Food Allergen Sensitization Research Articles

Allergic sensitization is associated with rhinovirus-, but not other virus-, induced wheezing in children

Jartti T, Kuusipalo H, Vuorinen T, Söderlund‐Venermo M, Allander T, Waris M, Hartiala J, Ruuskanen O. Allergic sensitization is associated with rhinovirus‐, but not other virus‐, induced wheezing in children. Pediatr Allergy Immunol 2010: 21: 1008–1014. © 2010 John Wiley & Sons A/S Background: Data on the link between atopy and viral wheeze are limited. Aim: To evaluate the association between IgE sensitization and viral infection in wheezing children. Methods: This is an observational study in hospitalized wheezing children (n = 247; median age 1.6 ; interquartile range 1.1, 2.9). Eighteen respiratory viral infections were studied using all available methods. A specific immunoglobulin E (IgE) sensitization for common food and aeroallergens and other atopy‐related variables including total IgE, blood and nasal eosinophils, exhaled nitric oxide, eczema and atopic eczema, parental allergy and asthma, number of wheezing episodes, positive asthma predictive index or asthma and use of inhaled corticosteroid were correlated with specific viral etiology. Results: Atopy was closely associated with sole rhinovirus etiology (n = 58) but not with sole respiratory syncytial virus, sole enterovirus, sole human bocavirus, sole other virus, mixed viral, or virus negative etiology. The number of sensitizations was particularly associated with sole rhinovirus etiology (odds ratio 4.59; 95% confidence interval 1.78, 11.8; adjusted to age and sex), followed by aeroallergen sensitization (respectively; 4.18; 2.00, 8.72), total IgE level (2.06; 1.32, 3.21), food allergen sensitization (2.02; 1.08, 3.78), and nasal eosinophil count (1.52; 1.08, 2.13). Conclusions: According to our data, allergic sensitization is positively linked to rhinovirus‐, but not other virus‐, associated wheezing and calls attention for studies to test rhinovirus‐associated wheezing as a part of asthma risk indices.

Partial Protein-Hydrolyzed Infant Formula Decreased Food Sensitization but Not Allergic Diseases in a Prospective Birth Cohort Study

Background: Exposure to cow’s milk protein in early infancy could lead to increased rates of allergic diseases later in life. We investigated whether feeding a protein-hydrolyzed formula (HF) in the first 6 months of life decreased allergic diseases up to 36 months later. Methods: Newborns who had at least 1 first-degree family member with a history of atopy and could not breast-feed were enrolled. They were fed with HF or cow’s milk infant formula (CM) for at least 6 months via an open-label protocol and were monitored prospectively at 6, 18 and 36 months of age to assess allergy sensitization and allergic diseases. Results: A total of 1,002 infants were enrolled and 679 infants were consistently fed the same formula for the first 6 months of life (345 HF and 334 CM). The percentage of food sensitization (especially to milk protein) was significantly lower in the HF group than in the CM group at 36 months (12.7 vs. 23.4%, p = 0.048). There was no significant difference in the prevalence of aeroallergen sensitization between the groups. Occurrence of allergic diseases during the first 3 years of life was significantly correlated with aeroallergen sensitization, but not to food allergen sensitization, parental atopy or feeding types. Conclusions: Infants fed with HF during the first 6 months of life had a significantly lower percentage of sensitization to milk protein allergens, but not allergic diseases during the first 3 years of life. Avoidance of cow’s milk protein alone in infancy is not enough to decrease rates of allergic diseases.

