Food Allergy Research Articles

Food insecurity and food bank use: who is most at risk of severe food insecurity and who uses food banks?

To identify (1) who experiences food insecurity of differing severity and (2) who uses food banks in England, Wales and Northern Ireland; (3) whether the same groups experience food insecurity and use food banks; and (4) to explore country- and region-level differences in food insecurity and food bank use. This pooled cross-sectional study analysed the characteristics of adults experiencing food insecurity of differing severity using generalised ordinal logistic regression models and the characteristics of adults using food banks using logistic regression models, using data from three waves of the Food and You 2 surveys, 2021-2023. England, Wales and Northern Ireland. 18 557 adults. 20·8 % of respondents experienced food insecurity in the past 12 months, and 3·6 % had used a food bank. Food insecurity was associated with income, working status, respondent age, family type, ethnicity, country, long-term health conditions, food hypersensitivity, urban-rural status and area-level deprivation. Severe food insecurity was concentrated among respondents with long-term health conditions and food hypersensitivities. Food bank use was more prevalent among food insecure respondents and unemployed and low-income respondents. Neither outcome showed clear geographical variation. Certain groups experienced an elevated likelihood of food insecurity but did not report correspondingly greater food bank use. Food insecurity is unevenly distributed, and its nutrition and health-related consequences demonstrate that food insecurity will intensify health inequalities. The divergence between the scale of food insecurity and food bank use strengthens calls for adequate policy responses.

Gut microbiome features in pediatric food allergy: a scoping review.

Increasing evidence suggests that alterations in the gut microbiome (GM) play a pivotal role in the pathogenesis of pediatric food allergy (FA). This scoping review analyzes the current evidence on GM features associated with pediatric FAs and highlights the importance of the GM as a potential target of intervention for preventing and treating this common condition in the pediatric age. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed and Embase using the keywords (gut microbiome OR dysbiosis OR gut microbiota OR microbiome signatures) AND (food allergy OR IgE-mediated food allergy OR food protein-induced allergic proctocolitis OR food protein-induced enterocolitis OR non-IgE food allergy OR cow milk allergy OR hen egg allergy OR peanut allergy OR fish allergy OR shellfish allergy OR tree nut allergy OR soy allergy OR wheat allergy OR rice allergy OR food sensitization). We included 34 studies reporting alterations in the GM in children affected by FA compared with healthy controls. The GM in pediatric FAs is characterized by a higher abundance of harmful microorganisms (e.g., Enterobacteriaceae, Clostridium sensu stricto, Ruminococcus gnavus, and Blautia spp.) and lower abundance of beneficial bacteria (e.g., Bifidobacteriaceae, Lactobacillaceae, some Bacteroides species). Moreover, we provide an overview of the mechanisms of action elicited by these bacterial species in regulating immune tolerance and of the main environmental factors that can modulate the composition and function of the GM in early life. Altogether, these data improve our knowledge of the pathogenesis of FA and can open the way to innovative diagnostic, preventive, and therapeutic strategies for managing these conditions.

Peanut Allergy in Children-Is Prevention Better than Cure?

Peanut allergy, one of the most frequently occurring allergies, usually starts in childhood and rarely subsides-often persisting throughout adult life. Accidental exposure to peanuts can often result in adverse reactions ranging from mild to life-threatening, such as anaphylactic shock. Historically, food avoidance and the use of rescue drugs have remained a fundamental management mechanism for dealing with food allergy. However, prevention of adverse reactions to food allergy is playing an increasing role. This is possible through the early introduction of peanuts into the diet, especially in infants at risk of this allergy. In recent years, specific immunotherapy has been used to develop desensitisation and, in some patients, tolerance-defined as a persistent state of clinical non-reactivity to the allergen after therapy is finished. The aim of this article is to summarise the current state of knowledge on the prevention and treatment of peanut allergy, with a focus on clinical trials, current guidelines, and recent experimental studies. This review may be particularly useful for paediatricians and general practitioners.

Nutritional Considerations of Plant-Based Diets for People With Food Allergy.

