Food Allergy In Young Children Research Articles

Difficulties in diagnosing non-IgE-dependent gastrointestinal forms of food allergy: How informative is fecal calprotectin?

The prevalence of allergic diseases is increasing at rates corresponding to epidemic’s spread rates. Cow’s milk protein allergy (CMPA) is one of the most common food allergies in infancy. Its clinical variants remain hard-to-diagnose diseases due to their multiple clinical faces. Food allergy can develop along the pathway associated with both IgE and non-IgE, or mixed one. Non-IgEassociated variants of food allergies, due to the lack of accurate and specific laboratory markers, can cause significant difficulties in making a diagnosis. The search for new diagnostic markers continues. Faecal calprotectin, a calcium-binding leukocyte protein consisting of a complex of two monomers S100A8 and S100A9, may be one of them. Faecal calprotectin concentration is directly proportional to the number of leukocytes migrating into the intestinal wall, due to which faecal calprotectin becomes an accurate, non-invasive and sensitive indicator reflecting the level of inflammation in the intestines. Today, serum and faecal calprotectin are used as laboratory markers, and the latter, being more accessible and not critical for collection material is widely known as a diagnostic marker of inflammatory bowel diseases. Some studies suggest that faecal calprotectin may be used to diagnose cow’s milk protein allergy in young infants when other diagnostic tests are not available. Data from various studies remain contradictory. Further studies to investigate the possibilities of using faecal calprotectin as a marker of the gastrointestinal food allergy in young children is needed.

Serum levels of specific IgE to cow's milk and its components as predictors of anaphylaxis in Chinese children with cow's milk allergy.

Cow's milk allergy (CMA) is one of the most common food allergies in young children. As improved diagnostic tools, allergic tests are inconsistent and limited in predicting anaphylaxis. To explore risk factors for anaphylaxis and to determine practical cut-offs for allergic tests in predicting anaphylaxis. This is a prospective cohort study. Children with IgE-mediated CMA were enrolled and divided into three groups (Group 1: non-anaphylaxis; Group 2: GRADE I anaphylaxis; Group 3: GRADE II-IV anaphylaxis that warranted epinephrine). Prick-to-prick tests (PTPs) using fresh cow's milk (CM) were performed. Serum specific IgE (sIgE) against CM and its components, including casein, alpha-lactalbumin, beta-lactoglobulin, and bovine serum albumin were measured. The 90% and 95% positive predictive value (PPV) decision points for predicting anaphylaxis were determined. Potential predictors of anaphylaxis were evaluated in logistic regression models. This study included 134 CMA patients with a median age of 14.4 months. The sensitization rate to any CM component was 89%. Group 3 was more likely to be sensitized to multiple CM components and have higher sIgE levels. The 95% PPV diagnostic decision points of casein-sIgE in predicting anaphylaxis was 13.0 kUA/L. For GRADE II-IV anaphylaxis, casein-sIgE ≥ 54.9 kUA/L could provide a PPV of 88.9%. The elevated casein-sIgE level (OR 14.0, P=0.025) and complicating respiratory allergic diseases (OR 4.8, P=0.022) were independent risk factors for GRADE II-IV anaphylaxis. High casein-sIgE levels are strongly associated with CM anaphylaxis. Detection of casein-sIgE may offer an additional value for the prediction of CM anaphylaxis.

Identification of cow milk epitopes to characterize and quantify disease-specific T cells in allergic children