Regulation by intestinal γδ T cells during establishment of food allergic sensitization in mice

Food allergy affects approximately 5% of children and is the leading cause of hospitalization for anaphylactic reactions in westernized countries. The mucosal adjuvant cholera toxin induces allergic sensitization to co-administered proteins in mice, while feeding the protein alone induces oral tolerance. Intestinal γδ T cells could be of importance in the induction of oral tolerance. This study aims to investigate whether γδ T cells have functional relevance in food allergic sensitization. Changes in γδ T cells on days 1, 2, 3, and 7 after initiation of food allergy were evaluated using flowcytometry. Furthermore, the anti-γδ T-cell receptor (TCR) antibody UC7 was used to block the γδ TCR in mice in vivo, followed by sensitization to peanut. After 4 weeks, peanut-specific antibodies in serum and cytokine production in spleen were measured. Induction of food allergy resulted in a profound decrease in the percentage of γδ T cells in intestinal tissues and Peyer's Patches, but not in mesenteric lymph nodes or spleen. This decrease could be detected from days 1 to 2 after the initiation of food allergy and the number of γδ T cells returned to normal on day 7. Blockade of the γδ TCR resulted in elevated food allergic responses upon sensitization with peanut characterized by increased IgE and Th2 cytokine production in splenocytes. These results demonstrate a unique regulatory role of γδ T cells, suggesting that targeting γδ T cells in the intestine may contribute to strategies to prevent and possibly treat food allergy.

Defining the Role of Food Allergy in a Population of Adult Patients with Eosinophilic Esophagitis

The aim of this study was to establish the clinical types of food reactions and the food sensitization profile in an adult cohort of patients with (EoE). We have prospectively analyzed the food allergen sensitization profile using skin prick test (SPT) and atopy patch test (APT) to 22 plant and animal-derived foods in 19 adult patients with biopsy-proven EoE. For each patient the following data was collected: age, sex, atopic disease status, and clinical characteristics of the EoE. A total of 123 food sensitizations were detected by SPT and 45 food sensitizations by patch testing in 18 patients (94.8%). Thirty-five double- positive (SPT+, APT+) responses against the same food were detected in 15 patients (78.9%). We have also identified 11 clinical episodes clearly suggestive of oral allergy syndrome, urticaria and/or anaphylaxis after intake of some specific foods. All cases showed positive SPT to the offending food (Type 1 food reactors). 68 clinically apparent episodes of EoE related with specific foods were detected in our patients. In 40 instances (58.8%) the foods involved in developing EoE symptoms showed a positive SPT and/or APT results (Type 2). 155 food sensitizations were identified in 18 patients (94.7%) using SPT and/or APT neither related with clinically apparent episodes of EoE nor with clinical episodes suggestive of oral allergy syndrome, urticaria and/or anaphylaxis after food intake (Type 3). In conclusion, the patients with EoE can be allocated into 3 different groups of food reactors, with well-defined clinical and biological characteristics.

An update on the immunopathogenesis of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic clinicopathological entity characterized by large numbers of intraepithelial eosinophils infiltrating the esophageal mucosa, which is not caused by gastroesophageal reflux. This disease has become widely recognized over the past few years and new methods have been developed to reveal its underlying pathophysiological mechanisms. Owing to the high prevalence of food and/or airborne allergen sensitization in EoE patients, the allergic nature of the disease had to be defined, which has certain factors in common with other IgE-dependent entities, such as bronchial asthma or allergic rhinitis. Of these, some cytokines and chemokines previously studied in asthma have also been implicated in molecular mechanisms causing eosinophil-rich esophageal inflammation. However, the role played by IgE in relation to the esophageal eosinophilic infiltrate must be clarified, together with the possible function of mast cells in the inflammatory infiltrate and its activation stimuli. A putative role has also been recently suggested for gastroesophageal reflux in the origin of EoE that should be profoundly analyzed, together with the role of specific genes implicated in other digestive inflammatory disorders. This article reviews recent advances in the immunopathogenesis of EoE, which should also consider other pathways to activate the esophageal mucosal immune system.

