1
|
Howard-Ruben J, Doucette J. Exploring novel approaches to food allergy management. J Am Assoc Nurse Pract 2023; 35:843-852. [PMID: 37335848 DOI: 10.1097/jxx.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023]
Abstract
ABSTRACT Nurse practitioners are likely to encounter pediatric and adult patients with symptoms of food allergy who need an accurate diagnosis, emergency treatment plans, and options for management. The pathophysiology of immunoglobulin E (IgE)-mediated food allergy, current and emerging diagnostics, treatment, and emergency management is briefly reviewed, and promising new and potential future treatment options are discussed. Currently, Food and Drug Administration-approved oral immunotherapy (OIT) treatment for peanut allergy, but clinical trials are underway to explore multiple-allergen OIT and alternate routes for IT such as sublingual and epicutaneous. Treatments that modulate the immune system are also potential treatments for food allergies (FAs), including biologic agents. Omalizumab, an anti-IgE therapy, dupilumab, an interleukin-4Ra receptor monoclonal antibody, and etokimab, an anti-IL-33, are all being studied for the treatment of food allergy. There is hope that these novel therapies for FAs will be a viable option translated to the practice setting in the near future, so that strict avoidance is not the only treatment plan for FAs. Nurse practitioners can support their patients with FAs and their families by keeping abreast of progress in food allergy research and assisting patients to consider novel treatment options, when appropriate, using shared decision making.
Collapse
Affiliation(s)
- Josie Howard-Ruben
- Department of Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, Illinois
| | - Julianne Doucette
- Department of Women, Children, and Family Nursing, Rush University College of Nursing, Chicago, Illinois
| |
Collapse
|
2
|
Zhang Z, Li XM, Wang H, Lin H, Xiao H, Li Z. Seafood allergy: Allergen, epitope mapping and immunotherapy strategy. Crit Rev Food Sci Nutr 2023; 63:1314-1338. [PMID: 36825451 DOI: 10.1080/10408398.2023.2181755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Seafoods are fashionable delicacies with high nutritional values and culinary properties, while seafood belongs to worldwide common food allergens. In recent years, many seafood allergens have been identified, while the diversity of various seafood species give a great challenge in identifying and characterizing seafood allergens, mapping IgE-binding epitopes and allergen immunotherapy development, which are critical for allergy diagnostics and immunotherapy treatments. This paper reviewed the recent progress on seafood (fish, crustacean, and mollusk) allergens, IgE-binding epitopes and allergen immunotherapy for seafood allergy. In recent years, many newly identified seafood allergens were reported, this work concluded the current situation of seafood allergen identification and designation by the World Health Organization (WHO)/International Union of Immunological Societies (IUIS) Allergen Nomenclature Sub-Committee. Moreover, this review represented the recent advances in identifying the IgE-binding epitopes of seafood allergens, which were helpful to the diagnosis, prevention and treatment for seafood allergy. Furthermore, the allergen immunotherapy could alleviate seafood allergy and provide promising approaches for seafood allergy treatment. This review represents the recent advances and future outlook on seafood allergen identification, IgE-binding epitope mapping and allergen immunotherapy strategies for seafood allergy prevention and treatment.
Collapse
Affiliation(s)
- Ziye Zhang
- Laboratory of Food Safety, College of Food Science and Engineering, Ocean University of China, Qingdao, China
| | - Xiu-Min Li
- Department of Pathology, Microbiology and Immunology and Department of Otolaryngology, School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Hao Wang
- Laboratory of Food Safety, College of Food Science and Engineering, Ocean University of China, Qingdao, China
| | - Hong Lin
- Laboratory of Food Safety, College of Food Science and Engineering, Ocean University of China, Qingdao, China
| | - Hang Xiao
- Department of Food Science, University of Massachusetts, Amherst, Massachusetts, USA
| | - Zhenxing Li
- Laboratory of Food Safety, College of Food Science and Engineering, Ocean University of China, Qingdao, China
| |
Collapse
|
3
|
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. Foods 2022; 11:foods11233758. [PMID: 36496564 PMCID: PMC9741085 DOI: 10.3390/foods11233758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
|
4
|
Lemos L, Assis HC, Alves JL, Reis DS, Campos Canesso MC, Almeida Oliveira M, Moreira TG, Miranda Sato BK, Batista LA, Gomes Lenzi J, Moraes MA, Melo L, Resende B, Aguiar D, Rezende Souza B, Cara DC, Gomes-Santos AC, Faria AMC. Neuroimmune circuits involved in β-lactoglobulin-induced food allergy. Brain Behav Immun Health 2022; 23:100471. [PMID: 35668724 PMCID: PMC9166446 DOI: 10.1016/j.bbih.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