Plant-based diets (PBD) have been reported throughout history, but are increasingly common in current times, likely in part due to considerable emphasis on climate change and human health and wellness. Many dietary organisations around the world endorse well-planned, nutritionally adequate PBD, which exclude some or all forms of animal-based foods. However, special attention must be given to patients who follow PBD and also have food allergy (FA), as avoidance may increase the risk of developing nutritional deficiencies, including poor growth in children, weight loss in adults and vitamin and mineral deficiencies. Given the increasing prevalence of both PBD and food allergen avoidance diets, healthcare providers are likely to counsel patients with FA who also follow a PBD. In this review, an overview of PBD in patients with FA is provided, including recent trends, macro- and micronutrient needs, and growth for children and weight gain considerations for adults. With regard to a PBD, special attention should be given to ensure adequate fat and protein intake and improving the bioavailability of several minerals such as iron, zinc, iodine, calcium and magnesium, and vitamins such as A, B2, B12 and D. Although the collective data on growth amongst children following a PBD are varied in outcome and may be influenced in part by the type of PBD, growth must be regularly monitored and in adults weight gain assessed as part of any clinical assessment in those people with FA.

Antioxidant Activity and Hypoallergenicity of Egg Protein Matrices Containing Polyphenols from Citrus Waste.

This study reports on the interactions of egg proteins, which represent a major health concern in food allergy, with polyphenols obtained from orange and lemon peels. The antioxidant properties of such citrus peel extracts prior to protein binding were evaluated. The resulting edible, and therefore inherently safe, matrices exhibit reduced IgE binding compared to pure proteins in indirect immunological assays (ELISA) using individual sera from patients allergic to ovalbumin and lysozyme. The reduced allergenicity could arise from the interactions with polyphenols, which alter the structure and functionality of the native proteins. It is hypothesized that the anti-inflammatory and antioxidant properties of the polyphenols, described as inhibitors of the allergic response, could add immunomodulatory features to the hypoallergenic complexes. A docking analysis using lysozyme was conducted to scrutinize the nature of the protein-polyphenol interactions. An in silico study unravelled the complexity of binding modes depending on the isoforms considered. Altogether, the presented results validate the antioxidant properties and reduced allergenicity of polyphenol-fortified proteins. Lastly, this study highlights the upgrading of vegetable wastes as a source of natural antioxidants, thus showing the benefits of a circular economy in agri-food science.

Risk factors associated with the incidence of asthma among adolescents in Ukraine

Background. Asthma is a common disease among children and adolescents. The purpose of this study was to describe the detailed characteristics of adolescents with asthma, identify risk factors associated with the development of asthma and to evaluate medical care for patients with asthma. Materials and methods. Asthma patients (n = 80) aged 12 to 18 years from the Allergology Department of the Kyiv City Children’s Clinical Hospital 2, the clinical base of the Department of Pediatrics 2 of the Bogomolets National Medical University, were included in the study. The control group consisted of 120 children without asthma. In the group of interviewed children, asthma was diagnosed based on clinical data and objective measurement of lung function. All children underwent spirometry and skin prick test with aeroallergens. During the clinical examination, weight and height were measured, and body mass index was calculated. The survey was conducted by a research doctor using a Google form. Results. Parents of 80 children with asthma were involved in our survey between September 2023 and May 2024. Asthma occurred more often in boys than in girls: odds ratio (OR) = 7.3 (95% confidence interval (CI) 3.84–14.16, P < 0.0001). 31.25 % respondents reported a history of atopic dermatitis, 26.25 % had atopic dermatitis at the time of the study. Food allergy was detected in 25 % children. 48.75 % children had concomitant allergic rhinitis, of which 33.75 % had seasonal, 15 % had perennial. We found that children living in the city had asthma more often: OR = 7.3 (95% CI 3.26–16.62, P < 0.0001). Having an older sibling was associated with a lower risk of asthma: OR = 3.6 (95% CI 1.86–6.92, P < 0.0001). Also, we found that cat owners were significantly more likely not to have asthma: OR = 7.7 (95% CI 3.96–14.99, P < 0.0001). Such data are most likely related to the refusal to own a cat due to the prevalence of cat allergy among children with asthma or at risk of cat allergy. We have not found a statistically significant difference in the group of children with asthma and in the control group in relation to the exposure to tobacco smoke in the atmosphere (passive smoking): OR = 1.4 (95% CI 0.79–2.59, P > 0.05). Conclusions. Treatment of allergies and atopic conditions should be considered an important component of asthma treatment, which may affect the frequency and severity of the disease. In adolescents and adults, smoking cessation, in particular, as a factor in the impact of passive smoking on a sick child can also significantly reduce the number of hospitalizations. Confirming the diagnosis of asthma, demonstrating good inhaler technique, and emphasizing adherence to preventive therapies such as inhaled glucocorticosteroids can improve asthma control and reduce overreliance on short-acting bronchodilators.