Prospective association between food sensitization and food allergy: results of the LISA birth cohort study

Food allergy is common, especially in childhood, where 6-8% of children are affected. Identification of early and efficient markers for later development of food allergy is very important. We examined the ability of repeated measurements of food sensitization in early childhood to predict doctor-diagnosed food allergy (DDFA) at the age of 6 years. The analysis was based on data from a prospective birth cohort study. Information was collected by parental questionnaires, and blood samples were obtained at 2 and 6 years of age. Children with repeated determination of sensitization to food allergens at 2 and 6 years of age were categorized into the sensitization phenotypes: no, early onset, late onset and persistent sensitization. The association between sensitization phenotypes and DDFA was prospectively investigated using multiple logistic regression analyses. Of 3097 children recruited at birth, a complete follow-up of IgE measurements and questionnaires at 1.5, 2 and 6 years were available for 1082 children. Early food allergen sensitization (fx5) was a strong risk for DDFA at 6 years [odds ratio (OR)=4.7; 95% confidence intervals (95% CI) 2.0-11.2] and for a new onset of DDFA at 6 years (OR=4.1; 95% CI 1.5-11.3). Additionally, persistent food allergen sensitization increased the risk of DDFA at 6 years (OR=6.1; 95% CI 2.7-13.7). Early sensitized children with a history of parental atopy showed the highest risk for DDFA at 6 years. Food-sensitized children during the first 2 years of life, especially with a family history of atopy, might be considered as a susceptible subgroup that requires specific attention concerning the development of food allergy-related symptoms.

Gestational Diabetes is Associated with Food Allergen Sensitization in an Inner-City Population

Gestational Diabetes is Associated with Food Allergen Sensitization in an Inner-City Population

Oral Superantigen Promotes Th2-skewed Immune Responses and Anaphylaxis to Food Antigens

RationaleFood allergy is characterized by the generation of immune responses to antigenic proteins in foods. Oral tolerance usually prevents such responses and the factors that promote food allergen sensitization in food allergy remain unknown. Enterotoxin-secreting strains of Staphylococcus aureus are associated with allergic diseases such as atopic dermatitis and chronic rhinosinusitis but are also a common cause of food contamination. We examined the influence of oral administration of Staphylococcal enterotoxin B (SEB) on the generation of oral tolerance to food allergens.MethodsBalb/c mice received OVA or whole peanut extract (WPE) by oral gavage once weekly for 8 weeks with or without addition of SEB. As a positive control, separate groups received antigen plus cholera toxin, a commonly utilized mucosal adjuvant. On week 9, mice were challenged with a single bolus administration of antigen and anaphylactic responses monitored. 24 hours later, samples were collected for immunological analysis.ResultsSEB promoted the generation of ovalbumin or peanut-specific IgE and anaphylaxis upon food antigen challenge. Challenge with BSA failed to elicit anaphylaxis. Unlike CT-driven sensitization, SEB promoted minimal antigen-specific IgG2a responses. Additionally, peripheral blood eosinophilia was significantly increased by SEB and not by CT-driven sensitization. CD3/CD28 and antigen stimulated splenocytes from SEB/Ag treated mice elicited a strong Th2-biased immune response while gene expression of Th2 cytokines in jejunum and mesenteric lymph nodes were also elevated.ConclusionsOur findings establish that oral exposure to SEB is sufficient to promote allergic responses and anaphylaxis to food antigens and demonstrates a promising new model for food allergy research. RationaleFood allergy is characterized by the generation of immune responses to antigenic proteins in foods. Oral tolerance usually prevents such responses and the factors that promote food allergen sensitization in food allergy remain unknown. Enterotoxin-secreting strains of Staphylococcus aureus are associated with allergic diseases such as atopic dermatitis and chronic rhinosinusitis but are also a common cause of food contamination. We examined the influence of oral administration of Staphylococcal enterotoxin B (SEB) on the generation of oral tolerance to food allergens. Food allergy is characterized by the generation of immune responses to antigenic proteins in foods. Oral tolerance usually prevents such responses and the factors that promote food allergen sensitization in food allergy remain unknown. Enterotoxin-secreting strains of Staphylococcus aureus are associated with allergic diseases such as atopic dermatitis and chronic rhinosinusitis but are also a common cause of food contamination. We examined the influence of oral administration of Staphylococcal enterotoxin B (SEB) on the generation of oral tolerance to food allergens. MethodsBalb/c mice received OVA or whole peanut extract (WPE) by oral gavage once weekly for 8 weeks with or without addition of SEB. As a positive control, separate groups received antigen plus cholera toxin, a commonly utilized mucosal adjuvant. On week 9, mice were challenged with a single bolus administration of antigen and anaphylactic responses monitored. 24 hours later, samples were collected for immunological analysis. Balb/c mice received OVA or whole peanut extract (WPE) by oral gavage once weekly for 8 weeks with or without addition of SEB. As a positive control, separate groups received antigen plus cholera toxin, a commonly utilized mucosal adjuvant. On week 9, mice were challenged with a single bolus administration of antigen and anaphylactic responses monitored. 24 hours later, samples were collected for immunological analysis. ResultsSEB promoted the generation of ovalbumin or peanut-specific IgE and anaphylaxis upon food antigen challenge. Challenge with BSA failed to elicit anaphylaxis. Unlike CT-driven sensitization, SEB promoted minimal antigen-specific IgG2a responses. Additionally, peripheral blood eosinophilia was significantly increased by SEB and not by CT-driven sensitization. CD3/CD28 and antigen stimulated splenocytes from SEB/Ag treated mice elicited a strong Th2-biased immune response while gene expression of Th2 cytokines in jejunum and mesenteric lymph nodes were also elevated. SEB promoted the generation of ovalbumin or peanut-specific IgE and anaphylaxis upon food antigen challenge. Challenge with BSA failed to elicit anaphylaxis. Unlike CT-driven sensitization, SEB promoted minimal antigen-specific IgG2a responses. Additionally, peripheral blood eosinophilia was significantly increased by SEB and not by CT-driven sensitization. CD3/CD28 and antigen stimulated splenocytes from SEB/Ag treated mice elicited a strong Th2-biased immune response while gene expression of Th2 cytokines in jejunum and mesenteric lymph nodes were also elevated. ConclusionsOur findings establish that oral exposure to SEB is sufficient to promote allergic responses and anaphylaxis to food antigens and demonstrates a promising new model for food allergy research. Our findings establish that oral exposure to SEB is sufficient to promote allergic responses and anaphylaxis to food antigens and demonstrates a promising new model for food allergy research.