Several antigens can act as allergens eliciting IgE-mediated food allergy reactions when fed to sensitized animals. One of them is ovalbumin (OVA) which is the main allergen in egg white. Allergic mice develop aversion to OVA consumption. This aversive behavior is associated with anxiety, and it can be transferred to non-sensitized mice by injection of serum of allergic mice. However, it is yet to be determined whether altered behavior is a general component of food allergy or whether it is specific for some types of allergens. Cow's milk allergy is the most prevalent food allergy that usually begins early in life and β-lactoglobulin (BLG) is the milk component with the highest allergenicity. In this study, we investigated behavioral and neuroimmune circuits triggered by allergic sensitization to BLG. A neuroimmune conflict between aversion and reward was observed in a model of food allergy induced by BLG intake. Mice sensitized to BLG did not present aversive behavior when BLG was used for sensitization and oral challenge. Mice allergic to BLG preferred to drink the allergen-containing solution over water even though they had high levels of specific IgE, inflammatory cells in the intestinal mucosa and significant weight loss. When sensitized to OVA and challenged with the same antigen, mice had increased levels of neuron activation in the amygdala, a brain area related to anxiety. On the other hand, when mice were sensitized to OVA and received a mixture of BLG and OVA in the oral challenge, mice preferred to drink this mixture, despite their aversion to OVA, which was associated with neuron activation in the nucleus accumbens, an area related to reward behavior. Thus, the aversive behavior observed in food allergy to OVA does not apply to all antigens and some allergens may activate the brain reward system rather than anxiety and aversion. Our study provides novel insights into the neuroimmune conflicts regarding preference and avoidance to a common antigen associated with food allergy.
Collapse
Affiliation(s)
- Luísa Lemos
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Helder Carvalho Assis
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Juliana Lima Alves
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Daniela Silva Reis
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Cecilia Campos Canesso
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mariana Almeida Oliveira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Thais Garcias Moreira
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Luara Augusta Batista
- Departamento de Fisiologia e Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Julia Gomes Lenzi
- Departamento de Fisiologia e Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Muiara Aparecida Moraes
- Departamento de Fisiologia e Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luciana Melo
- Departamento de Fisiologia e Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bruna Resende
- Departamento de Fisiologia e Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Danielle Aguiar
- Departamento de Fisiologia e Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bruno Rezende Souza
- Departamento de Fisiologia e Farmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Denise Carmona Cara
- Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Cristina Gomes-Santos
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Centro Universitário UNA, Instituto de Ciências Biológicas e da Saúde, Belo Horizonte, MG, Brazil
| | - Ana Maria Caetano Faria
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
5
|
Sampath V, Abrams EM, Adlou B, Akdis C, Akdis M, Brough HA, Chan S, Chatchatee P, Chinthrajah RS, Cocco RR, Deschildre A, Eigenmann P, Galvan C, Gupta R, Hossny E, Koplin JJ, Lack G, Levin M, Shek LP, Makela M, Mendoza-Hernandez D, Muraro A, Papadopoulous NG, Pawankar R, Perrett KP, Roberts G, Sackesen C, Sampson H, Tang MLK, Togias A, Venter C, Warren CM, Wheatley LM, Wong GWK, Beyer K, Nadeau KC, Renz H. Food allergy across the globe. J Allergy Clin Immunol 2021; 148:1347-1364. [PMID: 34872649 DOI: 10.1016/j.jaci.2021.10.018] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023]
Abstract
The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the need for better strategies for prevention, diagnosis, and therapy. In the last few decades, we have made great strides in understanding the causes and mechanisms underlying FAs, prompting guideline updates. Earlier guidelines recommended avoidance of common food allergens during pregnancy and lactation and delaying the introduction of allergenic foods in children aged between 1 and 3 years. Recent guidelines for allergy prevention recommend consumption of a healthy and diverse diet without eliminating or increasing the consumption of allergenic foods during pregnancy or breast-feeding. Early introduction of allergenic foods is recommended by most guidelines for allergy prevention after a period of exclusive breast-feedng (6 months [World Health Organization] or 4 months [European Academy of Allergy and Clinical Immunology]). New diagnostics for FA have been developed with varied availability of these tests in different countries. Finally, the first oral immunotherapy drug for FA was approved by the US Food and Drug Administration and European Medicines Agency in 2020. In this review, we will address the global prevalence of FA, our current understanding of the causes of FA, and the latest guidelines for preventing, diagnosing, and treating FA. We will also discuss similarities and differences between FA guidelines.