Cow milk (CM) allergy is the most prevalent food allergy in young children in the United States and Great Britain. Current diagnostic tests are either unreliable (IgE test and skin prick test) or resource-intensive with risks (food challenges). We sought to determine whether allergen-specific T cells in CM-allergic (CMA) patients have a distinct quality and/or quantity that could potentially be used as a diagnostic marker. Using PBMCs from 147 food-allergic pediatric subjects, we mapped T-cell responses to a set of reactive epitopes in CM that we compiled in a peptide pool. This pool induced cytokine responses in invitro cultured cells distinguishing subjects with CMA from subjects without CMA. We further used the pool to isolate and characterize antigen-specific CD4 memory T cells using flow cytometry and single-cell RNA/TCR sequencing assays. We detected significant changes in the transcriptional program and clonality of CM antigen-specific (CM+) T cells elicited by the pool in subjects with CMA versus subjects without CMA exvivo. CM+ T cells from subjects with CMA had increased percentages of FOXP3+ cells over FOXP3- cells. FOXP3+ cells are often equated with regulatory T cells that have suppressive activity, but CM+ FOXP3+ cells from subjects with CMA showed significant expression of interferon-responsive genes and dysregulated chemokine receptor expression compared with subjects without CMA, suggesting that these are not conventional regulatory T cells. The CM+ FOXP3+ cells were also more clonally expanded than the FOXP3- population. We were further able to use surface markers (CD25, CD127, and CCR7) in combination with our peptide pool stimulation to quantify these CM+ FOXP3+ cells by a simple flow-cytometry assay. We show increased percentages of CM+ CD127-CD25+ cells from subjects with CMA in an independent cohort, which could be used for diagnostic purposes. Looking specifically for TH2 cells normally associated with allergic diseases, we found a small population of clonally expanded CM+ cells that were significantly increased in subjects with CMA and that had high expression of TH2 cytokines and pathogenic TH2/T follicular helper markers. Overall, these findings suggest that there are several differences in the phenotypes of CM+ T cells with CM allergy and that the increase in CM+ FOXP3+ cells is a potential diagnostic marker of an allergic state. Such markers have promising applications in monitoring natural disease outgrowth and/or the efficacy of immunotherapy that will need to be validated in future studies.

Tackling food allergens-The role of food processing on proteins' allergenicity.

This chapter examines how innovative and emerging food processing technologies, such as those that use heat, electricity, electromagnetic waves, and pressure, can modify protein denaturation, aggregation, and intermolecular interactions pathways, which can result in varying immunoreactive responses. It emphasizes the need to understand how these processing methods affect the protein epitopes recognized by antibodies and their respective priming pathways, especially during the sensitization stage that precedes an allergic response. Although traditional processing methods have been investigated, the impact of novel technologies on food protein allergenicity remains largely unknown. The chapter specifically focuses on milk proteins, which have clinical significance and are associated with cow's milk allergy, one of the most common food allergies in young children. Additionally, it examines potential scientific advancements that novel processing methods may bring to this field.

Preventing Food Allergy in Young Children

Preventing Food Allergy in Young Children

Prenatal and perinatal risk factors of food allergy in Taiwanese young children

BackgroundIn recent decades, the prevalence of food allergy (FA) in children has increased in Western countries; however, there have been only limited studies on FA, especially among young children, in Asian countries, including Taiwan. In this study, we identified prenatal and perinatal risk factors associated with FA in young children in Taiwan. MethodsFor this prospective birth cohort study, we adopted the Southern Taiwan Allergy Research Alliance (STARA)-FA questionnaire to collect data related to prenatal and perinatal risk factors and self-reported allergic symptoms in children aged 1–3 years in the well-baby clinics of 4 medical centers located in 3 cities, Chia-Yi, Tainan, and Kaohsiung, Taiwan. The STARA-FA questionnaire consisted of 99 questions to investigate the association of prenatal and perinatal risk factors with FA. ResultsWe recruited 903 young children aged 1–3 years in Taiwan. Among those, 95 (14.7%) children had allergic reactions to foods. The most common food allergens were eggs (26/95, 27.3%), milk (22/95, 23.2%), fruits (13/95, 13.7%), and seafood (12/95, 12.6%). We also found that there were 134 (14.8%) children with eczema, 86 (9.5%) with wheezing, and 240 (26.6%) with rhinitis. Children with a personal history of eczema (adjusted odds ratio [AOR], 2.48; 95% confidence interval [CI], 1.38–4.45) and a family allergy history (AOR, 2.06; 95% CI, 1.18–3.57) had a significantly increased risk of FA. Maternal peanut consumption during pregnancy was associated with a decreased risk of FA in children (AOR, 0.57; 95% CI, 0.33–0.98). ConclusionsIn this study, the prevalence of FA in a cohort of Taiwanese young children was 14.7%. Risk factors associated with FA were a personal eczema history and a family allergy history, which might serve as predictive or prevention factors for the development of FA in young children in Taiwan.