항원감작식품과 어린이 알레르기 질환과의 관계

2005년 3월부터 2006년 4월까지 어린이 74명(남 47, 여 27, 1-4세)을 대상으로 식품에 대한 IgE 특이 항체량을 검사하였다. 알레르기 증상을 나타낸 어린이의 연령은 영 유아(0-3세)가 34명, 4-6세가 24명, 7-9세가 8명, 10세 이상이 8명으로, 나이가 어릴수록 알레르기 증상을 보이는 어린이가 많은 것으로 나타났다. 검사한 어린이가 21종류의 식품 중 3종류, 4종류, 5종류의 식품에 반응을 보인 어린이는 각각 10명, 21명, 15명으로 나타났다. IgE 항체반응에서 class 2 미만으로 나타난 어린이의 식품은 콩 28명, 우유 29명, 치즈 21명, 난백 7명, 돼지고기 18명으로 나타났고 class 2 이상은 콩 20명, 우유 17명, 치즈 24명, 난백 20명, 돼지고기 21명으로 나타나 이러한 식품들이 주로 식품 알레르기와 관련이 있는 것으로 판단된다. 가족력에서는 알레르기 증상을 나타낸 비율이 남아는 45.5%, 여아는 50%로 절반 정도로 나타났고, 가족 중 알레르기 질병의 병력은 아토피 피부염은 26%, 아토피 비염은 10.5%,아토피 피부염과 아토피 비염은 31.5%, 두드러기 21.0%, 천식 10.5%이었다. 섭식력은 모유와 분유를 혼합하여 섭취한 어린이가 분유만 섭취한 어린이, 모유만 섭취한 어린이보다 높았다. 알레르기 유발식품으로 제한하는 식품은 계란과 우유 12.5%, 우유 2.5%, 계란 10.0%등이었다. We have investigated the relationship between food allergen sensitization and allergic disease in 74 child (male 47, female 27) patients from 0 to 14 years of age diagnosed with allergic disease. The age distribution for the study was: newborn to 3 years old, 34 children; 4 to 6 years old, 24 children; 7 to 9 years old, 8 children and above 10 years old, 8 children. Of the 74 children, 10 children were allergic to 3 of the 21 types of foods tested, 21 children were allergic to 4 types and 15 children were allergic to 5 types. The results of specific IgE tests for class 2 (0.070-3.49 IV/mL, IgE density in serum) showed that 29 children were allergic to milk, 28 children to bean, 21 children to cheese, 7 children to egg, and 18 children to pork, while over class 2, 20 children were allergic to bean, 17 children to milk, 24 children to cheese, 20 children to egg, and 21 children to pork. A questionnaire was used to survey family allergy history and diet patterns for 40 child (male 22, female 18) patients with allergic disease. The frequencies of a family history of allergy were 45.5% for males and 50.0% for females. The allergic diseases included atopic dermatitis: 26.0%, atopic nasitis: 10.5%, atopic dermatitis + atopic nasitis : 31.5%, hives: 21.0%, and asthma: 10.5%. Children on diets of mixed breast feeding and infant formula were more allergic than those on either breast feeding or infant formula feeding. Eliminated allergenic foods were egg + milk: 12.5%, egg: 10.0%, and milk 2.5%.

Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis

Eosinophilic esophagitis (EE) is an emerging condition where patients commonly present with symptoms of gastroesophageal reflux disease and fail to respond adequately to anti-reflux therapy. Food allergy is currently recognized as the main immunological cause of EE; recent evidence suggests an etiological role for inhalant allergens. The presence of EE appears to be associated with other atopic illnesses. To report the sensitization profile of both food and inhalant allergens in our EE patient cohort in relation to age, and to profile the prevalence of other allergic conditions in patients with EE. The study prospectively analyzed allergen sensitization profiles using skin prick tests to common food allergens and inhalant allergens in 45 children with EE. Patch testing to common food allergens was performed on 33 patients in the same cohort. Comorbidity of atopic eczema, asthma, allergic rhinitis and anaphylaxis were obtained from patient history. Younger patients with EE showed more IgE and patch sensitization to foods while older patients showed greater IgE sensitization to inhalant allergens. The prevalence of atopic eczema, allergic rhinitis and asthma was significantly increased in our EE cohort compared with the general Australian population. A total of 24% of our cohort of patients with EE had a history of anaphylaxis. In children with EE, the sensitization to inhalant allergens increases with age, particularly after 4 years. Also, specific enquiry about severe food reactions in patients presenting with EE is strongly recommended as it appears this patient group has a high incidence of anaphylaxis.

The changing face of food hypersensitivity in an Asian community

Food allergy seems to be increasing in Asia as well as world-wide. Our aim was to characterize food protein sensitization patterns in a population of Asian children with possible food allergy. Children presenting to our allergy clinic over 3 years with symptomatic allergic disease and at least one specific food allergen sensitization documented on skin prick testing were included in the analysis. Two hundred and twenty-seven patients fulfilled inclusion criteria. Ninety (40%) of the positive skin tests were positive to egg, 87 (39%) to shellfish, 62 (27.3%) to peanut, 30 (13.2%) to fish, 27 (11.8%) to cow's milk, 21 (9.3%) to sesame, 13 (3.7%) to wheat and eight (3.2%) to soy. Peanut sensitization was the third most common sensitizing allergen, and seen mostly in young atopic children with multiple food hypersensitivities and a family history of atopic dermatitis. The median reported age of first exposure to fish and shellfish was 6 and 12 months, respectively. The mean age at presentation of children with shellfish hypersensitivity was at 6.7 years of age. The likelihood of shellfish sensitization was increased in children with concomitant sensitization to cockroaches. In contrast to previously reported low peanut allergy rates in Asia, in our review, peanut sensitization is present in 27% (62/227) of food-allergic children, mostly in patients with multiple food protein sensitizations. Temporal patterns of first exposure of infants to fish and shellfish are unique to the Asian diet. Shellfish are a major sensitizing food source in Asian children, especially in allergic rhinitis patients sensitized to cockroaches.

