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Hong X, Nadeau K, Wang G, Larman B, Smith KN, Pearson C, Ji H, Frischmeyer-Guerrerio P, Liang L, Hu FB, Wang X. Metabolomic profiles during early childhood and risk of food allergies and asthma in multiethnic children from a prospective birth cohort. J Allergy Clin Immunol 2024:S0091-6749(24)00295-1. [PMID: 38548091 DOI: 10.1016/j.jaci.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/08/2024] [Accepted: 02/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND There are increasing numbers of metabolomic studies in food allergy (FA) and asthma, which, however, are predominantly limited by cross-sectional designs, small sample size, and being conducted in European populations. OBJECTIVE We sought to identify metabolites unique to and shared by children with FA and/or asthma in a racially diverse prospective birth cohort, the Boston Birth Cohort. METHODS Mass spectrometry-based untargeted metabolomic profiling was performed using venous plasma collected in early childhood (n = 811). FA was diagnosed according to clinical symptoms consistent with an acute hypersensitivity reaction at food ingestion and food specific-IgE > 0.35 kU/L. Asthma was defined on the basis of physician diagnosis. Generalized estimating equations were applied to analyze metabolomic associations with FA and asthma, adjusting for potential confounders. RESULTS During a mean ± standard deviation follow-up of 11.8 ± 5.2 years from birth, 78 children developed FA and 171 developed asthma. Androgenic and pregnenolone steroids were significantly associated with a lower risk of FA, especially for egg allergy. N,N,N-trimethyl-5-aminovalerate (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.48-0.87), and 1-oleoyl-2-arachidonoyl-sn-glycero-3-phosphoinositol (OR = 0.77; 95% CI = 0.66-0.90) were inversely associated with FA risk. Orotidine (OR = 4.73; 95% CI = 2.2-10.2) and 4-cholesten-3-one (OR = 0.52; 95% CI = 0.35-0.77) were the top 2 metabolites associated with risk of asthma, although they had no association with FA. In comparison, children with both FA and asthma exhibited an altered metabolomic profile that aligned with that of FA, including altered levels of lipids and steroids. CONCLUSION In this US multiethnic prospective birth cohort, unique and shared alterations in plasma metabolites during early childhood were associated with risk of developing FA and/or asthma. These findings await further validation.
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Affiliation(s)
- Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Kari Nadeau
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Ben Larman
- Department of Pathology, Division of Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kellie N Smith
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, and the Bloomberg-Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Colleen Pearson
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Mass
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Pamela Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Liming Liang
- Department of Epidemiology and Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, Mass
| | - Frank B Hu
- Department of Epidemiology and Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, Mass; Department of Nutrition, T. H. Chan School of Public Health, Harvard University, Boston, Mass; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Department of Pediatrics, Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
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Rojo Gutiérrez MI, Ballesteros González D. [Oral allergy syndrome (OAS)]. REVISTA ALERGIA MÉXICO 2023; 70:306-312. [PMID: 38506877 DOI: 10.29262/ram.v70i4.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
The pollen-food allergy syndrome, also known as oral allergy syndrome, is characterized by local reactions in the mouth and throat after consuming certain raw plant foods in individuals sensitized to pollen from grass, weeds, and trees. Birch-apple is the prototype of this syndrome, with apple, pear, and plum being the most commonly associated foods. Symptoms are usually limited to the oral cavity but can include systemic reactions, including anaphylaxis. Sensitization to pollen allergens, such as lipid transfer proteins, profilin, and PR-10 proteins, triggers this syndrome. Its prevalence varies by geographic region and the predominant pollen type, affecting between 30% and 60% of food allergies. Diagnosis involves a clinical history, skin tests, and, in ambiguous cases, double-blind, placebo-controlled oral food challenges. Treatment primarily involves avoiding trigger foods.
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Affiliation(s)
- María Isabel Rojo Gutiérrez
- Pediatra, Alergóloga e Inmunóloga; profesora de Alergia pediátrica, Facultad de Medicina; Presidenta electa de la Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI) Montevideo,
| | - Diego Ballesteros González
- Médico Cirujano y Partero, Escuela Superior de Medicina, Instituto Politécnico Nacional; Aler-gólogo e inmunólogo clínico, Hospital Juárez de México, Ciudad de México
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3
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Urrutia Pereira M, Solé D. [Food allergy and environmental contamination]. REVISTA ALERGIA MÉXICO 2023; 70:313-318. [PMID: 38506878 DOI: 10.29262/ram.v70i4.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
The interaction between genetic potential and the environment, especially increased urbanization and inadequate waste management, contributes to the manifestation of allergic diseases. Pediatric patients are the most vulnerable, due to the immaturity of the respiratory and immune systems. Prenatal and postnatal exposure to air pollutants, both indoors and outdoors, accelerates or aggravates morbidity and mortality from allergic diseases. The "exposome," which encompasses all environmental exposures throughout life, influences health. Biological and chemical attacks alter the epithelial barrier, triggering inflammatory responses and favoring allergic diseases, such as food allergies. The uncontrolled use of toxic fuels, particulate matter, detergents and other factors contribute to the continuous deterioration of the intestinal epithelial barrier, increasing the risk of allergic diseases. It is important to take urgent action to address these issues and protect the health of the planet.
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Affiliation(s)
- Marilyn Urrutia Pereira
- Pediatra, profesora adjunta de la disciplina de Pediatría, Universidad Federal de Pampa, Uruguaiana, Brasil. Coordinadora del Programa de Prevención del Asma Infantil (PIPA),
| | - Dirceu Solé
- Pediatra, Alergólogo e Inmunólogo; profesor titular de la disciplina de Alergia, Inmunología Clínica y Reumatología, Departamento de Pediatría, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brasil
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Zhang Q, Zhang C, Zhang Y, Liu Y, Wang J, Gao Z, Sun J, Li Q, Sun J, Cui X, Wang Y, Fu L. Early-life risk factors for food allergy: Dietary and environmental factors revisited. Compr Rev Food Sci Food Saf 2023; 22:4355-4377. [PMID: 37679957 DOI: 10.1111/1541-4337.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 09/09/2023]
Abstract
There appears a steep increase in the prevalence of food allergy worldwide in the past few decades. It is believed that, rather than genetic factors, the recently altered dietary and environmental factors are the driving forces behind the rapid increase of this disease. Accumulating evidence has implied that external exposures that occurred in prenatal and postnatal periods could affect the development of oral tolerance in later life. Understanding the potential risk factors for food allergy would greatly benefit the progress of intervention and therapy. In this review, we present updated knowledge on the dietary and environmental risk factors in early life that have been shown to impact the development of food allergy. These predominantly include dietary habits, microbial exposures, allergen exposure routes, environmental pollutants, and so on. The key evidence, conflicts, and potential research topics of each theory are discussed, and associated interventional strategies to prevent the disease development and ameliorate treatment burden are included. Accumulating evidence has supported the causative role of certain dietary and environmental factors in the establishment of oral tolerance in early life, especially the time of introducing allergenic foods, skin barrier function, and microbial exposures. In addition to certain immunomodulatory factors, increasing interest is raised toward modern dietary patterns, where adequately powered studies are required to identify contributions of those modifiable risk factors. This review broadens our understanding of the connections between diet, environment, and early-life immunity, thus benefiting the progress of intervention and therapy of food allergy.