Epidemiological investigation of allergic rhinitis in children aged 6-12 years in Bayannur City, China.

Allergic rhinitis (AR) is an inflammatory condition of the nasal mucosa triggered by exposure to non-harmful substances. Over the past decade, the prevalence of AR in Chinese children has been steadily increasing. However, detailed epidemiological data on AR in children from Bayannur City are lacking. This study randomly selected six primary schools in Bayannur City. Electronic questionnaires were distributed via the web, and parents and children completed the questionnaires by scanning the two-dimensional code within a designated timeframe. Statistical analysis was performed on the collected data. A total of 4,754 valid responses were obtained. The self-reported prevalence of AR among children in Bayannur city was 39.79%. Multivariate analysis revealed that male gender, belonging to an ethnic minority, a history of food or drug allergies, frequent antibiotic use (≥3 times per year in the past two years, with each course lasting ≥3 days), and residence in urban or pastoral areas was associated with an increased prevalence of AR in children. The proportion of children experiencing moderate to severe AR hat impacted their studies or daily life was 48.78%. Chronic AR was reported in 56.71% of cases. Among AR patients with other allergic conditions, the incidence rates were as follows: bronchial asthma 35.99%, upper airway cough syndrome (UACS) 64.32%, secretory otitis media (SOM) 22.41%, obstructive sleep apnea hypopnea-syndrome (OSAHS) 49.58%, allergic dermatitis (AD) 48.72%, and allergic conjunctivitis (AC) 85.20%. The prevalence of AR was 50.30% in urban areas, 13.733% in rural areas and 20.90% in pastoral areas. Seasonal effects on AR prevalence were notably significant in urban and pastoral regions. The prevalence of AR among children in Bayannur city was 39.80%. Of those with AR, 48.72% experienced significant impacts on their learning or daily life, while only 14.80% had no other allergic conditions. There were significant variations in the prevalence and onset of AR among children between urban, agricultural and pastoral areas.

'Omics-Based Digital Twins for Personalised Paediatric Healthcare.

Digital twins offer potential to enhance the precision and personalisation of healthcare delivery. As part of a collaborative project between La Trobe University and the Murdoch Children's Research Institute, Melbourne, Australia, multidimensional 'omics-based digital twins of children are being developed. The aim is to explore their application to a range of health contexts in children. A pilot project is commencing that focuses on food allergy diagnosed at one year of age.

Association of immunoglobulin E levels with glioma risk and survival.

Previous epidemiologic studies have reported an association of serum immunoglobulin E (IgE) levels with reduced glioma risk, but the association between IgE and glioma prognosis has not been characterized. This study aimed to examine how sex, tumor subtype, and IgE class modulate the association of serum IgE levels with glioma risk and survival. We conducted a case-control study using participants from the University of California, San Francisco Adult Glioma Study (1997-2010). Serum IgE levels for total, respiratory and food allergy were measured in adults diagnosed with glioma (n=1319) and cancer-free controls (n=1139) matched based on age, sex, and race and ethnicity. Logistic regression was adjusted for patient demographics to assess the association between IgE levels and glioma risk. Multivariable Cox regression adjusted for patient-specific and tumor-specific factors compared survival between the elevated and normal IgE groups. All statistical tests were 2-sided. Elevated total IgE was associated with reduced risk of IDH-wildtype (RR=0.78, 95% CI: 0.71-0.86) and IDH-mutant glioma (RR=0.73, 95% CI: 0.63-0.85). In multivariable Cox regression, positive respiratory IgE was associated with improved survival for IDH-wildtype glioma (RR=0.79, 95% CI: 0.67-0.93). The reduction in mortality risk was significant in females only (RR=0.75, 95% CI: 0.57-0.98) with an improvement in median survival of 6.9 months (P<.001). Elevated serum IgE was associated with improved prognosis for IDH-wildtype glioma, with a more pronounced protective effect in females than males, which has implications for the future study of IgE-based immunotherapies for glioma.