Early food intervention and skin emollients to prevent food allergy in young children (PreventADALL): a factorial, multicentre, cluster-randomised trial

Primary prevention of food allergy by early introduction of allergenic foods seems promising. We aimed to determine whether early food introduction or the application of regular skin emollients in infants from a general population reduced the risk of food allergy. This 2 × 2 factorial, cluster-randomised trial was done at Oslo University Hospital and Østfold Hospital Trust, Oslo, Norway, and Karolinska University Hospital, Stockholm, Sweden. Infants of women recruited antenatally at the routine 18-week ultrasound examination were cluster-randomised at birth to the following groups: (1) no intervention group; (2) the skin intervention group (skin emollients; bath additives and facial cream; from age 2 weeks to <9 months, both at least four times per week); (3) the food intervention group (early complementary feeding of peanut, cow's milk, wheat, and egg from age 3 months); or (4) combined intervention group (skin and food interventions). Participants were randomly assigned (1:1:1:1) using computer-generated randomisation based on clusters of 92 geographical areas and eight 3-month time blocks. Study personnel performing clinical assessments were masked to group allocation. The primary outcome was allergy to any interventional food at 36 months of age. The primary efficacy analysis was done by intention-to-treat analysis, which included all participants who were randomly assigned, apart from three individuals who withdrew their consent. This was a study performed within ORAACLE (the Oslo Research Group of Asthma and Allergy in Childhood; the Lung and Environment). This study is registered as ClinicalTrials.gov, NCT02449850. We recruited 2697 women with 2701 pregnancies, from whom 2397 newborn infants were enrolled between April 14, 2015, and April 11, 2017. Of these infants, 597 were randomly assigned to the no intervention group, 575 to the skin intervention group, 642 to the food intervention group, and 583 to the combined intervention group. One participant in each of the no intervention, food intervention, and skin intervention groups withdrew consent and were therefore not included in any analyses. Food allergy was diagnosed in 44 children; 14 (2·3%) of 596 infants in the non-intervention group, 17 (3·0%) of 574 infants in the skin intervention group, six (0·9%) of 641 infants in the food intervention group, and seven (1·2%) of 583 infants in the combined intervention group. Peanut allergy was diagnosed in 32 children, egg allergy in 12 children, and milk allergy in four children. None had allergy to wheat. Prevalence of food allergy was reduced in the food intervention group compared with the no food intervention group (risk difference -1·6% [95% CI -2·7 to -0·5]; odds ratio [OR] 0·4 [95% CI 0·2 to 0·8]), but not compared with the skin intervention group (0·4% [95% CI -0·6 to 1· 5%]; OR 1·3 [0·7 to 2·3]), with no significant interaction effect (p=1·0). Preventing food allergy in one child required early exposure to allergenic foods in 63 children. No serious adverse events were observed. Exposure to allergenic foods from 3 months of age reduced food allergy at 36 months in a general population. Our results support that early introduction of common allergenic foods is a safe and effective strategy to prevent food allergy. Full funding sources listed at end of paper (see Acknowledgments).