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Affiliation(s)
- Qiaozhi Zhang
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Chi Zhang
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Yong Zhang
- Nutrition Department of the First Medical Centre of PLA General Hospital, Beijing, China
| | - Yinghua Liu
- Nutrition Department of the First Medical Centre of PLA General Hospital, Beijing, China
| | - Jin Wang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
- Department of Bioresource Engineering, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Zhongshan Gao
- Allergy Research Center, Zhejiang University, Hangzhou, China
| | - Jinlyu Sun
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qianqian Li
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jiachen Sun
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Xin Cui
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Yanbo Wang
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Linglin Fu
- Food Safety Key Laboratory of Zhejiang Province, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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Xiao S, Sahasrabudhe N, Yang M, Hu D, Sleiman P, Hochstadt S, Cabral W, Gilliland F, Gauderman WJ, Martinez F, Hakonarson H, Kumar R, Burchard EG, Williams LK. Differences in Self-Reported Food Allergy and Food-Associated Anaphylaxis by Race and Ethnicity Among SAPPHIRE Cohort Participants. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1123-1133.e11. [PMID: 36403896 PMCID: PMC10085828 DOI: 10.1016/j.jaip.2022.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/13/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although food allergies are considered common, relatively little is known about disparities in food allergy by race in the United States. OBJECTIVE To evaluate differences in reported food allergy and food-associated anaphylaxis among individuals enrolled in a longitudinal cohort study from metropolitan Detroit, Michigan. METHODS Participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity (SAPPHIRE) were asked about food allergies, including the inciting food and associated symptoms. Individuals were considered to have food-associated anaphylaxis if symptoms coincided with established clinical criteria. Logistic regression was used to assess whether race difference persisted after adjusting for and stratifying by potential confounders. African genetic ancestry was individually estimated among African American SAPPHIRE participants to assess whether ancestry was associated with food allergy. RESULTS Within the SAPPHIRE cohort, African American participants were significantly more likely to report food allergy (26.1% vs 17%; P = 3.47 × 10-18) and have food-associated anaphylactic symptoms (12.7% vs 7%; P = 4.65 × 10-14) when compared with European American participants. Allergy to seafood accounted for the largest difference (13.1% vs 4.6%; P = 1.38 × 10-31). Differences in food allergy by race persisted after adjusting for potential confounders including asthma status. Among African American participants, the proportion of African ancestry was not associated with any outcome evaluated. CONCLUSION Compared with European Americans, African Americans appear to be at higher risk for developing food allergy and food-associated anaphylaxis, particularly with regard to seafood allergy. The lack of association with genetic ancestry suggests that socioenvironmental determinants may play a role in these disparities.
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Affiliation(s)
- Shujie Xiao
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Neha Sahasrabudhe
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Mao Yang
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Donglei Hu
- Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Patrick Sleiman
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Samantha Hochstadt
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Whitney Cabral
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich
| | - Frank Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - W James Gauderman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Fernando Martinez
- Arizona Respiratory Center and Department of Pediatrics, University of Arizona, Tucson, Ariz
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Rajesh Kumar
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Esteban G Burchard
- Department of Medicine, University of California San Francisco, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, Calif
| | - L Keoki Williams
- Department of Internal Medicine, Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Health System, Detroit, Mich.
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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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7
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Järvinen KM, Davis EC, Bevec E, Jackson CM, Pizzarello C, Catlin E, Klein M, Sunkara A, Diaz N, Miller J, Martina CA, Thakar J, Seppo AE, Looney RJ. Biomarkers of Development of Immunity and Allergic Diseases in Farming and Non-farming Lifestyle Infants: Design, Methods and 1 Year Outcomes in the "Zooming in to Old Order Mennonites" Birth Cohort Study. Front Pediatr 2022; 10:916184. [PMID: 35874571 PMCID: PMC9299374 DOI: 10.3389/fped.2022.916184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Traditional farming lifestyle has been shown to be protective against asthma and allergic diseases. The individual factors that appear to be associated with this "farm-life effect" include consumption of unpasteurized farm milk and exposure to farm animals and stables. However, the biomarkers of the protective immunity and those associated with early development of allergic diseases in infancy remain unclear. The "Zooming in to Old Order Mennonites (ZOOM)" study was designed to assess the differences in the lifestyle and the development of the microbiome, systemic and mucosal immunity between infants born to traditional farming lifestyle at low risk for allergic diseases and those born to urban/suburban atopic families with a high risk for allergic diseases in order to identify biomarkers of development of allergic diseases in infancy. 190 mothers and their infants born to Old Order Mennonite population protected from or in Rochester families at high risk for allergic diseases were recruited before birth from the Finger Lakes Region of New York State. Questionnaires and samples are collected from mothers during pregnancy and after delivery and from infants at birth and at 1-2 weeks, 6 weeks, 6, 12, 18, and 24 months, with 3-, 4-, and 5-year follow-up ongoing. Samples collected include maternal blood, stool, saliva, nasal and skin swabs and urine during pregnancy; breast milk postnatally; infant blood, stool, saliva, nasal and skin swabs. Signs and symptoms of allergic diseases are assessed at every visit and serum specific IgE is measured at 1 and 2 years of age. Allergic diseases are diagnosed by clinical history, exam, and sensitization by skin prick test and/or serum specific IgE. By the end of the first year of life, the prevalence of food allergy and atopic dermatitis were higher in ROC infants compared to the rates observed in OOM infants as was the number of infants sensitized to foods. These studies of immune system development in a population protected from and in those at risk for allergic diseases will provide critical new knowledge about the development of the mucosal and systemic immunity and lay the groundwork for future studies of prevention of allergic diseases.
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Affiliation(s)
- Kirsi M. Järvinen
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
- Department of Microbiology & Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Erin C. Davis
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - Erin Bevec
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Courtney M. Jackson
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - Catherine Pizzarello
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
- Department of Microbiology & Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Elizabeth Catlin
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - Miranda Klein
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - Akhila Sunkara
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - Nichole Diaz
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - James Miller
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - Camille A. Martina
- Department of Public Health and Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Juilee Thakar
- Department of Microbiology & Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Antti E. Seppo
- Division of Allergy and Immunology, Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children’s Hospital, Rochester, NY, United States
| | - R. John Looney
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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Elghoudi A, Narchi H. Food allergy in children—the current status and the way forward. World J Clin Pediatr 2022; 11:253-269. [PMID: 35663006 PMCID: PMC9134150 DOI: 10.5409/wjcp.v11.i3.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/16/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Food allergy in children is a major health concern, and its prevalence is rising. It is often over-diagnosed by parents, resulting occasionally in unnecessary exclusion of some important food. It also causes stress, anxiety, and even depression in parents and affects the family’s quality of life. Current diagnostic tests are useful when interpreted in the context of the clinical history, although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations. Although the oral food challenge is the current gold standard for making the diagnosis, it is only available to a small number of patients because of its requirement in time and medical personnel. New diagnostic methods have recently emerged, such as the Component Resolved Diagnostics and the Basophil Activation Test, but their use is still limited, and the latter lacks standardisation. Currently, there is no definite treatment available to induce life-long natural tolerance and cure for food allergy. Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food, usually taken by accident. New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy. If standardised and widely implemented, this may result in decreasing the prevalence of food allergy.
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Affiliation(s)
- Ahmed Elghoudi
- Paediatric Department, Sheikh Khalifa Medical City, Abu Dhabi NA, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, Abu Dhabi, United Arab Emirates
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9
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Egg Allergy in Children and Weaning Diet. Nutrients 2022; 14:nu14081540. [PMID: 35458102 PMCID: PMC9025129 DOI: 10.3390/nu14081540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
Eggs are a fundamental food in the human diet, and together with cow’s milk, they are the most common food allergen. This work highlights the main nutritional characteristics of eggs to show how their absence from a child’s diet can constitute a serious deficiency. We then analyze the risk factors that facilitate the onset of egg allergy. The third part of the paper reports possible interventions to lower the appearance of food allergy that have been occurred in trials. The last part of the paper is a synthesis of this research study that has been taken from several of the latest guidelines or from position papers.
