Clinical Manifestations Of Food Allergy Research Articles

Metabolomics identifies phenotypic biomarkers of amino acid metabolism in milk allergy and sensitized tolerance

BackgroundA substantial proportion of sensitized individuals tolerate suspected foods without developing allergic symptoms; this phenomenon is known as sensitized tolerance. The immunogenic and metabolic features underlying the sensitized-tolerant phenotype remain largely unknown. ObjectiveIn this study, we aimed to uncover the metabolic signatures associated with clinical milk allergy and sensitized tolerance using metabolomics. MethodsWe characterized the serum metabolic and immunological profiles of children with clinical IgE-mediated milk allergy (MA; n = 30) or milk-sensitized tolerance (MST; n = 20) and healthy controls (n = 21). A comparative analysis was performed to identify dysregulated pathways associated with the clinical manifestations of food allergy. We also analyzed specific biomarkers indicative of different sensitization phenotypes in children with MA. The candidate metabolites were validated in an independent quantification cohort (n = 41). ResultsMetabolomic profiling confirmed the presence of a distinct metabolic signature that discriminated children with MA from those with MST. Amino acid metabolites generated via arginine, proline, and glutathione metabolism were uniquely altered in children with sensitized tolerance. Arginine depletion and metabolism through the polyamine pathway to fuel glutamate synthesis were closely associated with the suppression of clinical symptoms in the presence of allergen-specific IgE. In children with MA, the polysensitized state was characterized by disturbances in tryptophan metabolism. ConclusionsBy combining untargeted metabolomics with targeted validation in an independent quantification cohort, we identified candidate metabolites as phenotypic and diagnostic biomarkers of food allergy. Our results provide insights into the pathological mechanisms underlying childhood allergy and suggest potential therapeutic targets.

A clinical case of secondary eosinophilia in a child

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.

Clinical and anamnestic characteristics of children with gastrointestinal food alergy

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.

Feeding difficulties in children fed a cows' milk elimination diet.

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.

Features of the quality of life in children with food allergy

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.

Modern Principles of Managing Children with Food Allergies

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.

Comorbidity of atopic bronchial asthma and food allergy in adults

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.

Characteristics of pollen-related food allergy based on individual pollen allergy profiles in the Chinese population

BackgroundPatients with pollinosis are often multi-sensitized to diverse pollen allergens. However, little is known about pollen allergy types among Chinese pollinosis patients. This study is aimed to characterize clinical manifestations of food allergy among patients with different types of pollen allergy. MethodsWe retrospectively analyzed 402 pollinosis patients from an outpatient allergy department of the Peking Union Medical College Hospital who had been diagnosed by experienced allergists. All included patients who answered a questionnaire regarding seasonal pollinosis and clinical symptoms after ingestion of food and underwent intradermal skin tests. Total IgE and specific IgE levels were quantified by ImmunoCAP, using 0.35 kUA/L as a threshold for positivity. ResultsThe patients were divided into 3 groups, based on the season during which they experienced symptoms and the 2 peaks of Chinese airborne pollen: spring-tree pollen symptoms group (SG), autumn-weed pollen symptoms group (AG), and a combined spring and autumn pollen symptoms group (CG). Birch pollen (83%) and ash pollen (74%) were common allergens among patients with spring symptoms, while mugwort pollen (87%) was a common allergen among patients with autumn symptoms. In total, 30% of the study population experienced pollen-related food allergy. Pollen-related food allergies were more prevalent among the single-season symptom groups (68% and 50% for the SG and AG, respectively) than among the CG (20%). All patients with pollen-related food-induced anaphylaxis exhibited autumn weed pollen symptoms. Except for 2 patients, all patients with food-induced anaphylaxis were allergic to mugwort pollen. In the SG, all patients with food allergy were sensitive to birch pollen, with birch and Bet v 1-specific IgE levels higher in this group than in the group without food allergy (p < 0.001). In the AG, Art v 3 was more prevalent among patients with pollen-related food allergy than without food allergy (79% vs. 33%, p < 0.001), a proportion similar to the one in the CG (67% vs. 48%, p = 0.01). Meanwhile, the Art v 3-specific IgE levels among patients with pollen-related food allergy were higher than among tolerant patients in the AG (p < 0.001) and CG (p = 0.02). Unexpectedly, the Art v 3-specific IgE levels were higher in patients with food-induced anaphylaxis than with oral allergy syndrome only in the CG. ConclusionsBet v 1 (a Pathogenesis-related 10 protein) and Art v 3 (a non-specific lipid transfer protein; nsLTP) are candidate molecular biomarkers for the diagnosis of food allergies in patients with season-specific pollen-related allergies. Measuring pollen allergen component-specific IgE levels might be an effective tool for the management of pollinosis in clinical practice in China.