Collapse
Affiliation(s)
- Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif
| | - Elissa M Abrams
- Department of Paediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Department of Paediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Bahman Adlou
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service and Evelina Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Susan Chan
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service and Evelina Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Pantipa Chatchatee
- Pediatric Allergy and Clinical Immunology Research Unit, Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif
| | | | - Antoine Deschildre
- CHU Lille, University of Lille, Pediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France
| | - Philippe Eigenmann
- University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Cesar Galvan
- National Institute of Children Health, National Reference Center of Allergy, Asthma and Immunology, Lima, Peru; International Clinic, B&D Health Clinic, Lima, Peru
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Jennifer J Koplin
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Gideon Lack
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine and Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service and Evelina Children's Hospital, Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Michael Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa; inVIVO Planetary Health Group of the Worldwide Universities Network
| | - Lynette P Shek
- Department of Paediatrics, National University of Singapore, Singapore, Singapore
| | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Antonella Muraro
- Food Allergy Centre, Department of Woman and Child Health, Padua University Hospital, Padua, Italy
| | - Nikolaos G Papadopoulous
- Allergy Department, National and Kapodistrian University of Athens, Athens, Greece; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Graham Roberts
- Clinical and Experimental Sciences & Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Hospital, Southampton, United Kingdom; David Hide Asthma and Allergy Research Centre, St Mary' Hospital, Isle of Wight, United Kingdom
| | - Cansin Sackesen
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Hugh Sampson
- The Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Carina Venter
- Pediatric Allergy and Immunology, University of Colorado/Childrens Hospital Colorado, Boulder, Colo
| | - Christopher Michael Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Lisa M Wheatley
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Gary W K Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kirsten Beyer
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, Calif; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, Calif.
| | - Harald Renz
- Institute of Laboratory Medicine, Philipps University Marburg, Member of the German Center for Lung Research (DZL), Member of Universities Giessen and Marburg Lung Center, Marburg, Germany; Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia
| |
Collapse
|
6
|
Clinical Manifestations of Pediatric Food Allergy: a Contemporary Review. Clin Rev Allergy Immunol 2021; 62:180-199. [PMID: 34519995 DOI: 10.1007/s12016-021-08895-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/12/2022]
Abstract
Food allergies (FAs) are an emerging health care issue, and a "second wave of the allergy epidemic" was named. There are extensive data that documented the prevalence rate as high as approximately 10%. FAs are immunological adverse reactions, including IgE-mediated mechanisms, cell-mediated mechanisms, or mixed IgE- and cell-mediated mechanisms. A diagnosis of FA is made by specific symptoms encounter with food, detailed past history, sensitization tests, and oral food challenges (OFCs) if necessary. The component-resolved diagnostics (CRD) test can distinguish true or cross-reaction. "Minimal elimination" from the results of CRD and OFC could avoid unnecessary food restriction. Strict food limitation is harsh and stressful on patients and their families. Children with FAs experience a higher rate of post-traumatic stress symptoms (PTSS) and bullying than others. In the last 20 years, oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT) are treatment strategies. OIT and EPIT are the most two encouraging treatments for FA. This review aims to introduce FAs in diverse clinical disorders, new perspectives, and their practical implications in diagnosing and treating FA.
Collapse
|
7
|
Sicherer SH, Warren CM, Dant C, Gupta RS, Nadeau KC. Food Allergy from Infancy Through Adulthood. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1854-1864. [PMID: 32499034 DOI: 10.1016/j.jaip.2020.02.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 12/26/2022]
Abstract
Food allergies are the result of immune responses that cause adverse reactions to foods. Immune responses to foods may produce a spectrum of symptoms and disorders, including acute allergic reactions and anaphylaxis, food protein-induced allergic proctocolitis, food protein-induced enterocolitis syndrome, food-dependent, exercise-induced anaphylaxis, and oral allergy syndrome (pollen-food allergy syndrome). Food-allergic responses also contribute to chronic inflammatory disorders such as eosinophilic esophagitis and atopic dermatitis. Although food allergy affects people from infancy through adulthood, there are allergic features that differ according to age (ie, presentation, triggers, and natural course) and have important implications for diagnosis, prognosis, and management. New food allergies can develop at any age, and we propose similarities in the etiology of de novo food allergy whether in infancy or adulthood. The approach to managing food allergy changes dramatically over the life course, and physicians and patients must respond accordingly to optimize care. Food allergy therapies are emerging, and the efficacy and safety of these interventions could differ by age group of those treated. In this review, we highlight interesting observations on the etiology and characteristics of food allergy presenting at different ages and discuss clinical management as it relates to life stage.
