Common Food Allergens Research Articles

Linking Macronutrient Composition of Common Allergenic Foods to European and North American Food Allergy Prevalence.

Linking Macronutrient Composition of Common Allergenic Foods to European and North American Food Allergy Prevalence.

Safety of Oral Food Challenges for Individuals with Low Levels of Cow's Milk-Specific Immunoglobulin E Antibodies.

Cow's milk (CM) is one of the most common food allergens in Japan. The oral food challenge (OFC) of CM is important for the definite diagnosis of children with CM allergy and it is recommended to be actively and safely performed in individuals with low CM-sIgE levels. This study aimed to investigate the safety of low-dose CM-OFC in individuals with low CM-sIgE levels and discuss the prognostic factors and appropriate approaches for assessing the starting doses of CM-OFC in these individuals. We retrospectively analyzed 6,929 OFC tests conducted between January 1, 2017 and December 31, 2021; of which, 1,390 were CM-OFC tests. The characteristics, OFC-positive rates, CM loading, and related factors were analyzed in 138 cases involving low CM-sIgE levels. Stepwise OFC tests were conducted according to the FA guidelines in Japan using an open and unblinded method. Among 138 individuals with low CM-sIgE levels, 110 (79.7%) passed the OFC test without any symptoms. Among the cases with OFC-positive status, 50.0% (14/28) cases showed symptoms with low-dose OFC (30-105 mg CM protein). Moreover, complete CM elimination was associated with a significantly high OFC-positive rate, and 60.0% (12/20) of the cases involving complete CM elimination showed symptoms with low-dose OFC. Eighty percent of the patients with low CM-sIgE levels safely completed the OFC test. Nevertheless, careful observation is essential during low-dose OFC test in cases with low CM-sIgE levels, especially in the cases with complete elimination. The starting dose of the OFC test should be re-evaluated and modified using baked milk or a lower dose of CM to ensure safety and early outgrowth of CM allergy.

Food Allergy Test-Guided Dietary Advice for Children With Atopic Dermatitis: A Consensus Study.

The use of blood specific IgE or skin prick tests (SPT) to guide dietary exclusions for disease control in children with atopic dermatitis (AD) is controversial. We undertook a consensus exercise on how to interpret SPT results and dietary history for cow's milk, hen's egg, wheat, and soy in children < 2 years old with AD. Fourteen clinicians from general practice, pediatrics, pediatric dermatology, pediatric allergy, and pediatric dietetics from UK and Ireland took part in an online modified Delphi study. Over three rounds, participants gave their anonymous opinions and received individualized and group feedback, based on the premise that all children had SPTs. The findings were discussed in an online workshop. Of 18 symptoms, 12 were identified as relevant to immediate and 7 to delayed allergy. Regarding SPTs, there was consensus over which allergens to use for wheat and soy but not cow's milk or hen's egg; for all study foods, wheal size was determined as 0-1 mm negative, ≥ 5 mm sensitized, but between 2 and 4 mm, categorization varied by food. During the final workshop, consensus was reached on dietary advice for nine combinations of SPT results and dietary history. We attained consensus on how SPTs and dietary history for four common food allergens should be interpreted in young children under 2 years of age with AD. These pragmatic recommendations may support clinician education, consistency of decision-making, and future research.

Interpreting epidemiologic distribution of total and specific IgE levels for food allergy in Southern China from 2004 to 2023: understanding the mechanisms and focusing on prevention

