Immunoglobulin E-mediated Food Allergy Research Articles

Сучасні особливості ведення дітей із гастроінтестинальною формою харчової алергії

Харчова алергія вражає багато мільйонів людей, призводить до зниження якості життя людини та суспільства загалом, а в деяких випадках може призвести до фатальних наслідків. На сьогодні багато уваги приділяється дослідженням, що спрямовані на розробку оптимальних профілактичних заходів для зменшення поширеності харчової алергії. До недавнього часу вважалося, що для профілактики харчової алергії доцільне уникнення найпоширеніших харчових алергенів під час вагітності і грудного вигодовування. Однак існують дані про те, що ранній вплив потенційних харчових алергенів може зменшити ризик розвитку відповідної алергії. Рекомендовано уникати дієтичних обмежень, зокрема введення твердих продуктів, після 4–6 місяців життя навіть для дітей із високим ризиком розвитку алергічних захворювань. До загальних напрямів управління харчовою алергією відносять заходи, що спрямовані на лікування гострих реакцій, та заходи, що спрямовані на мінімізацію ризику появи таких реакцій у майбутньому, так звані довгострокові стратегії (зміни раціону харчування, освітні заходи, фармакологічні та нефармакологічні заходи). У статті розглянуті підходи до ведення дітей з окремими формами гастроінтестинальної харчової алергії. На сьогодні елімінаційна дієта в комбінації з терапією системних реакцій, викликаних харчовими алергенами, залишається стандартним заходом у веденні таких пацієнтів. Головним підходом у первинному лікуванні IgE-опосередкованої гастроінтестинальної харчової алергії вважається уникнення вживання відомих харчових тригерів. Топічні глюкокортикостероїди залишаються препаратами першої лінії в лікуванні еозинофільного езофагіту. Існує багато спірних питань щодо ведення дітей із не-IgE-опосередкованою гастроінтестинальною харчовою алергією. Відмічається нагальна потреба в проведенні численних нових досліджень, спрямованих на розроблення ефективних лікувально-профілактичних заходів для ведення пацієнтів із цією поширеною і складною проблемою — харчовою алергією.

Skin care interventions in infants for preventing eczema and food allergy.

Skin care interventions in infants for preventing eczema and food allergy.

Food Intolerance of Unknown Origin: Caused by Mucosal Inflammation? A Pilot Study.

INTRODUCTION:The prevalence of patients with food intolerance (FI) has increased significantly. Immunoglobulin (Ig)E-mediated food allergies (FAs) are detected by determining IgE antibodies and skin prick test. Carbohydrate malabsorptions are clarified with breath tests. However, these diagnostic measures cannot capture all intolerances and have limitations in case of gut-mediated FI. The aims of this pilot study were to evaluate different methods to determine intestinal mucosal IgE in patients with FA and to characterize the intestinal mucosa in patients with FI of unknown origin (FH).METHODS:Patients with FA and FH were compared with healthy controls. To determine the IgE antibodies and the cytokines tumor necrosis factor (TNF)-α and interferon (IFN)-γ of the intestinal mucosal, a lavage was performed as part of an ileocolonoscopy and samples were taken using the cytobrush and biopsy forceps. In a subgroup, mucosal samples were also taken from the duodenum.RESULTS:Data in homogenates of intestinal mucosal samples yielded the highest sensitivity for IgE antibody titers compared with lavage and cytobrush. Patients with FA presented increased intestinal TNF-α and low IFN-γ values. This was in contrast to FH patients, who showed low intestinal IgE antibodies and TNF-α levels, but increased IFN-γ values.DISCUSSION:The determination of IgE antibodies to diagnose intestinal IgE-mediated FA is most reliable in intestinal mucosal samples. Increased TNF-α and low IFN-γ levels in patients with FA characterize an allergic reaction. Decreased TNF-α and increased IFN-γ levels in patients with FH indicate an inflammation-related intolerance reaction (see Visual , Supplementary Digital Content 1, http://links.lww.com/CTG/A520).