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10
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de Jong NW, van Splunter ME, Emons JAM, Hettinga KA, Gerth van Wijk R, Wichers HJ, Savelkoul HFJ, Sprikkelman AB, van Neerven RJJ, Liu L, van der Meulen G, Herpertz I, Duijvestijn YCM, Breukels M, Brouwer MI, Schilperoord J, van Doorn O, Vlieg-Boerstra B, van den Berg J, Pellis L, Terlouw S, Hendriks AI, Schreurs MWJ, van Boven FE, Arends NJT. Introduction of Heated Cow's Milk Protein in Challenge-Proven Cow's Milk Allergic Children: The iAGE Study. Nutrients 2022; 14:nu14030629. [PMID: 35276990 PMCID: PMC8838309 DOI: 10.3390/nu14030629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023] Open
Abstract
The introduction of baked milk products in cow’s milk (CM) allergic children has previously been shown to accelerate induction tolerance in a selected group of children. However, there is no standardized baked milk product on the market. Recently, a new standardized, heated and glycated cow’s milk protein (HP) product was developed. The aim of this study was to measure safety and tolerability of a new, well characterized heated CM protein (HP) product in cow’s milk allergic (CMA) children between the age of 3 and 36 months. The children were recruited from seven clinics throughout The Netherlands. The HP product was introduced in six incremental doses under clinical supervision. Symptoms were registered after introduction of the HP product. Several questionnaires were filled out by parents of the children. Skin prick tests were performed with CM and HP product, sIgE to CM and α-lactalbumin (Bos d4), β-lactoglobulin (Bos d5), serum albumin (Bos d 6), lactoferrin (Bos d7) and casein (Bos d8). Whereas 72% percent (18 out of 25) of the children tolerated the HP product, seven children experienced adverse events. Risk factors for intolerance to the HP product were higher skin prick test (SPT) histamine equivalent index (HEP) results with CM and the HP product, higher specific IgE levels against Bos d4 and Bos d8 levels and Bos d5 levels. In conclusion, the HP product was tolerated by 72% of the CM allergic children. Outcomes of SPT with CM and the HP product, as well as values of sIgE against caseins, α-lactalbumin, and β-lactoglobulin may predict the tolerability of the HP product. Larger studies are needed to confirm these conclusions.
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Affiliation(s)
- Nicolette W. de Jong
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (M.E.v.S.); (R.G.v.W.); (S.T.); (F.E.v.B.)
- Depertment of Peadiatric Allergology, Sophia Children Hospital, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (J.A.M.E.); (A.I.H.); (N.J.T.A.)
- Correspondence: ; Tel.: +31-6-21697954
| | - Marloes E. van Splunter
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (M.E.v.S.); (R.G.v.W.); (S.T.); (F.E.v.B.)
| | - Joyce A. M. Emons
- Depertment of Peadiatric Allergology, Sophia Children Hospital, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (J.A.M.E.); (A.I.H.); (N.J.T.A.)
| | - Kasper A. Hettinga
- Food Quality & Design Group, Wageningen University & Research Centre, 6708PB Wageningen, The Netherlands; (K.A.H.); (H.J.W.)
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (M.E.v.S.); (R.G.v.W.); (S.T.); (F.E.v.B.)
| | - Harry J. Wichers
- Food Quality & Design Group, Wageningen University & Research Centre, 6708PB Wageningen, The Netherlands; (K.A.H.); (H.J.W.)
| | - Huub F. J. Savelkoul
- Cell Biology & Immunology Group, Wageningen University & Research Centre, 6708PB Wageningen, The Netherlands; (H.F.J.S.); (R.J.J.v.N.)
| | - Aline B. Sprikkelman
- Department of Peadiatric Pulmonology & Allergology, UMCG, University Medical Center Groningen, 9713GZ Groningen, The Netherlands;
- University Medical Center Groningen, GRIAC Research Institute, University of Groningen, 9713GZ Groningen, The Netherlands
| | - R. J. Joost van Neerven
- Cell Biology & Immunology Group, Wageningen University & Research Centre, 6708PB Wageningen, The Netherlands; (H.F.J.S.); (R.J.J.v.N.)
- FrieslandCampina, 3811LP Amersfoort, The Netherlands
| | - Liu Liu
- Department of Rheumatoloy, Leiden University, 2311BD Leiden, The Netherlands;
| | | | - Irene Herpertz
- Paediatric Allegology Center, VieCuri Medisch Centrum, 5912BL Venlo, The Netherlands;
| | | | - Mijke Breukels
- Deparment of Peadiatrics, Elkerliek, 5707HA Helmond, The Netherlands;
| | - Marianne I. Brouwer
- Department of Peadiatrics, Canisius Wilhelmina Ziekenhuis, 6532SZ Nijmegen, The Netherlands;
| | - Jaap Schilperoord
- Department of Peadiatrics, OLVG Hospital, 1091AC Amsterdam, The Netherlands; (J.S.); (O.v.D.); (B.V.-B.)
| | - Olga van Doorn
- Department of Peadiatrics, OLVG Hospital, 1091AC Amsterdam, The Netherlands; (J.S.); (O.v.D.); (B.V.-B.)
| | - Berber Vlieg-Boerstra
- Department of Peadiatrics, OLVG Hospital, 1091AC Amsterdam, The Netherlands; (J.S.); (O.v.D.); (B.V.-B.)
| | | | | | - Severina Terlouw
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (M.E.v.S.); (R.G.v.W.); (S.T.); (F.E.v.B.)
| | - Astrid I. Hendriks
- Depertment of Peadiatric Allergology, Sophia Children Hospital, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (J.A.M.E.); (A.I.H.); (N.J.T.A.)
| | - Marco W. J. Schreurs
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands;
| | - Frank E. van Boven
- Department of Internal Medicine, Section of Allergology & Clinical Immunology, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (M.E.v.S.); (R.G.v.W.); (S.T.); (F.E.v.B.)
| | - Nicolette J. T. Arends
- Depertment of Peadiatric Allergology, Sophia Children Hospital, Erasmus MC, University Medical Centre Rotterdam, 3015GD Rotterdam, The Netherlands; (J.A.M.E.); (A.I.H.); (N.J.T.A.)
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11
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Kwong KYC, Chen E, Tran P, Leibel S, Masood M, Boyle S, Scott L. Patterns of allergenic food introduction in Los Angeles inner-city children. Asia Pac Allergy 2022; 12:e24. [PMID: 35966161 PMCID: PMC9353202 DOI: 10.5415/apallergy.2022.12.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Early introduction of allergenic foods is recommended to reduce the risk of developing food allergies, but it is unclear whether recommendations are being followed. Objective We examine patterns of allergenic food introduction in inner-city children enrolled in an academic pediatric practice in the greater Los Angeles area Methods This was a prospective study with patients ages 12 to 24 months recruited from the pediatrics continuity clinic at an inner-city tertiary medical center in the greater Los Angeles area. Caregivers were asked via anonymous surveys about their child’s history of atopic diseases and at what age they first introduced egg, soy, wheat, peanut, tree nuts, fish, shrimp, and shellfish into their child’s diet. Results Two hundred caregivers responded to the survey. The average age of introduction of egg was 9.2 months, soy 10 months, wheat 9.3 months, peanut 10.5 months, tree nuts 10.9 months, fish 10.9 months, shrimp 11.3 months, and shellfish 11.5 months. Between ages 4–11 months, 65.3% of children were introduced egg, 19.1% soy, 55.8% wheat, 28.6% peanut, 17.1% tree nuts, 28.1% fish, 13.6% shrimp, and 7.0% shellfish. By age 24 months, 92% of children were introduced egg, 37.7% soy, 85.4% wheat, 67.3% peanut, 47.7% tree nuts, 67.8% fish, 48.2% shrimp, and 30.2% shellfish. Of the 14 children with eczema or egg allergy, 26.1% were introduced peanut by age 4-6 months and 50% by age 4–11 months. Conclusion Despite recommendations, inner-city caregivers may not be introducing allergenic foods in a timely manner to their children.