BackgroundThe burgeoning prevalence of food allergy-related diseases is closely associated with geographical allergen distribution and societal lifestyle paradigms. This study aims to shed light on the distribution patterns of specific IgE (sIgE) and total IgE (tIgE) reactivity to common food allergens in the Southern Chinese populace.MethodsEmploying an analytical technique spanning two decades, we conducted specific IgE and total IgE on serum samples harvested from patients with food allergy-related pathologies at First Affiliated Hospital of Guangzhou Medical University from 2004 to 2023. This comprehensive examination of eight prototypical food allergens: egg white, milk, wheat, sesame, peanut, soybean, shrimp, and crab.ResultsOur analysis showed a 100% positivity rate for sIgE and an 86.54% positivity rate for tIgE. Milk had the highest positive response rate, followed by egg white and shrimp. Age-stratified data indicated that milk sensitization peaked in children aged 2 years or younger, while egg white sensitization peaked between 3 and 5 years of age. Sensitization rates for the remaining six allergens increased with age. Additionally, co-sensitization was observed between milk, egg white, crab, and shrimp with other allergens.ConclusionIn common allergens of Southern China, egg white, milk, and shrimp ascend as the dominant subjects, underlining their imperative role in food allergy pathogenesis. This landscape-wide allergenic profiling, segregated across age clusters and enhanced by co-sensitization data, augments our power for early diagnosis and strategic intervention in food allergy diseases.

A Multi-centre Analysis of Serum IgE Levels in Atopic Dermatitis

Abstract Objective: To assess the characteristics of total immunoglobulin E (IgE) and allergen-specific IgE (sIgE) to 20 common allergens in 154 patients with atopic dermatitis (AD). To assess the correlation of clinical food allergy with positive food allergens’ sIgE results. We further discuss the significance of IgE as a potential biomarker for AD disease severity. Methods: A total of 154 AD patients were collected from 15 hospitals nationwide in China from 2019 to 2021. Serum IgE was measured using reverse-enzyme immuno capture test (REAST). Patients were required to have at least one positive sIgE (N ≥ 0.35 IU/mL). Patients were divided into groups according to gender, age, disease severity, and region. SPSS 26.0 software was used for statistical analysis. Results: Compared with adolescent and adult, AD in infancy and childhood showed significantly higher frequencies of positive sIgE to food allergens, including egg, cow milk, and wheat (P &lt; 0.01). However, adolescent and adult AD showed significantly higher frequencies of positive sIgE to inhaled allergens, dermatophagoides farinae, and house dust mite. In addition, sIgE in different sexes were different. Compared with women, men showed higher frequencies of positive allergen-specific IgE level to wheat, dermatophagoides farinae, and house dust mite. The most common food allergens with elevated sIgE levels were egg (71%), cow milk (39%) and wheat (32%). However, AD patients reported seafood, including crab, shrimp, and fish, as the most frequent food allergens which aggravate their disease in their daily life. Only 18 (12%) patients reported definite correlation of clinical practice with positive food allergens’ IgE results. Among 154 sIgE-positive patients, 99 patients had an increase of total IgE (≥60 IU/ml). TotalIgE (tIgE) levels were significantly different between mild (193 ± 239 IU/mL), moderate (170 ± 202 IU/mL), and severe (375 ± 343 IU/mL) forms of AD patients (P &lt; 0.01). AD patients with accompanied allergic diseases showed significantly higher tIgE levels than those without accompanied allergic symptoms (280 ± 286 IU/mL vs 194 ± 248 IU/mL). Conclusion: Neither sIgE nor tIgE levels can be used to evaluate the condition or severity of AD. AD patients with accompanied allergic diseases showed significantly higher tIgE levels than those without accompanied allergic symptoms. Infantile AD patients are more allergic to food, while adolescents and adults are more allergic to environmental antigens. IgE tests must be interpreted by combining with clinical history to avoid unnecessary food avoidance. Early food allergen introduction for infants may be promising for the prevention of food allergies.

Breakthrough in allergy mitigation using an innovative steam pressure-based processing technique

Peanuts are recognized as one of the most common allergenic foods, known to induce severe Th2-mediated allergic reactions. The resulting global health concern has fostered the necessity to design innovative technologies capable of mitigating allergenicity. This study investigated the effect of an innovative thermomechanical process, “Intensification of Vaporization by Decompression to the Vacuum” (IVDV), on the protein content and immunogenicity of whole peanuts. Through animal studies using peanut allergy BALB/c mouse models, this research revealed a clear reduction in allergic symptoms once challenged with IVDV-treated peanut protein extract, compared to those receiving raw or deep-fried peanut protein extracts. Significant changes in immune response markers in animals were observed, including reduced levels of histamine, Th1/Th2 cytokines, and antibodies, thus confirming the efficacy of IVDV in mitigating allergenicity in peanuts. Saturated steam pressure was demonstrated to have a highly significant positive effect on the reduction of protein content in IVDV-treated samples through degradation, with a noteworthy reduction ranging from 42.3% to 89.2%. This pilot study embarked on a pioneering exploration into the ability of IVDV to offer a viable solution in reducing peanut allergenicity, opening new avenues for enhanced food safety and inclusivity. The ease of scalability of IVDV technology to an industrial level, along with its cost-efficiency, further enhance its appeal for widespread adoption.