Clinical peculiarities of gastrointestinal symptoms in children with food allergy

Introduction. Pediatric allergy problems are widely spread among children of almost all age groups. Number of cases with combined allergic a digestive disorders increases and study of gastrointestinal lesions in children with allergies became an urgent medical and social problem. It is based on the increasing frequency of both allergy and pathology of the digestive system, increasing severity of cases and necessity to analyze type of gastrointestinal disorder in children with allergy and correlation among it. Objective. To study the clinical features of gastrointestinal symptoms in children with food allergies. Materials and methods. 169 pediatric patients 3–17 years old were examined. The main group was of 105 children with food allergies, the control group – 64 children without allergies. Verification of food allergy and pathology of the digestive system was carried out in accordance with the current protocols. All patients had skin prick tests, provocative test, determination of specific IgE. All patients were divided into 3 groups by age: 1st – 3–6 years old, 2nd – 7–11 years old, 3rd – 12–17 years old. The results were processed by the methods of variation statistics. Results. Gastrointestinal manifestations were observed in children of all age groups (59 %, 65 %, 74 %). Skin manifestations predominated in the 1st and the 3rd group. Respiratory symptoms – in groups 2 and 3. A combination (more often of skin and gastrointestinal) manifestations was found in group 3. Pain syndrome in children of the main group was characterized by moderate intensity (55.2 %), more often not associated with food intake (45.7 %), localized in the umbilical region (58 %), less often in the epigastrium (23.4 %), in 15 % there was no pain. Dyspeptic syndrome was manifested by nausea (36.2 %), decreased appetite (25.7 %) and belching (17.1 %). Dyspeptic syndrome was absent in 34.3 % of patients. The manifestations of asthenovegetative syndrome were noted in 38.1 % of children in the main group. The correlation between the type of allergen and the reason of gastrointestinal symptoms has not been identified. Conclusions. A variety of clinical manifestations of food allergy has been proven in the form of skin, gastrointestinal, respiratory symptoms and their combination. Gastrointestinal symptoms indicate the presence of functional disorders of the digestive tract. With age, the variety of food allergens increases, without qualitatively affecting the nature of gastrointestinal symptoms.

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

A clear understanding of the differences in the epidemiology of food allergy between rural and urban populations may provide insights into the causes of increasing prevalence of food allergy in the developed world. We used a standardized methodology to determine the prevalence and types of food-specific allergic sensitization and food allergies in schoolchildren from urban and rural regions of China, Russia, and India. The current study is a multicenter epidemiological survey of children recruited from 5 cities in China (Hong Kong and Guangzhou), Russia (Tomsk), and India (Bengaluru and Mysore) and 1 rural county in Southern China (Shaoguan). A total of 35,549 children aged 6 to 11 years from 3 countries participated in this survey. Random samples of children from 3 countries were first screened by the EuroPrevall screening questionnaire. Children with and without a history of adverse reactions to foods were then recruited for the subsequent case-control comparative studies. We determined the prevalence rates of food-specific IgE sensitization and food allergies using the predefined criteria. The prevalence rates of food-specific IgE sensitization (≥0.7 kU/L) to at least 1 food were 16.6% in Hong Kong, 7.0% in Guangzhou, 16.8% in rural Shaoguan, 8.0% in Tomsk, and 19.1% in India. Using a definition of probable food allergy as reporting allergic symptoms within 2 hours of ingestion of a specific food plus the presence of allergic sensitization to the specific food (positive IgE and/or positive skin prick test result), the prevalence of food allergy was highest in Hong Kong (1.50%), intermediate in Russia (0.87%), and lowest in Guangzhou (0.21%), Shaoguan (0.69%), and India (0.14%). For children recruited from Hong Kong, both sensitization and food allergy were significantly higher in children who were born and raised in Hong Kong when compared with those who were born in mainland China and migrated to Hong Kong, highlighting the importance of early-life exposures in affecting the subsequent development of food sensitization and food allergy. There are wide variations in the prevalence of food-specific IgE sensitization and food allergy in the 3 participating countries. Food allergy appears to be less common when compared with developed countries. The variations in the prevalence of food allergen sensitization cannot be explained by the differences in the degree of urbanization. Despite the high prevalence of food-specific IgE sensitization in India and rural China, food allergy is still extremely uncommon. In addition to IgE sensitization, other factors must play important roles resulting in the clinical manifestations of food allergies.

