Increase In Food Allergy Research Articles

Emollient application from birth to prevent eczema in high-risk children: the BEEP RCT.

Atopic eczema is a common childhood skin problem linked with asthma, food allergy and allergic rhinitis that impairs quality of life. To determine whether advising parents to apply daily emollients in the first year can prevent eczema and/or other atopic diseases in high-risk children. A United Kingdom, multicentre, pragmatic, two-arm, parallel-group randomised controlled prevention trial with follow-up to 5 years. Twelve secondary and four primary care centres. Healthy infants (at least 37 weeks' gestation) at high risk of developing eczema, screened and consented during the third trimester or post delivery. Infants were randomised (1 : 1) within 21 days of birth to apply emollient (Doublebase Gel®; Dermal Laboratories Ltd, Hitchin, UK or Diprobase Cream®) daily to the whole body (excluding scalp) for the first year, plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). Families were not blinded to allocation. Primary outcome was eczema diagnosis in the last year at age 2 years, as defined by the UK Working Party refinement of the Hanifin and Rajka diagnostic criteria, assessed by research nurses blinded to allocation. Secondary outcomes up to age 2 years included other eczema definitions, time to onset and severity of eczema, allergic rhinitis, wheezing, allergic sensitisation, food allergy, safety (skin infections and slippages) and cost-effectiveness. One thousand three hundred and ninety-four newborns were randomised between November 2014 and November 2016; 693 emollient and 701 control. Adherence in the emollient group was 88% (466/532), 82% (427/519) and 74% (375/506) at 3, 6 and 12 months. At 2 years, eczema was present in 139/598 (23%) in the emollient group and 150/612 (25%) in controls (adjusted relative risk 0.95, 95% confidence interval 0.78 to 1.16; p = 0.61 and adjusted risk difference -1.2%, 95% confidence interval -5.9% to 3.6%). Other eczema definitions supported the primary analysis. Food allergy (milk, egg, peanut) was present in 41/547 (7.5%) in the emollient group versus 29/568 (5.1%) in controls (adjusted relative risk 1.47, 95% confidence interval 0.93 to 2.33). Mean number of skin infections per child in the first year was 0.23 (standard deviation 0.68) in the emollient group versus 0.15 (standard deviation 0.46) in controls; adjusted incidence rate ratio 1.55, 95% confidence interval 1.15 to 2.09. The adjusted incremental cost per percentage decrease in risk of eczema at 2 years was £5337 (£7281 unadjusted). No difference between the groups in eczema or other atopic diseases was observed during follow-up to age 5 years via parental questionnaires. Two emollient types were used which could have had different effects. The median time for starting emollients was 11 days after birth. Some contamination occurred in the control group (< 20%). Participating families were unblinded and reported on some outcomes. We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children. Emollient use was associated with a higher risk of skin infections and a possible increase in food allergy. Emollient use is unlikely to be considered cost-effective in this context. To pool similar studies in an individual patient data meta-analysis. This trial is registered as ISRCTN21528841. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/67/12) and is published in full in Health Technology Assessment; Vol. 28, No. 29. See the NIHR Funding and Awards website for further award information.

Australian Infant Food Allergy Emergency Presentations Following Updated Early Food Introduction Guidelines

The Australasian Society of Clinical Immunology and Allergy food allergy prevention guidelines were updated in 2016 to recommend home introduction of allergenic foods actively in the first year of life, including to infants at high risk of allergy. An important consideration for parents and providers is whether this practice increases food allergy reactions or anaphylaxis. We aimed to determine whether the 2016 update of food allergy prevention guidelines was associated with an increase in food allergy or anaphylaxis emergency department (ED) presentations. We obtained hospital electronic medical records for infants aged 4 to 12 months who attended the Royal Children's Hospital Melbourne ED in 2015 or in 2018 with a presenting problem or an encounter diagnosis of food allergy or anaphylaxis. Emergency department presentations owing to food allergy increased from 1.0% (95% CI, 0.85-1.23) in 2015 to 1.4% (95% CI, 1.22-1.67) in 2018 (P= .006). There was no increase in the number of anaphylaxis presentations (28 in 2015 and 22 in 2018) or peanut anaphylaxis presentations (three in 2015 and three in 2018). Overall, the proportion of food allergy presentations attributed to IgE-mediated food allergy was similar (82.1% in 2015 and 84.1% in 2018), whereas peanut allergy presentations increased slightly, although not statically significantly, from 14.6% to 21.2% (P= .09). Food protein-induced enterocolitis syndrome ED presentations were five in 2015 (4.3%) and 12 in 2018(7.6%), although not statistically significant (P= .25). Changes to food allergy prevention guidelines recommending the earlier introduction of allergenic food may have led to a small increase in ED presentations for food allergy but not anaphylaxis.

