Cockroach, dust mite, and shrimp sensitization correlations in the National Health and Nutrition Examination Survey

Food Allergy Genetics and Epigenetics: A Review of Genome-Wide Association Studies

In this review, we provide an overview of food allergy genetics and epigenetics aimed at clinicians and researchers. This includes a brief review of the current understanding of genetic and epigenetic mechanisms, inheritance of food allergy, as well as a discussion of advantages and limitations of the different types of studies in genetic research. We specifically focus on the results of genome-wide association studies in food allergy, which have identified 16 genetic variants that reach genome-wide significance, many of which overlap with other allergic diseases, including asthma, atopic dermatitis, and allergic rhinitis. Identified genes for food allergy are mainly involved in epithelial barrier function (e.g., FLG, SERPINB7) and immune function (e.g., HLA, IL4). Epigenome-wide significant findings at 32 loci are also summarized as well as 14 additional loci with significance at a false discovery of < 1 × 10-4. Integration of epigenetic and genetic data is discussed in the context of disease mechanisms, many of which are shared with other allergic diseases. The potential utility of genetic and epigenetic discoveries is deliberated. In the future, genetic and epigenetic markers may offer ways to predict the presence or absence of clinical IgE-mediated food allergy among sensitized individuals, likelihood of development of natural tolerance, and response to immunotherapy.

Anaphylaxis after Shrimp Intake in a European Pediatric Population: Role of Molecular Diagnostics and Implications for Novel Foods

(1) Background: Tropomyosin is a major cause of shellfish allergy and anaphylaxis triggered by food. It acts as a pan-allergen, inducing cross-reactivity in insects, dust mites, crustaceans, and mollusks. Our study investigates anaphylaxis in children with asthma or atopic diseases after consuming tropomyosin-containing food. (2) Methods: We analyzed the molecular sensitization profiles of pediatric patients at the University of Campania 'Luigi Vanvitelli' from 2017 to 2021, with conditions such as allergic rhinitis, asthma, atopic dermatitis, urticaria, and food allergies. (3) Results: Out of a total of 253 patients aged 1 to 18 years (167 males, 86 females), 21 patients (8.3%) experienced anaphylaxis after shrimp ingestion. All 21 (100%) were sensitized to various tropomyosins: Pen m 1 (100%), Der p 10 (90.5%), Ani s 3 (81%), and Bla g 7 (76.2%). Clinical symptoms included allergic asthma (76.2%), atopic dermatitis (61.9%), urticaria (38.1%), and allergic rhinitis (38.1%). (4) Conclusions: Crustaceans and mollusks are major allergens in Italy and Europe, requiring mandatory declaration on food labels. Italian pediatric patients demonstrated significant anaphylaxis after consuming shrimp, often accompanied by multiple atopic disorders such as asthma, rhinitis, and atopic dermatitis. Considering the cross-reactivity of tropomyosin among various invertebrates and the emergence of 'novel foods' containing insect flours in Europe, there is ongoing debate about introducing precautionary labeling for these products.

Socioeconomic Determinants of Food Allergy Burden-A clinical introduction

OBJECTIVE

This review characterizes what is currently known about how prevalence, severity, distribution, and management of food allergy (FA) differs across socioeconomic strata and provides guidance for practicing clinicians about how to improve equity in research participation, healthcare delivery, and patient outcomes through a deeper understanding of the socioeconomic determinants of FA.

DATA SOURCES

Epidemiological and biomedical literature published prior to April 2022.

RESULTS

Socioeconomic status (SES) is a complex concept that not only encompasses economic resources (e.g., income, wealth) but also a person's social, economic and political power and standing, each of which can impact health. However, in many studies of individuals and families with FA, assessment of SES has been limited and often a respondent's membership within a racial and ethnic group is utilized as a proxy for low SES. As a whole, findings from US-population-based studies indicate a consistent trend: those who self-identify as non-Hispanic Black, and to a lesser extent other subpopulations who identify as being of non-White race and ethnicity, experience a greater burden of food-allergic sensitization and disease including higher rates of emergency health care utilization and food-induced anaphylactic fatality as compared to those identifying as White.

