Presence Of Food Allergy Research Articles

Association between the presence of food allergy and asthma outcomes in allergic asthmatic adults: A case-control study

Association between the presence of food allergy and asthma outcomes in allergic asthmatic adults: A case-control study

FOOD MARKERS OF THE CANINE NUTRITION SYSTEM

The markers of the canine nutrition system represent a very important aspect in choosing a proper diet for the animal. They are distinguished by the use of age, waist, and physiological condition as determinants in the diet of a dog. It is also necessary to know the nutritional value and the components of each type of food to achieve the biological needs of each organism, depending on the individual representative medical needs. For a healthy body, depending on the needs, a balanced diet should consist of a source of protein with a high nutritional value and a small amount of carbohydrates that will lead to proper nutrition, without the presence of food allergies. Increased attention is paid to the nutrition of dogs, and seniors, over the age of 9, where the appearance of various diseases is observed with advancing age (heart disease, lung disease, liver, and kidney dysfunction) trying to avoid large amounts of fats and the use of foods low in sodium, potassium, and phosphorus that can attack the already weakened liver and kidneys. The purpose of writing this article is to review nutritional markers and analyze the nutritional components of diets, depending on various factors.

The Prevalence of Atopic Diseases Among Pediatric Food Allergic Patients.

Introduction Food allergy is an immunological reaction that occurs in response to particular proteins in food. As food allergy can affect multiple body organs, symptoms usually include pruritus, urticaria, rash, cough, dyspnea, and wheezing. Atopic diseases are common in patients with food allergies, and multiple significant associations have been made between them. As such, the presence of food allergy in atopic patients can be used as an indicator of disease severity. The aim of this study was to estimate the prevalence of atopic diseases in food allergy patients. Methodology This was a retrospective cohort study that included pediatric patients aged 0-14 with confirmed food allergies between January 2016 and June 2022. Data was retrieved from electronic medical records and included patients' demographics, type of food allergens, symptoms of food allergy, presence of atopic diseases, and the utilization of healthcare services. Categorical variables were reported as frequencies and percentages, with Chi-squared being used for comparison. Results A total of 228 patients were included in the study. Half of them (114, 50%) were diagnosed with an atopic disease. Seventy-four (64.9%) had asthma, 57 (50%) had atopic dermatitis, and 45 (39.5%) had allergic rhinitis. The most common food allergens in atopic patients were eggs and milk products, in 53 (46.4%) and 42 (36.8%), respectively. There was a significant association between allergy to eggs (p=0.0005), bananas (p=0.0242), and strawberries (p=0.0393), and the presence of an atopic disease. No significant difference was found between atopic and non-atopic patients in terms of utilization of outpatient (p=0.09), inpatient (p=0.50), or ER visits (p=0.31) due to food allergy. Conclusion The current study demonstrates the prevalence of atopic disease in patients with food allergies. Although certain foods were associated with the prevalence of atopic diseases, both atopic and non-atopic patients have similar utilization of health care services such as outpatient, inpatient, and ER.

Vegan diets from an allergy point of view - Position paper of the DGAKI working group on food allergy.

Vegan diets are currently attracting a great deal of attention. However, avoiding animal-based foods restricts the diet and is associated with risks, the extent and medical implications of which are at present not sufficiently understood. Elimination diets represent the usual therapeutic long-term management in the presence of food allergy. In order to understand the risks of vegan diets and to discuss these critically from the perspective of food allergies, the expertise of a nutritionist/dietitian with expertise in this area is indispensable. This position paper deals with the incentives behind and the benefits of a plant-based diet. The knowledge required to cover macro- and micronutrient dietary requirements is presented. Using the avoidance of cow's milk as an example, the challenges of adequately meeting nutritional needs are identified and (so-called) milk alternatives are evaluated from an allergy and nutritional point of view. Finally, other plant-based (substitute) products are evaluated from the same perspective, as significant protein sources in vegan diets (e.g., legumes, nuts, and seeds) are at the same time potential and potent triggers of allergic reactions. However, the allergic potential of many substitute products cannot be fully assessed at present due to gaps in research. Wheat as the most important trigger for anaphylaxis in adults is also evaluated. Finally, the increase in ultra-processed products in the (vegan) food sector and their potential consequences for the immune system are discussed.