Prevalence of confirmed immunoglobulin E-mediated food allergy among adult Egyptian patients

Food allergy (FA) represents an increasing social and economic health problem. Prevalence of food allergy differs from one country to another depending on genetic and environmental as well as feeding habits of each country. Estimate the prevalence of confirmed immunoglobulin E-mediated food allergy (FA) among adult Egyptian patients and identify its possible risk factors. A total of 2081 adult subjects were randomly selected from the Allergy outpatient clinic at Ain Shams university hospitals. Patients who disclosed food adverse complaints (probable food allergy group) were further subjected to a detailed questionnaire, complete blood cell count, total immunoglobulin E level, skin prick test and /or specific immunoglobulin E test for common food allergens, and oral food challenge with the culprit food. Patients were classified into confirmed food allergy and no food allergy groups depending on the results of oral food challenge test. Out of the 2081 adults, 100 subjects had self-reported food adverse complaints, and of them, 45 (45%) had confirmed diagnosis of FA. Thirty four (75.6%) confirmed FA patients were females with mean age ± SD of (38.02 ± 13.08) years, five patients (11.1%) had persistent childhood FA, 11 (24.4 %) had family history of atopy, five (11.1%) had associated atopic diseases and 24 (53.3%) were polysensitized. Female gender, young age and exercise were found to be risk factors for confirmed FA (OR: 1.766, 1.4, and 1.9 respectively). Cutaneous manifestations were the most common presentation of confirmed FA patients in the form of urticaria 40/45 (88.9%) and angioedema 18/45 (40%). The most common food allergen was milk, banana, fish, tomato, strawberry and eggs. In conclusion, IgE mediated food allergy is a noticeable health problem among adult Egyptians, particularly adult females and young age groups.

Immunoglobulin E-mediated food allergy diagnosis and differential diagnosis.

Food allergies consist of aberrant immunologic, typically immunoglobulin E mediated, reactions that involve food proteins. A clinical history with regard to the suspected food, temporal associations, the duration of symptoms, characteristic symptom complex, and reproducibility in some cases is the key to making an accurate diagnosis. The differential diagnosis includes, for example, other immunologic adverse food reactions, nonimmunologic adverse food reactions, and reactions that involve nonfood items. Skin and blood immunoglobulin E testing for the suspected food antigen can aid the diagnosis in the context of a supportive clinical history. Immunoglobulin E testing for food components may further enhance diagnostic accuracy. Novel testing modalities are under development but are not yet ready to replace the current paradigm. Thus, double-blinded placebo controlled oral food challenge is considered the criterion standard of testing, although unblinded oral food challenges are usually confirmatory.

Clinical manifestations of immunoglobulin E-mediated food allergy, including pollen-food allergy syndrome.

Immunoglobulin E-(IgE) mediated food allergy affects people of all ages but does not have a consistent presentation and may result in various manifestations, even for an individual. The onset of symptoms is usually quite rapid, minutes to a few hours after consumption of the allergen, although exceptions exist. Cutaneous and gastrointestinal symptoms are the most common clinical manifestations; however, they are not present in all allergic reactions. Clinicians, particularly those in emergency care settings, need to be aware that the lack of cutaneous manifestations does not exclude the possibility of anaphylaxis. It is extremely unusual for food allergy reactions to present with isolated upper or lower respiratory symptoms, nor is chronic urticaria a manifestation of food allergy. Clinical manifestations of IgE-mediated food allergy range from mild to severe and, in rare cases, can be fatal. Mild, localized reactions, such as those that occur in pollen-food allergy syndrome, occur in individuals with sensitization to pollens. A small proportion of patients with this syndrome develop anaphylaxis. Alcohol, medications (nonsteroidal anti-inflammatory drugs, antacids), physical exertion, increased body temperature, acute infection, and menstruation are factors that are known to augment the severity of food-induced allergic reactions.

Pathophysiology of immunoglobulin E-mediated food allergy.