CONCLUSION

Reports of FA management and outcomes highlight inequities among specific low SES populations in the US. Clinicians can and should act to reduce inequities by engaging more diverse populations in clinical research, equitably implementing FA risk screening and prevention, thoughtfully utilizing emerging technologies to ameliorate disparities based on SES in healthcare delivery and outcomes, and advocating for social change.

Health disparities in pediatric food allergy

OBJECTIVE

To review the current literature regarding the health disparities in the prevalence, diagnosis, and management of pediatric food allergy and discuss possible interventions.

DATA SOURCES

Literature search of PubMed and Google Scholar databases regarding pediatric food allergy and health disparities.

STUDY SELECTIONS

Original research articles, reviews, and guidelines on health disparities in pediatric food allergy were included in this review.

RESULTS

The overall prevalence of food allergy appears to be increasing and disproportionately affecting minority groups. Racial and socioeconomic disparities are evident across all aspects of food allergy care: diagnosis, prevention, acute management (eg, access to epinephrine autoinjectors, visits to emergency department), and long-term management (eg, oral immunotherapy). Children of minority populations and those of low socioeconomic status are at a greater risk of food insecurity, which is further exacerbated by the high cost of allergen-free foods and limited support from food assistance programs.

CONCLUSION

Racial, ethnic, and socioeconomic disparities in food allergy among children in the United States are evident and negatively affect the outcomes of children with food allergies. Active efforts to decrease racial and socioeconomic disparities, through education, research, and advocacy, will be important to help improve health outcomes in food allergy for all children, regardless of their race, ethnicity, or socioeconomic status.

African American Children Are More Likely to Be Allergic to Shellfish and Finfish: Findings from FORWARD, a Multisite Cohort Study

BACKGROUND

Despite major differences in health profiles and rates of health care utilization between African American and White children with food allergy (FA), the detailed phenotypic variables that can potentially impact these outcomes have not been thoroughly studied.

OBJECTIVE

We aimed to characterize phenotypic differences such as allergies to different foods and allergic comorbidities between African American and White children with FA enrolled in the Food Allergy Outcomes Related to White and African American Racial Differences study.

METHODS

Our active, prospective, multicenter cohort study is currently enrolling African American and White children aged 0 to 12 years diagnosed with FA and followed by allergy/immunology clinics at 4 urban tertiary centers in the United States. To evaluate associations between race and phenotypic variables, we used multivariable logistic regression, adjusting for important demographic and confounding factors, as well as potential household clustering.

RESULTS

As of May 2020, there were 239 African Americans and 425 Whites with complete intake information enrolled in the study. In comparison with Whites, we found that African Americans had significantly higher adjusted odds of allergy to finfish (odds ratio [OR]: 2.54, P < .01) and shellfish (OR: 3.10, P < .001). African Americans also had higher adjusted odds of asthma than Whites (asthma prevalence of 60.5% in African Americans and 27.2% in Whites; OR: 2.70, P < .001). In addition, shellfish allergy was associated with asthma, after controlling for race.

CONCLUSION

Among a diverse cohort of children with physician-diagnosed FA, we observed that African American children had higher odds of allergy to shellfish and finfish, and higher rates of asthma. Interestingly, having asthma was independently associated with allergy to shellfish, after controlling for race.

The External Exposome and Food Allergy

PURPOSE OF REVIEW

The recent increase in childhood food allergy prevalence strongly suggests that environmental exposures are contributing to food allergy development. This review summarizes current knowledge about the role of the external exposome in food allergy.

RECENT FINDINGS

There is growing evidence that environmental exposure to food antigens in house dust through non-oral routes contributes to food sensitization and allergy. Co-exposure to environmental adjuvants in house dust, such as microbial products and fungal allergens, may also facilitate allergic sensitization. While a high-microbe environment is associated with decreased atopy, studies are mixed on whether endotoxin exposure protects against food sensitization. Several chemicals and air pollutants have been associated with food sensitization, but their role in food allergy remains understudied. Children are exposed to numerous environmental agents that can influence food allergy risk. Further studies are needed to identify the key early-life exposures that promote or inhibit food allergy development.