Highlights: Sometimes blood eosinophilia in a patient is an “unexpected finding” for a physician, especially if the complaints are scanty, nonspecific, and objective examination does not reveal any significant health abnormalities. In the presented case, secondary (reactive) peripheral blood eosinophilia was diagnosed due to intestinal damage induced by food allergens. This clinical case is of practical interest to physicians, presenting a diagnostic search for the cause of blood eosinophilia, which eventually proved to be a mixed IgE/ non-IgE mediated food allergy manifesting as allergic enterocolitis. The IgE-mediated mechanism of food allergy is evidenced by a high level of IgE and its decrease with administered elimination diet; delayed-type response and low severity of clinical manifestations of food allergy, as well as blood eosinophilia suggest a non-IgE mediated food allergy. In this particular case, the severity of laboratory changes (blood eosinophilia, a significant increase in the levels of specific IgE) was associated with scarce intestinal symptoms. An opposite situation is observed, especially, in young children where the disease manifests with a pronounced clinical pattern of enterocolitis in the absence of laboratory changes.

Adverse reactions to foods are a diverse group of clinical syndromes resulting from immunologic and non-immunologic responses to food ingestion. Symptoms can range from mild, self-limiting reactions to severe, life-threatening reactions depending on the mechanism. This review primarily focuses on the clinical manifestations of immunologically derived adverse food reactions or food allergies.The true prevalence of food allergy is unknown. Up to 25% of the general population believes that they may be allergic to some food; however, the actual prevalence of food allergy diagnosed by a provider appears to be 1.5% to 2% of the adult population and approximately 6% to 8% of children. This discrepancy makes it imperative that clinicians are aware of the different food allergy syndromes. With a clear understanding of the clinical manifestations of food allergies, an accurate diagnosis and treatment plan can be formulated. Failing to do so may result in unnecessary dietary restrictions that may adversely affect nutritional status, growth, and quality of life.Most food allergic reactions are secondary to a limited number of foods, and the most common foods causing allergic reactions in children include milk, egg, peanuts, tree nuts, and fish. In adolescents and adults, allergies to peanuts, tree nuts, fish, and shellfish are most prevalent. Food allergies can result from immunoglobulin E (IgE)-mediated, non-IGE-mediated, or mixed IgE/non-IgE mechanisms. The purpose of this review is to discuss the clinical manifestations of each of these types of food allergy.

OC-54 The role of prevention in food allergies

PRS104 - USING OF "THE FOOD HYPERSENSITIVITY FAMILY IMPACT” (FLIP) QUESTIONNAIRE FOR ASSESSMENT OF QUALITY OF LIFE OF FOOD-ALLERGIC CHILD'S FAMILY MEMBERS.

Introduction. Food allergy (FA) being a clinically heterogeneous condition, the only treatment for which is a strong elimination diet. The need to exclude one or more foods from the diet, constant monitoring of the diet, anxiety and excitement about the exacerbation of allergic symptoms lead to a significant decrease in the quality of life. Materials and methods. The study included thirty eight 2-7 year children patients with various clinical manifestations of FA (atopic dermatitis, allergic and alimentary colitis, food-borne dermatitis). The comparison group consisted of twenty seven healthy children matched by age. The quality of life in all children was assessed using the Pediatric Quality of Life - PedsQLTM4.0 questionnaire. Results. All FA children patients showed a significant decrease in the quality of life in terms of such indicators as emotional functioning (60.2 in the main group and 83.5 in the comparison group), social functioning (77.9 in the main group and 88.1 in the comparison group), role functioning or kindergarten functioning (FDS) (77.5 in the main group and 84.9 in the comparison group) and psycho-social health (69.3 in the main group and 85.5 in the comparison group). The overall score in assessing the quality of life is significantly lower in the group of FA children (71 in the main group and 87 in the comparison group). Conclusion. To improve the quality of life of children with FA, there is needed a comprehensive individual approach including both psychological support for the child and his family members, and the solution of issues with the provision of «safe» food in children’s educational institutions.