Collapse
Affiliation(s)
- Scott H Sicherer
- Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Christopher M Warren
- Center for Food Allergy & Asthma Research, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Christopher Dant
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Ruchi S Gupta
- Center for Food Allergy & Asthma Research, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| |
Collapse
|
8
|
Albuhairi S, Rachid R. Biologics and Novel Therapies for Food Allergy. Immunol Allergy Clin North Am 2021; 41:271-283. [PMID: 33863483 DOI: 10.1016/j.iac.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Food allergy is a significant public health burden affecting around 10% of adults and 8% of children. Although the first peanut oral immunotherapy product received Food and Drug Administration approval in 2020, there is still an unmet need for more effective therapeutic options that minimize the risk of anaphylaxis, nutritional deficiencies, and patient's quality of life. Biologics are promising modalities, as they may improve compliance, target multiple food allergies, and treat other concomitant atopic diseases. Although omalizumab has been evaluated extensively, most biologics are more novel and have broader immunologic impact. Careful evaluation of their safety profile should therefore be conducted.
Collapse
Affiliation(s)
- Sultan Albuhairi
- Department of Pediatrics, Allergy and Immunology Section, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
9
|
Sørensen P, Turánek-Knotigová P, Mašek J, Kotouček J, Hubatka F, Mašková E, Kulich P, Lubasová D, Raška M, Leenhouts K, Turánek J. Short-course sublingual immunotherapy by mucoadhesive patch and tolerogenic particle enhanced allergen presentation. Clin Exp Allergy 2021; 51:853-857. [PMID: 33682209 DOI: 10.1111/cea.13862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Poul Sørensen
- Allero Therapeutics BV, Rotterdam, Netherlands.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Josef Mašek
- Department of Pharmacology and Immunotherapy, Veterinary Research Institute, Brno, Czech Republic
| | - Jan Kotouček
- Department of Pharmacology and Immunotherapy, Veterinary Research Institute, Brno, Czech Republic
| | - Frantisek Hubatka
- Department of Pharmacology and Immunotherapy, Veterinary Research Institute, Brno, Czech Republic
| | - Eliska Mašková
- Department of Pharmacology and Immunotherapy, Veterinary Research Institute, Brno, Czech Republic
| | - Pavel Kulich
- Department of Pharmacology and Immunotherapy, Veterinary Research Institute, Brno, Czech Republic
| | - Daniela Lubasová
- The Institute for Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Liberec, Czech Republic
| | - Milan Raška
- Department of Pharmacology and Immunotherapy, Veterinary Research Institute, Brno, Czech Republic.,Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | | | - Jaroslav Turánek
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,University Hospital Hradec Kralove. Institute Clinical Immunology and Allergology, Charles University Prague, Hradec Kralove, Czech Republic
| |
Collapse
|
10
|
Leonard SA, Laubach S, Wang J. Integrating oral immunotherapy into clinical practice. J Allergy Clin Immunol 2021; 147:1-13. [PMID: 33436161 DOI: 10.1016/j.jaci.2020.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
In 2020, the first food allergy treatment, an oral immunotherapy (OIT) product for peanut allergy, was approved by the Food and Drug Administration, and a peanut epicutaneous immunotherapy patch was under review. As food allergy therapies become available and widespread, allergy offices will need to adjust practices to be able to offer their patients these new treatments. OIT is an intensive therapy that requires commitment from patients and their families, and open communication with the practice is paramount. OIT may not be the right therapy for every patient, and although identifying good candidates is still an area rich for research opportunity, experience from cohorts and clinical trials provides some insight. It is important to understand the scope of practice for each member of the OIT team based on state regulations for a particular location. Staffing and space will likely dictate how many patients at an individual office could be on active OIT at one time. Emergency medications, supplies, and protocols must be in place. Screening, scheduling, visit procedures, monitoring, home dosing, dose modifications, safety precautions, adverse reactions, and maintenance will be addressed in this article. Finally, adjunct therapies under investigation will be reviewed.