Nutritional risks in children with food allergy.

Food allergies (FA) are a growing problem in the pediatric population and clinical features differ according to the underlying immunological mechanisms. While the primary management strategy is to eliminate the culprit food from the diet, assessment of the potential nutritional risks of elimination is also an integral part of management. In cases that do not improve over time; if you have basic food allergies and multiple food allergies, this can also lead to negative nutritional consequences. The contribution of basic nutrients, economical and easily accessible foods to the diet, is critical and has an important place in meeting the daily adequate intake of many nutrients. In the presence of food allergy, it is necessary to meet the vitamins and minerals that cannot be obtained from allergic foods, with alternative sources or supplements. For example, insufficient calcium intake in cow's milk allergy (CMA), the most common FA in early childhood, is very likely if an alternative supplement has not been introduced. In the management of CMA, choosing the appropriate formula and/or supplement for the clinical characteristics of children, when necessary, has an important place. In conclusion, nutritional risk assessment of children with FA requires a comprehensive, detailed, and multidisciplinary approach.

Relationship between maternal-infant gut microbiota and infant food allergy.

The gut microbiota plays a crucial role in food allergies. We sought to identify characteristics of the maternal gut microbiota in the third trimester and the infant gut microbiota in early life and the association of these microbiotas with infant food allergy. A total of 68 healthy pregnant women and their full-term newborns were selected from a cohort of 202 mother-infant pairs; among them, 24 infants had been diagnosed with food allergy within 1 year of age, whereas 44 infants were healthy without allergic symptoms. We collected 65 maternal fecal samples before delivery and 253 infant fecal samples at five time points following birth. Fecal samples were microbiologically analyzed using 16S rRNA gene sequencing. Holdemania abundance in the maternal gut microbiota in the third trimester was significantly higher in the non-allergy group than in the food allergy group (P = 0.036). In the infant gut microbiota, Holdemania was only found in meconium samples; its abundance did not differ significantly between the two groups. The change in the abundance of Actinobacteria over time differed between the non-allergy and food allergy groups (FA, P = 0.013; NA, P = 9.8 × 10-5), and the change in the abundance of Firmicutes over time differed significantly in the non-allergy group (P = 0.023). The abundances of genera Anaerotruncus, Roseburia, Ruminococcus, and Erysipelotricaceae were significantly different between the non-allergy and food allergy groups at different time points. Our results showed that maternal carriage of Holdemania during the third trimester strongly predicted the absence of food allergies in infants; there was no correlation between the presence of food allergies and the abundance of Holdemania in the infant gut microbiota. More dynamic fluctuations in phyla Actinobacteria and Firmicutes early in life protect against food allergy. Thus, the enrichment of the infant gut microbiota early in life with short-chain fatty acid-producing bacteria may be beneficial in preventing the development of food allergies in infants.

SIGNIFICANCE OF TOLL-LIKE RECEPTOR-2 POLYMORPHISM rs4696480 FOR THE DEVELOPMENT OF FOOD ALLERGY IN CHILDREN WITH ATOPIC DERMATITIS

Relevance. Food allergy is one of the most common chronic diseases in children. Toll-like receptors may be unique in the development of food allergies due to their expression by intestinal epithelial and dendritic cells.
 Objective. The aim of this study was to investigate the relationship between the rs4696480 polymorphism in TLR2 and the presence of food allergy in children with atopic dermatitis.
 Material and methods. The study included 103 patients with atopic dermatitis and 84 healthy children. Polymorphism genotyping was performed in the group of patients and the control group using real-time PCR. Food sensitization was determined by presence sIgE to food allergens by the immunochemiluminescent method using an ImmunoCAP 100 (Thermo Fisher Scientific Inc., Phadia, Sweden). The presence of food allergy was determined by a detailed clinical history and review of clinical records.
 Results. In the subgroup of children with food allergies, 9 children had the AA genotype, 7 patients had the heterozygous variant, and 3 children had the TT genotype. Among patients without food allergy, 20 patients had the AA genotype, 39 were heterozygotes, and 25 had the TT genotype. The OR assessment demonstrated that the AA genotype of the rs4696480 polymorphism is reliably associated with the development of food allergy in children with atopic dermatitis, OR=2,880 (1,0271-8,0757).
 Conclusion. The rs4696480 polymorphism in TLR2 gene is associated with the development of food allergy in Ukrainian children with atopic dermatitis.