Transplant-Acquired Food Allergy in Children.

Organ transplantation in children is a vital procedure for those with end-stage organ failure, but it has been linked to the development of post-transplant allergies, especially food allergies. This phenomenon, known as transplant-acquired food allergy (TAFA), is becoming increasingly recognized, though its mechanisms remain under investigation. Pediatric transplant recipients often require lifelong immunosuppressive therapy to prevent graft rejection, which can alter immune function and heighten the risk of allergic reactions. Our review aimed to gather the latest evidence on TAFA. We conducted a PubMed search from 25 June to 5 July 2024, using specific search terms, identifying 143 articles. After screening, 36 studies were included: 24 retrospective studies, 1 prospective study, 2 cross-sectional researches, and 9 case reports/series. Most studies focused on liver transplants in children. The prevalence of food allergies ranged from 3.3% to 54.3%. Tacrolimus, alongside corticosteroids, was the most commonly used immunosuppressive therapy. In addition to food allergies, some patients developed atopic dermatitis, asthma, and rhinitis. Allergic symptoms typically emerged within a year post-transplant, with common allergens including milk, eggs, fish, nuts, soy, wheat, and shellfish. Both IgE-mediated and non-IgE-mediated reactions were observed, with treatment often involving the removal of offending foods and the use of adrenaline when necessary. Consistent immunological monitoring, such as skin prick tests and IgE level assessments, is essential for early detection and management of allergies in these patients. Understanding the link between transplantation and allergy development is crucial for improving long-term outcomes for pediatric transplant recipients.

Parents' Perspectives on Prevention and Risk Prediction of Food Allergies in Children: A Qualitative Study

Parents' Perspectives on Prevention and Risk Prediction of Food Allergies in Children: A Qualitative Study

Baked Egg Oral Immunotherapy: Current State in Pediatric Age.

Hen's egg allergy is one of the most common food allergies in the Western world, with an increase in recent years. It affects about 9.5% of the pediatric population, and the onset most often occurs before the first year of life. The occurrence of spontaneous oral tolerance acquisition varies among studies, but it is generally high by school age. Nowadays, allergen immunotherapy may represent the only therapeutic strategy able to modify the natural history of hen's egg allergy. Specifically, many children with hen's egg allergy may tolerate baked eggs. Food processing, specifically high temperatures, alters the allergenicity of hen's egg proteins by causing conformational changes in allergen epitopes, which makes them less allergenic. This review aims to discuss the scientific evidence in the field of baked egg oral immunotherapy in hen's egg-allergic children, with a meticulous examination of the pertinent literature surrounding the subject matter.

Selection of signature peptide biomarkers for the sesame allergens in commercial food based on LC-MS/MS

Sesame is a commonly used food ingredient, yet it is one of the eight major allergens. As sesame is often consumed in various processed forms, it is important to establish methods for detecting sesame allergens in processed foods. Liquid chromatography-tandem mass spectrometry (LC-MS/MS), using characteristic peptides as biomarkers, detects multiple allergenic proteins simultaneously with high sensitivity and accuracy. Choosing robust biomarkers is beneficial for developing a specific, universal, and sensitive method. To obtain excellent peptides of sesame allergens, sixteen commercial products were used as test materials. Proteins from these materials were extracted, digested, and analyzed. Peptides were screened based on several criteria, including specificity and amino acid composition. Only peptides showing process robustness were retained. Ultimately, nine peptides were selected as the best biomarkers. Based on the above peptides, it is possible to achieve precise and high-sensitivity detection of sesame allergens in processed products.