Cow’s Milk Protein Allergy in Children - A Case Study

Now days due to lactation failure cow milk is the first choice for an infant and accordingly is one of the first and most common causes of food allergy in early childhood. Cow milk allergy is the allergy to the protein (casein and whey protein) in cow milk. It is the leading cause of food allergy in infants and early childhood (less than 3 years). This review summarizes current evidence and recommendations regarding cow milk protein allergy (CMPA), the most common food allergy in young children, for the parents with incidence estimated as 2% to 7.5% in the first year of life. In classics, it has been mentioned that cow milk should always processed with Laghupanchmoola before it is consumed. There is no treatment for this disease in modern science as well as in Ayurveda, so there is a need to find a safe and effective remedy in the management of CMPA. A 1-year old male patient was brought to Out Patient Department of Kaumarabhritya, Rishikul campus UAU Haridwar Uttrakhand, with complaints of loose motion and vomiting after cow’s milk intake. These complaints were persisting for the past 20 days. After that he gradually developed abdominal pain for 10 days. This condition can be understood as CMPA treatments including Laghupanchmoola granules with cow milk, course of 2 months. There were significant improvements in the condition of the patient.

Genetic susceptibility to cow's milk allergy in Chinese children.

Cow's milk allergy (CMA) is the most common food allergy in young children. Previous studies have reported that single-nucleotide polymorphisms (SNPs) are associated with CMA. The extent to which SNPs contribute to the occurrence of CMA is unknown. The purpose of this study was to investigate the independent relevance of genetic predisposition to CMA in Chinese children. 200 infants with CMA and 799 healthy controls aged 0-12 months were included. Five previously identified genetic variants (rs17616434, rs2069772, rs1800896, rs855791 and rs20541) were genotyped. Logistic regression was used to analyze the genetic associations or their interactions with a family history of allergy on CMA. Among the five SNPs, only IL10 rs1800896 was significantly associated with CMA (odds ratio (OR) 1.60, p=0.042). Each 1-risk allele increase in the genetic risk score (GRS) was suggestively associated with an 11% higher risk of CMA (1.11: 0.99-1.27, p=0.069) and a 45% increased risk of CMA in the GRS high-risk group compared to the GRS low-risk group (1.45: 1.02-2.06, p=0.037). Furthermore, parental allergy also increased the risk of CMA among children (1.87: 1.46-2.39, p<0.001). Importantly, parental allergy exacerbated the genetic effect on the risk of CMA. The rs1800896 variant in the IL-10 gene is associated with CMA in Chinese children. In addition, the GRS had an interaction with parental history of allergy, implying that genetic risk for CMA was exacerbated among those with parental history of allergy.

Efficacy and safety of baked milk oral immunotherapy in children with severe milk allergy: A randomized, double-blind, placebo-controlled phase 2 trial

Cow's milk allergy is the most common food allergy in young children and has no current treatment. Oral immunotherapy studies to date have shown efficacy but high rates of adverse reactions. We sought to evaluate the safety and efficacy of baked milk oral immunotherapy (BMOIT) in children allergic to baked milk. Participants (3-18 years) were randomized to receive BMOIT or placebo for 12 months. Efficacy was assessed by double-blind placebo-controlled food challenge after 12 months of treatment. Safety, quality of life, and mechanistic parameters were also evaluated. Eleven of 15 (73%) BMOIT participants reached the primary end point, tolerating 4044 mg of baked milk protein after 12 months of oral immunotherapy, compared with 0 of 15 (0%) on placebo. The median maximum tolerated dose and median change from baseline was significantly higher in the BMOIT group than in the placebo group (median maximum tolerated dose, 4044 mg vs 144 mg; P= .001; median change in maximum tolerated dose of 3900 mg vs 0 mg, P= .0001). Dose-related reactions were common, but more than 95% in both groups were mild. There was no significant change in cow's milk- or beta lactoglobulin-IgE from baseline for either group. Cow's milk-sIgG4 did significantly increase and casein IgE decreased in the BMOIT group. For proxy-reported food allergy quality of life, there was a significant difference in the emotional impact domain only, with more improving while on placebo compared with BMOIT. Most children and adolescents in the BMOIT group directly reported improvement in at least 1 domain. BMOIT was well tolerated and induced a substantial level of desensitization after 12 months of treatment.