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN.

Few pediatric data on phenotypic aspects of eosinophilic esophagitis (EoE) are available. The pEEr registry was developed to prospectively characterize children with EoE from Europe and Israel. pEEr is an ongoing prospective registry enrolling children with esophageal eosinophilia (≥15 eos/HPF). Anonymized data were collected from 19 pediatric centers. Data regarding demographics, clinical manifestations, endoscopy, histology, and therapies were collected. A total of 582 subjects (61% male) were analyzed. The median age at diagnosis was 10.5 years [interquartile range (IQR): 5.7-17.7], whereas the age at symptom onset was 9.2 years (IQR: 4.3-16.4), resulting in a median diagnostic delay of 1.2 years (IQR: 0.7-2.3). The diagnostic delay was longer below age <6 years. Shorter diagnostic delays were associated with the presence of food allergy or a family history for EoE. Symptoms varied by age with dysphagia and food impaction more common in adolescents, while vomiting and failure to thrive more common in younger children ( P < 0.001). Among endoscopic findings, esophageal rings were more common in adolescents, whereas exudates were more frequent in younger children( P < 0.001). Patients who responded to proton pump inhibitors (PPIs) were more likely to be older, males, and less often presented severe endoscopic findings. Patients unresponsive to PPIs received topical steroids (40%), elimination diet (41%), or a combined therapy (19%). EoE findings vary according to age in pediatric EoE. Young children are commonly characterized by non-specific symptoms, atopic dermatitis, food allergy, and inflammatory endoscopic lesions. Adolescents usually have dysphagia or food impaction, fibrostenotic lesions, and a better PPI response.

ЗНАЧЕНИЕ ОРАЛЬНЫХ ПИЩЕВЫХ ПРОВОКАЦИОННЫХ ПРОБ В ВЕДЕНИИ ДЕТЕЙ С АТОПИЧЕСКИМ ДЕРМАТИТОМ

One of the important tasks in the management of children with atopic dermatitis (AD) is the assessment of tolerance to previously excluded foods. An oral provocative test is considered to be the «gold standard» of confirming/excluding the presence of food allergies (FA), but food provocative trials are a potentially dangerous method of diagnosis. Objective of the study: to evaluate the feasibility of using oral provocative tests when expanding the diet in children with AD and allergy to cow's milk proteins (CMP). Materials and methods of research: a single-center cohort retrospective study was conducted. 154 patients with AD aged from 1 to 17 years had an oral provocation test with cow's milk for assessing the informativity of the concentration of IgE specific to CMP. At the first stage of the study, the incidence of symptoms, the time of onset of reactions, and the frequency of delayed reactions were assessed. The second step was to analyze the diagnostic informativeness of concentration of specific IgE to CMP in order to determine the value of the IgE-specific concentration, in which a provocative test to introduce cow’s milk into the diet would be the safest. To detect sensitization in all patients, the concentrations of specific IgE (ImmunoCAP Fadia test system) in blood serum to CMP were preliminarily determined. The result was considered positive when the values of the concentration of specific IgE&gt;0.35 IU/ml. Results: a positive result of the provocative test was observed in 44 (28.6%) patients, delayed-type reactions – in 24 (54.5%). CMP-Specific IgE was detected in 62 (40.2%) of 154 patients, of which a positive result of provocative tests was observed in 16 (25%) children. In 92 patients, the concentration of CMP-Specific IgE was below 0.35 kU/l, of which a positive provocative test result was observed in 28 (30%). The probability of a positive result at a concentration of specific IgE ≤0.35 kU/l is 25.8%, at a concentration above 1.5 kU/l – 40%, at a concentration above 2.0 kU/l – 61.5%. Conclusion: oral provocation tests are a necessary component in the management of children with AD induced by FA. This technique should be used not only to confirm the diagnosis of FA, but also when introducing products into the diet.