The pathophysiology of immunoglobulin E (IgE) mediated food allergy has been understood on a superficial level for several decades. Surveillance by dendritic cells for exogenous antigens leads to a high-affinity IgE response that arms effector cells (sensitization), such that subsequent exposures can trigger a type 1 hypersensitivity recall response. However, merely scratching the surface, whether confronting unmet needs in a clinical setting or probing the basic immunology of allergic immunity, quickly reveals the many unmet fundamental questions that lie there. This review article focused on the following such questions. Why are common allergens common? How does sensitization most often occur? How is IgE maintained over long time periods, even in the apparent absence of exposure? What distinguishes sensitization from clinical allergy? Can we stratify risk (i.e., sensitivity and severity)? What distinguishes the pathophysiology of non-IgE-mediated allergy when so much of it seems to overlap?

Immunoglobulin E-Mediated Food Allergies Differ in East Mediterranean Children Aged 0–2 Years

Objective: Precise diagnosis of allergy requires knowledge of the population’s food allergy (FA) spectrum and predictors. Methods: Medical charts of Turkish children aged 0–2 years with FA and/or atopic dermatitis (AD) were reviewed. Results: A total of 1,389 patients, 912 with FA and 1,140 with AD, were included. In the FA group, the most frequently diagnosed FAs were egg white (75.9%), cow’s milk (55.7%), tree nuts (31.5%) and sesame (20.6%). The detection of FA in 99% of children with any kind of FA necessitate testing with egg white, cow’s milk, hazelnut, sesame, walnut, cashew, and pistachio. In the FA group, 72.7 and 56.8% had AD and multiple FA respectively. Multiple FA (56.8 vs. 49.8%) and hen’s egg allergy (85.5 vs. 50.2%, p < 0.005) were more common and cow’s milk allergy (51.4 vs. 67.1%, p < 0.005) less common in the AD subgroup of the FA group than in the non-AD subgroup. Multiple FA likelihood increases parallel to the severity of AD (p < 0.05). In the AD group, 58.2% had an immunoglobulin E-mediated FA. The risk of concomitant FA increased as the age at symptom onset of AD decreased (OR 0.800 [95% CI 0.731–0.875]; p < 0.001) and the severity of AD increased (OR 2.350 [95% CI 1.898–2.911]; p < 0.001). Conclusion: Although severe and early-onset AD is a predictor of the presence and magnitude of FA in infancy, the spectrum of FA is a reflection of cultural characteristics. The clinical presentations of both AD and FA may in fact be an expression of the extent of the immune dysregulation underlying atopy and allergy.

Skincare interventions in infants for preventing eczema and food allergy

Skincare interventions in infants for preventing eczema and food allergy

Diagnosis of Food Hypersensitivity and Food Intolerance in Patients with a Functional Gastrointestinal Disorder

Patients with a functional gastrointestinal disorder (FGID) frequently report abdominal discomfort and bloating after ingesting specific foods. However, evidence on the relationship between foods and symptoms is lacking. In addition, the diagnosis of food hypersensitivity and food intolerance does not seem to be established yet. Food hypersensitivity can be divided into immunologically mediated and non-immunologically mediated forms. The immunologically mediated forms are specifically termed food allergies, whereas the non-immunologically mediated forms are referred to as food intolerances. Various diagnostic tools are required to make an accurate diagnosis of a food allergy or a food intolerance. First, a thorough examination of the history and basic tests to rule out other organic diseases are needed. Next, diagnostic tests for immunoglobulin E-mediated food allergies are required and diseases, such as celiac disease and lactose intolerance, should be differentiated. A diagnosis for non-celiac gluten sensitivity (NCGS) is also required. A double blind, randomized, placebo-controlled, dietary challenge test can be used for diagnosing NCGS and food intolerance. Diagnostic tests for food intolerance, in which scientific evidence is lacking, may result in a misdiagnosis of food hypersensitivity or food intolerance in patients with a FGID. Therefore, an accurate diagnosis of food hypersensitivity or food intolerance based on reliable tests is required. Keywords: Food intolerance; Food hypersensitivity; Gastrointestinal diseases 중심 단어: 음식 과민증; 음식 불내증; 기능성 위장관 질환

Allergen-Specific Immunotherapy for Immunoglobulin E-Mediated Food Allergy

Food allergy is a potentially life-threatening condition and a significant public health concern worldwide. The current management includes food avoidance and use of emergency medications. The growing prevalence of food allergy drives research towards specific allergen immunotherapy (AIT), which represents a potential disease-modifying approach. AIT consists of the progressive administration of amounts of the offending allergen in order to induce food desensitisation, creating an increase in reaction threshold with regular exposure to the allergen. AIT can be performed through oral, sublingual, epicutaneous, and subcutaneous routes. The target is to achieve post desensitisation effectiveness: a long-lasting condition allowing patients to introduce food without reactions, even after a period of discontinuation of the offending food.

