Food Allergen Avoidance Research Articles

The role of food allergy in atopic dermatitis

Atopic dermatitis (AD) affects ∼10% of children. Food allergy is a known provoking cause of AD in a subset of affected children. A literature search of PubMed and Medline was conducted to review the epidemiology and pathophysiology of AD, with special focus on the role of food allergy in the development of AD, its management, and its long-term preventive strategies. A literature search of PubMed and Medline was conducted. Food allergens readily provoke AD in ∼35% of patients, as proven through double-blind placebo-controlled food challenge studies. Milk, egg, wheat, soy, and peanut account for 75% of the cases of food-induced AD. However, the positive predictive values of the parental history, skin-prick tests, or serum tests for detecting food-specific IgE are low, making these unsuitable for use as single diagnostic modalities. Therefore, the use of a food challenge test is very helpful in objectively confirming the history or positive tests. Elimination diets are often helpful in challenge-proven cases, but care must be taken to evaluate the nutritional status of the child. There are few effective long-term strategies to prevent the development of food allergen-induced AD. Early onset of AD has been shown to be a risk factor for the development of other allergic diseases, including other food allergy/sensitization, as part of the atopic march. Treatment of other causes of AD, such as barrier dysfunction and cutaneous infection, are of equal importance to food allergen avoidance. Food allergy is an important provoking cause of AD, but it is only relevant in ∼35% of affected individuals.

Effectiveness of Food Allergen Avoidance During Late Pregnancy and Beyond In High Risk Families

Effectiveness of Food Allergen Avoidance During Late Pregnancy and Beyond In High Risk Families

Role of diet in the development of immune tolerance in the context of allergic disease

Diet is arguably one of the most significant environmental exposures during early development. Here, we explore the effects of key perinatal dietary exposures on immune development and susceptibility to allergic disease. Dietary changes are at the centre of the emerging epigenetic paradigms that underpin the rise in many modern diseases. There is growing evidence that exposures in pregnancy and the early postnatal period can modify gene expression and disease susceptibility. Specific nutrients, including antioxidants, oligosaccharides, polyunsaturated fatty acids, folate and other vitamins, have documented effects on immune function. Some have also been implicated in modified risk of allergic disease in observational studies. Intervention studies are largely limited to trials with polyunsaturated fatty acids and oligosaccharides, showing preliminary but yet unconfirmed benefits in allergy prevention. Avoidance of food allergens in pregnancy, lactation or infancy has provided no clear evidence in allergy prevention and is no longer recommended. Rather there is focus on their role in tolerance induction. Modern dietary changes are clearly implicated in the rising propensity for inflammatory immune responses. These dietary changes, which appear to be providing less tolerogenic conditions during early immune programming, may provide important avenues for preventing disease.

Association of acute urticaria with Mycoplasma pneumoniae infection in hospitalized children

Acute urticaria is a common and disturbing disorder in children and has a versatile etiology. To investigate the association of acute urticaria with Mycoplasma pneumoniae infection in hospitalized children. Hospitalized children with acute urticaria from Taiwan who did not respond to antihistamine treatment and avoidance of food allergens were studied from February 1, 2006, to July 31, 2007. These patients with urticaria were compared with those who had other respiratory tract diseases and were classified into 2 groups: urticaria patients with and without M pneumoniae infection. The presence of M pneumoniae infection was determined by positive serologic findings. Sixty-five patients with acute urticaria and 49 patients with other respiratory tract diseases were enrolled in this study. Patients with urticaria had significantly less febrile duration but significantly higher platelet and lymphocyte counts than those with other respiratory tract diseases. Of the 65 patients with urticaria, 21 (32%) showed serologic evidence of M pneumoniae infection. Patients with M pneumoniae-associated urticaria received azithromycin treatment and needed a shorter time for improvement (P = .01) and complete resolution (P = .04). The total IgE levels and the results of specific IgE tests were not significantly different between urticaria patients with and without M pneumoniae infection. This study found that in Taiwan one-third of acute childhood urticaria leading to patient hospitalization was related to M pneumoniae infection. Therefore, children with urticaria who are not responding to antihistamine treatment and abstinence from food allergens should be encouraged to undergo serologic examinations for M pneumoniae to diagnose this antibiotic-responsive disorder.

Food allergy: Is strict avoidance the only answer?