Allergens weaning: what is missing from commercial baby food?

Background. Current recommendations for infant weaning suggest introducing common food allergens by the age of 12 months. While homemade meals are advisable, there is a notable demand for commercially available complementary foods (CACF). Furthermore, emerging evidence suggests a potential link between the consumption of ultra-processed products and the incidence of allergic diseases. This study aimed to examine the presence of the fourteen main food allergens in CACF ingredients through label analysis and evaluate their extent of processing. Methods. Between January and February 2024, labels of all CACF found in infant feeding sections of 10 Portuguese grocery retailers were analyzed. CACF were categorized based on the NOVA food classification system's processing levels. Milk formulas, products for children over 15 months, and those for children with food allergies or intolerances were excluded Results. Of the 492 products analysed, 132 contained wheat and 112 contained milk. 16 products included fish and 6 contained egg. Soy was listed as an ingredient in 11 products, mainly as soy lecithin. Only 2 product contained nuts, and 1 product contained peanuts. None of the products contained the remaining six allergens. The majority of milk- and wheat-containing products were classified as ultra-processed and contained added sugars and/or sweeteners. Conclusions. Despite the current guidelines, commercial baby foods often lack major allergens, namely nuts and peanuts, eggs, and shellfish. Our results underscore the need for healthy, age-appropriate, minimally processed products that incorporate rather than exclude major food allergens.

Component diagnosis of food allergy: precise identification of allergenic components in egg and milk

Food allergy are triggered by an abnormal immune response to specific food components, with milk and eggs being the most common food allergens, especially in children. Food allergy can cause various symptoms such as rashes, difficulty breathing, and digestive issues. Allergen component diagnostics is a technique used to identify specific allergenic proteins, aiding doctors in providing more precise treatment and management recommendations for patients. This article analyzes the latest research developments and clinical significance of milk and egg allergen components based on the " Molecular Allergology User's Guide 2.0 (MAUG 2.0)" issued by the European Academy of Allergy and Clinical Immunology (EAACI), including their applications in clinical diagnosis, treatment, and management. This article aims to enhance healthcare professionals' understanding of milk and egg allergies, offering new perspectives and practical guidelines for research and clinical practice to promote accurate diagnosis and personalized treatment strategies.

Protein-Induced DNA Dumbbell Amplification (PINDA) and its applications to food hazards detection

Quantification of trace amounts of proteins is technically challenging because proteins cannot be directly amplified like nucleic acids. To improve the analytical sensitivity and to complement conventional protein analysis methods, we developed a highly sensitive and homogeneous detection strategy called Protein-Induced DNA Dumbbell Amplification (PINDA). PINDA combines protein recognition with exponential nucleic acid amplification by using protein binding probes made of DNA strands conjugated to protein affinity ligands. When a pair of probes bind to the same target protein, complementary nucleic acid sequences that are conjugated to each probe are brought into close proximity. The increased local concentration of the probes results in the formation of a stable dumbbell structure of the nucleic acids. The DNA dumbbell is readily amplifiable exponentially using techniques such as loop-mediated isothermal amplification. The PINDA assay eliminates the need for washing or separation steps, and is suitable for on-site applications. Detection of the model protein, thrombin, has a linear range of 10 fM-100 pM and detection limit of 10 fM. The PINDA technique is successfully applied to the analysis of dairy samples for the detection of β-lactoglobulin, a common food allergen, and Salmonella enteritidis, a foodborne pathogenic bacterium. The PINDA assay can be easily modified to detect other targets by changing the affinity ligands used to bind to the specific targets.