Asthmatic Versus Non-Allergic Children in Relation to The Presence of Cow Milk Protein

Background: Cow’s milk allergy is among the most frequent food allergies in young children and one of the risk factors of asthma. Objective: The study aimed to assess the role of Cow’s milk allergy (CMA) to induce asthma and to study the effect cow milk protein on asthmatic and non-allergic children to prevent occurrence of asthma among children. Patients and methods: A case-control study that was carried out in Pulmonology Unit of Pediatric Department, Faculty of Medicine, Zagazig University Hospital. The patients were investigated at Medical Community and Immunology Department. The study included 154 child divided equally into two groups. Group A included patients with bronchial asthma and group B (control) included age- and sex-matched healthy individuals. Iinvestigations: complete blood picture, renal and liver function tests, skin prick test, total immunoglobulin (IgE) was done for all participants. Results: There was high statistically significant difference between the two studied groups as regards skin pick test. There was statistically significant increase in the levels of both total and specific Ig E in allergic group compared to control group. There was high significant increase in the severity recorded in respiratory function test in allergic group compared to control group. There was non-significant difference between the two groups regarding GIT manifestation. There was high statistically significant difference between the two groups regarding skin and respiratory manifestations. Conclusion: CMA can exacerbate the symptoms in children with asthma. Therefore, it is worth considering a possible role of food allergy in asthma in young children, particularly when asthma is not adequately controlled in spite of proper routine management.

Clinical and diagnostic significance of the intestinal fraction of fatty acid binding protein in children with protein-induced enteropathy

Protein-induced enteropathyis a common manifestation of gastrointestinal food allergy in young children. Non-invasive diagnostic methods are especially relevant for the timely diagnosis and prevention of exacerbations.Objective. To evaluate serum, fecal and urinal levels of the intestinal fraction of fatty acids-binding proteins in children with protein-induced enteropathy and their clinical and diagnostic significance.Material and methods. The authors examined 29 children with protein-induced enteropathy aged from 1,5 to 12 months and 20 healthy children (control group). For differential diagnosis with congenital diseases of the gastrointestinal tract, all patients underwent esophagogastroduodenoscopy with morphological examination of biopsies. The Cow’s Milk-related Symptom Score (CoMMiS) was used to assess clinical symptoms. In all children, the intestinal fraction of the protein binding fatty acids (I-FABP) was determined in blood serum, urine, coprofiltrate byenzyme-linked immunosorbent assay.Results. The scientists found an increase in the protein level in the blood 125,20±23,79 pg/ml, in coprofiltrate 0,36±0,05 ng/ml, in urine 0,164±0,031 pg/ml compared with those in the control group (19,21±4,94pg/ml, 0,18±0,02 ng/ml and 0,039±4,62 pg/ ml, respectively; p&lt;0,05). The authors found direct strong relationship between the degreeof morphological changes, clinical severity of gastrointestinal manifestations and the concentration of fatty acid binding protein in serum and urine, moderate relationship with the indicators in coprofiltrate (p&lt;0,05).Conclusion. An increase in serum, fecal and urinal levels of I-FABP in children with protein-induced enteropathy confirms the clinical and diagnostic significance of this biomarker in all biological fluids. Its high sensitivity and specificity of determination in urine is promising for pediatric practice.

Analysis of the content of I-FABP in urine and blood serum in children with gastrointestinal food allergy