Food Allergen Sensitization is Independently Associated with Decreased Lung Function in Children

Food Allergen Sensitization is Independently Associated with Decreased Lung Function in Children

The Effects of Breast-milk Feeding on Severe Atopic Dermatitis In Korean Infant and Toddler

RATIONALE: This study is designed to evaluate the effect of breast-milk feeding among the severe atopic dermatitis having multiple food allergen sensitization in Korean children. METHODS: This study subjects were recruited from the Pediatric Allergy Clinic at Inha University hospital from April 2005 to March 2006. The subjects above 56 SCORAD score and under 24 months old were selected. Parents or guardians were interviewed. The specific IgE test(MAST) for 20 foods was done. The MAST above 2 class is thought to be positive sensitization. RESULTS: The number of subjects is 24 (18 boy, 6 girl). The mean age is 11 months old(4-20 months). The patients who ate breast-milk till 4 months after birth are 19 (79.2%), who till 2 weeks are 2 (8.3%), and who never breast-milk are 3 (12.5%). The patients with frequent wheezing are 11 (45.8%). The average of positive MAST allergens are 7.5 kinds of allergens(3-19 allergens). The all patients are positive for egg white and 22 patients (91.7%) for milk. Parents allergy history shows 8 allergic rhinitis, 1 asthma, 1 allergic rhinitis and asthma, 3 atopic dermatitis, 1 food allergy, and 10 nothing of allergic disorders. CONCLUSIONS: In this study, breast-milk feeding till 4 months after birth did not give the prevention effects on the patients of severe atopic dermatitis under 24 months old from atopic or non atopic parents. The research to identify the certain antibodies or allergens from breast-milk to develop and aggravate the atopic dermatitis is needed.

Study of food allergy on Spanish population

Background The aim of the study was to investigate the prevalence of food allergy in patients referred to our Allergy Unit and to evaluate the diagnostic methods used. Methods We selected 674 patients referred to the Allergy Unit of our hospital from May 2002 to October 2004. The prevalence of symptoms was determined by a standardized questionnaire, prick-prick test, and serum specific IgE. In a second phase, double- blind oral challenge tests were administered. Results Food allergy was found in 106 patients (15.7%): 71 adults (67 %) and 35 children (33 %). The prevalence of food allergen sensitization was 14 % in adults and 20.8 % in children. A total of 89.6 % of the patients experienced symptoms immediately. Only 29.2% the patients of sought medical attention and adrenaline was administered to five (16.1 %). The foods most frequently involved in allergic reactions were fruits (56.6%) and tree nuts (22.6%).The most common symptoms were oral allergy syndrome (46.2 %), urticaria (32.1 %), and anaphylaxis (14.2 %). Combining the results of the questionnaire with those of prick-prick tests in patients whose allergy was confirmed by double-blind, placebo-controlled food challenge (9.1 %) showed a sensitivity of 95.5 %, a negative predictive value of 96 %, a specificity of 75 % and a positive predictive value of 73%. Conclusions 1. The prevalence of food allergy in our sample was 9.1 %. 2. The foods most frequently involved in allergic reactions were fruits and tree nuts. 3. The most common symptoms were oral allergy syndrome, urticaria, and anaphylaxis. 4. Combining our questionnaire with in vivo tests allowed us to diagnose 75-96% of patients with no food allergy and 95 % of food allergy patients.