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Affiliation(s)
- Kenny Yat-Choi Kwong
- Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Erica Chen
- Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Paulina Tran
- Division of Allergy-Immunology, Childrens Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sydney Leibel
- Division of Allergy-immunology, Rady Childrens Hospital, San Diego, CA, USA
| | - Maryam Masood
- Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Spencer Boyle
- Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
| | - Lyne Scott
- Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
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12
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Almodallal Y, Weaver AL, Joshi AY. Population-based incidence of food allergies in Olmsted County over 17 years. Allergy Asthma Proc 2022; 43:44-49. [PMID: 34983710 DOI: 10.2500/aap.2022.43.210088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: There is growing concern about the rising incidence and prevalence of food allergy globally. We previously reported the incidence of food allergy in Olmsted County, Minnesota, between 2002 and 2011. We sought to update the incidence and temporal trends of food allergies in our region through 2018. Methods: By using the Rochester Epidemiology Project, all Olmsted County residents, with an incident diagnosis of food allergy between January 2, 2012, and December 31, 2018, were identified and their medical records were reviewed. These cases were combined with the previously collected incidence cases from January 2, 2002, and December 31, 2011, to understand longitudinal trends in food allergy incidence rates. Results: Over the 17-year study period, 1076 patients (58.0% male patients, 72.1% white) were diagnosed with an incident food allergy. The median (interquartile range) age at first diagnosis was 2.0 years (1.1-8.4 years). The overall annual incidence rate for all ages was 3.9 (95% confidence interval [CI], 3.6-4.1) per 10,000 person-years and was significantly higher in male than in female patients (4.4 [95% CI, 4.0-4.7] and 3.3 [95% CI, 3.0-3.6], respectively; p < 0.001). The most common food allergen was egg in infancy (57.7%), peanuts in ages 1-4 years (58.3%), tree nuts in ages 5-18 years (57.4%), and seafood in adults (≥19 years) (45.3%). Conclusion: The incidence of food allergy in Olmsted County steadily increased from 2002 to 2008, then remained relatively stable between the years 2008 and 2013, and again presented a rising trend over the next 5 years until 2018. This warrants further investigations into the effects of changes in guidelines for early introductions of allergenic foods and other factors that affect causality.
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Affiliation(s)
| | - Amy L. Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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13
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Pagano F, Conti MG, Boscarino G, Pannucci C, Dito L, Regoli D, Di Chiara M, Battaglia G, Prota R, Cinicola B, Zicari AM, Aloi M, Oliva S, Terrin G. Atopic Manifestations in Children Born Preterm: A Long-Term Observational Study. CHILDREN-BASEL 2021; 8:children8100843. [PMID: 34682108 PMCID: PMC8534898 DOI: 10.3390/children8100843] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 01/01/2023]
Abstract
(1) Background: Preterm birth exposes the infant to the known risk factors for atopic diseases. We aimed to study the neonatal risk factors and to describe the clinical manifestations of atopy, including the march of symptoms, in a cohort of preschool children born preterm. (2) Methods: We enrolled neonates with gestational age < 32 weeks or birth weight < 1500 g. We classified patients in cases and controls according to the presence of at least one atopic manifestation. (3) Results: We observed 72 cases and 93 controls. Multivariate models showed that the administration of more than one cycle of antibiotics (B 0.902, p = 0.026) and gestational diabetes (B 1.207, p = 0.035) influence the risk of atopy in babies born preterm. In addition, risk of atopic dermatitis was influenced by gestational age < 29 weeks (B -1.710, p = 0.025) and gestational diabetes (B 1.275, p = 0.027). The risk of wheeze was associated with familiarity for asthma (B 1.392, p = 0.022) and the administration of more than one cycle of antibiotics (B 0.969, p = 0.025). We observed a significant reduction in the rate of atopic manifestation after 2 years of life (33.9% vs. 23.8%, p < 0.05). (4) Conclusions: Modifiable (gestational diabetes, antibiotics use) and unmodifiable (familiarity for asthma) conditions influence the risk of atopy in babies born preterm. Extreme prematurity reduces the risk of atopic dermatitis. Preterm babies showed a peculiar atopic march.
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Affiliation(s)
- Federica Pagano
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Chiara Pannucci
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Lucia Dito
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Daniela Regoli
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Maria Di Chiara
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Giuseppe Battaglia
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Rita Prota
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Bianca Cinicola
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Anna Maria Zicari
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Marina Aloi
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Salvatore Oliva
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy; (F.P.); (M.G.C.); (G.B.); (C.P.); (L.D.); (D.R.); (M.D.C.); (G.B.); (R.P.); (B.C.); (A.M.Z.); (M.A.); (S.O.)
- Correspondence: ; Tel.: +39-064-997-2536
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14
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Primary Prevention of Food Allergy-Environmental Protection beyond Diet. Nutrients 2021; 13:nu13062025. [PMID: 34204606 PMCID: PMC8231128 DOI: 10.3390/nu13062025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023] Open
Abstract
A food allergy is a potentially life-threatening disease with a genetic and environmental background. As its prevalence has increased significantly in recent years, the need for its effective prevention has been emphasized. The role of diet modifications and nutrients in food allergy reduction has been extensively studied. Much less is known about the role of other environmental factors, which can influence the incidence of this disease. Changes in neonates gut microbiome by delivery mode, animal contact, inhalant allergens, oral and then cutaneous allergen exposure, air pollution, smoking, infections and vaccinations can be the potential modifiers of food allergy development. There is some data about their role as the risk or preventive factors, but yet the results are not entirely consistent. In this paper we present the current knowledge about their possible role in primary prevention of food allergies. We discuss the mechanisms of action, difficulties in designing accurate studies about food allergy and the potential biases in interpreting the connection between environmental factors and food allergy prevention. A better understanding of the role of environmental factors in food allergies development may help in implementing practical solutions for food allergy primary prevention in the future.
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15
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Kulis MD, Smeekens JM, Immormino RM, Moran TP. The airway as a route of sensitization to peanut: An update to the dual allergen exposure hypothesis. J Allergy Clin Immunol 2021; 148:689-693. [PMID: 34111450 DOI: 10.1016/j.jaci.2021.05.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 01/17/2023]
Abstract
Food allergies have increased at an alarming rate over the past 2 decades, indicating that environmental factors are driving disease progression. It has been postulated that sensitization to foods, in particular, peanut, occurs through impaired skin. Peanut allergens have been quantified in household dust and may be the culprit source. Indeed, TH2 cell-skewing innate cytokines can be driven by application of food antigens on both intact and impaired skin of mice, resulting in antigen-specific IgE production and anaphylaxis following allergen exposure. However, allergy induction through the skin can be prevented by induction of oral tolerance before skin exposure. These observations led to the dual allergen exposure hypothesis, according to which oral exposure to food antigens leads to tolerance and antigen exposure on impaired skin leads to allergy. Here, we propose the airway as an alternative route of sensitization in the dual allergen exposure hypothesis that leads to food allergy. Specifically, we will provide evidence from mouse models and human cell-based studies that together implicate the airway as a plausible route of sensitization.