Клинические проявления расстройств моторной функции верхнего отдела пищеварительного тракта у детей с вегетативной дисфункцией

Было обследовано 109 детей с синдромом вегетативной дисфункции в возрасте 6–16 лет, которые были распределены на 2 группы. Основная группа — 87 детей с синдромом вегетативной дисфункции и нарушениями моторной функции верхнего отдела пищеварительного канала и группа сравнения — 22 ребенка с синдромом вегетативной дисфункции без нарушений моторной функции верхнего отдела пищеварительного тракта. По разработанной нами схеме обследования у детей, находившихся под наблюдением, нами был проведен анализ жалоб, анамнеза жизни и болезни, объективное обследование с использованием клинических, инструментальных и лабораторных методов исследования. Была изучена следующая информация: возраст, пол, течение беременности и родов у матери, заболевания в раннем детском возрасте, наличие хронических и функциональных заболеваний органов пищеварения у родителей, наличие у родителей ребенка вегетативной дисфункции, характер питания в грудном и школьном возрасте, наличие пищевой аллергии и влияния психогенных факторов, продолжительность жалоб, частота обострений, сопутствующая патология. Для оценки клинического течения вегетативной дисфункции и моторных нарушений верхнего отдела пищеварительного тракта была изучена симптоматика заболеваний с учетом физикальных данных, результатов общего клинического исследования крови и мочи, биохимического исследования крови, исследование кала на яйца гельминтов, данных электрокардиографии, консультаций врачей-специалистов (лор, невролог, офтальмолог), ультразвукового исследования органов брюшной полости. Состояние слизистой оболочки желудка, двенадцатиперстной кишки и наличие моторно-эвакуаторной нарушений в виде рефлюкса нами оценивались по данным фиброэзофагогастродуоденоскопии, которую проводили с помощью фиброскопов Richard Wolf 2163 (Германия) и Оlympus CLE 10 (Япония) с последующим взятием биопсии по общепринятой методике.

Comorbidity of atopic bronchial asthma and food allergy in adults

Adult patients with atopic bronchial asthma are susceptible to food allergy, in more than one third of cases, while asthma is a risk factor for severe life-threatening factors. The aim of the study was to determine the prevalence and relationship of food allergies with atopic bronchial asthma in adults living in Chelyabinsk. Materials and methods. An analysis of 313 outpatient case histories of patients with atopic bronchial asthma over the age of 18 was performed. Results. The presence of food allergy was a factor in the earlier onset of atopic bronchial asthma, which is consistent with the concept of comorbidity of these diseases. Patients with seasonal allergic rhinitis and pollen sensitization have an increased risk of developing food allergies (OR – 2.075 [1.27- 3.39]), p=0,004. The overall incidence of oral allergic syndrome among all patients with atopic asthma and plant sensitization was 33% [28; 37]. Plant products (fruits, honey, nuts) were the cause of food allergic reactions in 87% [80; 92] of adult cases. The main clinical manifestations were: oral allergic syndrome, urticaria, angioedema, shortness of breath. Sensitization to pollen of trees, grasses and weeds approximately equally increases the risk of developing an oral allergic syndrome, upon sensitization to tree pollen (OR – 3.08 [2.32-4.25]), to grass pollen (OR – 3.5 [2.23-5.61]), to weed pollen (OR – 2.86 [2.02-4.03]). The combination of several types of pollen sensitization increases by 4 times the risk of developing oral allergic syndrome to a wide range of foods. Conclusion. Data on the causes and clinical manifestations of food allergies in combination with bronchial asthma have been obtained. The notion of a significant risk of developing dangerous clinical manifestations of food allergy in patients with atopic bronchial asthma will make it possible to reasonably prescribe emergency drugs for independent use.

Prevalence of Self-Reported Food Allergies and Their Association with Other Health Conditions among Adults in Saudi Arabia.

Food allergies are a potentially life-threatening health issue, and few studies have determined their prevalence throughout Saudi Arabia. The main objective of our study was to estimate the prevalence and distribution of self-reported food allergies, and explore their association with other health conditions among adults in Saudi Arabia. This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was used to obtain equal distributions of participants by age and gender across the 13 regions of Saudi Arabia. Self-reported food allergy, height, weight, health conditions, mental health status, and demographic variables were collected. Of the 6239 participants contacted, 4709 (75.48%) participants responded and completed the interview. Furthermore, 50.1% of the participants were female, with a mean age of 36.4 ± 13.5 years (18–90 years). The prevalence of food allergies was 19.7%. The most self-reported food allergies were egg, shellfish and shrimp, and peanuts, with a prevalence of 3.7%, 3.1%, and 3.0%, respectively. There was an association between the presence of food allergies and reported bariatric surgery, asthma, colon disease, and being at risk of depression. Bariatric surgery was significantly associated with lower likelihood of self-reported allergy (OR 1.69, 95% CI 1.22–2.34, p = 0.002). This study revealed, for the first time, a high prevalence of self-reported food allergies among adults in Saudi Arabia in a large nationwide sample, and food allergy association with bariatric surgery, asthma, colon disease, and being at risk of depression. This information is valuable for clinicians and policymakers, particularly in terms of food allergen labeling.