Mechanisms by Which Atopic Dermatitis Predisposes to Food Allergy and the Atopic March.

The Atopic march denotes the progression from atopic dermatitis (AD) to the development of other allergic disorders such as immunoglobulin (Ig) E-mediated food allergy, allergic rhinitis and asthma in later childhood. There is increasing evidence from prospective birth cohort studies that early-onset AD is a risk factor for other allergic diseases or is found in strong association with them. Animal studies now provide mechanistic insights into the pathways that may be responsible for triggering the progression from the skin barrier dysfunction seen in AD to epicutaneous sensitization, food allergy and allergic airway disorders. Recent large randomized controlled trials have demonstrated the efficacy of early interventions targeted at AD and food allergy prevention. These show great promise for research into future strategies aimed at prevention of the atopic march.

Food oral immunotherapy is superior to food avoidance-PRO

Over the last decade much attention has focused on the possibility of using oral immunotherapy (OIT) as a therapeutic approach for treatment of immunoglobulin (Ig) E-mediated food allergies, a disease without a Food and Drug Administration (FDA)–approved disease-modifying therapy. Peanut allergy has been a particular concern because of its persistent nature and association with potentially life-threatening reactions. The OIT literature has been criticized for heterogeneity in trial design with disparities in identification of allergic individuals by double blind placebo-controlled food challenges, differences in desensitization approaches and maintenance doses of allergen, absence of a standardized product, inconsistency in the primary endpoint (eg, desensitization vs sustained unresponsiveness (SU)), a paucity of data on long-term effects on quality of life (QOL) and sustainability of therapy, and unproven benefits of therapeutic intervention over avoidance. In 2014, Wood and Sampson 1 Wood R.A. Sampson H.A. Oral immunotherapy for the treatment of peanut allergy: is it ready for prime time?. J Allergy Clin Immunol Pract. 2014; 2: 97-98 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar identified many of these factors in their editorial piece in response to whether OIT was ready for clinical practice and argued that peanut OIT existed in a state of equipoise without clear evidence that the benefits of therapeutic intervention with OIT outweighed the burden of avoidance of allergen. 1 Wood R.A. Sampson H.A. Oral immunotherapy for the treatment of peanut allergy: is it ready for prime time?. J Allergy Clin Immunol Pract. 2014; 2: 97-98 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Food-for-thoughtAnnals of Allergy, Asthma & ImmunologyVol. 122Issue 6PreviewThis year's Food Allergy theme puts a hefty portion of food-for-thought on your plate! We bring you important updates on the clinically relevant sizzling hot topics in food allergy, spanning prevention, diagnosis, and management of IgE and non-IgE-mediated food allergic disorders. For the first time, we are show-casing a series of pro and con debates presenting opposing views and welcome your feedback whether you enjoy reading such exchanges of opinions among the experts. Full-Text PDF Pro-Con DebateAnnals of Allergy, Asthma & ImmunologyVol. 122Issue 6PreviewIn this month's issue of the Annals of Allergy, Asthma and Immunology, we are kicking off a new feature that we hope will be an exciting addition to the spectrum of information available to our readers. This will be based on the extremely popular “Pro-Con Debates” that have been featured at many annual meetings of the College. The structure of this feature is to address a topic in allergy-immunology which may be controversial, have multiple schools of thought, and/or have little hard data but still be important to our practices so that hearing contrasting opinions can be educational and, hopefully, provocative to have the reader think and read more on the subject. Full-Text PDF

Early Infant Feeding Practices as Possible Risk Factors for Immunoglobulin E-Mediated Food Allergies in Kuwait.