Insights into the clinical, immunologic, and genetic underpinnings of food allergy.

The last few decades have seen striking changes in the field of food allergy. The prevalence of the disease has risen dramatically in many parts of the globe, and management of the condition has undergone major revision. While delayed introduction of common allergenic foods during infancy was advised for many years, the learning early about peanut allergy (LEAP) trial and other studies led to a major shift in infant feeding practices, with deliberate early introduction of these foods now recommended. Additionally, the Food and Drug Administration approved the first treatment for food allergy in 2020-a peanut oral immunotherapy (OIT) product that likely represents just the beginning of new immunotherapy-based and other treatments for food allergy. Our knowledge of the environmental and genetic factors contributing to the pathogenesis of food allergy has also undergone transformational advances. Here, we will discuss our efforts to improve the clinical care of patients with food allergy and our understanding of the immunological mechanisms contributing to this common disease.

Routinely Used and Emerging Diagnostic and Immunotherapeutic Approaches for Wheat Allergy.

Wheat, a component of the staple diet globally, is a common food allergen in children. The symptoms of wheat allergy (WA) range from skin rash to shortness of breath, significantly impairing quality of life. Following initial clinical suspicion, individuals may undergo routinely used allergy tests such as a wheat allergen-specific skin prick test (SPT), a blood test for specific immunoglobulin E (sIgE) levels, or oral food challenge. Conventional management of WA lies in wheat avoidance, yet accidental consumption may be inevitable owing to the ubiquity of wheat in various food products. This article aims to provide an overview of the immunologic pathway of WA, followed by its emerging diagnostic methods, namely alcohol-soluble SPT extracts, component-resolved diagnosis, and the basophil activation test (BAT). The mechanisms underlying wheat allergen-specific oral immunotherapy (OIT) as well as a summary of the efficacy, tolerability, and safety of related clinical trials will then be discussed.

Impact of wheat sensitization on wheeze and T2 phenotypes in general population of children

BackgroundThe association between sensitization to specific aeroallergens and outcomes in patients with asthma is well-researched; however, the association between childhood-onset wheeze/asthma and sensitization to various aeroallergens and food allergens in the general pediatric population remains poorly understood. ObjectiveThe association between sensitization to common aeroallergens and food allergens with wheeze and type 2 (T2) inflammation in the general pediatric population was investigated. MethodsSpecific IgEs against nine aeroallergens and four food allergens were measured in the prospective Hokkaido birth cohort of 428 school-age children (approximately 10 years of age). Wheeze and other allergic symptoms were assessed using the International Study of Asthma and Allergies in Childhood questionnaire. Blood eosinophil count and fractional exhaled nitric oxide level were assessed as T2 biomarkers. The Isle of Wight (IOW) birth cohort in UK was used for replication analysis (n=1032). ResultsThe prevalence of sensitization to at least one aeroallergen and food allergen was 70.5% and 22.3%, respectively. A significant association between wheeze and sensitization to aeroallergens such as ragweed, Japanese cedar, mugwort, and pet dander, were found. However, the association between wheeze and wheat sensitization was highly significant (Hokkaido birth cohort, odds ratio [OR]: 4.67; 95% confidence interval [CI]: 1.98–11.01; IOW birth cohort, OR: 4.01, 95% CI: 1.78–9.07). Sensitization to most aeroallergens, though not any food allergens, was associated with the T2high phenotype. ConclusionSensitization to wheat may be an important risk factor for wheeze/asthma development, especially the pathogenesis of T2-non/low asthma, independent of aeroallergens, in the general pediatric population.

