Food Allergy Research Articles

Enfant présentant une allergie alimentaire en crèche : quelle est la place du Projet d’Accueil Individualisé ? Quels ressentis pour le personnel ?

ContextThe nursery welcomes children from a few months to the age of 3 years, age range where there is an increase in cases of anaphylaxis related to food allergies (FA). ObjectivesTo draw up an inventory of the training and knowledge of staff with regard to FA. Observe the organization of the Individualized Reception Project (IRP) in the nursery. Take stock of the feelings and possible apprehensions of professionals to work on a daily basis with a child with FA. MethodsSurvey conducted in 2023 with 50 staff working in different childcare facilities. ResultsSeventy-four per cent had initial training on FA, 64% had no training on FA since taking a position in nursery and 66% never handled an adrenaline auto-injector (AAI). Twenty-one per cent of the structures have an internal medicine cabinet to support an inaugural reaction of FA and 14% are equipped with AAI (internal stock not taking into account the AAI of possible IRP). Sixty-eight per cent know that they are allowed to apply the IRP themselves in emergency situations in the nursery, in connection with the ministerial circular of 2021. Sixty-six per cent are comfortable in the daily reception of the child with FA, 38% are comfortable with the handling of the AAI. ConclusionGiven the increasing frequency of FA in small children, it is necessary for early childhood professionals to be better trained and informed during their studies and in the nursery, especially on the administration of AAI. It is desirable that an in-house pharmacy be equipped with AAI for the management of inaugural FA.

LUPIN FOOD ALLERGY AND CROSS REACTIVITY WITH PEANUT ALLERGY

LUPIN FOOD ALLERGY AND CROSS REACTIVITY WITH PEANUT ALLERGY

Factors Associated with Weaning in Infants with Cow's Milk Allergy: A Cohort Study.

Objective: To analyze the factors associated with weaning in infants with cow's milk allergy (CMA) treated at a food allergy reference center in a state in the northeast of Brazil. Method: A prospective cohort study, with a case group (children with CMA) and two control groups (symptomatic nonallergic children [SC] and asymptomatic [AC]). At the beginning of the study, 30 children comprised the CMA group, 84 the SC group, and 52 the AC group. Survival analysis was performed to compare breastfeeding time between the three groups and an adjusted linear regression model to verify the factors associated with breastfeeding time. Results: At the beginning of the study, 33.3% of children in the CMA group, 17.1% in the SC group, and 69.6% in the AC group were exclusively breastfeeding (p = 0.005). The most common factors for weaning in children with CMA were the cow's milk elimination diet (30%), allergic symptoms in the child (20%), and breast engorgement (20%). Children who used a cup as a means of offering infant formula spent 281 more days breastfeeding compared with those who used a baby bottle (Bstd = 1.39; p = 0.031). Conclusion: Children with CMA and nonallergic gastrointestinal complaints weaned earlier compared with asymptomatic children. The main causes of weaning in CMA children were maternal difficulty adhering to the elimination diet, breast engorgement, and allergic symptoms in the child. Using a cup was the main factor associated with longer breastfeeding duration, regardless of gastrointestinal symptoms and socioeconomic factors.

From bite to brain: Neuro-immune interactions in food allergy.

Immunoglobulin E (IgE)-mediated food allergies are reported to affect around 3.5% of children and 2.4% of adults, with symptoms varying in range and severity. While being the gold standard for diagnosis, oral food challenges are burdensome, and diagnostic tools based on specific IgE can be flawed. Furthering our understanding of the mechanisms behind food allergy onset, severity and persistence could help reveal immune profiles associated with the disease, to ultimately aid in diagnosis. Alterations to cytokine levels and immune cell ratios have been identified, though further research is needed to fully capture the heterogenous nature of food allergy. Moreover, the existence of such immune alterations also raises the question of potential wider systemic effects. For example, recent research has emphasised the existence and impact of neuro-immune interactions and implicated behavioural and neurological changes associated with food allergy. This review will provide an overview of such food allergy-driven neuro-immune interactions, with the aim of emphasising the importance of furthering our understanding of the immune mechanisms underlying IgE-mediated food allergy.