It is an immunological paradigm that avoidance of food allergen may reduce the risk or prevent immunological reactions and conversely that a greater exposure increases the magnitude of the immune response. Consequently, food allergen avoidance has been recommended to reduce the risk of sensitization in infants and to prevent clinical reactions in children with positive skin prick tests (SPT). In the latter setting, it is hoped that avoidance may either promote or at least not retard the development of tolerance. Animal studies, however, have demonstrated that tolerance to food allergens may be induced by either large (high zone tolerance) or small (low zone tolerance) doses, whereas doses in between may actually stimulate immune responses. In this review, we discuss whether strict allergen avoidance is always the most appropriate strategy for preventing or managing IgE-mediated food allergy.

Otite séreuse et allergie

Respiratory and/or food allergy is common in children. Serous otitis media is also very frequent in children, especially those between 3 and 6 years of age. On the other hand, in spite of promising animal studies, a cause-and-effect relation between these two conditions in man has not been established. Concerning the treatment, avoidance of food allergens may be as efficacious for an active serous otitis media as for avoidance of a new episode. Conversely, antihistamines do not appear to be efficacious, at least with respect to being curative.

What’s new in atopic eczema? An analysis of the clinical significance of systematic reviews on atopic eczema published in 2006 and 2007

This review summarizes clinically important findings from 19 systematic reviews published between January 2006 and August 2007 on the topic of atopic eczema (AE). The evidence suggests that avoidance of allergenic foods during pregnancy or the use of hydrolyzed or soy formula milks does not prevent eczema. Delayed introduction of solids may decrease eczema risk. Asthma typically develops in around a third of children with eczema, and wheezing in early infancy is a predictor of risk. Established topical corticosteroids such as betamethasone should be used just once daily. Topical tacrolimus and pimecrolimus can be used for people who become dependent on topical corticosteroids, especially on sensitive sites such as the face. Wet wraps are useful in secondary care for inducing remission in a child, but they are not a treatment for mild eczema and they should not be used long term. Oral ciclosporin can be used for inducing a remission in severe eczema, and azathioprine can be considered for maintenance treatment. Narrowband ultraviolet (UV)B phototherapy can be used for chronic AE, and UVA1 may be useful for acute eczema. There is little convincing evidence of a clinical benefit with evening primrose oil for eczema, but there is some good new evidence that educational support to eczema families is beneficial. Future trials need to be larger, and include active comparators, patient-reported outcomes and longer-term aspects of disease control. They should be better reported, and registered on a public clinical trials register.

Food-induced Anaphylaxis: Who, What, Why, and Where?

Food-induced anaphylaxis is a leading cause of anaphylaxis treated in emergency departments and hospitals around the world. Peanuts, tree nuts, fish, and shellfish are the most commonly implicated foods. Food-induced anaphylaxis may occur in any age group and with any food. However, food-induced anaphylaxis fatalities disproportionately affect adolescents and young adults with peanut and tree nut allergy. Individuals who have both IgE-mediated food allergy and asthma are at a higher risk for food-induced anaphylaxis fatality. Delayed administration of epinephrine is also associated with fatal outcome. Often, in fatal reactions, the food allergen is unknowingly ingested away from home, in settings such as restaurants and schools. Although avoidance of food allergens is critical, timely administration of epinephrine is also of great importance in the treatment of food-induced anaphylaxis. Patients, families, and caregivers must be well educated regarding the signs, symptoms and risk factors for anaphylaxis. They must also be counseled on the importance of strict food avoidance of the implicated food allergens, compliance with having self-injectable epinephrine available at all times, and the importance of timely administration of epinephrine, even when cutaneous symptoms are lacking.

REDALL (Reduced allergenicity of processed foods) – allergeninduzierte Nahrungsmittel als Alternative zur Karenz bei Nahrungsmittelallergie?

Background: For patients with food allergy there has been no alternative treatment to food allergen avoidance. In a study supported by the European union, a new approach aimed to reduce the allergenicity of foods of animal origin to achieve better tolerance. Patients and methods: the prevalence of food allergy was assessed by telephone interviews with more than 40000 persons in 10 European countries. By thermal and enzymatic the allergenicity of the animal food allergens hen's egg, cow's milk, beef and poultry was reduced. Patients with proven food allergy to those foods of animal origin were recruited and assessed allergologically. In-vitro cellular test systems were established. The allergenicity of food products were investigated before and after allergen reduction. Results: The prevalence of food allergy in Europe is 3% with considerable regional differences. In 41.1% of food allergic patients, food allergens of animal origin were thought to be responsible for eliciting symptoms. In total, 249 patients with food allergy were recruited. The threshold for eliciting symptoms was below the lowest test dose (e.g. 10μg egg powder) in the double-blind placebo-controlled food challenge in 53 of 249 (21%) of patients, whereas 50 of 249 patients (20%) only reacted to the highest given dose (e.g. one full egg). Symptoms in the provocation test developed predominantly on the skin and in the gastrointestinal tract, however, also involved respiratory tract and cardiovascular system. Allergen-reduced cow's milk and hen's egg were produced and in part tolerated by patients in the skin prick test and provocation test. The extent of allergen reduction was characterized, also by cellular test systems involving mast cell lines. Conclusions: the concept of allergen reduction in food allergy is a new approach, which could reduce dietary interventions and support tolerance in food allergic patients.