Novel Intervention Protocol to Promote Feeding 8 Common Allergenic Foods Beginning Around 4-6 Months of Age

Novel Intervention Protocol to Promote Feeding 8 Common Allergenic Foods Beginning Around 4-6 Months of Age

Sensitization to Food and Aero-Allergens in Children with Coeliac Disease Assessed with the Use of a Multiplex Molecular Diagnostic Technique

(1) Background. Coeliac disease (CD) often co-occurs with autoimmune conditions or genetic syndromes, but there are few studies on the co-existence of CD and immunoglobulin E (IgE)-mediated allergies. The purpose of this study was to assess sensitization to food and aero-allergens in pediatric patients with CD. (2) Methods. A multiplex ALEX®2 test was used to determine specific IgEs (sIgEs). (3) Results. The study included 108 children newly diagnosed with CD. Allergen extract- and/or allergen molecule-sIgEs were detected in 49.1% of children. Most children (41.5%) were sensitized to both inhalant and food allergens. The three most common aero-allergens (timothy pollen, ryegrass, silver birch) were molecules Phl p 1, Lol p 1, and Bet v 1. The most common food allergens (hazelnut, apple, and peanut) were Cor a 1, Mal d 1, and Ara h 8 molecules of the PR-10 subfamily. Patients were not sensitized to cereal allergens containing gluten. Spearman’s rank correlation analysis of sensitized patients showed a significant positive relationship (r = 0.31) between the patients’ age and the occurrence of positive sIgEs (≥0.3 kUA/L) for inhalant allergen molecules (p = 0.045). In sensitized patients, mainly symptoms of inhalant allergy were observed, such as hay fever, conjunctivitis, and bronchial asthma. (4) Conclusions. The current study indicates the co-occurrence of IgE sensitization to food and inhalant allergens in children with CD. The study highlights the need to take a closer look at the diagnosis of IgE-mediated allergy in patients with CD, which may help in their care and lead to a better understanding of the relationship between CD and IgE-mediated allergy.

Parent-reported offering of allergen foods to infants during complementary feeding: an observational study

The prevalence of food allergies in New Zealand infants is unknown; however, it is thought to be similar to Australia, where the prevalence is over 10% of 1-year-olds(1). Current New Zealand recommendations for reducing the risk of food allergies are to: offer all infants major food allergens (age appropriate texture) at the start of complementary feeding (around 6 months); ensure major allergens are given to all infants before 1 year; once a major allergen is tolerated, maintain tolerance by regularly (approximately twice a week) offering the allergen food; and continue breastfeeding while introducing complementary foods(2). To our knowledge, there is no research investigating whether parents follow these recommendations. Therefore, this study aimed to explore parental offering of major food allergens to infants during complementary feeding and parental-reported food allergies. The cross-sectional study included 625 parent-infant dyads from the multi-centred (Auckland and Dunedin) First Foods New Zealand study. Infants were 7-10 months of age and participants were recruited in 2020-2022. This secondary analysis included the use of a study questionnaire and 24-hour diet recall data. The questionnaire included determining whether the infant was currently breastfed, whether major food allergens were offered to the infant, whether parents intended to avoid any foods during the first year of life, whether the infant had any known food allergies, and if so, how they were diagnosed. For assessing consumers of major food allergens, 24-hour diet recall data was used (2 days per infant). The questionnaire was used to determine that all major food allergens were offered to 17% of infants aged 9-10 months. On the diet recall days, dairy (94.4%) and wheat (91.2%) were the most common major food allergens consumed. Breastfed infants (n = 414) were more likely to consume sesame than non-breastfed infants (n = 211) (48.8% vs 33.7%, p≤0.001). Overall, 12.6% of infants had a parental-reported food allergy, with egg allergy being the most common (45.6% of the parents who reported a food allergy). A symptomatic response after exposure was the most common diagnostic tool. In conclusion, only 17% of infants were offered all major food allergens by 9-10 months of age. More guidance may be required to ensure current recommendations are followed and that all major food allergens are introduced by 1 year of age. These results provide critical insight into parents’ current practices, which is essential in determining whether more targeted advice regarding allergy prevention and diagnosis is required.

Understanding of lipid transfer protein sensitization patterns and its clinical significance in children.