The Relationship Between Asthma and Food Allergies in Children

Asthma and food allergy are two complex allergic diseases with an increasing prevalence in childhood. They share risk factors, including atopic family history, atopic dermatitis, allergen sensitization, and T2 inflammatory pathways. Several studies have shown that in children with a food allergy, the risk of developing asthma, particularly in early childhood, is high. Food allergen intake or the inhalation of aerosolized allergens can induce respiratory symptoms such as bronchospasm. Patients with both conditions have an increased risk of severe asthma exacerbations, hospitalization, and mortality. The current management of clinical food hypersensitivity primarily involves the dietary avoidance of food allergens and the use of self-injectable adrenaline for severe reactions. Poorly controlled asthma limits the prescription of oral immunotherapy to foods, which has emerged as an alternative therapy for managing food allergies. Biological therapies that are effective in severe asthma have been explored for treating food allergies. Omalizumab improves asthma control and, either alone or in combination with oral immunotherapy, increases the threshold of allergen tolerance. Understanding the interplay between asthma and food allergy is crucial for developing successful treatment approaches and ameliorating patient results.

Rank correlation between atopic comorbidity and laboratory parameters in allergic rhinitis

One of the current cutting-edge problems in allergy and ENT is the study of comorbidity in allergic rhinitis, which is the most common atopic disease among all other atopies. Two decades ago, a new endotype of the disease, local allergic rhinitis, was discovered. In the past, some patients with typical complaints of chronic nasal congestion, persistent runny nose, and other similar symptoms, did not display such characteristic diagnostic criteria as positive allergy skin tests and an increased value of serum total IgE and specific IgE antibodies. They were qualified by allergists and ENT specialists as individualists with non-allergic rhinitis and, accordingly, did not receive adequate treatment. However, their symptoms remained, prompting them to abuse decongestants and resulting in an increased burden on the cardiovascular system. This, along with the burden of concomitant pathology, including other atopies, can be considered a significant medical and social problem. With the purpose to study rank correlation between comorbidity and three laboratory biomarkers, 46 patients with allergic rhinitis were examined. The list of parameters included two routine items such as serum total IgE and eosinophilic cationic protein, and rarely studied IL-4 in skin exudate. Clinical analysis showed that significantly more often allergic rhinitis in patients was combined with bronchial asthma (in 39.1%, p 0.05), less often with food allergy (in 19.6%), atopic dermatitis (in 10.9%), insect allergy (in 8.7%), and allergic urticaria (in 4.5%). In one case, local perennial rhinitis was identified, accompanied by conventional seasonal rhinitis with a high content of serum total IgE and positive allergic skin tests with pollen allergens. Skin tests with household allergens, including house dust mite products, showed a negative result. This case was regarded as a manifestation of the so-called “double” allergic rhinitis. The Spearman correlation demonstrated a negative mean strength relationship between comorbidity and serum IgE and eosinophilic cationic protein (p 0.05). The seemingly paradoxical result can be interpreted quite logically, taking into account immunopathogenetic mechanisms of allergic inflammation. In particular, with an increase in the frequency of atopic comorbidity, the migration of eosinophils from the blood to sites of eosinophilic inflammation increases.

Association of immunoglobulin E levels with glioma risk and survival.

Previous epidemiologic studies have reported an association of serum immunoglobulin E (IgE) levels with reduced glioma risk, but the association between IgE and glioma prognosis has not been characterized. This study aimed to examine how sex, tumor subtype, and IgE class modulate the association of serum IgE levels with glioma risk and survival. We conducted a case-control study using participants from the University of California, San Francisco Adult Glioma Study (1997-2010). Serum IgE levels for total, respiratory and food allergy were measured in adults diagnosed with glioma (n = 1319) and cancer-free controls (n = 1139) matched based on age, sex, and race and ethnicity. Logistic regression was adjusted for patient demographics to assess the association between IgE levels and glioma risk. Multivariable Cox regression adjusted for patient-specific and tumor-specific factors compared survival between the elevated and normal IgE groups. All statistical tests were 2-sided. Elevated total IgE was associated with reduced risk of IDH-wildtype (RR = 0.78, 95% CI: 0.71-0.86) and IDH-mutant glioma (RR = 0.73, 95% CI: 0.63-0.85). In multivariable Cox regression, positive respiratory IgE was associated with improved survival for IDH-wildtype glioma (RR = 0.79, 95% CI: 0.67-0.93). The reduction in mortality risk was significant in females only (RR = 0.75, 95% CI: 0.57-0.98) with an improvement in median survival of 6.9 months (P<.001). Elevated serum IgE was associated with improved prognosis for IDH-wildtype glioma, with a more pronounced protective effect in females than males, which has implications for the future study of IgE-based immunotherapies for glioma.