Prevention of food allergy.

Primary prevention and secondary prevention in the context of food allergy refer to prevention of the development of sensitization (i.e., the presence of food-specific immunoglobulin E (IgE) as measured by skin-prick testing and/or laboratory testing) and sensitization plus the clinical manifestations of food allergy, respectively. Until recently, interventions that target the prevention of food allergy have been limited. Although exclusive breast-feeding for the first 6 months of life has been a long-standing recommendation due to associated health benefits, recommendations regarding complementary feeding in infancy have significantly changed over the past 20 years. There now is evidence to support early introduction of peanut into the diet of infants with egg allergy, severe atopic dermatitis, or both diagnoses, defined as high risk for peanut allergy, to try to prevent development of peanut allergy. Although guideline-based recommendations are not available for early introduction of additional allergenic foods, this topic is being actively studied. There is no evidence to support additional dietary modification of the maternal or infant diet for the prevention of food allergy. Similarly, there is no conclusive evidence to support maternal avoidance diets for the prevention of food allergy.

Modern ways to improve effectiveness of food allergy treatment in children

Aim. To evaluate the effectiveness and safety of a multi-strain probiotic in children with various clinical manifestations of food allergy. Materials and methods. Under the supervision there were 192 children aged from 3 months to 3 years with skin, gastrointestinal and combined (skingastrointestinal) manifestations of food allergies. Patients of the main group received complex therapy and a multistrain probiotic. Patients in the control group did not receive probiotic. Clinical assessment of symptoms during the treatment was conducted (initially and after 30 days). Results. The use of a multistrain probiotic in children with various clinical manifestations of food allergy during 30 days showed improvement of skin and gastrointestinal symptoms of food allergy. The overall effectiveness of therapy in children of the main group was 80.3% versus 68.6% in the control group. Probiotic tolerance was good; no adverse reactions were noted. Conclusion. The inclusion of a new generation probiotic in the complex therapy of food allergies helps to improve the course of the disease and increase the effectiveness of treatment.

Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome.

PurposeMany studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis.Materials and MethodsData were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130).ResultsThe most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (p<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25–10.23; p=0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79–15.53; p=0.003), timothy (OR, 11.8; 95% CI, 2.70–51.64; p=0.001), or ragweed (OR, 3.18; 95% CI, 1.03–9.87; p=0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15–1.37; p<0.001) were related to the development of anaphylaxis in PFAS.ConclusionThe most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.

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

The aim of the study was to assess the influence of disease characteristics and therapy effectiveness on the QOLof food-allergic children’s family members. 154 children aged 1–18 months with FA, were under examination. The diagnosis of food allergy was established in accordance with EAACI recommendations. Severity of AD manifestations was assessed by the SCORAD index. For assessment of severity of gastrointestinal symptoms of FA, the CoMiSS tool was used. All patients were on an elimination diet. Validated Questionnaire “The Food hypersensitivity family ImPact“ (FLIP) was used for assessment of QOL of food-allergic child’s family members. Linguistic and cultural adaptation of the FLIP questionnaire on russianwas performed involving parents/legal representatives of children with FA. Results of evaluation of the Russian version questionnaire’s psychometric properties demonstrated an average level of internal consistency of the questionnaire (Cronbach’s > 0.72). Statistically significant differences in the indicators of the questionnaire were revealed for the following parameters: strictness of adherence to dietary advice (r-0.47, p-0.033), severity of clinical manifestations of food allergies (r- -0.68, p-0.010), pharmacotherapy duration (r-0.60,p- 0.010), breastfeeding for 6 months or more (r-0.51, p-0.033), number of products excluded from the diet (r- -0.57, p-0.010), parental compliance (r- -0.23, p-0.05). We found the difference in FLIP result for families whose children had developed and not developed food tolerance after six-month follow-up. It is known that atopic dermatitis (AD) is associated with a significant decrease of theQOL. Following the recommendations of the elimination diet for children with food allergy (FA) can further reduce the QOLfor the child and the whole family. The FLIP questionnaire indicated a negative impact of FA on the QOLof family members of child with this disease. Disease characteristics, parents compliance and elimination diet influence the quality of life of food-allergic children’s family members.