Nutritional and Environmental Approaches to Preventing and Treating Autism and Attention Deficit Hyperactivity Disorder (ADHD): A Review

The purpose of this study was to concisely review the available literature of nutritional and environmental factors on autistic spectrum and attention deficit hyperactivity disorder (ADHD). Review of journal articles found on the PubMed database and from information from several conference proceedings. Many, but not all, studies link exposure to toxins such as mercury, lead, pesticides, and in utero smoking exposure to higher levels of autism and/or ADHD. Some studies have reported many nutritional deficiencies in autism/ADHD patients. Numerous studies have reported that supplemental nutrients such as omega-3 fatty acids, vitamins, zinc, magnesium, and phytochemicals may provide moderate benefits to autism/ADHD patients. Avoidance of food allergens, food chemicals, and chelation therapy may also provide some relief to autism/ADHD patients. Autistic spectrum disorders and ADHD are complicated conditions in which nutritional and environmental factors play major roles. Larger studies are needed to determine optimum multifactorial treatment plans involving nutrition, environmental control,medication, and behavioral/education/speech/physical therapies.

Primary prevention of allergy: avoiding risk or providing protection?

Primary prevention strategies of allergy so far have been aimed to fight allergy causes, by avoiding risk factors and inhibiting their mechanisms of action. The results of trials testing food or airborne allergen avoidance as a prevention strategy were, however, rather disappointing. A reverse approach for primary prevention of allergies aims to facilitate exposure to protecting factors which promote the induction of immunologic tolerance against innocuous antigens. These factors are associated with farming environment and a 'traditional lifestyle', but identification of these factors is quite difficult. Major candidates include food-borne microbes, helminths or their components, which are able to stimulate mucosal immunity, particularly in the gut. Similarly, new preventive and therapeutic strategies are being tested to induce specific food-allergen oral tolerance through the ingestion of progressively increasing doses of the offending food. This shifting of allergy prevention research from avoidance to tolerance induction will hopefully allow us to reverse the epidemic trend of allergy diseases.

Food anaphylaxis

Anaphylaxis is a life-threatening allergic reaction, and food is one of the most common responsible allergens in the outpatient setting. The prevalence of food-induced anaphylaxis has been steadily rising. Education regarding food allergen avoidance is crucial as most of the fatal reactions occurred in those with known food allergies. The lack of a consensus definition for anaphylaxis has made its diagnosis difficult. Symptoms affect multiple organ systems and include pruritus, urticaria, angioedema, vomiting, diarrhoea, abdominal cramps, respiratory difficulty, wheezing, hypotension, and shock. Prompt recognition of anaphylaxis is essential as delayed treatment has been associated with fatalities. Although epinephrine is accepted as the treatment of choice, timely administration does not always occur, partly due to a lack of awareness of the diagnostic criteria. Several novel tools are currently being investigated, which will potentially aid in the diagnosis and treatment of food-induced anaphylaxis.

WITHDRAWN: Cow's milk protein avoidance and development of childhood wheeze in children with a family history of atopy.

In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease, when breast-feeding is not possible or supplemental feeding is needed. Most infant formulas are based on cow's milk protein. Alternative choices include soya based and hydrolysed cows milk formulas. To estimate the effect of dietary avoidance of cow's milk protein on the development of asthma or wheeze in children. We searched the Cochrane database for eligible trials until February 2002. We obtained the full text papers of all abstracts identified as RCTs and two reviewers independently reviewed them. We included randomised controlled trials involving children with a family history of atopy in at least one first degree relative, if feeding with cow's milk based standard formula was compared to dietary avoidance of cow's milk protein, using soya or other hypoallergenic formula during the initial four months of life or longer. Two reviewers extracted data independently. A priori defined subgroups were the types of hypoallergenic artificial feed and dietary restrictions on mother and/or child's diet. Six trials used hydrolysed formula for at least four months, in addition to dietary restrictions and in some cases dust-mite reduction measures. The risk of infants experiencing asthma or wheeze during the first year of life was reduced compared to standard cow's milk based formula (Relative Risk 0.40, 95% Confidence Intervals 0.19 to 0.85). Feeding soya-based formula as opposed to standard cow's milk formula did not reduce the risk of having asthma or wheeze at any age. Breast-milk should remain the feed of choice for all babies. In infants with at least one first degree relative with atopy, hydrolysed formula for a minimum of four months combined with dietary restrictions and environment measures may reduce the risk of developing asthma or wheeze in the first year of life. There is insufficient evidence to suggest that soya-based milk formula has any benefit.