Eating fish and fruits are associated with lower prevalence of allergic diseases

BackgroundAllergic diseases are recognized as a burden on the public health. They stand as one of the most common chronic diseases, especially in developed countries. Therefore, the objective of this study is to evaluate the association between the development of atopic allergy and the presence of food allergy in children, and food consumption. MethodsThis multidisciplinary cross-observational epidemiological study was conducted among 1199 schoolchildren who were recruited in 4th grade and 5th grade (9–11 years old from Marseille). Data were collected by means of a standardized epidemiological questionnaire with a medical assessment focusing on allergic diseases, and questions on lifestyle and child nutrition (FFQ). ResultsDuring the last 12 months, prevalence of allergic diseases were shown as follows: 41% of children presented allergic rhinitis symptoms, 24% reported having asthma related symptoms, while 28% suffered of eczema and 7% complained of food allergy. There was a significant association between food allergy and asthma symptoms (P-value<0.001, IC=[2.29–7.69]), eczema (P-value<0.001, IC=[2.37–8.32]) and allergic rhinitis (P-value<0.001, IC=[2.32–8.17]). Regarding dietary habits, the multivariate analysis shows that the consumption of vegetables (ORa=0.72 [0.64–0.74]) and fish (ORa=0.74 [0.50–1.09], ORa=0.66 [0.47–0.94] respectively) are associated decreased risk of developing asthma and allergic rhinitis symptoms, while fruit consumption (ORa=0.68 [0.45–1.03]) is associated with a decrease in eczema symptoms. ConclusionThis study shows that the presence of a food allergy is strongly associated with allergic diseases. Indeed, the consumption of vegetables, fruits and fish seems to have a protective effect on the occurrence of these diseases.

The role of nutritional factors and food allergy in the development of psoriasis

Psoriasis is a chronic relapsing disease that affects about 2% of the world's population and leads to medical and social losses. There is evidence of the effect of nutritional factors on the course of psoriasis in modern literature. The aim of the research was to analyze modern domestic and foreign literature on the role of nutritional factors, food allergies and the state of the gastrointestinal tract in the etiopathogenesis of psoriasis Material and methods. The electronic resources were used in preparing the article: the PubMed/MEDLINE portal, "Scientific Electronic Library eLIBRARY.RU". The following filters and keywords were requested: psoriasis and nutrition, food allergies and psoriasis, gastrointestinal manifestations and psoriasis, diet and psoriasis, obesity and psoriasis. Results and discussion. The role of nutrition as a predictor of the development of psoriatic skin rashes and exacerbation of the disease has been discussed. The mechanisms of the positive influence of the correction of metabolic disorders on skin processes in patients with psoriasis have been analyzed. It has been noted that further studies are needed to study the effectiveness of a lowcalorie diet for psoriasis treatment. Particular attention has been paid to the role of food allergy and pathology of the gastrointestinal tract in the etiopathogenesis of psoriatic disease. It is noted that in patients with psoriasis, structural and functional disorders in the gastrointestinal tract are observed, which lead to metabolic changes, endotoxinemia and autosensitization of the body. The role of intolerance to certain foods in the development of psoriasis has been discussed. Most of the available data indicate a high incidence of celiac disease and gluten intolerance in patients with psoriasis, however, information about the effectiveness of a gluten-free diet is controversial. Attention is drawn to the "non-celiac gluten sensitivity" associated with psoriasis, which represents a syndrome of neither allergic nor autoimmune genesis, which is manifested by gluten intolerance and characterized by symptoms similar to celiac disease. An increase in the frequency of occurrence of a high concentration of specific IgE to potato and carrot allergens in patients with psoriasis is noted, which most likely reflects cross-reactions with pollen allergens. An interesting hypothesis is the discussion of a lesion of the gastrointestinal tract in the presence of food allergies in patients with psoriasis, which may be a reflection of the systemic dermatogastrointestinal process and manifest psoriatic rashes on the skin. The mechanism of the anti-inflammatory effect associated with adhering to the Mediterranean diet for psoriasis is described in detail. Conclusion. The data presented allow us to consider the role of nutrition in the etiopathogenesis of psoriasis as significant, both from the point of view of the influence of nutritional factors and food allergens, that must be taken into account when prescribing therapeutic nutrition and elimination diet in combination with standard systemic therapy.