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Affiliation(s)
- Michael D Kulis
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC.
| | - Johanna M Smeekens
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Robert M Immormino
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Timothy P Moran
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC
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16
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An Overview of the Relevance of IgG4 Antibodies in Allergic Disease with a Focus on Food Allergens. CHILDREN-BASEL 2021; 8:children8050418. [PMID: 34065166 PMCID: PMC8160978 DOI: 10.3390/children8050418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 12/25/2022]
Abstract
Antibodies of the IgG4 isotype are strongly associated with allergic disease but have several properties such as not precipitating with allergens, not activating complement and poor binding to Fcγ receptors that argue against a pro-inflammatory role. In keeping with that, IgG4 antibodies are a striking feature of the response to immunotherapy. In two naturally occurring situations IgG4 antibodies are common with low or absent IgE antibodies. The first example is children raised in a house with a cat and the second is eosinophilic esophagitis (EoE). In many population-based cohorts, the ownership of a cat in early childhood is associated with a decreased prevalence of a cat allergy at age 10. The second example (i.e., EoE) is a novel form of food allergy that is not mediated by IgE and is related to consuming cow’s milk or wheat. In EoE, patients have IgG4 to milk proteins in high > 10 µg/mL or very high > 100 µg/mL titers. Enigmatically these patients are found to have deposits of IgG4 in the wall of their inflamed esophagus. The factors that have given rise to EoE remain unclear; however, changes in food processing over the past 50 years, particularly ultra-heat treatment and the high pressure homogenization of milk, represent a logical hypothesis.
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17
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Wang F, Trier AM, Li F, Kim S, Chen Z, Chai JN, Mack MR, Morrison SA, Hamilton JD, Baek J, Yang TLB, Ver Heul AM, Xu AZ, Xie Z, Dong X, Kubo M, Hu H, Hsieh CS, Dong X, Liu Q, Margolis DJ, Ardeleanu M, Miller MJ, Kim BS. A basophil-neuronal axis promotes itch. Cell 2021; 184:422-440.e17. [PMID: 33450207 PMCID: PMC7878015 DOI: 10.1016/j.cell.2020.12.033] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/09/2020] [Accepted: 12/21/2020] [Indexed: 01/09/2023]
Abstract
Itch is an evolutionarily conserved sensation that facilitates expulsion of pathogens and noxious stimuli from the skin. However, in organ failure, cancer, and chronic inflammatory disorders such as atopic dermatitis (AD), itch becomes chronic, intractable, and debilitating. In addition to chronic itch, patients often experience intense acute itch exacerbations. Recent discoveries have unearthed the neuroimmune circuitry of itch, leading to the development of anti-itch treatments. However, mechanisms underlying acute itch exacerbations remain overlooked. Herein, we identify that a large proportion of patients with AD harbor allergen-specific immunoglobulin E (IgE) and exhibit a propensity for acute itch flares. In mice, while allergen-provoked acute itch is mediated by the mast cell-histamine axis in steady state, AD-associated inflammation renders this pathway dispensable. Instead, a previously unrecognized basophil-leukotriene (LT) axis emerges as critical for acute itch flares. By probing fundamental itch mechanisms, our study highlights a basophil-neuronal circuit that may underlie a variety of neuroimmune processes.
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Affiliation(s)
- Fang Wang
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Anna M Trier
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Fengxian Li
- Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Seonyoung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zhen Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Jiani N Chai
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Madison R Mack
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Stephanie A Morrison
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Jinok Baek
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Dermatology, College of Medicine, Gachon University, Incheon 21565, Korea
| | - Ting-Lin B Yang
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aaron M Ver Heul
- Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Allergy and Immunology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Amy Z Xu
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zili Xie
- Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Xintong Dong
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Masato Kubo
- Laboratory for Cytokine Regulation, Center for Integrative Medical Science, RIKEN Yokohama Institute, Yokohama 230-0045, Kanagawa Prefecture, Japan; Division of Molecular Pathology, Research Institute for Biomedical Science, Tokyo University of Science, Noda 278-0022, Chiba Prefecture, Japan
| | - Hongzhen Hu
- Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chyi-Song Hsieh
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Rheumatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Qin Liu
- Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | - Mark J Miller
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Brian S Kim
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for the Study of Itch and Sensory Disorders, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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18
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Adachi T, Kainuma K, Asano K, Amagai M, Arai H, Ishii KJ, Ito K, Uchio E, Ebisawa M, Okano M, Kabashima K, Kondo K, Konno S, Saeki H, Sonobe M, Nagao M, Hizawa N, Fukushima A, Fujieda S, Matsumoto K, Morita H, Yamamoto K, Yoshimoto A, Tamari M. Strategic Outlook toward 2030: Japan's research for allergy and immunology - Secondary publication. Allergol Int 2020; 69:561-570. [PMID: 32600925 DOI: 10.1016/j.alit.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/09/2020] [Indexed: 12/17/2022] Open
Abstract
Strategic Outlook toward 2030: Japan's Research for Allergy and Immunology (Strategy 2030) is the national research strategy based on Japan's Basic Law on Measures Against Allergic Diseases, a first of its kind worldwide. This strategy was established by a multi-disciplinary committee consisting of administrators of the Ministry of Health, Labour and Welfare of Japan, young and senior experts from various research societies and associations, and representatives of patient and public groups. Whereas the issues of transition, integration, and international collaboration have yet to be solved in this research realm in Japan, identification of unmet needs, digitization of information and transparent procedures, and strategic planning for complex problems (a process dubbed MIERUKA by the Toyota Way) are crucial to share and tackle the same vision and goals. The committee developed three specific actions focusing on preemptive treatment, interdisciplinarity and internationality, and life stage. The real success of Strategy 2030 is made by the spontaneous contributions of doctors, dentists, veterinarians, and other medical professionals; basic and clinical research scientists, research supporters, and pharmaceutical/medical device companies; manufacturers of food, healthcare, and home appliances; and patients, their families, and the public. The hope is to establish a stable society in which people can live long, healthy lives, as free as possible from allergic and immunological diseases, at each individual life stage. This article is based on a Japanese review first reported in Arerugi, introduces the developmental process and details of Strategy 2030.
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Affiliation(s)
- Takeya Adachi
- Japan Agency for Medical Research and Development (AMED), Tokyo, Japan; International Human Frontier Science Program Organization (HFSPO), Strasbourg, France; CNRS UPR 3572, Institut de Biologie Moléculaire et Cellulaire (IBMC), Université de Strasbourg, Strasbourg, France.
| | - Keigo Kainuma
- Institute for Clinical Research, National Hospital Organization, Mie National Hospital, Mie, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University, School of Medicine, Kanagawa, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Arai
- Pharmaceuticals and Medical Devices Agency (PMDA), Tokyo, Japan
| | - Ken J Ishii
- Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Mitsuhiro Okano
- Department of Otorhinolaryngology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Hidehisa Saeki
- Department of Cutaneous and Mucosal Pathophysiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Mariko Sonobe
- Japanese Mother's Society for Allergy Care (JMSAC), Kanagawa, Japan
| | - Mizuho Nagao
- Institute for Clinical Research, National Hospital Organization, Mie National Hospital, Mie, Japan
| | - Nobuyuki Hizawa
- Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Shigeharu Fujieda
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Fukui, Fukui, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Kazuhiko Yamamoto
- Center for Integrative Medical Sciences, The Institute of Physical and Chemical Research (RIKEN), Kanagawa, Japan
| | | | - Mayumi Tamari
- Division of Molecular Genetics, The Jikei University School of Medicine, Research Center for Medical Science, Tokyo, Japan.