Prevention of allergic disease during childhood by allergen avoidance: The Isle of Wight prevention study

Early life allergen exposure may increase the risk of childhood allergy, but the protective effect of reduction in allergen exposure remains uncertain. To evaluate the effect of reduction in food and house dust mite (HDM) allergen exposure in infancy in preventing asthma and allergy. Infants, at higher risk because of family predisposition, were recruited prenatally and randomized to prophylactic (n = 58) and control (n = 62) groups. Prophylactic group infants were either breast-fed with mother on a low allergen diet or given an extensively hydrolyzed formula. Exposure to HDM was reduced by the use of an acaricide and mattress covers. The control group followed standard advice. Development of allergic diseases and sensitization to common allergens (atopy) was assessed blindly at ages 1, 2, 4, and 8 years in all 120 children. Repeated measurement analysis, adjusted for all relevant confounding variables, confirmed a preventive effect on asthma: adjusted odds ratio (OR), 0.24; 95% CI, 0.09-0.66; P = .005; atopic dermatitis, OR, 0.23; CI, 0.08-0.64; P = .005; rhinitis, OR, 0.42; CI, 0.19-0.92; P = .03; and atopy, OR, 0.13; CI, 0.05-0.32; P < .001. The protective effect was primarily observed in the subgroup of children with persistent disease (symptoms at all visits) and in those with evidence of allergic sensitization. Allergic diseases can be reduced, for at least the first 8 years of life, by combined food and HDM allergen avoidance in infancy. Strict food and HDM allergen avoidance should be considered for prevention of allergy in high-risk infants.

Dietary assessment in children adhering to a food allergen avoidance diet for allergy prevention

The purpose of this investigation was to verify if avoidance of allergenic foods in children adhering to a food allergen avoidance diet from birth was complete and feasible, and whether dietary assessment can be used as a tool in predicting the outcome of double-blind, placebo-controlled food challenges (DBPCFCs). Children adhering to an allergen avoidance diet from birth underwent DBPCFCs. The investigator-dietician verified whether the elimination was complete, using food frequency questionnaires for common allergenic foods. University Medical Centre Groningen, the Netherlands. Thiry-eight children aged 1-13 years, who were consecutively referred to the University Medical Centre Groningen for DBPCFC between January 2002 and February 2004. Among the 38 children undergoing DBPCFCs, there were 15 challenges with egg, 15 with peanut, five with hazelnut and three with soy. Fifteen food challenges (39%) were positive. Small quantities of allergenic foods were inadvertently present in the diets of 13 patients (34%), were possibly present in the diets of 14 patients (37%) and could not be identified in the diets of 11 patients (29%). Seven patients (54%) who had inadvertently ingested small quantities of allergenic foods without sequelae had a positive DBPCFC. Dietary avoidance was incomplete and not feasible in most cases. Tolerance of small amounts of allergenic foods does not preclude positive challenge reactions. Dietary assessment does not seem a useful tool in predicting the outcome of DBPCFC in children adhering to an elimination diet. The Stichting Astma Bestrijding (Foundation for the Prevention of Asthma), The Netherlands.

Eosinophilic esophagitis

Eosinophilic esophagitis is a new disease commonly confused with gastroesophageal reflux disease. Because of different treatments, recognition of eosinophilic esophagitis is important. Recent work further characterizes the allergic response, demonstrating a population of eosinophils different from gut and blood that specifically homes to the esophagus in eosinophilic esophagitis. Further data suggest a multi-step allergy process starting with an atopic skin response that later primes the esophagus on further allergen exposure. Diagnosis of eosinophilic esophagitis is suggested by food impaction in a young adult with a personal and family history of allergy. Barium radiography may be useful for obvious signs of eosinophilic esophagitis including rings and strictures. Treatment is based on systemic or topical steroids or identification and elimination of food allergens sometimes with elemental diets. Recent data show the latter to be superior both for the short and long term but with the caveat of compliance being difficult. Eosinophilic esophagitis is an allergy-based disorder. It presents commonly in adults as long standing dysphagia, sometimes with food impaction. Radiography is useful but will miss subtle signs of eosinophilic esophagitis. Treatment options are limited to steroid formulations or avoidance of food allergens though compliance, particularly with elemental formulas, remains problematic.