Objective Early feeding and infant exposures have been suggested as potential risk factors for immunoglobulin E- (IgE-) mediated food allergy (FA). We aimed to evaluate the association between IgE-mediated FA in children and early exposures including the child's nutritional status, breastfeeding and its duration, the age at which the solid food was first introduced, antibiotic exposure during the first year of life, and the child's vitamin D status during infancy. Design A case-control study. Setting and Subjects Children aged 0–13 years were recruited from pediatric allergy and immunology clinics (PAICs) located at major government hospitals in Kuwait (total FA cases: n = 100; boys = 67%), and healthy controls (n = 100, boys 55%) were recruited from various vaccination units at primary healthcare centers. Results Cow's milk allergy was the most common type of FA. FA status was independently associated with the early exposures of exclusive breastfeeding (aOR = 15.55 (3.26–74.19), p = 0.001), vitamin D deficiency or insufficiency during infancy (aOR = 5.42 (1.92–15.30), p = 0.001), and antibiotic exposure during the first year of life (aOR = 5.00 (1.58–15.84), p = 0.006). Conclusions FA is highly prevalent among children in Kuwait, and our data indicate that early nutrition-related and antibiotic exposures are associated with FA risk.

Peanut allergens: new consolidated findings on structure, characteristics, and allergome.

Immunoglobulin E-mediated food allergy is the result of a complex pathomechanism. Factors contributing to the dysfunction of the immune system are the allergenic sources and the variable matrix effects arising from the processes involved in interaction with the gastrointestinal tract, the allergens themselves through their structural features, and the specific behavior of the individual immune system. The starting point for elucidating the pathomechanism of food allergy is the identification of allergens and the description of their structure. They are the basis for in vitro diagnostics as well as the development of immunotherapeutic drugs. With regard to Class I food allergy, peanut allergy affects by far the largest group of patients. 11 allergens have been identified in peanuts. Ara h 1, Ara h 3, and Ara h 4 belong to the cupin superfamily, Ara h 2, Ara h 6, and Ara h 7 to the prolamin superfamily; Ara h 5 (profilins) and Ara h 8 (superfamily of Bet v 1-homologous proteins) are associated with aeroallergens. Peanut lipid transfer proteins (LTP) and two peanut oleosins are listed as Ara h 9, Ara h 10, and Ara h 11 by the IUIS Allergen Nomenclature Subcommittee. Peanut agglutinin (PNA) and a third oleosin have been shown to possess allergenic properties. The effect of the above specified allergens has to be considered in the context of their matrix, which is influenced by processing factors.

Experimental Models for Studying Food Allergy.

Immunoglobulin E–mediated food allergy is rapidly developing into a global health problem. Publicly available therapeutic intervention strategies are currently restricted to allergen avoidance and emergency treatments. To gain a better understanding of the disease pathophysiology so that new therapies can be developed, major research efforts have been put into studying food allergy in mice. Animal models should reflect the human pathology as closely as possible to allow for a rapid translation of basic science observations to the bedside. In this regard, experimental models of food allergy provide significant challenges for research because of discrepancies between the presentation of disease in humans and mice. The goal of this review is to give a summary of commonly used murine disease models and to discuss how they relate to the human condition. We will focus on epicutaneous sensitization models, on mouse strains that sensitize spontaneously to food as seen in humans, and on models in humanized animals. In summary, expanding the research toolbox of experimental food allergy provides an important step toward closing gaps in our understanding of the derailing immune mechanism that underlies the human disease. The availability of additional experimental models will provide exciting opportunities to discover new intervention points for the treatment of food allergies. (Cell Mol Gastroenterol Hepatol 2018;x:x)

Current concepts: diagnosis and management of food allergy in children.