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19
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Smeekens JM, Immormino RM, Kulis MD, Moran TP. Timing of exposure to environmental adjuvants is critical to mitigate peanut allergy. J Allergy Clin Immunol 2020; 147:387-390.e4. [PMID: 32980426 DOI: 10.1016/j.jaci.2020.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/27/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC.
| | - Robert M Immormino
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, Chapel Hill, NC
| | - Timothy P Moran
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
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20
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Abstract
Food allergy is 1 of the 4 manifestations of the "atopic march," along with eczema, allergic rhinitis, and asthma. Depending on the pathophysiologic immune mechanisms behind a food allergy, it can be classified as immunoglobulin E-mediated, non-immunoglobulin E-mediated, or mixed. The prevalence of food allergies has risen worldwide during the past few decades, becoming a significant global health concern. Patients experiencing food allergies and their caregivers are heavily burdened personally, socially, emotionally, and financially. The health-care system is also considerably affected. Pediatricians, as primary health-care providers, are often challenged with these patients, becoming the first-line for the recognition and management of food allergies. The purpose of this review is to provide a comprehensive summary of food allergies, including the most up-to-date information, recent guidelines, and recommendations.
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Affiliation(s)
- Wilfredo Cosme-Blanco
- Department of Allergy and Immunology, Veterans Affairs Caribbean Healthcare System, San Juan, Puerto Rico
| | - Erving Arroyo-Flores
- Department of Allergy and Immunology, COSSMA, Las Piedras, Puerto Rico.,Department of Allergy and Immunology, HIMA-San Pablo Bayamon Hospital, Bayamon, Puerto Rico
| | - Hanadys Ale
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL.,Department of Pediatrics, Florida International University Herbert Wertheim College of Medicine, Miami, FL.,Department of Pediatrics, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
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21
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Abstract
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.
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Affiliation(s)
- Timothy P Moran
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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22
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Hicke-Roberts A, Wennergren G, Hesselmar B. Late introduction of solids into infants' diets may increase the risk of food allergy development. BMC Pediatr 2020; 20:273. [PMID: 32493408 PMCID: PMC7268275 DOI: 10.1186/s12887-020-02158-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background This study investigated risk factors associated with food allergy or food intolerance among school children in two Swedish towns. Methods Questionnaires were used to collect data on self-reported food allergy or intolerance (SRFA) in children aged 7–8 years from Mölndal in southwestern Sweden and Kiruna in northern Sweden. It included questions about specific food allergy or intolerance to cows’ milk, hens’ eggs, fish, peanuts, tree nuts, and cereals and also age of onset, type of symptoms and age of cessation. Information was also gathered on family allergy history, dietary habits, and certain lifestyle aspects. Results Of 1838 questionnaires distributed, 1029 were returned: 717/1354 (53%) from Mölndal and 312/484 (64%) from Kiruna. The cumulative incidence of SRFA was 19.6% with a significantly higher cumulative incidence in Kiruna (28.5%) than in Mölndal (15.7%), P < .001. Solids were introduced at a later age in Kiruna. Introduction of solids into a child’s diet from the age of 7 months or later, and maternal history of allergic disease, were both risk factors associated with a higher risk of food allergy or intolerance. Conclusion Late introduction of solids into an infant’s diet may be one risk factor for developing food allergy or intolerance. Later introduction of solids in Kiruna may be one explanation for the higher cumulative incidence of SRFA in that region.
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Affiliation(s)
- Anna Hicke-Roberts
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Göran Wennergren
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bill Hesselmar
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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23
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Lyons SA, Knulst AC, Burney PGJ, Fernández-Rivas M, Ballmer-Weber BK, Barreales L, Bieli C, Clausen M, Dubakiene R, Fernández-Perez C, Jedrzejczak-Czechowicz M, Kowalski ML, Kummeling I, Mustakov TB, van Os-Medendorp H, Papadopoulos NG, Popov TA, Potts J, Xepapadaki P, Welsing PMJ, Mills ENC, van Ree R, Le TM. Predictors of Food Sensitization in Children and Adults Across Europe. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3074-3083.e32. [PMID: 32348914 DOI: 10.1016/j.jaip.2020.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The geographical variation and temporal increase in the prevalence of food sensitization (FS) suggest environmental influences. OBJECTIVE To investigate how environment, infant diet, and demographic characteristics, are associated with FS in children and adults, focusing on early-life exposures. METHODS Data on childhood and adult environmental exposures (including, among others, sibship size, day care, pets, farm environment, and smoking), infant diet (including breast-feeding and timing of introduction to infant formula and solids), and demographic characteristics were collected from 2196 school-age children and 2185 adults completing an extensive questionnaire and blood sampling in the cross-sectional pan-European EuroPrevall project. Multivariable logistic regression was applied to determine associations between the predictor variables and sensitization to foods commonly implicated in food allergy (specific IgE ≥0.35 kUA/L). Secondary outcomes were inhalant sensitization and primary (non-cross-reactive) FS. RESULTS Dog ownership in early childhood was inversely associated with childhood FS (odds ratio, 0.65; 95% CI, 0.48-0.90), as was higher gestational age at delivery (odds ratio, 0.93 [95% CI, 0.87-0.99] per week increase in age). Lower age and male sex were associated with a higher prevalence of adult FS (odds ratio, 0.97 [95% CI, 0.96-0.98] per year increase in age, and 1.39 [95% CI, 1.12-1.71] for male sex). No statistically significant associations were found between other evaluated environmental determinants and childhood or adult FS, nor between infant diet and childhood FS, although early introduction of solids did show a trend toward prevention of FS. CONCLUSIONS Dog ownership seems to protect against childhood FS, but independent effects of other currently conceived environmental and infant dietary determinants on FS in childhood or adulthood could not be confirmed.
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Affiliation(s)
- Sarah A Lyons
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - André C Knulst
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter G J Burney
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Barbara K Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland; Faculty of Medicine, University of Zürich, Zürich, Switzerland; Clinic for Dermatology and Allergology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Laura Barreales
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, UCM, IdISSC, Madrid, Spain
| | - Christian Bieli
- Department of Paediatric Pulmonology, University Children's Hospital, Zürich, Switzerland
| | - Michael Clausen
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Cristina Fernández-Perez
- Clinical Epidemiology Unit, Preventive Medicine Department, Hospital Clinico San Carlos, UCM, IdISSC, Madrid, Spain
| | | | - Marek L Kowalski
- Department of Immunology, Rheumatology, and Allergy, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Ischa Kummeling
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tihomir B Mustakov
- Clinical Centre of Allergology of the Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Harmieke van Os-Medendorp
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Saxion University of Applied Sciences, Deventer, The Netherlands
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Division of Infection, Immunity and Respiratory Medicine, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Paco M J Welsing
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E N Clare Mills
- Division of Infection, Immunity and Respiratory Medicine, Manchester Institute of Biotechnology & Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - Ronald van Ree
- Department of Experimental Immunology and Department of Otorhinolaryngology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
| | - Thuy-My Le
- Department of Dermatology & Allergology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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24
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Tsuang A, Grishin A, Grishina G, Do AN, Sordillo J, Chew GL, Bunyavanich S. Endotoxin, food allergen sensitization, and food allergy: A complementary epidemiologic and experimental study. Allergy 2020; 75:625-635. [PMID: 31535385 DOI: 10.1111/all.14054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Household endotoxin levels have been variably associated with risk for asthma and atopy. METHODS We studied participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES, n = 6963), a large cohort representative of the US population (aged 1-84 years). We built logistic regression models to test for associations between house dust endotoxin and sensitization to specific foods (milk, egg, and peanut). To experimentally explore the detected epidemiologic associations, peripheral blood mononuclear cells (PBMCs) were collected from 21 children (aged 1-19 years) mono-food allergic (ie, sensitized and clinically reactive) to milk, egg, or peanut and nonallergic controls for stimulation with endotoxin and secreted cytokine measurement. For each food allergy, linear mixed-effects models were built to test the association between endotoxin stimulation and cytokine level. RESULTS Among NHANES subjects, the geometric mean household endotoxin level was 15.5 EU/mg (GSE 0.5). Prevalence of food allergen sensitization (sIgE ≥ 0.35 kUA /L) varied by food: milk 5.7%, egg 4.0%, and peanut 7.9%. In models adjusted for potential confounders (age, race, country of birth, total people per household, US region, and history of wheezing in the past year), household endotoxin level was associated with sensitization to milk (OR 1.7, 95% CI 1.2-2.1) and egg (OR 1.4, 95% CI 1.01-1.9), but not peanut (OR 0.98, 95% CI 0.8-1.2). Interferon-γ levels of endotoxin-stimulated PBMCs from children allergic to milk or egg, but not peanut, were significantly lower compared to controls in linear mixed-effects models adjusted for repeated measures, experimental variables, age, and inter-individual variability (P-values .007, .018, and .058, respectively). CONCLUSION Higher household endotoxin is associated with increased odds of milk and egg sensitization. Altered cytokine responsiveness to endotoxin is also observed in PBMCs from individuals with milk and egg allergy.