Immunization practices in children with a history of allergies.

Aim:In the presence of food allergies, especially egg allergies, primary physicians in Turkey avoid vaccine administration and refer children to a hospital setting. We aimed to evaluate children who had allergies or suspected allergies and were referred to our Well Child Clinic in a university hospital for vaccination.Material and Methods:Charts of all children referred to our clinic due to concerns for allergies in the last two years, were reviewed. Demographic data, laboratory evaluation and reactions after immunization were recorded.Results:A total of 122 children with or without a confirmed diagnosis of allergies were referred by primary physicians. In the history, 50 children (43.5%) had reactions with egg, 42 (36.5%) had reactions with multiple foods, nine (7.8%) had reactions with milk and seven (6.1%) had reactions with a previous vaccination. The most common reaction was rash (n=89, 86.4%). Nine children reported anaphylaxis. Skin testing or serum allergen specific IgE measurement revealed that 66 (54.1%) children had sensitization to egg white and 25 (20.5%) had sensitization to egg yolk. Most children (n=87, 71.9%) were referred for all the 12th-month vaccines, and 21 children were referred only for the measles-mumps-rubella vaccine (n=21, 17.4%). The median delay time in the administration of the measles-mumps-rubella vaccine was 20.0 (interquartile range: 8.7-41.2) days. No reaction was observed except for one child reporting a slight rash several hours after vaccination.Conclusion:Egg allergy was the most common barrier of vaccine administration in children referred from family physicians. Given the absence of any reactions, we support the administration of the measles-mumps-rubella vaccine in primary care settings to prevent delays in national vaccine schedule.

Microparticle Responses to Aerobic Exercise and Meal Consumption in Healthy Men.

Microparticles (MP) are shed extracellular vesicles that express the prothrombotic tissue factor (TF). Aerobic exercise may reduce MP count and TF expression. This study investigated the impact of acute running or rest followed by standardized meal consumption on MP phenotypes and TF expression. Fifteen males (age, 22.9 ± 3.3 yr; body mass, 81.9 ± 11.4 kg; V˙O2max, 54.9 ± 6.5 mL·kg·min; mean ± SD) completed 1 h of running (70% V˙O2max) or rest at 9:00 AM and consumed a standardized meal (1170 kcal, 43% CHO, 17% PRO, 40% fat) at 10:45 AM. Venous blood samples were taken at 9:00 AM, 10:00 AM, and 11:30 AM. The MP concentration, diameter, phenotypes, and TF expression were assessed using nanoparticle tracking analysis and flow cytometry. Nanoparticle tracking analysis identified no changes in MP concentration or diameter in response to time or trial. Flow cytometry revealed total MP count increased from 9:00 AM to 10:00 AM (1.62 ± 2.28 to 1.74 ± 2.61 × 10 L, P = 0.016, effect size (η) = 0.105), but was unaffected by trial. TF platelet-derived MP % reduced from 9:00 AM to 10:00 AM (44.0% ± 21.2% to 21.5% ± 9.3%, P = 0.001, η = 0.582) after exercise only (control, 36.8% ± 18.2% to 34.9% ± 11.9%; P = 0.972). TF neutrophil-derived MP percentage reduced from 9:00 AM to 11:30 AM (42.3% ± 17.2% to 25.1% ± 14.9%; P = 0.048, η = 0.801) in the exercise trial only (control, 28.5% ± 15.7% to 32.2% ± 9.6%; P = 0.508). Running induced a significant reduction in %TF platelet and neutrophil MP, suggesting a transient reduction in cardiovascular risk via reduced TF-stimulated thrombosis. This requires further investigation over longer periods in cardiovascular disease populations.