Advances in the prevention and treatment of food allergy have been published in the last few years and are placed in context using a review format. Preventing food allergy has been studied for years with questions of whether avoidance or exposure was a better strategy. Recent research has suggested that peanut allergy can be substantially reduced in high-risk infants through intentional oral exposure. For children with food allergy, the primary treatment remains avoidance, but controlled trials have shown some success with oral immunotherapy and sublingual immunotherapy. Providers who see children with food allergies should be aware of the newer recommendations of preventing peanut allergy and the emerging therapies for children with immunoglobulin E-mediated food allergy.

Association of bronchial asthma and allergic rhinitis with IgE mediated allergy to common food allergens

Background and objective: Prevalence of immunoglobulin (Ig) E-mediated food allergy is primarily reported in patients of all age groups. The present study was aimed to investigate the relative prevalence of food allergy andallergens in patients with bronchial asthma and allergic rhinitis. Methods: Patients of all age groups and both sexes were screened using standard questionnaire and skin prick-test (SPT) with common foods. Specific IgE level was determined by enzyme linked immunosorbent assay (ELISA) and allergy wasestablished. Results: Of 575 patients screened, 120 (21%) gave history of food allergy. Of the history positive patients skin testedall showed a marked positive reaction to food extracts. Egg whole, black gram and lemon elicited marked positive SPT reaction in maximum of 12 (10%) cases each followed by rice, mushroom and corn in 11 cases each (9.1%), milk and cheese 10 cases each (8.3%), paneer and sardine fish 9 cases each (7.5%), maize and tamarind 8 cases each (6.6%), peanut and brinjal 7 cases each (5.8%), garlic and cabbage 4 cases each (3.3%), banana, sago and mutton 3 cases each (2.5%0, pineapple, pork, potato and almond with 2 cases each (1.6%), 1 case of beef, lady finger and drumstick (0.8%). The SPT positive patients showed elevated specific IgE levels (range: 0.8-79 IU/mL) againstrespective food allergens than normal controls (0.73 IU/mL, mean±2SD). The prevalence of food allergy was estimated to be 4.5% (2.6%-6.34%)at 95% confidence interval (95% CI) in test population (n=470). Conclusions: Food allergy is estimated to be 21% in adolescents and adults with asthma, rhinitis or both. Many food allergens were recorded as per the test.

Comparison of atopic features between children and adults with eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a clinicopathological diagnosis seen in children as well as adults. Growing evidence suggests that EoE is strongly associated with atopic disorders. Presenting symptoms differ in children and adults and it is not known whether atopic features vary by age. This study was designed to compare atopic features and allergic sensitization between children and adults with EoE. We conducted a retrospective analysis of demographic and clinical data from 50 children (aged 2-18 years) and 50 adults (aged 21-75 years) with a biopsy-proven diagnosis of EoE referred to our allergy clinic. Data regarding patient characteristics, history of atopic diseases, and allergy test results were collected for analysis. The majority of children and adults were white and male patients. When compared with adults, a higher percentage of children had a history of asthma (52% versus 24%; p < 0.05). There was no statistically significant difference between adults and children regarding history of allergic rhinitis, atopic dermatitis, immunoglobulin E-mediated food allergy, and family history of atopy. There was no statistically significant difference between children and adults regarding immediate-type sensitization to foods and aeroallergens. Compared with adults, a higher percentage of children showed a positive reaction to one or more foods on patch testing (62% versus 31%; p = 0.01). A high prevalence of comorbid atopic diseases and sensitizations to food and environmental allergens was seen in both children and adults. Children had a significantly higher rate of asthma and positive patch test to foods compared with adults.

Diagnosis of Food Allergy

Diagnosis of food allergy can be challenging. Given the limited specificity of available allergy tests, these need to be interpreted in light of pre-test probability that is determined by a careful history. Using likelihood ratios calculated from previous publication may allow a more individualized assessment. This approach is likely to be most useful in patients with low to moderate results, below the 95% positive predictive value for that food. This review covers the diagnostic approach of immunoglobulin E-mediated food allergy. We first focus on the pre-test clinical assessment of a patient with a suspected food allergy. We then compare currently available diagnostic tests and discuss their performance for frequent food allergens. Finally, we conclude with the interpretation of allergy tests in light of the pre-test assessment to determine final probability of food allergy and indications for referral to an allergy specialist for food challenge.