Abstract Introduction. Protein-induced enteropathy is one of the common manifestations of gastrointestinal food allergy in young children. The search of non-invasive methods for intestine estimation is especially relevant for early diagnosis and timely prevention of exacerbation.The aimof the study was to determine the serum and urinal levels of the intestinal fraction of the protein binding fatty acids in children with protein-induced enteropathy and to evaluate their clinical and diagnostic significance.Materials and methods. It was examined 36 children with protein-induced enteropathy aged 1.5 months to 1 year and 20 healthy children (control group). All patients underwent esophagogastroenteroscopy with morphological examination of biopsy specimens for differential diagnosis with congenital gastrointestinal diseases. The Cow’s Milk-related Symptom Score (CoMMiS) was used to evaluate clinical symptoms. The intestinal fraction of a fatty acid binding protein was determined for all children in blood serum, urine by enzyme- linked immunosorbent analysis.Results.It was found the increase its serum level (125.20 ± 23.79 pg / ml), and urinal level (0.164 ± 0.031 pkg / ml) compared with the control group (19.21 ± 4.94 pg / ml, 00.039 ± 4.62 pkg / ml, respectively, p &lt; 0.05). There were found direct strong correlations between the severity of gastrointestinal manifestations and its serum and urine level (p &lt; 0.05).Discussion.Epithelial barrier damage provides an increased penetration of intact food allergens. It plays a key role in allergic sensitization, and it is the first pathogenetic link of allergic inflammation in most cases. A statistically significant I-FABP increased level in all studied biological fluids correlates with morphological changes in the children with protein-induced enteropathy, as well as with clinical symptoms of gastrointestinal tract lesions. That confirms its high informational value for an indirect assessment of the state of the intestinal barrier.Conclusions.Thus, an increase in serum and urinal I-FABP levels in children with protein-induced enteropathy confirms the clinical and diagnostic significance of determining this biomarker in all biological fluids. Its high sensitivity and specificity of determination in urine are promising for use in pediatric practice.

Persistent diarrhea as manifestation of gastrointestinal food allergy in young children: diagnostic possibilities

Persistent diarrhea can be a sign of a number of medical conditions, including a gastrointestinal food allergy. Diagnosis in childhood is not very informative, since allergic diseases at this age often have a non-IgE-dependent mechanism of development. Objective. To study the diagnostic value of the fecal eosinophilic neurotoxin test for the diagnosis of gastrointestinal food allergy in young children with persistent diarrhea. Material and methods. The authors examined 70 young children (from 1 month to 3 years) with persistent diarrhea and 20 conditionally healthy children of the same age without burdened allergic background. They determined fecal eosinophilic neurotoxin levels in all children. The children were divided into 2 groups according to the results of this examination: Group with normal level of neurotoxin and Group with increased level of neurotoxin. Results. The physical development of children with persistent diarrhea with high levels of eosinophilic neurotoxin is often assessed as low or very low. With persistent diarrhea, blood and mucus in the stool was significantly more often detected in children with a high level of eosinophilic neurotoxin. Persistent diarrhea with an increased level of eosinophilic neurotoxin, was significantly more often combined with atopic dermatitis reflecting its allergic nature. The total IgE test turned out to be a highly specific marker of the allergic nature of persistent diarrhea, however, it has a low sensitivity and it is positive only in 26.3% of children with an increased eosinophilic neurotoxin. This fact confirms the non-IgE dependent pathogenetic mechanisms of gastrointestinal allergy. Conclusion: The study demonstrated a high differential diagnostic value of the eosinophilic neurotoxin test in the feces of children with persistent diarrhea. The authors revealed a statistical interconnection of a high level of eosinophilic neurotoxin and other markers of allergy. The results obtained substantiate the advisability of the eosinophilic neurotoxin test as a non-invasive method in the diagnosis of gastrointestinal food allergy.

Characteristics of Baked Cheese Challenge

Cow’s milk (CM) is the most common food allergy in young children. While commonly outgrown, avoidance is difficult, and causes significant deficits in quality of life. Baked milk (BM) may hasten outgrowing CM allergy, but little is known about baked cheese (BC) tolerance, which can be an intermediate step between baked milk and CM.

Systemic reaction to an extensively hydrolyzed formula in an infant with cow's milk anaphylaxis.