Collapse
Affiliation(s)
- Stephanie A Leonard
- Division of Pediatric Allergy & Immunology, University of California San Diego, Rady Children's Hospital San Diego, San Diego, Calif.
| | - Susan Laubach
- Division of Pediatric Allergy & Immunology, University of California San Diego, Rady Children's Hospital San Diego, San Diego, Calif
| | - Julie Wang
- Jaffe Food Allergy Institute, Division of Pediatric Allergy, Mount Sinai School of Medicine, New York, NY
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW To critically appraise the recent most relevant studies in the rapidly advancing field of food oral and sublingual immunotherapy. RECENT FINDINGS Food allergen-specific immunotherapy via oral (OIT) and sublingual route (SLIT) increases the threshold of reactivity to peanut, cow's milk, egg, wheat, and many other foods in the majority of the treated individuals. This desensitized state is contingent upon the continued ingestion of the maintenance doses of the food. Permanent oral tolerance is achievable in a smaller subset of the treated individuals. The optimal duration of therapy has not been firmly established but is likely dependent on the phenotype (severity and persistence). Efficacy of food-OIT is superior compared with SLIT, whereas the safety of OIT is less favorable. Standardization of treatment protocols, maintenance dosing, duration of therapy, target populations and harmonization of the outcomes are top priorities at this stage. SUMMARY OIT and SLIT represent two different routes of food allergen-specific immunotherapy. Although significant progress has been made in the last decade, both treatment modalities are still in the very early stages of development and further investigations are necessary to optimize the protocols and improve safety while maximizing efficacy.
Collapse
|
12
|
Castaño N, Cordts SC, Nadeau KC, Tsai M, Galli SJ, Tang SKY. Microfluidic methods for precision diagnostics in food allergy. BIOMICROFLUIDICS 2020; 14:021503. [PMID: 32266046 PMCID: PMC7127910 DOI: 10.1063/1.5144135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/12/2020] [Indexed: 05/29/2023]
Abstract
Food allergy has reached epidemic proportions and has become a significant source of healthcare burden. Oral food challenge, the gold standard for food allergy assessment, often is not performed because it places the patient at risk of developing anaphylaxis. However, conventional alternative food allergy tests lack a sufficient predictive value. Therefore, there is a critical need for better diagnostic tests that are both accurate and safe. Microfluidic methods have the potential of helping one to address such needs and to personalize the diagnostics. This article first reviews conventional diagnostic approaches used in food allergy. Second, it reviews recent efforts to develop novel biomarkers and in vitro diagnostics. Third, it summarizes the microfluidic methods developed thus far for food allergy diagnosis. The article concludes with a discussion of future opportunities for using microfluidic methods for achieving precision diagnostics in food allergy, including multiplexing the detection of multiple biomarkers, sampling of tissue-resident cytokines and immune cells, and multi-organ-on-a-chip technology.
Collapse
Affiliation(s)
- Nicolas Castaño
- Department of Mechanical Engineering, Stanford University, Stanford, California 94305, USA
| | - Seth C. Cordts
- Department of Mechanical Engineering, Stanford University, Stanford, California 94305, USA
| | - Kari C. Nadeau
- Department of Pediatrics—Allergy and Clinical Immunology, Stanford University, Stanford, California 94305, USA
| | - Mindy Tsai
- Department of Pathology, Stanford University, Stanford, California 94305, USA
| | | | - Sindy K. Y. Tang
- Department of Mechanical Engineering, Stanford University, Stanford, California 94305, USA
| |
Collapse
|
13
|
|
14
|
The Best of 2018 in the Annals of Allergy, Asthma, and Immunology: The Editors' Choices. Ann Allergy Asthma Immunol 2019; 122:127-133. [PMID: 30711033 DOI: 10.1016/j.anai.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/23/2022]
|
15
|
Chinthrajah S, Cao S, Liu C, Lyu SC, Sindher SB, Long A, Sampath V, Petroni D, Londei M, Nadeau KC. Phase 2a randomized, placebo-controlled study of anti-IL-33 in peanut allergy. JCI Insight 2019; 4:131347. [PMID: 31723064 PMCID: PMC6948865 DOI: 10.1172/jci.insight.131347] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/02/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUNDIL-33, found in high levels in participants with allergic disorders, is thought to mediate allergic reactions. Etokimab, an anti-IL-33 biologic, has previously demonstrated a good safety profile and favorable pharmacodynamic properties in many clinical studies.METHODSIn this 6-week placebo-controlled phase 2a study, we evaluated the safety and the ability of a single dose of etokimab to desensitize peanut-allergic adults. Participants received either etokimab (n = 15) or blinded placebo (n = 5). Clinical tests included oral food challenges and skin prick tests at days 15 and 45. Blood samples were collected for IgE levels and measurement of ex vivo peanut-stimulated T cell cytokine production.RESULTSEfficacy measurements for active vs. placebo participants at the day 15 and 45 food challenge (tolerating a cumulative 275 mg of peanut protein, which was the food challenge outcome defined in this paper) demonstrated, respectively, 73% vs. 0% (P = 0.008) to 57% vs. 0% (ns). The etokimab group had fewer adverse events compared with placebo. IL-4, IL-5, IL-9, IL-13, and ST2 levels in CD4+ T cells were reduced in the active vs. placebo arm upon peanut-induced T cell activation (P = 0.036 for IL-13 and IL-9 at day 15), and peanut-specific IgE was reduced in active vs. placebo (P = 0.014 at day 15).CONCLUSIONThe phase 2a results suggest etokimab is safe and well tolerated and that a single dose of etokimab could have the potential to desensitize peanut-allergic participants and possibly reduce atopy-related adverse events.TRIAL REGISTRATIONClinicalTrials.gov NCT02920021.FUNDINGThis work was supported by NIH grant R01AI140134, AnaptysBio, the Hartman Vaccine Fund, and the Sean N. Parker Center for Allergy and Asthma Research at Stanford University.