Food Allergen Sensitization in Inner-City Children With Asthma

Purpose of the Study. To determine the prevalence of food allergen sensitization and its association with asthma symptoms and health care utilization in an inner-city asthma population. Study Population. Random serum samples were obtained from children (n = 544) aged 4 to 9 years (median: 6 years) with asthma living in inner-city areas enrolled in the National Cooperative Inner City-Asthma Study. Methods. Information regarding demographics, health history, medication use, health care utilization, and asthma symptoms was recorded on the basis of 3-month recall at baseline and at 3-month intervals for a period of 12 months. No information regarding food allergy diagnoses or reactions was obtained. Skin-prick testing to 13 environmental allergens was performed at enrollment in the National Cooperative Inner City-Asthma Study. The random serum samples were evaluated for specific immunoglobulin E (IgE) (UniCap System) to egg, milk, soy, peanut, wheat, and fish. On the basis of IgE levels, subjects were stratified into 4 groups: group 1, food-specific IgE levels that had >95% positive predictive value for food allergy; group 2, probable food allergy (IgE ≥ 0.7 kU/L); group 3, any sensitization (IgE ≥ 0.35 kU/L); and group 4, no evidence of food allergy (IgE < 0.35 kU/L). Results. There was a significant correlation between sensitization to foods and sensitization to aeroallergens, with sensitization to the highest number of aeroallergens correlating with sensitization to soy, wheat, and peanut. Forty-five percent of study patients were sensitized to at least one food (groups 1–3): 4% of the participants were categorized to group 1, 26% to group 2, and 14% to group 3. Fifty-five percent were not sensitized to any of the 6 foods (group 4). Food allergy to egg and peanut were associated with the highest specific IgE levels. Patients who were sensitized to at least one food had higher rates of hospitalization and steroid medication use. The food-sensitized groups required more medications in general, but this difference was not significant. Most group 1 children (96%) demonstrated sensitization to >1 food, with 25% of the patients sensitized to all 6 foods tested. Most group 2 patients (75%) and 19% of group 3 patients were sensitized to multiple foods. There was a significant increase in hospitalizations for asthma in children sensitized to >1 food. When specific foods were examined, a correlation between higher asthma morbidity and sensitization to fish or soy was noted. Conclusions. Food sensitization correlated with increased asthma severity in the study population. The prevalence of food allergy was not determined because of the nature of the study (anonymous serum samples and lack of blinded food challenges); however, on the basis of the study results, the authors predicted that inner-city children with asthma were more likely than the general population to have food allergy. The association of increased asthma morbidity with at least 1 food sensitization, and findings that patients with sensitization to multiple foods had significantly more asthma morbidity than those with single-food sensitization, suggest that food sensitization is a marker for increased asthma severity. Reviewer Comments. This study suggests that the prevalence of food sensitization, and possibly food allergy, is increased in patients with asthma and may be a useful marker for increased asthma severity. Health care providers should consider screening for food sensitization in patients with severe or poorly controlled asthma.

Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report

There are remarkable differences in the diagnostic and therapeutic management of atopic dermatitis practiced by dermatologists and pediatricians in different countries. Therefore, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nominated expert teams who were given the task of finding a consensus to serve as a guideline for clinical practice in Europe as well as in North America. The consensus report is part of the PRACTALL initiative, which is endorsed by both academies.