Interpersonal consequences of joint food consumption for connection and conflict

AbstractFor centuries, the preparation and eating of a meal has brought people together, making food consumption an inherently social process. Yet the way in which people connect over food is changing. Rising health concerns, due in part to the increase in food allergies and obesity, have shifted attention away from the social aspects of food to food's nutritional aspects. Recognizing the social context in which food consumption takes place, this article reviews research highlighting the interpersonal consequences of joint food consumption. We first examine research on how sharing food connects people together, both via the type of food consumed (e.g., incidental food similarity) and the manner in which people serve and eat food (e.g., from shared vs. separate plates). We then turn to research that addresses the opposite side of the coin, discussing how the inability to share in a meal can be isolating, as well as how people navigate conflicting preferences when making food decisions with others. We conclude with a discussion of promising future directions for research on joint food consumption.

Food allergy prevention: Where are we in 2023?

Food allergy prevention involves recommendations to the maternal diet during pregnancy and breast feeding, early life feeding and introduction of solid foods. Pregnant and breastfeeding women are not recommended to exclude any food allergens from their diet, but data are lacking to support active consumption of food allergens for prevention of food allergy. Breastfeeding is recommended for the many health benefits to the mother and child but has not shown any association with reduction in childhood food allergies. There is currently no recommendation regarding the use of any infant formula for allergy prevention, including the use of partially or extensively hydrolyzed formulas. Once the introduction of solid food commences, based on randomized controlled trials, it is advised to actively introduce peanuts and egg early into the infant diet and continue with consumption of these. Although there are limited data with respect to other major food allergens and whether early introduction may prevent allergy development, there is no need to delay the introduction of these allergens into the infant diet. Interpreting food allergen consumption in the context of cultural food practices has not been studied, but it makes sense to introduce the infant to family foods by 1 year of age. Consumption of foods typical of the Western diet and foods high in advanced glycation end products may be associated with an increase in food allergies. Similarly, intake of micronutrients, such as vitamin D and omega-3 fatty acids in both the maternal and infant diet, needs further clarification in the context of food allergy prevention.

Technological evolution and food allergies: issues of threats or contributions to the consumer?

Objective: To verify through a review of scientific literature, whether industrial and technological developments are directly related to the increase and prevalence of food allergies or whether it has contributed to the quality of life of allergic consumers. Methods: Searches were carried out in the Scielo (Scientific Electronic Library Online), Google Scholar, Lilacs (Latin American and Caribbean Health Sciences Literature) and PubMed (National Library of Medicine) databases. Results: The results obtained in the scientific literature identified that the significant increase in food allergies has accompanied the technological process, due to the greater consumption of food additives in ultra-processed products, but environmental influences such as dietary factors and lifestyle are also involved in the higher incidence of allergies. On the other hand, technological advances have collaborated with alternative food products for this specific population group by offering foods with reduction or exemption of allergenic compounds produced by different processing techniques or supported by biotechnology and other sciences. Final considerations: As claims for products free from allergenic compounds become mandatory, the food industry must make investments aimed at studies and production of safe alternative foods for allergic consumers.

The Interaction of Food Allergy and Diabetes: Food Allergy Effects on Diabetic Mice by Intestinal Barrier Destruction and Glucagon-like Peptide 1 Reduction in Jejunum.