Background: Lipid transfer proteins (LTP) are the most common food allergens in the Mediterranean region. Objective: The study aimed to investigate co-sensitization patterns and cluster relationships between LTP allergen molecules across a broad range of allergen-specific sensitization patterns, and clinical outcomes in eastern Mediterranean children. Methods: Among 496 children evaluated for multiple sensitizations with multiplex testing, 105 children (21%) with 16 different LTP sensitizations were analyzed. Clinical reactivity was examined based on clear-cut history of immunoglobulin E mediated symptoms (oral allergy syndrome [OAS], systemic reactions, and anaphylaxis). Results: All children included were sensitive to food LTPs, but 56% were sensitive to pollen LTPs. The number of children with OAS and clinical reactivity was 12 and 59, respectively, and no cofactors were reported. The most common sensitizations were Pru p 3 (74%) and Cor a 8 (66%). Significant correlations were observed in the heatmap between the LTP molecules other than Par j 2 and Tri a 14. Overall, clinical reactivity was associated with increased age and number of LTP molecule positivity. Conclusion: In the eastern Mediterranean region, 21% of children with multiple food and/or pollen sensitizations were found to have LTP sensitization; however, almost half reported clinical reactivity. The hierarchical pathway highlights that distinct LTP allergen molecules can act as primary sensitizers. Clinical reactivity is linked to increasing numbers of LTP molecule positivity and increasing age.

Omalizumab for the Treatment of Multiple Food Allergies

BackgroundFood allergies are common and are associated with substantial morbidity; the only approved treatment is oral immunotherapy for peanut allergy.MethodsIn this trial, we assessed whether omalizumab, a monoclonal anti-IgE antibody, would be effective and safe as monotherapy in patients with multiple food allergies. Persons 1 to 55 years of age who were allergic to peanuts and at least two other trial-specified foods (cashew, milk, egg, walnut, wheat, and hazelnut) were screened. Inclusion required a reaction to a food challenge of 100 mg or less of peanut protein and 300 mg or less of the two other foods. Participants were randomly assigned, in a 2:1 ratio, to receive omalizumab or placebo administered subcutaneously (with the dose based on weight and IgE levels) every 2 to 4 weeks for 16 to 20 weeks, after which the challenges were repeated. The primary end point was ingestion of peanut protein in a single dose of 600 mg or more without dose-limiting symptoms. The three key secondary end points were the consumption of cashew, of milk, and of egg in single doses of at least 1000 mg each without dose-limiting symptoms. The first 60 participants (59 of whom were children or adolescents) who completed this first stage were enrolled in a 24-week open-label extension.ResultsOf the 462 persons who were screened, 180 underwent randomization. The analysis population consisted of the 177 children and adolescents (1 to 17 years of age). A total of 79 of the 118 participants (67%) receiving omalizumab met the primary end-point criteria, as compared with 4 of the 59 participants (7%) receiving placebo (P<0.001). Results for the key secondary end points were consistent with those of the primary end point (cashew, 41% vs. 3%; milk, 66% vs. 10%; egg, 67% vs. 0%; P<0.001 for all comparisons). Safety end points did not differ between the groups, aside from more injection-site reactions in the omalizumab group.ConclusionsIn persons as young as 1 year of age with multiple food allergies, omalizumab treatment for 16 weeks was superior to placebo in increasing the reaction threshold for peanut and other common food allergens. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT03881696.)