Clinical Aspects of Food Allergy in Infants in Pleven Region, Bulgaria

Summary Food allergy is an immunoglobulin E-meditated reaction, to which the organism’s immune system reacts to a food allergen, recognizing it as harmful. The study aimed to establish at what age cow’s milk protein allergy is manifested and determine the values of immunoglobulin E (IgE) and hemoglobin(Hb) in children with CMPA in Pleven region, Bulgaria. The study included 94 infants presenting with clinical manifestations of food allergy (age range 0 to 12 months) from Pleven and Pleven region, consulted in 2017 by a pediatrician at the University Hospital Consulting Center in Pleven. Venous blood was collected to determine the IgE and Hb values. Chronic iron-deficiency anemia could be the only clinical manifestation in children with CMPA. Out of all the children with CMPA, 17% had a pronounced anemic syndrome. The rest had normal Hb values. Anemic syndrome could have severe consequences for a growing child. Elevated IgE values were found in 73% of the children tested. CMPA is frequently seen in infants. Early diagnosis of clinical manifestations and diet could prevent severe complications of allergy such as chronic diarrhea, chronic urticaria, and asthma.

Food Allergy in Children with Inherited Epidermolysis Bullosa. The Results of the Observational Study

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.

Pollen-Food Allergy Syndrome in Korean Pollinosis Patients: A Nationwide Survey.

PurposePollen-food allergy syndrome (PFAS) is an immunoglobulin E (IgE)-mediated allergy in pollinosis patients caused by raw fruits and vegetables and is the most common food allergy in adults. However, there has been no nationwide study on PFAS in Korea. In this study, we investigated the prevalence and clinical characteristics of PFAS in Korea.MethodsTwenty-two investigators participated in this study, in which patients with allergic rhinoconjunctivitis and/or bronchial asthma with pollen allergy were enrolled. The questionnaires included demographic characteristics, a list of fruits and vegetables, and clinical manifestations of food allergy. Pollen allergy was diagnosed by skin prick test and/or measurement of the serum level of specific IgE.ResultsA total of 648 pollinosis patients were enrolled. The prevalence of PFAS was 41.7% (n = 270). PFAS patients exhibited cutaneous (43.0%), respiratory (20.0%), cardiovascular (3.7%) or neurologic symptoms (4.8%) in addition to oropharyngeal symptoms. Anaphylaxis was noted in 8.9% of the PFAS patients. Seventy types of foods were linked to PFAS; e.g., peach (48.5%), apple (46.7%), kiwi (30.4%), peanut (17.4%), plum (16.3%), chestnut (14.8%), pineapple (13.7%), walnut (14.1%), Korean melon (12.6%), tomato (11.9%), melon (11.5%) and apricot (10.7%). Korean foods such as taro/taro stem (8.9%), ginseong (8.2%), perilla leaf (4.4%), bellflower root (4.4%), crown daisy (3.0%), deodeok (3.3%), kudzu root (3.0%) and lotus root (2.6%) were also linked to PFAS.ConclusionsThis was the first nationwide study of PFAS in Korea. The prevalence of PFAS was 41.7%, and 8.9% of the PFAS patients had anaphylaxis. These results will provide clinically useful information to physicians.