Impact of Ingredient Labeling Practices on Food-Allergic Consumers

Allergy and Immunology| April 01 2006 Impact of Ingredient Labeling Practices on Food-Allergic Consumers AAP Grand Rounds (2006) 15 (4): 44–45. https://doi.org/10.1542/gr.15-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Impact of Ingredient Labeling Practices on Food-Allergic Consumers. AAP Grand Rounds April 2006; 15 (4): 44–45. https://doi.org/10.1542/gr.15-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP News Search Advanced Search Topics: food, allergens, tree nut Source: Simons E, Weiss CC, Furlong TJ, et al. Impact of ingredient labeling practices on food allergic consumers. Ann Allergy Asthma Immunol. 2005;95:426–428. Food allergy affects nearly 4% of Americans and a larger proportion of children.1 Avoidance of the offending foods is the only effective remedy currently available. Unfortunately, avoidance of food allergens is complicated by lack of clarity in manufacturers’ labels. The Food Allergen Labeling and Consumer Protections Act (FALCPA) requires clear identification of 8 major food allergens (cow’s milk, egg, wheat, soy, peanut, tree nuts, fish, shellfish) on packaging, including those present in flavorings or spices. The FALCPA went into effect on January 1, 2006.2 The objective of this study from Mount Sinai School of Medicine, New York and the Food Allergy and Anaphylaxis Network (FAAN), Fairfax, Va, was to... Copyright © 2006 by the American Academy of Pediatrics2006 You do not currently have access to this content.

Allergen avoidance in the primary prevention of asthma

Six primary prevention studies trialing environmental modifications to reduce asthma in children have published results of clinical outcomes. All are still in progress. In the Isle of Wight study, mite and food avoidance were evaluated to age 9 months. At 8 years, children in the active group had less current wheeze, wheeze with bronchial hyperresponsiveness and atopy (P < or = 0.05). The Canadian Primary Prevention Study examined avoidance of inhalant and food allergens. At 1 year there was a reduction in probable asthma and rhinitis in the active group. The Study on the Prevention of Allergy in Children in Europe tested avoidance of inhalant and food allergens. At 1 year there was less atopy and sensitization to mites in the active group. In the Childhood Asthma Prevention Study both mite avoidance and a dietary supplement of omega 3 fatty acids were analysed in a factorial design. At age 18 months, children in the dietary intervention group had significantly less wheeze. Eczema was more common amongst children using the mite avoidance measures. The Prevention and Incidence of Asthma and Mite Allergy Study is a placebo-controlled study of mite avoidance. At 2 years, there was a small reduction in nocturnal cough without a cold in the active group. The Manchester Asthma and Allergy Study included stringent environmental control. At 1 year prescribed medication for wheeze and wheeze with shortness of breath were significantly less common in the active group than the control group. Although initial results look promising, further follow up of the ongoing cohorts is required before any recommendations can be made within the public health context.

Nutrition and food allergies: the dietitian's role

A varied nutrient intake provides the opportunity for an adequate nutrient intake balance while reducing malnutrition risks. When a food allergy diagnosis has been made, medical nutrition therapy with scheduled follow-up visits can provide a way to monitor the overall health effects of food elimination. Identifying individuals at risk may protect and possibly improve the patient's nutritional and overall health status. Medical nutrition therapy with appropriate food allergen substitution(s) provides the tools necessary giving the food-allergic patient the specific focus needed for improved nutrition self-care and food allergen avoidance. To reduce the food allergic patient's risk of developing malnutrition by providing exceptional nutrition intervention. Review of the literature with clinical perspectives. The food-allergic patient is less likely to develop nutrient deficiencies or malnutrition when provided with appropriate food alternatives and careful monitoring while eliminating the food allergen(s), short- or long-term, from the diet. The dietitian is the most qualified professional to address the food-allergic patient's medical nutrition therapy needs.

Food Allergen Avoidance in the Prevention of Food Allergy in Infants and Children

Food allergy afflicts an increasing number of infants and children and is associated with both clinical and familial burdens. To help lessen this burden, the Nutritional Committees from the American Academy of Pediatrics and jointly the European Society for Pediatric Allergology and Clinical Immunology and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition published recommendations to prevent and treat food allergy. Although there is much in common with these recommendations, differences exist. This review compares, contrasts, and reconciles them, presenting the evidence that has led to their statements.