A34 DEVELOPING A NOVEL MOUSE MODEL TO ELUCIDATE MECHANISMS OF ORAL TOLERANCE IN EARLY LIFE

Abstract Background Oral tolerance is the active suppression of immune responses to antigens that are first encountered in the gastrointestinal tract. When this process fails, food allergies can arise. Food allergies affect up to 6% of Canadian children underlining the need for a thorough understanding of how oral tolerance develops in childhood. Despite this, tolerance has historically been studied using adult rodent models instead of focusing on more physiologically relevant early-life time points. Aims Our research aims to develop a robust mouse model to elucidate mechanisms of oral tolerance development in early life and we hypothesize that the mesenteric lymph nodes are a major site of food antigen-specific T cell development in early life. Methods Prior to weaning, actively suckling mouse pups were orally gavaged with ovalbumin (OVA), an egg white component and common food allergen or water as a control. Following a series of systemic challenges with OVA, circulating antibody levels were quantified by ELISA to measure the development of oral tolerance to OVA. Additionally, splenocytes isolated from tolerized and control mice were stimulated in vitro with exogenous OVA and cytokines were quantified in culture supernatants via a cytometric bead array assay to assess the suppression of T cell responses to OVA in tolerized mice. One week following oral OVA exposure flow cytometry was used to characterize the expansion of T cell populations in the mesenteric lymph nodes, spleen and thymus. Results Mice orally gavaged with OVA in early life show reduced systemic antibody production after subsequent challenges with OVA, compared to mice not orally exposed to OVA. We determined the minimum dosage of OVA required to confer tolerance in these mice and confirmed the validity of this model in both male and female C57BL/6 and BALB/c mice. Further, we detected an active suppression of IL-5 production, a cytokine indicative of a Type 2 immune response, in OVA-stimulated splenocyte cultures isolated from mice tolerized to OVA. We found a significant increase in the frequency of CD4 T cells in the mesenteric lymph nodes just 1-week following oral OVA exposure. Conclusions We have developed a robust mouse model of oral tolerance where mice are directly exposed to OVA in an early life period while they are still actively ingesting breastmilk, and their mucosal immune system and intestinal microbiota composition are under significant development. To date, our data suggests that the gut draining mesenteric lymph nodes may be a site of food antigen-specific T cell expansion in early life. Funding Agencies CIHRTRIANGLE

Complementary Feeding Practices: Recommendations of Pediatricians for Infants with and without Allergy Risk.

To investigate the routine guidance provided by pediatricians concerning the timing of complementary feeding (CF) for both healthy infants and those at a heightened risk of allergies. A total of 233 pediatricians participated in an anonymous online survey that included questions about demographics and recommendations for CF. Specifically, they provided guidance on the types of foods, preparation methods, supplements, time intervals for introducing new foods to infants at low and high allergy risk, and delayed food introductions for high-risk cases. The respondents advised introducing certain foods at specific ages: fruits, starchy non-gluten grains, vegetables, olive oil, and meat were appropriate at 6 months; gluten-rich grains at 7 months; yogurt, hard-boiled eggs, and legumes at 8 months; fish at 8.5 months; and nuts at 9 months. Pediatricians, especially those with less than 15 years of practice, often introduced egg, seafood, gluten-rich grains, legumes, and nuts earlier for high-risk infants. Parenthood and male gender were associated with the earlier introduction of eggs and grains. Greek pediatricians follow a structured food introduction schedule for CF in infants. Interestingly, they tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants. Key Notes: Despite recent evidence-based indications on healthy complementary feeding strategies for infants, discrepancies persist among pediatricians regarding food choices and the order and timing of food introduction, both for healthy infants and those at risk of allergy. Guidance on complementary feeding by pediatricians is influenced by their individual characteristics. Pediatricians tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants.

Early-Life Risk Factors and Clinical Features of Food Allergy Among Thai Children.

Background: Food allergy affects 1%-10% of children under five worldwide, with genetic and early-life factors playing a primary role. Reported factors include a family history of allergic diseases, personal atopic dermatitis, cesarean section, dietary restrictions during pregnancy and lactation, and the timing of introducing solid foods. This study was aimed at identifying various factors associated with food allergy and evaluate each food allergy's clinical features. Methods: We conducted a case-control study with a participant ratio of 1:2 between cases and controls. Data were gathered from both groups of participants, and questionnaires included living area, sex, and natal history (birth details, maternal diet during pregnancy and breastfeeding, feeding history during infancy, family history of atopic diseases, and household smoking). Results: All 72 cases with food allergy and 145 controls were included in the study. Term birth comprised a protective factor for developing food allergy (adjusted odds ratio [aOR] 0.213, p value 0.022). In contrast, personal atopic dermatitis (aOR 20.097, p value 0.001) and a family history of allergic disease constituted risks (aOR 3.183, p value 0.002). Food allergy was unrelated to cesarean section, low birth weight, dietary restrictions during lactation and pregnancy, exclusive breastfeeding, or the early introduction of complementary foods. The three most common food allergens were egg white (40.2%), wheat (34.7%), and cow's milk (30.5%), respectively. Conclusions: In this study, risk factors associated with food allergy comprised a personal history of atopic dermatitis and a family allergic disease, which may be used as predictive factors for developing food allergy among Thai children.