Safety and adherence of early oral immunotherapy for peanut allergy in a primary care setting: a retrospective cross-sectional study

BackgroundPeanut allergy is a common food allergy with potentially life-threatening implications. Early oral immunotherapy for peanut allergy (P-EOIT) has been shown to be effective and safe in research and specialty clinic settings. Provision of P-EOIT in primary care would make it available to more patients. We sought to assess the safety of P-EOIT in a primary care setting by documenting the rates of peanut-related allergic reactions leading to emergency department (ED) visits and use of epinephrine. We also examined adherence by assessing the percentage of patients reaching maintenance phase and continuing ingestion after one year of P-EOIT.MethodsThis retrospective study included all patients aged less than 36 months who started P-EOIT at a primary care allergy clinic in New Brunswick, Canada, from 2016 to 2020. The population included patients who (1) had a history of an allergic reaction to peanuts with a positive skin prick test or positive peanut specific IgE level (ps-IgE) or (2) no history of ingestion and a baseline ps-IgE ≥5 kU/L. Patients had biweekly clinic visits with graded increases in peanut protein up to a maintenance dose of 300 mg of peanut protein daily. A blinded retrospective review of paper charts and electronic medical records was conducted along with phone interviews regarding ED visits and epinephrine use.ResultsAll 69 consented patients reached maintenance dose over a median of 29 weeks, and 66 patients (95.7%) were still regularly consuming peanut protein after 1 year of maintenance. One patient had a peanut ingestion-related ED visit requiring epinephrine during the escalation phase of peanut protein dosing (1.4%). During the first year of maintenance phase, no patients had peanut ingestion-related ED visits nor required epinephrine.ConclusionEarly oral immunotherapy for peanut allergy in a primary care setting appears to be safe and our findings suggest that it does not lead to an increased burden of emergency department visits. Our population had high adherence rates, with the majority achieving maintenance dose and staying on this dose for one year.

Restaurant staff's knowledge, practices, and attitudes pertaining to food allergy in Qassim region, Saudi Arabia: A cross-sectional analysis.

Food allergies, often triggered by minute amounts of certain foods, affect people of all ages and frequently occur in dining-out settings. Previous research in Saudi Arabia has not investigated the extent of restaurant workers' knowledge of food allergies and their role in protecting patrons from allergic reactions. This descriptive study assessed the knowledge, attitudes, and practices of restaurant staff regarding food allergies in Qassim, Saudi Arabia between January and March 2023. Interviews and observations were conducted in four stages, and data were analyzed using the Environmental Health Specialists Network Food Allergen Study Protocol. Results showed that most restaurant staff had limited knowledge of food allergens and their symptoms, and a small proportion had received specific training on food allergies. Moreover, only 14% of restaurants provided allergen information on their menus. Despite these knowledge gaps, most staff exhibited positive attitudes toward managing food allergies. Findings also indicated that factors such as experience, training, and restaurant policies were associated with higher levels of knowledge and more positive attitudes. These results highlight the urgent need for the restaurant sector to implement food allergy measures, including clear policies and comprehensive training, to prevent potentially life-threatening incidents.

Increasing prevalence of galactose-α-1,3-galactose sensitization in the Danish general adult population.