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Affiliation(s)
- Angela Tsuang
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Alexander Grishin
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Galina Grishina
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Anh N. Do
- Department of Genetics & Genomic Sciences Icahn School of Medicine at Mount Sinai New York NY USA
| | - Joanne Sordillo
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
| | - Ginger L. Chew
- Department of Environmental Health Sciences Mailman School of Public Health Columbia University New York NY USA
| | - Supinda Bunyavanich
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Genetics & Genomic Sciences Icahn School of Medicine at Mount Sinai New York NY USA
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25
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Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Bresson JL, Fewtrell M, Kersting M, Przyrembel H, Dumas C, Titz A, Turck D. Appropriate age range for introduction of complementary feeding into an infant's diet. EFSA J 2019; 17:e05780. [PMID: 32626427 PMCID: PMC7009265 DOI: 10.2903/j.efsa.2019.5780] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Following a request from the European Commission, the Panel on Nutrition, Novel Foods and Food Allergens (NDA) revised its 2009 Opinion on the appropriate age for introduction of complementary feeding of infants. This age has been evaluated considering the effects on health outcomes, nutritional aspects and infant development, and depends on the individual's characteristics and development. As long as foods have an age-appropriate texture, are nutritionally appropriate and prepared following good hygiene practices, there is no convincing evidence that at any age investigated in the included studies (< 1 to < 6 months), the introduction of complementary foods (CFs) is associated with adverse health effects or benefits (except for infants at risk of iron depletion). For nutritional reasons, the majority of infants need CFs from around 6 months of age. Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status, or with early umbilical cord clamping (< 1 min after birth), or born preterm, or born small-for-gestational age or with high growth velocity) may benefit from earlier introduction of CFs that are a source of iron. The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5-7 months. The fact that an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age does not imply that there is a need to introduce CFs. There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.
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26
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Smeekens JM, Immormino RM, Balogh PA, Randell SH, Kulis MD, Moran TP. Indoor dust acts as an adjuvant to promote sensitization to peanut through the airway. Clin Exp Allergy 2019; 49:1500-1511. [PMID: 31444814 DOI: 10.1111/cea.13486] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/26/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is growing evidence that environmental peanut exposure through non-oral routes, including the skin and respiratory tract, can result in peanut sensitization. Environmental adjuvants in indoor dust can promote sensitization to inhaled antigens, but whether they contribute to peanut allergy development is unclear. OBJECTIVE We investigated whether indoor dust promotes airway sensitization to peanut and peanut allergy development in mice. METHODS Female and male C57BL/6J mice were exposed via the airways to peanut, indoor dust extract, or both for 2 weeks. Mice were then challenged with peanut and assessed for anaphylaxis. Peanut-specific immunoglobulins, peanut uptake by lung conventional dendritic cells (cDCs), lung innate cytokines, and T cell differentiation in lung-draining lymph nodes were quantified. Innate cytokine production by primary human bronchial epithelial cells exposed to indoor dust was also determined. RESULTS Inhalational exposure to low levels of peanut in combination with indoor dust, but neither alone, resulted in production of peanut-specific IgE and development of anaphylaxis upon peanut challenge. Indoor dust triggered production of innate cytokines in murine lungs and in primary human bronchial epithelial cells. Additionally, inhaled indoor dust stimulated maturation and migration of peanut-laden lung type 1 cDCs to draining lymph nodes. Inhalational exposure to peanut and indoor dust induced peanut-specific T helper 2 cell differentiation and accumulation of T follicular helper cells in draining lymph nodes, which were associated with increased B cell numbers and peanut-specific immunoglobulin production. CONCLUSIONS & CLINICAL RELEVANCE Indoor dust promotes airway sensitization to peanut and development of peanut allergy in mice. Our findings suggest that environmental adjuvants in indoor dust may be determinants of peanut allergy development in children.
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Affiliation(s)
- Johanna M Smeekens
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC.,UNC Food Allergy Initiative, Chapel Hill, NC
| | | | - Peter A Balogh
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC
| | - Scott H Randell
- Department of Cell Biology and Physiology, UNC School of Medicine, Chapel Hill, NC
| | - Michael D Kulis
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC.,UNC Food Allergy Initiative, Chapel Hill, NC
| | - Timothy P Moran
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC
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27
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Davisse-Paturet C, Raherison C, Adel-Patient K, Divaret-Chauveau A, Bois C, Dufourg MN, Lioret S, Charles MA, de Lauzon-Guillain B. Use of partially hydrolysed formula in infancy and incidence of eczema, respiratory symptoms or food allergies in toddlers from the ELFE cohort. Pediatr Allergy Immunol 2019; 30:614-623. [PMID: 31206800 DOI: 10.1111/pai.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/07/2019] [Accepted: 06/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Partially hydrolyzed formulas (pHF) are recommended in non-breastfed infants with familial history of allergy to prevent allergy development. However, recent meta-analysis does not provide strong support for their protective effect. The present work assesses the links between 2-month infant formula use and the incidence of eczema, respiratory symptoms, or food allergies (FA) up to 2 years of age. METHODS The nationwide ELFE birth cohort is a population-based study from mainland France. Infant feeding (breast milk only, partially hydrolyzed formula with [pHF-HA] or without a hypoallergenic label [pHF-non-HA], and non-hydrolyzed formula [Nhf]) was reported at 2 months. Eczema, FA, and respiratory symptoms such as wheezing and asthma were reported at 2 months, 1 year, and 2 years. Infants with prior FA at 2 months were excluded from analyses. RESULTS Among 11 720 infants, those who received only breast milk at 2 months were at lower risk of eczema at 1 year than those who received nHF (OR[95% CI] = 0.78[0.65-0.94] in non-at-risk infants; 0.86[0.75-0.98] in at-risk infants). The use of pHF-HA, compared with nHF, at 2 months was related to higher risk of wheezing at 1 year in at-risk infants (1.68[1.24-2.28]) and higher risk of FA at 2 years both in non-at-risk infants (3.78[1.52-9.41]) and in at-risk infants (2.31[1.36-3.94]). CONCLUSIONS In this nationwide study, pHF-HA use was not associated with a lower risk of any of the studied outcomes. Quite the reverse, it was associated with a higher risk of wheezing and FA. This should be confirmed in further studies.