An algorithm for the diagnosis and management of IgE‐mediated food allergy, 2024 update

An algorithm for the diagnosis and management of IgE‐mediated food allergy, 2024 update

Can Physicochemical Properties Alter the Potency of Aeroallergens? Part 2 - Impact of Physicochemical Properties.

A holistic perspective on how physicochemical properties modulate the allergenicity of proteins has recently been performed for food allergens, launching the challenge of a similar analysis for aeroallergens. After a first review on aeroallergen classification into protein families (Part 1), this second part (Part 2) will exploit the impact of physicochemical properties (abundance/biological function, protein structure/presence of post-translational modifications, ligand/cofactor/lipid-binding) on inhalant protein allergenicity. The abundance linked to biological function is correlated with increased allergenic risk for most protein families, while the loss of structural integrity with consequent destruction of conformational epitopes is well linked with decreased allergenicity. Ligand-binding effect totally depends on the ligand type being highly variable among aeroallergens. Knowledge about the physicochemical properties of aeroallergens is still scarce, which highlights the need for research using integrated approaches (in silico and experimental) to generate and analyze new data on known/new aeroallergens.

Oral Food Challenge in Children with Tree Nut and Peanut Allergy: The Predictive Value of Diagnostic Tests.

Food allergy (FA) affects approximately 6-8% of young children, with a peak prevalence at approximately one year of age. Tree nut and peanut allergies are among the main causes of anaphylaxis in the world. The gold standard for the diagnosis of FAs is the oral food challenge (OFC). Other diagnostic tests used in the clinical practice are skin prick tests (SPTs) and laboratory tests to measure out the presence of serum specific IgE (sIgE). In this narrative review, we collect the current evidence of the predictive value (PV) of SPTs and sIgE for the outcome of the OFCs. In literature, data are conflicting as to whether increasing sIgE concentration and wheal size in SPTs correlate with OFC outcomes. Most studies included in our review have shown that in vivo and in vitro tests may predict OFC outcomes with variable PV, but data are not conclusive; therefore, the OFC currently remains the gold standard for FA diagnosis.

Loss of tolerance to dietary proteins: From mouse models to human model diseases.

The critical importance of the immunoregulatory mechanisms, which prevent adverse responses to dietary proteins is demonstrated by the consequences of their failure in two common but distinct human pathological conditions, food allergy and celiac disease. The mechanisms of tolerance to dietary proteins have been extensively studied in mouse models but the extent to which the results in mice can be extrapolated to humans remains unclear. Here, after summarizing the mechanisms known to control oral tolerance in mouse models, we discuss how the monogenic immune disorders associated with food allergy on the one hand, and celiac disease, on the other hand, represent model diseases to gain insight into the key immunoregulatory pathways that control immune responses to food antigens in humans. The spectrum of monogenic disorders, in which the dysfunction of a single gene, is strongly associated with TH2-mediated food allergy suggests an important overlap between the mechanisms that regulate TH2 and IgE responses to food antigens in humans and mice. In contrast, celiac disease provides a unique example of the link between autoimmunity and loss of tolerance to a food antigen.

Specific detection of crustacean allergens in food: Development of indirect competitive and sandwich ELISA targeting sarcoplasmic calcium binding protein

To overcome the problem of cross-reactivity between crustaceans, mollusks, insects, and mites in current crustacean allergen immunodetection, the significant stable crustacean allergen, sarcoplasmic calcium binding protein (SCP) was innovatively selected as the target of ELISA detection. An indirect competitive ELISA (icELISA) and a sandwich ELISA (sELISA) were constructed and evaluated with spiked model foods. The sELISA (LOD 0.001 mg/kg and LOQ 0.003 mg/kg) is more sensitive than icELISA (LOD 0.11 mg/kg and LOQ 0.56 mg/kg). But the icELISA presented a wider standard range (10–10000 ng/mL) and greater recoveries of SCP in matrices (84.04%–118.94%). Sufficient precision (repeatability and reproducibility <15%), excellent specificity distinguishing crustaceans from others, and adequate detectability in diverse commercial processed foods were observed from the SCP-based icELISA. These results demonstrated the feasibility and applicability of SCP-targeted icELISA and provided a new direction to improve the capacity for crustacean allergen detection.