Cow's milk allergy is the most common cause of food allergy in young children. Ingestion of milk products in children with a milk protein allergy can lead to anaphylaxis and must be avoided. Some guidelines suggest the use of an extensively hydrolyzed formula (EHF) in these cases; however, rare allergic reactions can still occur. Here, we presented a 3-month-old boy who developed anaphylaxis to a cow's milk formula. Subsequently, he developed a rare systemic reaction to soy and to an EHF. The patient had an unremarkable medical history and presented with signs and symptoms consistent with anaphylaxis after being fed cow's milk formula for the first time. Symptoms included immediate vomiting, wheezing, stridor, angioedema of eyelids and lips. Although intramuscular epinephrine was given, the patient continued to clinically deteriorate, becoming more lethargic and necessitating admission to the pediatric intensive care unit. Subsequently, a trial of soy formula ingestion reproduced the symptoms and an EHF was given. However, immediately after taking an EHF, he developed facial angioedema and diffuse urticarial lesions. In most patients with a cow's milk allergy, an extensively based formula can be tolerated safely due to a hydrolyzed protein chain. However, medical providers must be vigilant when switching formula because a rare systemic allergic reaction to EHF can still occur.

Maternal antioxidant intake during pregnancy and the development of cows' milk allergy in the offspring.

Cows' milk allergy (CMA) is the most common food allergy in young children, and it is often the first manifestation of atopic diseases. Accordingly, very early environmental factors, such as maternal diet during pregnancy, may play a role in the development of CMA, but the evidence is limited. The aim of this study was to investigate the association between maternal intake of antioxidant nutrients during pregnancy and the subsequent development of CMA in the offspring in a prospective, population-based birth cohort within the Finnish Type 1 Diabetes Prediction and Prevention Study. Maternal dietary information during pregnancy was collected with a detailed, validated FFQ. The maternal dietary information and the information on putative confounding factors were available for 4403 children. Information on diagnosed CMA (n 448) was obtained from a medical registry and queried from the parents up to child's age of 3 years. The Finnish food composition database was used to calculate the average daily intake of nutrients. Logistic regression was applied for statistical analyses, and the nutrient intakes were adjusted for energy intake. OR are presented per 1 sd increment of the particular nutrient intake. Maternal total and dietary intake of β-carotene was associated with an increased risk of CMA in the offspring when adjusted for the putative confounding factors (total OR 1·10, 95 % CI 1·02, 1·20; dietary OR 1·10; 95 % CI 1·01, 1·19). Using dietary supplements containing antioxidants in addition to a balanced diet may not confer any additional benefits.

Serum folate metabolites, asthma, and lung function in a nationwide US study

In a U.S. nationwide study, a high serum 5-MTHF to UMFA ratio is associated with decreased odds of asthma, increased FEV1 in children and adults, and increased FVC in adults.

M307 ANAPHYLAXIS IN AN INFANT TO COW'S MILK AND AN EXTENSIVELY HYDROLYZED FORMULA

Cow's Milk allergy (CMA) is the most common cause of food allergy in young children. Although a common problem in the pediatric population, some cases of CMA can be challenging in the setting of IgE mediated reactions and the risk of morbidity and mortality high.

Analysis of Allergen-Specific T Cell and IgE Reactivity to Different Preparations of Cow's Milk-Containing Food Extracts.

Background: cow’s milk allergy (CM) is among the most common food allergies in young children and is often outgrown by adulthood. Prior to developing a tolerance to CM, a majority of CM-allergic children may tolerate extensively-heated CM. This study aims to characterize the IgE- and T cell-reactivity to unheated CM and the progressively more heated CM-containing foods. Methods: CM-containing food extracts from muffin, baked cheese, custard and raw, pasteurized CM commercial extract were tested for skin prick test reactivity, IgE binding and T cell reactivity as assessed by IL-5 and IFNγ production. Results: the skin prick test (SPT) reactivity was significantly decreased to muffin extract compared to raw, pasteurized CM. Both IgE- and T-cell reactivity were readily detectable against food extracts from all forms of CM. Western blot analysis of IgE reactivity revealed variability between extracts that was protein-specific. T cell-reactivity was detected against all four extracts with no significant difference in IL-5 or IFNγ production between them. Conclusion: our data indicate that despite reduced clinical reactivity, extracts from heated CM-containing foods retain immunogenicity when tested in vitro, particularly at the T cell level.