Eosinophilic Esophagitis and Proton Pump Inhibitor-Responsive Esophageal Eosinophilia; Single Center Experience

Objective: Eosinophilic esophagitis is a chronic inflammatory disease characterized by eosinophilic infiltration and esophagus dysfunction symptoms. Proton pump inhibitor responsive esophageal eosinophilia is similar to eosinophilic esophagitis in terms of clinical, laboratory, genetic expression profile, endoscopic and histopathological features. In this study, we aimed to share demographic features, clinical, laboratory and histopathological findings, and treatment outcomes of patient with eosinophilic esophagitis and proton pump inhibitor responsive esophageal eosinophilia. Materials and Methods: Demographic features, laboratory, endoscopic and histopathological findings, and treatment outcomes of patients followed in our clinic were recorded retrospectively since January 2010. Results: Four thousand six hundred fifty five patients underwent esophagogastroscopy since 2010 in our clinic and 0.4% (n=18) of these patients were diagnosed with eosinophilic esophagitis, and 0.2% (n=8) with proton pump inhibitor-responsive esophageal eosinophilia. The main symptom of patients with eosinophilic esophagitis were food impaction/dysphagia (n=5, 27.8%) and chronic abdominal pain (n=5, 27.8%). Allergen sensitization was found in 14 (77.8%), increased IgE in 12 (66.7%), peripheral eosinophilia in 12 (66.7%), and food allergen sensitization in 10 patients (55.6%) with eosinophilic esophagitis. On histopathological examination, the mean intraepithelial eosinophil count was 48.9 ± 30.9 cells / HPF (400x). When patients with eosinophilic esophagitis (group 1) and proton pump inhibitor-responsive esophageal eosinophilia (group 2) were compared, it was found that chronic abdominal pain was more common in the proton pump inhibitor-responsive esophageal eosinophilia group and food allergen sensitization in the eosinophilic esophagitis group (p<0.05). Total IgE, peripheral eosinophil count and intraepithelial eosinophil count were higher in the eosinophilic esophagitis group, but the differences were not statistically significant. Diet (n=11), medical (n=17) and dilatation (n=1) therapies were used in the eosinophilic esophagitis group. Fibrosis was detected on the histopathological examination in two patients who underwent TED and then SED was started. No side effect was seen any group in long term. Conclusion: Eosinophilic esophagitis and proton pump inhibitor-responsive esophageal eosinophilia have similar laboratory and histopathological features but eosinophilic esophagitis should be suspected more frequently in the presence of food allergy. Long-term followup is essential in patients with eosinophilic esophagitis.

Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

Allergic diseases are prevalent in childhood. Early exposure to medications that can alter the microbiome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy. To determine whether there is an association between the use of acid-suppressive medications or antibiotics in the first 6 months of infancy and development of allergic diseases in early childhood. A retrospective cohort study was conducted in 792 130 children who were Department of Defense TRICARE beneficiaries with a birth medical record in the Military Health System database between October 1, 2001, and September 30, 2013, with continued enrollment from within 35 days of birth until at least age 1 year. Children who had an initial birth stay of greater than 7 days or were diagnosed with any of the outcome allergic conditions within the first 6 months of life were excluded from the study. Data analysis was performed from April 15, 2015, to January 4, 2018. Exposures were defined as having any dispensed prescription for a histamine-2 receptor antagonist (H2RA), proton pump inhibitor (PPI), or antibiotic. The main outcome was allergic disease, defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticaria, contact dermatitis, medication allergy, or other allergy. Of 792 130 children (395 215 [49.9%] girls) included for analysis, 60 209 (7.6%) were prescribed an H2RA, 13 687 (1.7%) were prescribed a PPI, and 131 708 (16.6%) were prescribed an antibiotic during the first 6 months of life. Data for each child were available for a median of 4.6 years. Adjusted hazard ratios (aHRs) in children prescribed H2RAs and PPIs, respectively, were 2.18 (95% CI, 2.04-2.33) and 2.59 (95% CI, 2.25-3.00) for food allergy, 1.70 (95% CI, 1.60-1.80) and 1.84 (95% CI, 1.56-2.17) for medication allergy, 1.51 (95% CI, 1.38-1.66) and 1.45 (95% CI, 1.22-1.73) for anaphylaxis, 1.50 (95% CI, 1.46-1.54) and 1.44 (95% CI, 1.36-1.52) for allergic rhinitis, and 1.25 (95% CI, 1.21-1.29) and 1.41 (95% CI, 1.31-1.52) for asthma. The aHRs after antibiotic prescription in the first 6 months of life were 2.09 (95% CI, 2.05-2.13) for asthma, 1.75 (95% CI, 1.72-1.78) for allergic rhinitis, 1.51 (95% CI, 1.38-1.66) for anaphylaxis, and 1.42 (95% CI, 1.34-1.50) for allergic conjunctivitis. This study found associations between the use of acid-suppressive medications and antibiotics during the first 6 months of infancy and subsequent development of allergic disease. Acid-suppressive medications and antibiotics should be used during infancy only in situations of clear clinical benefit.