HLA-DR+ regulatory T cells and IL-10 are associated with success or failure of desensitization outcomes.

Omalizumab (XOLAIR®)-assisted multi-food oral immunotherapy (mOIT) has been shown to safely, effectively, and rapidly desensitize patients with multiple food allergies. In our clinical trial (NCT02626611) on omalizumab-assisted mOIT, different desensitization outcomes (success or failure of desensitization) were observed following a period of either continued or discontinued mOIT. However, the association between the immunological changes induced by omalizumab-assisted mOIT and desensitization outcomes has not yet been fully elucidated. In this study, due to the key roles of regulatory T (Treg) cells and the type 2 helper T cell (Th2) pathway in immune tolerance to food allergens, we aimed to characterize their association with the desensitization outcomes of omalizumab-assisted mOIT. Mass cytometry and multiplex cytokine assays were performed on blood samples obtained from participants with allergies to peanut, cashew, or milk in our phase 2 clinical study (NCT02626611). Comprehensive statistical and bioinformatic analyses were conducted on high-dimensional cytometry-based single-cell data and high-throughput multiplex cytokine data. Our results demonstrated that the frequency of HLA-DR+ Treg cells, and the production of Th2 cytokines (IL-4, IL-5, IL-13, and IL-9) as well as the immunoregulatory cytokine IL-10 by peripheral blood mononuclear cells (PBMCs) was significantly increased in cultures with allergen compared to cultures with media alone at baseline (Week 0). We also observed increased frequency of allergen responsive HLA-DR+ Treg cells and enhanced production of IL-10 by PBMCs in participants who achieved successful desensitization compared to those with failure of desensitization. However, the production of Th2 cytokines by PBMCs did not show significant differences between participants with different desensitization outcomes (success vs. failure of desensitization), despite omalizumab-assisted mOIT inducing a significant reduction in the production of Th2 cytokines. We demonstrated that the frequency of HLA-DR+ Treg cells and IL-10 cytokine production by PBMCs are associated with desensitization outcomes of omalizumab-assisted mOIT. These findings suggest potential immunological parameters that could be targeted to enhance desensitization success rates.

Modern Approaches to the Diagnosis o Food Allergy in Children: Oral Food Challenges (Review)

The diagnosis of food allergies significantly impacts the lives of patients and their families, restricting diets and social activities. A misdiagnosis can lead to severe allergic reactions, making accurate diagnosis crucial. Immunoglobulin E (IgE)-mediated food allergies are diagnosed using skin tests or serum-specific IgE levels. However, for most allergens, the only reliable method for confirming the diagnosis remains the oral food challenge (OFC). Objective — elucidation of the importance of oral provocation tests in the diagnosis of food allergy and their relevance for the future treatment of food allergy. Materials and methods. A search for information on OFC was conducted in scientometric databases such as Web of Science, Scopus, Google Scholar, ScienceDirect and PubMed using the following keywords: «food allergy», «oral food challenge», «children». After reviewing the publications, professional sources that met the query criteria and were published between 2017 and 2024 were selected for the review. Results and discussion. OFCs help determine allergen sensitivity and reaction severity, which is useful for further management. They also have therapeutic value, reducing anxiety related to food allergies and improving quality of life. Psychological aspects play an important role in food allergies, as the fear of severe reactions often exceeds actual risks.One limitation of OFCs is the need for substantial resources and specialized knowledge, available only in specialized medical centers. This leads to long waiting lists and delays in food introduction, increasing the risk of developing allergies. Additionally, OFCs are often conducted in controlled environments, which may not reflect real-world accidental exposures.OFC results can include false positives, false negatives, and inconclusive outcomes. They are also time-consuming and may affect school or work attendance for patients and caregivers. It is essential to standar­dize doses for each food according to portion sizes and patient age. Conclusions. The frequency of food allergies is currently increasing in Ukraine, highlighting the need for allergists to master the technique and implement oral food challenges in general allergy practice to establish food allergies in children.