The increase in food allergies and diabetes leads to the assumption that they are related. This study aimed to (1) verify the interaction between food allergy and diabetes and (2) explore the potential mechanisms by which food allergy promotes diabetes. Female BALB/c mice were grouped into a control group (CK), an ovalbumin-sensitized group (OVA), a diabetes group (STZ), and a diabetic allergic group (STZ + OVA) (Mice were modeled diabetes with STZ first, then were given OVA to model food allergies), and an allergic diabetic group (OVA + STZ) (Mice were modeled food allergies with OVA first, then were given STZ to model diabetes). The results showed that OVA + STZ mice exhibited a more serious Th2 humoral response, and they were more susceptible to diabetes. Furthermore, when the OVA + STZ mice were in the sensitized state, the intestinal barrier function was severely impaired, and mast cell activation was promoted. Moreover, we found that the effect of food allergy on diabetes is related to the inhibition of GLP-1 secretion and the up-regulation of the PI3K/Akt/mTOR/NF-κB P65 signaling pathway in the jejunum. Overall, our results suggest that food allergies have interactions with diabetes, which sheds new light on the importance of food allergies in diabetes.

Oral Wheat Immunotherapy: Long-Term Follow-Up in Children with Wheat Anaphylaxis

Introduction: There has been substantial increase in food allergies in recent decades. The management of severe food allergy often includes strict avoidance and medical therapies. However, oral immunotherapy (OIT) is a promising treatment option for these patients, which is still being investigated. Methods: The study recruited children from 2 years onward with a history of wheat anaphylaxis who had been referred to the Mofid Children Hospital. Wheat allergy was confirmed by a double-blind placebo-controlled food challenge. OIT was started to reach 5.28 g of wheat protein supplied in 60 g of bread. Besides immunologic measurements, a second and third oral food challenge (OFC) was performed after 3 months and 1 year of maintenance therapy to evaluate the long-term efficacy of wheat OIT (WOIT). Results: Seventeen patients completed the 3-month maintenance phase; 8 of them demonstrated negative OFCs. All of the 9 with positive OFCs were asked to continue the daily consumption of 60 g of bread for another year. Three patients with positive OFCs were followed for 1 more year and were asked to continue eating 60 g of bread every other day. The serum level of wheat sIgE was significantly increased at the end of the buildup phase (p = 0.026) and dramatically dropped at the end of the maintenance phase (p = 0.022). Conclusion: To conclude, WOIT is an effective and safe modality of treatment if it is administered under strict supervision.

The association of food-related anaphylaxis admissions with temperature and pollen counts in England

Background/AimSmall studies suggest that food-related anaphylaxis may be more common when temperature and pollen counts are higher. Robust quantitative evidence for such a relationship is lacking. We examined associations of food-related anaphylaxis hospital admissions (FRAHAs) with temperature and pollen counts in England.MethodsMonthly counts of FRAHAs in England in 2010-2018 were linked to monthly central England temperature and pollen counts in England. Poisson generalized additive models for time-series were applied to examine the associations of admissions with temperature and pollen including adjustment for yearly and seasonal trend. ResultsBetween 2010-2018 there were 15405 admissions. A seasonal peak of admission was observed in June with relative risk (RR) 1.22 (95%CI 1.13-1.31) compared to January. This seasonal peak disappeared after adjusting for Betula (birch) and Fraxinus (ash), both of which have a seasonal peak around April. Higher levels of Ambrosia (ragweed) (RR 1.16 95%CI 1.03-1.31; 95th vs. 5th percentile), Quercus (oak) (RR 1.12 95%CI 1.04-1.21) and lagged one-month Fraxinus (RR 1.05 95%CI 1.01-1.10) were associated with higher risk of admissions. Higher levels of Poaceae (all grass) were however associated with a lower risk of admissions (RR 0.86 95%CI 0.77-0.96). Temperature was weakly positively associated (RR 1.07 95%CI 0.99-1.16 per 10°C increase). ConclusionsTo the best of our knowledge, this is the first study quantifying the association of FRAHAs with temperature and pollen counts using time series approaches. Seasonality of admission was observed, with some evidence that this might be weakly related with temperature, and some pollen levels. Further studies applying species-specific data for grass and with more detailed spatio-temporal scale are needed. Individual level information on clinical characteristics of the admission are needed to fully understand the mechanisms involved. Such studies may be increasingly relevant in light of climate change and the general increase in food allergy across the world.

B cells and the microbiota: a missing connection in food allergy.