Collapse
Affiliation(s)
- Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
- Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, California, USA
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Cherie Liu
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Shu-Chen Lyu
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
- Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, California, USA
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Daniel Petroni
- ASTHMA Inc., Clinical Research Center, Northwest Asthma and Allergy Center, University of Washington, Seattle, Washington, USA
| | | | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University
- Division of Pulmonary, Allergy and Critical Care Medicine, and
- Division of Allergy, Immunology and Rheumatology, Stanford University, Stanford, California, USA
| |
Collapse
|
16
|
Abstract
Food allergy and allergic rhinitis are childhood diseases with special relevance to the pediatric otolaryngologist. Much of the diagnosis of food allergy can be made on history alone; strict avoidance is the mainstay treatment. Skin prick testing and serum-specific IgE testing play a stronger role in allergic rhinitis diagnosis. If pharmacotherapy fails, allergen immunotherapy is an option. Currently, there is intense investigation on diagnostic tests, novel treatments, and prevention strategies that could dramatically affect the way these diseases are identified and managed. This article summarizes the epidemiology, pathophysiology, diagnosis, and management of food allergy and allergic rhinitis.
Collapse
Affiliation(s)
- Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287-0910, USA
| | - Sandra Y Lin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Outpatient Center, 6th Floor, 601 North Caroline Street, Baltimore, MD 21287-0910, USA.
| |
Collapse
|
17
|
Zhu LG, Li ZY. [Research advances in influencing factors for immune tolerance to food allergens in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:613-618. [PMID: 31208519 PMCID: PMC7389578 DOI: 10.7499/j.issn.1008-8830.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
Food allergen-specific immune tolerance is defined as nonresponsiveness of the adaptive immune system to food antigens. Failed development or inhibition of such tolerance may cause food allergy. With the increasing incidence rate of food allergy year by year, more and more studies have found the association between food allergy and various diseases. The development of food allergen-specific immune tolerance in childhood has been taken more and more seriously. In recent years, many studies have shown that the development of food allergen-specific immune tolerance is influenced by various factors, which can be roughly divided into antigens, organisms, and environment. This article reviews the influencing factors for the development of immune tolerance to food allergens in children, in order to provide help for reducing the incidence of food allergy and improving the prognosis of food allergy.
Collapse
Affiliation(s)
- Li-Guang Zhu
- Department of Gastroenterology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
| | | |
Collapse
|
18
|
Sampath V, Nadeau KC. Newly identified T cell subsets in mechanistic studies of food immunotherapy. J Clin Invest 2019; 129:1431-1440. [PMID: 30932909 DOI: 10.1172/jci124605] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Allergen-specific immunotherapy has shown promise for the treatment of food allergy and is currently being evaluated in clinical trials. Although immunotherapy can induce desensitization, the mechanisms underlying this process are not completely understood. Recent advances in high-throughput technologies along with concomitant advances in data analytics have enabled monitoring of cells at the single-cell level and increased the research focus on upstream cellular factors involved in the efficacy of immunotherapy, particularly the role of T cells. As our appreciation of different T cell subsets and their plasticity increases, the initial simplistic view that restoring Th1/Th2 balance by decreasing Th2 or increasing Th1 responses can ameliorate food allergy is being enhanced by a more complex model involving other T cell subsets, particularly Tregs. In this Review, we focus on the current understanding of T cell functions in food allergy, tolerance, and immunotherapy.