Alpha-gal syndrome is a novel food allergy to the oligosaccharide galactose-α-1,3-galactose (alpha-gal) present in mammalian meat. Tick bites are considered an important route of sensitization to alpha-gal. Data on alpha-gal sensitization in the general population is scant. We utilized a unique data source of repeated population-based health examination studies to assess prevalence, time trends, risk factors, and characteristics of alpha-gal sensitization. Alpha-gal sensitization was assessed in >11.000 adults from four health examination studies of randomly invited residents in the Copenhagen region conducted in 1990-1991, 2011-2012, 2012-2015, and 2016-2017. Alpha-gal sensitization was defined as serum specific IgE (sIgE) to alpha-gal ≥0.1 kUA/L; ≥0.35 kUA/L; ≥0.7 kUA/L; ≥3.5 kUA/L. The population was characterized according to genetically determined ABO blood group, aeroallergen sensitization, and pets at home. The prevalence of sIgE to alpha-gal ≥0.1 kUA/L was 1.3% in 1990-1991, 3.7% in 2012-2015 and 3.2% in 2016-2017. Of those sensitized to alpha-gal >97% reported to consume red meat at least once a week, even for sIgE to alpha-gal ≥3.5 kUA/L. Male sex, older age, aeroallergen sensitization, cat at home, and blood group A were associated with increased odds of alpha-gal sensitization. The known protective effect of blood group B was confirmed. In this general adult population, the prevalence of alpha-gal sensitization had doubled from 1990-1991 to 2016-2017. This could potentially be due to increased tick exposure and an increased atopic predisposition.

Allergy to aquatic biological resources as food

The review reveals the problem of allergies to fish and other highly allergenic foods. First of all, the products obtained from aquatic organisms are considered. The world production of fish of various species is discussed with the presentation of FAO statistics for recent years in this article. The role of aquaculture in the production of fish, shellfish and crustaceans is considered. In particular, the trends of fishing in the Black Sea and the growth of aquaculture production in Russia are analyzed. Generalized data indicate an increase in the importance of aquatic biological resources (ABR) in a balanced human diet. The study demonstrates the role of parvalbumin in the mechanism of development of allergies to products from ABR. Examples of other allergenic proteins that contain epitopes that trigger allergic reactions in the human body are given. The mechanism of these reactions is briefly described. Attention is drawn to cross-allergic reactions. Anthropogenic factors that can exacerbate allergies to fish products are discussed. These are pesticides, herbicides, antibiotics, detergent components, changes in chemical composition, and food storage conditions. Pseudoallergens with the ability to cause allergic reactions are also mentioned. Allergy symptoms can range from skin rashes and itching to respiratory problems and anaphylaxis. Treatment of fish allergy is similar to treatment for allergies to other foods. It includes the use of antihistamines, corticosteroids and sorbents. Heredity plays a major role in the development of allergic reactions. It is important to pay attention to the purity and quality of products, cooking methods, and also follow a diet. Due to the potentially higher cumulative toxicity of freshwater species, it is recommended that marine fish be preferred.

Giftedness and allergy: A comparative study of the risk factors in gifted and typical children

Aim: To compare the various parameters associated with giftedness and allergy in gifted children within their group and with typical children of average intelligence. Methods: The case-control questionnaire study was conducted in Adıyaman, Türkiye, in April-May 2023. The study included 75 gifted and 190 typical children aged 6-14. The face-to-face survey consisted of 37 questions, 16 of which were added to the 21 questions of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3. Results: The prevalence of recurrent ear infections in gifted children (33.3%) was found to be significantly higher than in typical students (20.5%) (P= 0.028). The rate of asthma in gifted students with recurrent ear infections (40%) was found to be significantly higher than the rate in gifted students without recurrent ear infections (16%) (P=0.022). The rate of allergic rhinitis in gifted students with food allergies (38.5%) was found to be significantly higher than the rate of those without food allergies (11.3%) (P=0.029). The high food selectivity (21.3%) of gifted students was found to be significantly higher than that of typical students (8.4%) (P=0.002). Among the gifted students, 50% of those who were very selective about food had asthma (P=0.014), and 37.5% had allergic rhinitis (P=0.029). Conclusions: The study has shown the association between giftedness and various allergic conditions, suggesting that certain factors like recurrent otitis and food selectivity behavior may contribute to the higher prevalence of these conditions in gifted children.

Egg White Diet Induces Severe Allergic Enteritis in an Animal Model Driven by Caspase-3 and Gasdermin C-Mediated Mucosal Alarmin Secretion.