Food allergies are a major public health concern due to their widespread and rising prevalence. The increase in food allergy is partially due to Western lifestyle habits which deplete protective commensal microbiota. These microbial perturbations can result in adverse host-microbe interactions, altering the phenotype of various immune cells and instigating allergic sensitization. Although B cells are critical to allergic pathology, microbial influences on B cells have been somewhat overlooked. Here, we focus on direct and indirect interactions between bacteria and B cells and how such interactions regulate B-cell phenotype, namely antibody production (IgA, IgE, IgG1, and IgG4) and regulatory B-cell (Breg) function. Understanding how microbes modulate B-cell activity in the context of food allergies is critical to both tracing the development of disease and assessing future treatment options.

The Prevalence of Food Sensitization Appears Not to Have Changed between 2 Melbourne Cohorts of High-Risk Infants Recruited 15 Years Apart

Although food allergy has probably risen over recent decades, recent reports suggest that the prevalence of food sensitization in the general population has not changed. However, this has not been analyzed in infants at high risk of food allergy. The objective of this study was to compare the prevalence of food sensitization in high-risk infants from 2 cohorts recruited 15 years apart in the same region. This study includes 620 high-risk infants with a family history of allergy (Melbourne Atopy Cohort Study [MACS]) born 1990-1994, and a subgroup of high-risk infants from the population-based HealthNuts study (n= 3,661/5,276), born 2006-2010. Both studies undertook skin prick tests (SPT) to peanut, egg, and milk at age 12 months. A logistic regression model generated adjusted prevalences to account for differences in sampling frame. SPT ≥ 95% positive predictive values (PPVs) for food allergy were used as proxies for food allergy. The adjusted prevalence of sensitization in MACS was similar to the observed prevalence of sensitization in the high-risk subgroup of HealthNuts: 7.9% (95% confidence interval 6.8-8.9) and 7.9% (7.0-8.8) respectively for peanut, 15.0% (13.4-16.6) and 14.5% (13.4-15.7) respectively for egg, and 2.4% (1.6-3.1) and 2.6% (2.0-3.4) respectively for cow's milk. The prevalence of SPT ≥ 95% PPVs was similar between the 2 studies. The prevalence of food sensitization among high-risk infants has remained stable in Australia since the 1990s, despite the reported increase in food-related anaphylaxis in the same period. This discrepancy could be due to increased food allergy in the low-risk population, increased conversion of food sensitization to allergy, or increased number of high-risk infants. Alternatively, increased awareness or severity of reactions may have led to an apparent increase in food allergy.

The false alarm hypothesis: Food allergy is associated with high dietary advanced glycation end-products and proglycating dietary sugars that mimic alarmins

The incidence of food allergy has increased dramatically in the last few decades in westernized developed countries. We propose that the Western lifestyle and diet promote innate danger signals and immune responses through production of "alarmins." Alarmins are endogenous molecules secreted from cells undergoing nonprogrammed cell death that signal tissue and cell damage. High molecular group S (HMGB1) is a major alarmin that binds to the receptor for advanced glycation end-products (RAGE). Advanced glycation end-products (AGEs) are also present in foods. We propose the "false alarm" hypothesis, in which AGEs that are present in or formed from the food in our diet are predisposing to food allergy. The Western diet is high in AGEs, which are derived from cooked meat, oils, and cheese. AGEs are also formed in the presence of a high concentration of sugars. We propose that a diet high in AGEs and AGE-forming sugars results in misinterpretation of a threat from dietary allergens, promoting the development of food allergy. AGEs and other alarmins inadvertently prime innate signaling through multiple mechanisms, resulting in the development of allergic phenotypes. Current hypotheses and models of food allergy do not adequately explain the dramatic increase in food allergy in Western countries. Dietary AGEs and AGE-forming sugars might be the missing link,a hypothesis supported by a number of convincing epidemiologic and experimental observations, as discussed in this article.