Fecal Microbiome and Food Allergy in Pediatric Atopic Dermatitis: A Cross-Sectional Pilot Study

Background: Exposure to microbes may be important in the development of atopic disease. Atopic diseases have been associated with specific characteristics of the intestinal microbiome. The link between intestinal microbiota and food allergy has rarely been studied, and the gold standard for diagnosing food allergy (double-blind placebo-controlled food challenge [DBPCFC]) has seldom been used. We aimed to distinguish fecal microbial signatures for food allergy in children with atopic dermatitis (AD). Methods: Pediatric patients with AD, with and without food allergy, were included in this cross-sectional observational pilot study. AD was diagnosed according to the UK Working Party criteria. Food allergy was defined as a positive DBPCFC or a convincing clinical history, in combination with sensitization to the relevant food allergen. Fecal samples were analyzed using 16S rRNA microbial analysis. Microbial signature species, discriminating between the presence and absence food allergy, were selected by elastic net regression. Results: Eighty-two children with AD (39 girls) with a median age of 2.5 years, and 20 of whom were diagnosed with food allergy, provided fecal samples. Food allergy to peanut and cow's milk was the most common. Six bacterial species from the fecal microbiome were identified, that, when combined, distinguished between children with and without food allergy: Bifidobacterium breve, Bifidobacterium pseudocatenulatum, Bifidobacterium adolescentis, Escherichia coli, Faecalibacterium prausnitzii, and Akkermansia muciniphila (AUC 0.83, sensitivity 0.77, specificity 0.80). Conclusions: In this pilot study, we identified a microbial signature in children with AD that discriminates between the absence and presence of food allergy. Future studies are needed to confirm our findings.

A Survey of Self-Reported Food Allergy and Food-Related Anaphylaxis among Young Adult Students at Kuwait University, Kuwait

Objectives: To conduct a survey on self-reported food allergy to milk, egg, peanuts, tree nuts, fish, shellfish, wheat, and sesame, as well as reported food-related anaphylaxis and epinephrine prescription practices among Kuwaiti students attending Kuwait University. Subjects and Methods: One thousand questionnaires that included data on age, gender, presence of food allergies, and associated details were distributed. All participants reporting an allergy were categorized as having a perceived food allergy. Those with a convincing clinical history and history of undergoing diagnostic food allergy testing were further categorized as having a probable food allergy. Results: Of the 1,000 questionnaires, 865 (86.5%) were completed. Of the 865 students, 104 (12.02%) reported food allergy (perceived), and 47 of these (45.19%) were probable food allergies. For milk (46.7%), peanut (35.7%), fish (60%), and sesame (50%), probable food allergy occurred in early childhood (≤5 years) while those of egg (44.4%) and wheat (57.1%) occurred in late childhood (6-10 years), and shellfish (40%) occurred in early adolescence (11-15 years). Of the 47 students with a probable food allergy, 28 (59.6%) were moderate to severe: 20 (71%) of these moderate-to-severe allergy cases reported at least 1 food-related anaphylactic episode while 8 (29%) denied such episodes. Equally important, of the 28 students, 6 (21%) received an autoinjectable epinephrine prescription, while 22 (79%) did not receive any. Conclusions: In this study the reported occurrence of perceived food allergy was low and probable food allergy occurred mostly in early childhood. Milk, egg, and nut allergies were the most commonly reported in both groups.