Lifelong memory responses perpetuate humoral TH2 immunity and anaphylaxis in food allergy

A number of food allergies (eg, fish, shellfish, and nuts) are lifelong, without any disease-transforming therapies, and unclear in their underlying immunology. Clinical manifestations of food allergy are largely mediated by IgE. Although persistent IgE titers have been attributed conventionally to long-lived IgE+ plasma cells (PCs), this has not been directly and comprehensively tested. We sought to evaluate mechanisms underlying persistent IgE and allergic responses to food allergens. We used a model of peanut allergy and anaphylaxis, various knockout mice, adoptive transfer experiments, and invitro assays to identify mechanisms underlying persistent IgE humoral immunity over almost the entire lifespan of the mouse (18-20months). Contrary to conventional paradigms, our data show that clinically relevant lifelong IgE titers are not sustained by long-lived IgE+ PCs. Instead, lifelong reactivity is conferred by allergen-specific long-lived memory B cells that replenish the IgE+ PC compartment. B-cell reactivation requires allergen re-exposure and IL-4 production by CD4 T cells. We define the half-lives of antigen-specific germinal centers (23.3days), IgE+ and IgG1+ PCs (60 and 234.4 days, respectively), and clinically relevant cell-bound IgE (67.3days). These findings can explain lifelong food allergies observed in human subjects as the consequence of allergen exposures that recurrently activate memory B cells and identify these as a therapeutic target with disease-transforming potential.

A Retrospective Study of Korean Adults With Food Allergy: Differences in Phenotypes and Causes.

PurposeIncreasing in prevalence, food allergy (FA) is becoming an important public health concern. In Korean adults, however, clinical phenotypes and causes of FA have not been studied. We aimed to study common causative allergens and clinical manifestations of FA in Korean adults.MethodsThis study was conducted as a retrospective review of medical records for 95 patients (≥19 years old) diagnosed with FA from September 2014 to August 2015 at a single university hospital.ResultsIn the 95 patients, 181 FA events were recorded. The mean age of first onset of FA symptoms was 34.7±15.8 years. The most frequent causative food was seafood (34.8%); shrimp and crab allergies ranked highest, regardless of age and sex. Among all FA events, there were 47 (26.0%) cases of anaphylaxis and 26 (14.4%) cases of oral allergy syndrome (OAS). Seafood (51.1%) was the most frequent cause of anaphylaxis, followed by grains (14.9%). Most OAS cases were associated with fruits (95.7%). The frequency of fruit-induced FA was significantly higher in males than in females (23.0% vs 8.4%, P=0.011). While no cases of vegetables-induced FA were noted in younger individuals (19 to 30 years), vegetables accounted for 20.5% of FA symptoms in older subjects (≥51 years, P<0.001). Allergic rhinitis (44.2%) and drug allergy (20.0%) were major comorbidities associated with FA. Overall, 29 FA events had cofactors, of which 10 were combined with exercise.ConclusionsThe major causes of FA in Korean adults were crustacean, fruits, and grains. Interestingly, the clinical manifestations of FA and demographics varied according to type of food allergen.

Low-Dose IL-2 Induces Regulatory T Cell-Mediated Control of Experimental Food Allergy.

Regulatory T cells (Tregs) are pivotal for maintenance of immune self-tolerance and also regulate immune responses to exogenous Ags, including allergens. Both decreased Treg number and function have been reported in allergic patients, offering new therapeutic perspectives. We previously demonstrated that Tregs can be selectively expanded and activated by low doses of IL-2 (ld-IL-2) inducing immunoregulation without immunosuppression and established its protective effect in autoimmune diseases. In this study, we evaluated the ability of ld-IL-2 to control allergy in an experimental model of food allergy. Ld-IL-2 induced Treg expansion and activation that elicited protection against clinical manifestations of food allergy in two mouse models with OVA and peanut. This clinical effect was lost in Treg-depleted mice, demonstrating the major contribution of Tregs in ld-IL-2 efficacy. Mechanistic studies further indicated that protection from allergy could be explained by a Treg-dependent local modification of the Th1/Th2 balance and an inhibition of mast cell recruitment and activation. Preventive and therapeutic effects of ld-IL-2 were observed over a 7-mo-period, highlighting its long-term efficacy. This study demonstrated that ld-IL-2 is efficient to prevent and to treat allergic immune responses, and thus represents a promising therapeutic strategy for managing allergic diseases.