The discovery of IgE 50 years later

In 1906, Von Pirquet1 used the term supersensitivity without immunity to describe (1) symptoms of inhalant allergy, (2) positive immediate skin test results, and (3) the fact that the results of other tests of immunity were not positive in these patients. The other tests he referred to were precipitin tests and complement fixation. Thus, he opened up the question of serum tests for supersensitivity. In 1919, Ramirez2 reported that a patient who had received a blood transfusion from a horse allergic donor became allergic to horse dander. At this point, Prausnitz and Kustner3 set out to investigate whether the serum of allergic individuals contained a factor or factors that could sensitize the skin. In 1921, they reported that the local injection of serum from a fish allergic individual, Kustner, to an individual who was only allergic to pollen, Prausnitz, would transfer specific sensitivity.3 This transfer of sensitivity came to be known as the P-K test and was used widely to study sensitivity not only to common allergens but also to extracts as diverse as those obtained from schistosomes.4,5 Furthermore, in New York, Cooke et al6 identified that there were other antibodies in the serum that increased during desensitization treatment and could block the skin-sensitizing activity. By the 1950s, it was clear that the transferred sensitivity was specific, that it could be diluted extensively, and that the skin remained locally sensitive for days if not weeks after the injection of serum.7,8 It was also already clear that the ability to sensitize the skin was lost after moderate heating of the serum.7 Several studies had also been reported on the physical properties of P-K activity. Indeed, Heimlich et al9 at Cal Tech reported on the sedimentation properties of skin-sensitizing antibodies in 1960. However, the studies before 1964 had not succeeded in defining the nature of these antibodies.

No Association Between Atopic Outcomes and Pertussis Vaccine Given in Children Born on the Isle of Wight 2001-2

Public health bodies in the USA, Australia and Europe have noted that there has been an increase in food allergy which coincides with the switch from whole cell (WCP) to acellular pertussis (AcP) vaccination in the US, Australia and Europe. AcP drives a Th2-like immune response, in contrast to the WCP vaccine. The transition from WCP to AcP vaccine in the UK coincided with the establishment of a large birth cohort study on the Isle of Wight in 2001/2002 to assess atopic/allergic outcomes through to age 10 years. We analysed outcome data and linked this with the type of pertussis vaccine given to compare rates according to the number of doses of AcP received. Outcomes assessed included: IgE-mediated food allergy, asthma at 3 and 10 years, eczema at 6 months/1 year/3 years, allergic rhinitis and atopy (positive SPT). A total of 701 children were included in the primary analysis which was all those who received a first infant dose before 18 weeks of age, and doses 2 and 3 (if given) under 12 months of age. No significant association between any outcome measure and type of pertussis vaccine were identified. Of those who had had at least one AcP dose 10/340 (2.9%) had IgE-mediated food allergy compared to 8/356 (2.2%) of those with no AcP doses (P=0.64). We did not identify any link between type of pertussis vaccine received in infancy and allergic/atopic outcomes.

Prospects for Prevention of Food Allergy

A rise in both prevalence and public awareness of food allergy in developed countries means that clinicians and researchers are frequently asked to explain reasons for the increase in food allergy, and families are eager to know whether they can take steps to prevent food allergy in their children. In this review, we outline leading theories on risk factors for early life food allergy. We summarize the leading hypotheses to explain the increase in food allergy as "the 5 Ds": dry skin, diet, dogs, dribble (shared microbial exposure), and vitamin D. We discuss currently available evidence for these theories and how these can be translated into clinical recommendations. With the exception of dietary intervention studies, evidence for each of these theories is observational, and we describe the implications of this for explaining risk to families. Current infant feeding recommendations are that infants should be introduced to solids around the age of 4 to 6 months irrespective of family history risk and that allergenic solids do not need to be avoided, either by infants at the time of solid food introduction or by mothers whilst pregnant or lactating. Additional potential strategies currently being explored include optimization of early life skin barrier function through a decrease in drying soaps and detergents and an increase in the use of nonallergenic moisturizers. The investigation of the role of microbiota and vitamin D is ongoing and cannot yet be translated into clinical recommendations.

The march from early life food sensitization to allergic disease: a systematic review and meta-analyses of birth cohort studies.