Collapse
Affiliation(s)
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research and.,Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California, USA
| |
Collapse
|
19
|
Howe LC, Leibowitz KA, Perry MA, Bitler JM, Block W, Kaptchuk TJ, Nadeau KC, Crum AJ. Changing Patient Mindsets about Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1550-1559. [PMID: 30682576 DOI: 10.1016/j.jaip.2019.01.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/09/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) can lead to desensitization to food allergens, but patients can experience treatment-related symptoms of allergic reactions that cause anxiety and treatment dropout. Interventions to improve OIT for patients are needed. OBJECTIVE To determine whether fostering the mindset that non-life-threatening symptoms during OIT can signal desensitization improves treatment experience and outcomes. METHODS In a randomized, blinded, controlled phase II study, 50 children/adolescents (28% girls, aged 7-17 years, M = 10.82, standard deviation = 3.01) completed 6-month OIT for peanut allergies. Patients and their parent(s) had monthly clinic visits at the Sean N. Parker Center for Allergy and Asthma Research between January 5, 2017, and August 3, 2017. All families received identical symptom management training. In a 1:1 approach, 24 patients and their families were informed that non-life-threatening symptoms during OIT were unfortunate side effects of treatment, and 26 patients and their families were informed that non-life-threatening symptoms could signal desensitization. Families participated in activities to reinforce these symptom mindsets. RESULTS Compared with families informed that symptoms are side effects, families informed that symptoms can signal desensitization were less anxious (B = -0.46, 95% confidence interval [CI]: -0.76 to -0.16; P = .003), less likely to contact staff about symptoms (5/24 [9.4%] vs 27/154 [17.5%] instances; P = .036), experienced fewer non-life-threatening symptoms as doses increased (BInteraction = -0.54, 95% CI: -0.83 to -0.27; P < .001), less likely to skip/reduce doses (1/26 [4%] vs 5/24 [21%] patients; P = .065), and showed a greater increase in patient peanut-specific blood IgG4 levels (BInteraction = 0.76, 95% CI: 0.36 to 1.17; P < .001). CONCLUSIONS Fostering the mindset that symptoms can signal desensitization improves OIT experience and outcomes. Changing how providers inform patients about non-life-threatening symptoms is a promising avenue for improving treatment.
Collapse
Affiliation(s)
- Lauren C Howe
- Department of Psychology, Stanford University, Stanford, Calif.
| | | | | | - Julie M Bitler
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, El Camino Hospital, Mountain View, Calif
| | - Whitney Block
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, El Camino Hospital, Mountain View, Calif
| | - Ted J Kaptchuk
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, Mass
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, El Camino Hospital, Mountain View, Calif
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, Calif
| |
Collapse
|
20
|
Nowak-Wegrzyn A, Greenhawt M. The importance of food allergy to the practicing clinician. Ann Allergy Asthma Immunol 2018; 120:227-228. [PMID: 29391200 DOI: 10.1016/j.anai.2018.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Anna Nowak-Wegrzyn
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colorado
| |
Collapse
|
21
|
Krajewski D, Kaczenski E, Rovatti J, Polukort S, Thompson C, Dollard C, Ser-Dolansky J, Schneider SS, Kinney SRM, Mathias CB. Epigenetic Regulation via Altered Histone Acetylation Results in Suppression of Mast Cell Function and Mast Cell-Mediated Food Allergic Responses. Front Immunol 2018; 9:2414. [PMID: 30405614 PMCID: PMC6206211 DOI: 10.3389/fimmu.2018.02414] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/28/2018] [Indexed: 01/08/2023] Open
Abstract
Mast cells are highly versatile cells that perform a variety of functions depending on the immune trigger, context of activation, and cytokine stimulus. Antigen-mediated mast cell responses are regulated by transcriptional processes that result in the induction of numerous genes contributing to mast cell function. Recently, we also showed that exposure to dietary agents with known epigenetic actions such as curcumin can suppress mast cell-mediated food allergy, suggesting that mast cell responses in vivo may be epigenetically regulated. To further assess the effects of epigenetic modifications on mast cell function, we examined the behavior of bone marrow-derived mast cells (BMMCs) in response to trichostatin A (TSA) treatment, a well-studied histone deacetylase inhibitor. IgE-mediated BMMC activation resulted in enhanced expression and secretion of IL-4, IL-6, TNF-α, and IL-13. In contrast, pretreatment with TSA resulted in altered cytokine secretion. This was accompanied by decreased expression of FcεRI and mast cell degranulation. Interestingly, exposure to non-IgE stimuli such as IL-33, was also affected by TSA treatment. Furthermore, continuous TSA exposure contributed to mast cell apoptosis and a decrease in survival. Further examination revealed an increase in I-κBα and a decrease in phospho-relA levels in TSA-treated BMMCs, suggesting that TSA alters transcriptional processes, resulting in enhancement of I-κBα transcription and decreased NF-κB activation. Lastly, treatment of wild-type mice with TSA in a model of ovalbumin-induced food allergy resulted in a significant attenuation in the development of food allergy symptoms including decreases in allergic diarrhea and mast cell activation. These data therefore suggest that the epigenetic regulation of mast cell activation during immune responses may occur via altered histone acetylation, and that exposure to dietary substances may induce epigenetic modifications that modulate mast cell function.