Allergic enteritis is an important phenotype of food allergies. However, there is not a suitable animal model for deeply exploring the natural progression and mechanism of allergic enteritis. In our study, we successfully developed an allergic enteritis animal model by feeding mice with an egg white diet. Following the dietary challenge, allergic mice displayed typical food allergy manifestations, including decreased core temperature, aversion to the allergenic diet, and elevated levels of serum sIgE and mMCP-1. Notably, these dietary challenged mice exhibited severe gut damage, characterized by disrupted intestinal microstructure, tissue inflammation, and edema that were evident morphologically. Moreover, upon exposure to food allergens, we observed a marked increase in caspase-3 and GSDMC levels in allergic mice. These two active proteins were found to be colocalized in damaged mucosal enterocytes and were associated with the secretion of epithelial sourced alarmins, such as IL25 and TSLP. Further data on the cellular and molecular levels suggest that such severe food-induced enteritis is mediated by the caspase-3-GSDMC pathway. We believe that this established animal model provides a valuable tool for advancing research on the mechanisms of food allergies.

Early-Life Respiratory Syncytial Virus (RSV) Infection Triggers Immunological Changes in Gut-Associated Lymphoid Tissues in a Sex-Dependent Manner in Adulthood.

Severe respiratory syncytial virus (RSV) infection during early life has been linked to gut dysbiosis, which correlates with increased disease severity and a higher risk of developing asthma later in life. However, the impact of such early-life RSV infections on intestinal immunity in adulthood remains unclear. Herein, we show that RSV infection in 3-week-old mice induced persistent differential natural killer (NK) and T cell profiles within the lungs and gastrointestinal (GI) lymphoid tissues (GALT) in adulthood. Notably, male mice exhibited more pronounced RSV-induced changes in immune cell populations in both the lungs and GALT, while female mice displayed greater resilience. Importantly, early-life RSV infection was associated with the chronic downregulation of CD69-expressing T lymphocytes, particularly T regulatory cells in Peyer's patches, which could have a significant impact on T cell functionality and immune tolerance. We propose that RSV infection in early life is a trigger for the breakdown in immune tolerance at mucosal surfaces, with potential implications for airways allergic disease, food allergies, and other GI inflammatory diseases.

Diagnosis and management of shrimp allergy

Shrimp allergy, the most common food allergy in the United States, affects up to 2% of the population. Its etiology is multi-factorial with the combination of genetic predisposition and environmental exposures. This review summarizes the latest diagnosis and management strategies for shrimp allergy. Currently, the double-blind, placebo-controlled food challenge is the gold standard for diagnosis. Moreover, mainstream and experimental management strategies include food allergen avoidance, the FDA-approved omalizumab, and oral immunotherapy. Herein, we emphasize the urgent need to develop more effective diagnostic tools and therapies for shrimp allergy.

Exploring Fish Parvalbumins through Allergen Names and Gene Identities

Parvalbumins are the main source of food allergies in fish meat, with each fish possessing multiple different parvalbumins. The naming convention of these allergens in terms of allergen codes (numbers) is species-specific. Allergen codes for parvalbumin isoallergens and allergen variants are based on sequence identities relative to the first parvalbumin allergen discovered in that particular species. This means that parvalbumins with similar allergen codes, such as catfish Pan h 1.0201 and redfish Seb m 1.0201, are not necessarily the most similar proteins, or encoded by the same gene. Here, we aim to elucidate the molecular basis of parvalbumins. We explain the complicated genetics of fish parvalbumins in an accessible manner for fish allergen researchers. Teleost or modern bony fish, which include most commercial fish species, have varying numbers of up to 22 parvalbumin genes. All have derived from ten parvalbumin genes in their common ancestor. We have named these ten genes “parvalbumin 1-to-10” (PVALB1-to-PVALB10), building on earlier nomenclature established for zebrafish. For duplicated genes, we use variant names such as, for example, “PVALB2A and PVALB2B”. As illustrative examples of our gene identification system, we systematically analyze all parvalbumin genes in two common allergy-inducing species in Japan: red seabream (Pagrus major) and chum salmon (Oncorhynchus keta). We also provide gene identifications for known parvalbumin allergens in various fish species.

New dietary trends and alternative proteins: the emergence of novel food allergens.

New dietary trends driven by environmental and health considerations will undoubtedly lead to the emergence of novel food allergens. Assessment of the allergenic risk of new or modified protein-containing food sources and ingredients, as well as surveillance of emerging food allergies, is then required. Developments of in silico and in vitro models apprehending protein capacity to cross-react with other homologous proteins and to induce a de novo allergic sensitization are ongoing to better integrate multiple parameters such as 3D structural information or major histocompatibility complex class II (MHC-II) presentation propensity. However, the effects of food matrices and food processing still need to be addressed in these models. Consequently, clinical and postmarket surveillance remain of critical importance to alert on emergent food allergies, which are modulated by regional dietary practices. Monitoring of the emergence of food allergens requires close collaborations between allergologists, consumers, patient associations and food safety authorities. We also need to get a consensus on an acceptable level of allergenic risk that offers the possibility to develop and market innovative and sustainable food products.