There is growing evidence for an increase in food allergies. The question of whether early life food sensitization, a primary step in food allergies, leads to other allergic disease is a controversial but important issue. Birth cohorts are an ideal design to answer this question. We aimed to systematically investigate and meta-analyse the evidence for associations between early food sensitization and allergic disease in birth cohorts. MEDLINE and SCOPUS databases were searched for birth cohorts that have investigated the association between food sensitization in the first 2 years and subsequent wheeze/asthma, eczema and/or allergic rhinitis. We performed meta-analyses using random-effects models to obtain pooled estimates, stratified by age group. The search yielded fifteen original articles representing thirteen cohorts. Early life food sensitization was associated with an increased risk of infantile eczema, childhood wheeze/asthma, eczema and allergic rhinitis and young adult asthma. Meta-analyses demonstrated that early life food sensitization is related to an increased risk of wheeze/asthma (pooled OR 2.9; 95% CI 2.0-4.0), eczema (pooled OR 2.7; 95% CI 1.7-4.4) and allergic rhinitis (pooled OR 3.1; 95% CI 1.9-4.9) from 4 to 8 years. Food sensitization in the first 2 years of life can identify children at high risk of subsequent allergic disease who may benefit from early life preventive strategies. However, due to potential residual confounding in the majority of studies combined with lack of follow-up into adolescence and adulthood, further research is needed.

Changes in peanut allergy prevalence in different ethnic groups in 2 time periods

Changes in peanut allergy prevalence in different ethnic groups in 2 time periods

Access to health care and food in children with food allergy

Access to health care and food in children with food allergy

Potential links between the emerging risk factors for food allergy and vitamin D status

A variety of hypotheses have been proposed to explain the recently described increase in food allergy among children living in developed countries. In this study, we summarize the emerging risk factors for IgE-mediated food allergy in early life, and then review the evidence for and against an association between low vitamin status (VDS) and food allergy. We consider whether each of the epidemiological variables that have been associated with food allergy may also be associated with VDS; and argue that future studies must adequately account for the potential relationships between risk factors for food allergy and VDS, and must also discriminate between vitamin D derived by sun exposure, diet and oral supplementation.

Neonatal vitamin D status and childhood peanut allergy: a pilot study

BackgroundAlthough a number of factors have been proposed to explain the increase in food allergy during the last decade, the possibility that vitamin D status may play a pathogenic role has received recent attention. ObjectiveTo determine whether lower levels of neonatal 25-hydroxyvitamin D (25[OH]D) would be observed in children with peanut allergy compared with in population controls. MethodsThe concentration of 25(OH)D was measured from neonatal dried blood samples by liquid chromatography tandem mass spectrometry. Levels were compared between children with IgE-mediated peanut allergy younger than 72 months assessed during 2008–2011 in a specialist referral clinic in the Australian Capital Territory and population births matched by sex, birth date, and birth location. Odds ratios were calculated for the matched pairs across quintiles of 25(OH)D. ResultsNeonatal 25(OH)D levels ranged from 8 to 180 nmol/L (median, 66 nmol/L; interquartile range, 46–93 nmol/L); only 4 children (3%) had levels less than 25 nmol/L, and 24 (20.9%) had levels greater than 100 nmol/L. No significant association was found between socioeconomic or clinical factors and 25(OH)D levels. Compared with the reference group (50–74.9 nmol/L), levels of 75 to 99.9 nmol/L were associated with lower risk of peanut allergy (P = .02). No further reduction was found at levels of 100 nmol/L or higher, and the risk of peanut allergy at levels less than 50 nmol/L was not significantly different from the reference group. ConclusionThe relationship between neonatal 25(OH)D level and childhood peanut allergy was nonlinear, with slightly higher levels (75–99.9 nmol/L) associated with lower risk than those in the reference group (50–74.9 nmol/L). Vitamin D status may be one of many potential factors contributing to childhood peanut allergy pathogenesis.

Genèse de l’allergie alimentaire du nourrisson : possibilité d’une prophylaxie partielle

Food allergy originates from physiological fetal Th2 polarization. The normal shift towards Th1 dominance during the first months of life is defective in the atopic infant. Several factors are critical for the development of food allergy. The influence of genetic factors has been shown by familial aggregation studies, and numerous candidate genes have been identified Gene polymorphisms interact with the environment, contributing to fetal programming Heritable epigenetic modifications occur rapidly in response to environmental factors and may explain the recent increase in food allergies and other atopic diseases. Atmospheric agents and the maternal diet during pregnancy may either increase or decrease the risk. Birth conditions, the intestinal microbiota, age at which food diversification begins, and exposure to food allergens and pollutants by inhalation, ingestion and skin contact may all contribute to the onset of food allergy in infancy. Partial prophylaxis is now within reach. Preventive information must be provided to families at high risk of atopy in their offspring.