Collapse
Affiliation(s)
- Dylan Krajewski
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
| | - Edwin Kaczenski
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
| | - Jeffrey Rovatti
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
| | - Stephanie Polukort
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
| | - Chelsea Thompson
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
| | - Catherine Dollard
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States.,Northampton High School, Northampton, MA, United States
| | - Jennifer Ser-Dolansky
- Baystate Medical Center, Pioneer Valley Life Sciences Institute, Springfield, MA, United States
| | - Sallie S Schneider
- Baystate Medical Center, Pioneer Valley Life Sciences Institute, Springfield, MA, United States
| | - Shannon R M Kinney
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
| | - Clinton B Mathias
- Department of Pharmaceutical and Administrative Sciences, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, United States
| |
Collapse
|
22
|
De Jong NW. Epicutaneous immunotherapy: the next step for food allergy desensitization. Expert Rev Clin Immunol 2018; 14:977-978. [PMID: 30295101 DOI: 10.1080/1744666x.2018.1528873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Nicolette W De Jong
- a Section Allergology & Clinical Immunology , ErasmusMC, Internal Medicine , CA Rotterdam , the Netherlands
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW To familiarize the reader with the concept of precision medicine in food allergy by dealing with the current biomarkers for the diagnosis, prognosis, and management of the disease. RECENT FINDINGS Many efforts have been devoted in order to characterize reliable biomarkers able to identify specific phenotypes and endotypes in food allergy. Specific IgE (sIgE), sIgE/total IgE ratios, and T cell assays are just a few candidates that have been investigated over time. With the advent of omics sciences, a new era is commencing. A better understanding of pathogenesis of food allergy and mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient. In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the identification of proper biomarkers for a personalized treatment tailored on the specific patient's profile.
Collapse
Affiliation(s)
- Antonella Muraro
- Department of Woman and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Via Giustiniani 3, 35128, Padua, Italy.
| | - Stefania Arasi
- Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| |
Collapse
|
24
|
Tilles SA, Petroni D. FDA-approved peanut allergy treatment: The first wave is about to crest. Ann Allergy Asthma Immunol 2018; 121:145-149. [PMID: 29909055 DOI: 10.1016/j.anai.2018.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | - Daniel Petroni
- ASTHMA Inc, Clinical Research Center, Seattle, Washington
| |
Collapse
|
25
|
Mustafa SS, Russell AF, Kagan O, Kao LM, Houdek DV, Smith BM, Wang J, Gupta RS. Parent perspectives on school food allergy policy. BMC Pediatr 2018; 18:164. [PMID: 29753332 PMCID: PMC5948763 DOI: 10.1186/s12887-018-1135-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/30/2018] [Indexed: 11/24/2022] Open
Abstract
Background Food allergy affects up to 8% of children in the U.S. There is minimal research to date on food allergy policies that are currently in place in schools and the opinions of parents of children with food allergy on the effectiveness of or need for these policies. Methods An electronic survey was disseminated to parents of children with food allergy. Frequencies were calculated to describe respondent characteristics and responses. Chi-square tests were performed to examine associations between school and child characteristics and outcomes. Results Of the 289 parent respondents, 27.4% were unsure or felt school was unsafe for their child with food allergy. While the majority felt that the polices in their child’s school were helpful, most also believed that implementation of additional polices was necessary, including availability of stock epinephrine (94.2%), lunch menus with allergen information (86%), ingredient labels on food items (81%), and direct food allergy education for students (86%). There were significant differences in school food allergy policy depending on the age of the student body, private versus public school, and geographic location. Conclusions While most schools reportedly have one or more food allergy policies in place, many parents have concerns over the safety of their child at school and feel that additional policies are necessary to improve the safety of the school environment for children with food allergy. The availability of stock epinephrine, improved allergen labeling of food and menus and increased food allergy education may be key policy areas on which to focus.
Collapse
Affiliation(s)
- S Shahzad Mustafa
- Rochester Regional Health, Rochester, NY, USA.,University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Anne F Russell
- Food Allergy & Anaphylaxis Michigan Association, Ann Arbor, MI, USA
| | - Olga Kagan
- Molloy College, Rockville Centre, New York, USA
| | - Lauren M Kao
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane V Houdek
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bridget M Smith
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. Veterans Affairs Hospital, Hines, IL, USA
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruchi S Gupta
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Center for Community Health, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Dr., 6th Floor, Chicago, IL, 60611, USA.
| |
Collapse
|