Relationship between aeroallergen and food allergen sensitization in childhood

Previous studies measuring the prevalence of allergen sensitization have been relatively small and used small numbers of allergens. To effectively evaluate children with atopic disease, we need an accurate knowledge of which allergens are important. To measure the prevalence of sensitization within a large unselected birth cohort, to examine the associations between sensitization to different allergens and determine whether atopy can be defined by a small panel of allergens. The Avon Longitudinal Study of Parents and Children is a population-based birth cohort of 13,638 singletons surviving to 4 weeks of age. The cohort was skin tested at 7 years of age to house dust mite (Dermatophagoides pteronyssinus), grass pollens, cat, peanuts, mixed tree nuts and egg and one of three other panels: animal danders, foods or aeroallergens. Sensitization was defined as a weal diameter of > or =3 mm. The strength of associations between sensitization to different allergens was tested by calculating the odds ratio adjusted for sensitization to D. pteronyssinus and grass pollen and gender. Valid data were obtained from 6412 singletons. Sensitization was most common to aeroallergens: grass pollens (8.5%), D. pteronyssinus (7.8%), cat (4.9%), D. farinae (3.6%), dog (2.7%), horse (1.4%), rabbit (1.4%). Of the foods tested, the most common sensitization was to peanut (1.4%) and mixed tree nuts (1.0%). More than 95% of subjects with sensitization to any of the 29 allergens tested were sensitized to one of grass, D. pteronyssinus or cat allergen. There were strong associations of multiple sensitizations both within and between different allergen classes (pollens, animals, foods, peanut and tree nuts). Seven-year-old children in the UK are primarily sensitized to aeroallergens, but also to peanuts and tree nuts. There are strong associations between sensitization within allergen groups as well as between allergen groups. Further studies are required to observe whether similar associations are seen with clinical allergy to these allergens.

Food allergen sensitization in inner-city children with asthma

Asthma continues to be an increasing cause of morbidity in the pediatric population, and studies have shown an association between food sensitivity and asthma. We investigated the degree of food allergen sensitization in inner-city patients with asthma. Five hundred four random serum samples from the National Cooperative Inner City Asthma Study were evaluated for specific IgE (UniCap) to 6 common food allergens (egg, milk, soy, peanut, wheat, and fish). Statistical analyses were performed to determine food sensitization prevalence and its association with asthma morbidity. Forty-five percent of patients had evidence of sensitization (food-specific IgE > or = 0.35 kU/L) to at least 1 food. Nineteen percent had IgE levels at > or = 50% positive predictive value for clinical reactivity to at least 1 food, with 4% of patients having levels > 95% positive predictive value for food allergy. Children sensitized to foods had higher rates of asthma hospitalization (P < .01) and required more steroid medications (P = .025). Sensitization to foods also correlated with sensitization to more indoor and outdoor aeroallergens (P < .001). Food allergen sensitization is highly prevalent in the inner-city population with asthma, and it is associated with increased asthma healthcare and medication use. Therefore, food allergen sensitivity may be a marker for increased asthma severity.

Food allergen sensitization in inner city asthmatic children

Food allergen sensitization in inner city asthmatic children

CTLA-4 Signaling Regulates the Intensity of Hypersensitivity Responses to Food Antigens, but is Not Decisive in the Induction of Sensitization

Although food allergy has emerged as a major health problem, the mechanisms that are decisive in the development of sensitization to dietary Ag remain largely unknown. CTLA-4 signaling negatively regulates immune activation, and may play a crucial role in preventing induction and/or progression of sensitization to food Ag. To elucidate the role of CTLA-4 signaling in responses to food allergens, a murine model of peanut allergy was used. During oral exposure to peanut protein extract (PPE) together with the mucosal adjuvant cholera toxin (CT), which induces peanut allergy, CTLA-4 ligation was prevented using a CTLA-4 mAb. Additionally, the effect of inhibition of the CTLA-4 pathway on oral exposure to PPE in the absence of CT, which leads to unresponsiveness to peanut Ag, was explored. During sensitization, anti-CTLA-4 treatment considerably enhanced IgE responses to PPE and the peanut allergens, Ara h 1, Ara h 3, and Ara h 6, resulting in elevated mast cell degranulation upon an oral challenge. Remarkably, antagonizing CTLA-4 during exposure to PPE in the absence of CT resulted in significant induction of Th2 cytokines and an elevation in total serum IgE levels, but failed to induce allergen-specific IgE responses and mast cell degranulation upon a PPE challenge. These results indicate that CTLA-4 signaling is not the crucial factor in preventing sensitization to food allergens, but plays a pivotal role in regulating the intensity of a food allergic sensitization response. Furthermore, these data indicate that a profoundly Th2-biased cytokine environment is insufficient to induce allergic responses against dietary Ag.