Lactobacillus rhamnosus Helps to Reduce the Duration of Bleeding in Breastfed Infants with Allergic Proctocolitis.

Background: Cow's milk protein allergy (CMPA) is the most common food allergy in infants. The current standard of care (SOC) involves eliminating the allergen from both the infant's and mother's diet for 2-4 weeks. The purpose of this study is to assess the effectiveness of Lactobacillus rhamnosus (Ramnoflor) in reducing the duration of bleeding in these infants. Methods: This randomized clinical trial was conducted at Bahrami Children's Hospital on breastfed infants who were diagnosed with CMPA and had a positive occult blood (OB) test. Patients were randomly assigned to either the control or case groups. All patients received SOC therapy, with the case group receiving Ramnoflor and the control group receiving a placebo. Data were recorded on the checklist, and the children were followed and visited three times during the study, with an OB assessment at each visit. Results: The study enrolled 48 infants. Among the infants in the case group, the OB test was positive in four cases (8.3%) on the fifth day. However, there were no positive cases on the 14th and 30th days. The prevalence of this test was significantly lower in patients who received probiotics compared to the control group on the fifth day (p < 0.001). There were no positive OB tests on the 14th and 30th days in any of the groups, and no significant difference was observed between the groups. Conclusion: The addition of L. rhamnosus to SOC therapy led to a decrease in the duration of rectal bleeding in infants with CMPA compared to the control group.

Evolving Patterns in Inpatient Pediatric Consultations to Allergy/Immunology at an Academic Medical Center

Background: Consultations to pediatric allergy/immunology are of benefit to many hospitalized inpatients, but there is limited current information about how T-cell receptor excision circles (TREC) screening may have changed these patterns for pediatric populations. We aimed to determine the types of consults being requested and their relative frequencies for primary pediatric allergy/immunology consults under an academic fellowship program since the start of TREC screening in 2016. Information gained could help identify focal concepts for pediatric allergy inpatient training curricula for fellowship and graduate medical education programs. Methods: Under an IRB approved study of an academic allergy fellowship consultation log, we retrospectively reviewed electronic medical records of pediatric allergy and immunology consults and categorized consultations by their primary indication. Results: Three-hundred and eighty-three pediatric allergy/immunology consultations were seen between September 4, 2016 to November 24, 2022. In terms of frequency, the most common consultation was for immunodeficiency evaluation or treatment, n=205 (53.5%), followed by drug allergy n=55 (14.4%), general allergy concerns n=43 (11.2%), skin allergy n=35 (9.1%), and less commonly inflammatory syndromes, n=26 (6.8%) and food allergy, n=19 (5.0%). Questions related to TREC screening comprised 21% of all immunodeficiency consults, at n=43. Conclusion: At an academic allergy center where all allergy/immunology service lines are currently provided, the most common reason for pediatric consultations were for help with immunodeficiency evaluation/treatment and drug allergy. TREC screening is a new key indication for consultation. Fellowship programs may benefit from focusing on these content areas for the pediatric inpatient setting.

Unforeseen severity in a case of neonatal cow milk protein allergy: a case report

Cow milk protein allergy (CMPA) is one of the most common childhood allergies that manifests with a range of digestive symptoms and skin reactions, which usually resolve with age. In this report, we present the case of a one-month-old male who presented with a rare and severe manifestation of neonatal CMPA. The neonate underwent numerous hospital admissions due to a presentation that closely mimicked symptoms of a metabolic disorder and sepsis. Our primary objective is to highlight the significance of systematically considering or excluding a CMPA diagnosis, irrespective of the severity of presentation. This proactive approach may potentially reduce future complications among the affected paediatric population, thereby preventing prolonged hospitalisation and the associated disease burden, as seen in this case. Keywords: Cow milk protein allergy, Metabolic acidosis, Amino-acid based infant formula, Neonatal food allergy, CMPA.