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Affiliation(s)
- Camille Davisse-Paturet
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France
| | - Chantal Raherison
- Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux University, Bordeaux, France
| | - Karine Adel-Patient
- UMR Service de Pharmacologie et Immunoanalyse, CEA, INRA, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Amandine Divaret-Chauveau
- Unité d'allergologie Pédiatrique, Hôpital d'enfants, CHRU de Nancy, Vandoeuvre les Nancy, France.,EA3450, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Corinne Bois
- Unité Mixte Inserm-Ined-EFS Elfe, INED, Paris, France.,Service Départemental de PMI, Conseil Départemental des Hauts-de-Seine, Nanterre, France
| | | | - Sandrine Lioret
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France
| | - Marie-Aline Charles
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France.,Unité Mixte Inserm-Ined-EFS Elfe, INED, Paris, France
| | - Blandine de Lauzon-Guillain
- INSERM, UMR 1153 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France.,Université de Paris, Paris, France.,INRA, U1125 Centre for Research in Epidemiology and StatisticS (CRESS), Research Team on EARly Life Origins of Health (EAROH), Paris, France
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28
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Gao X, Yan Y, Zeng G, Sha T, Liu S, He Q, Chen C, Li L, Xiang S, Li H, Tan S, Yan Q. Influence of prenatal and early-life exposures on food allergy and eczema in infancy: a birth cohort study. BMC Pediatr 2019; 19:239. [PMID: 31315604 PMCID: PMC6636159 DOI: 10.1186/s12887-019-1623-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 07/12/2019] [Indexed: 12/30/2022] Open
Abstract
Background Few prospective birth cohort studies are available on the effects of prenatal and early-life exposures on food allergy and eczema among Chinese children. The aim of this study was to evaluate the influence of prenatal and early-life exposures on food allergy and eczema during the first year of life in a prospective birth cohort study. Methods This study was based on a prospective, observational birth cohort of 976 mother-child pairs in three Streets in Changsha, China from January to December 2015. Data on prenatal, early-life exposures and allergic outcomes were obtained from questionnaires collected at birth, and 1, 3, 6, 8, and 12 months of age. Multivariate logistic regression models were performed to estimate the effects of prenatal and early-life exposures on food allergy and eczema. Results Common risk factors for food allergy and eczema in infancy were parental history of allergy, while moderate eggs consumption (3–4 times/week) during pregnancy was protective for both of them compared with low consumption (≤ 2 times/week). Factors only associated with food allergy were maternal aquatic products consumption during pregnancy, number of older siblings and age of solid food introduction, whereas factors only associated with eczema were maternal milk or milk products consumption during pregnancy, maternal antibiotic exposure during pregnancy, season of birth and antibiotic exposure through medication during the first year of life. Conclusion Our study suggests that factors associated with food allergy and eczema are multifaceted, which involving hereditary, environmental and nutritional exposures. Furthermore, differential factors influence the development of food allergy and eczema in infants.
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Affiliation(s)
- Xiao Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China.
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Shiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Cheng Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Ling Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Shiting Xiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Hongyan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Shan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410078, Hunan Province, China
| | - Qiang Yan
- Department of Maternal and Child Health, Kaifu District Health Bureau, Changsha, China
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29
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Hong X, Liang L, Sun Q, Keet CA, Tsai HJ, Ji Y, Wang G, Ji H, Clish C, Pearson C, Wang Y, Wood RA, Hu FB, Wang X. Maternal triacylglycerol signature and risk of food allergy in offspring. J Allergy Clin Immunol 2019; 144:729-737. [PMID: 31004614 DOI: 10.1016/j.jaci.2019.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/20/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of IgE-mediated food allergy (FA) is increasing worldwide, but the underlying mechanisms are poorly understood. OBJECTIVE We sought to examine the role of maternal lipidomic profiles in risk of FA development in offspring and to investigate the potential modification effects by timing of first solid-food introduction. METHODS This report included 1068 mother-child dyads from the Boston Birth Cohort. Maternal lipid metabolites in plasma were assessed by using liquid chromatography tandem mass spectrometry. Food sensitization (FS) was defined as a specific IgE level of 0.35 kU/L or greater to any of the 8 common food allergens determined by using ImmunoCAP. FA was defined based on FS, clinical symptoms, and food avoidance. Logistic regression was applied to analyze associations between maternal metabolites and risk of FS and FA in offspring and to explore potential effect modifications. RESULTS Of the 1068 children, 411 had FS, and 132 had FA. Among the 209 metabolites, maternal triacylglycerols (TAGs) of shorter carbon chains and fewer double bonds were associated with greater risk of FA, whereas TAGs of longer carbon chains and more double bonds were significantly associated with lower risk of FA in offspring. These associations were stronger in children with delayed solid-food introduction (≥7 months of age) than those with earlier solid-food introduction (P = .010 for interaction between the maternal TAG score and timing of solid-food introduction). No significant association was found for FS. CONCLUSION This is the first study to demonstrate a link between maternal TAGs and risk of FA in offspring and potential risk modification by timing of solid-food introduction.
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Affiliation(s)
- Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston Mass
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Corinne A Keet
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Hui-Ju Tsai
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Institute of Population Health Sciences, National Health Research Institute, Zhunan, Taiwan
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Hongkai Ji
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Clary Clish
- Broad Institute of MIT and Harvard University, Cambridge, Mass
| | - Colleen Pearson
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Mass
| | - You Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Robert A Wood
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
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30
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Burgess JA, Dharmage SC, Allen K, Koplin J, Garcia-Larsen V, Boyle R, Waidyatillake N, Lodge CJ. Age at introduction to complementary solid food and food allergy and sensitization: A systematic review and meta-analysis. Clin Exp Allergy 2019; 49:754-769. [PMID: 30861244 DOI: 10.1111/cea.13383] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/11/2018] [Accepted: 02/11/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE An infant's age at introduction of complementary solids may contribute to food allergy. We aimed to synthesize the literature on the association between age at introduction of complementary solids, excluding milk products, and food allergy and sensitization. DESIGN We searched the electronic databases PubMed and EMBASE (January 1946-February 2017) using solid food, allergy and sensitization terms. METHODS Two authors selected papers according to inclusion criteria, identifying 16 cohort studies, 1 case-control study and 8 randomized controlled trials (RCTs). Pooled effects across studies were estimated using random-effects meta-analysis. RESULTS Cohort studies-Introducing complementary solids at age ≥ 4 months vs <4 months was not associated with food allergy (OR 1.22; 95% CI, 0.76-1.96) but was associated with food sensitization (OR 1.93; 95% CI 1.57-2.38). First exposure from age 4 to 6 months vs <4 months was not associated with food allergy (OR 1.01; 95% CI, 0.64-1.60) but was associated with food sensitization (OR 2.46; 95% CI 1.55-3.86). Randomized controlled trials-Egg exposure from age 4 months was associated with reduced egg allergy (OR 0.63, 95% CI, 0.44-0.90) and sensitization (OR 0.76, 95% CI, 0.51-0.95). Peanut exposure from age 4 months compared to delayed exposure was associated with reduced peanut allergy (OR 0.28, 95% CI 0.14-0.57). CONCLUSIONS We found no evidence from observational studies that introducing solids before 4 months protected against food allergy, but there was evidence for protection against food sensitization. From RCTs, introducing egg from 4 to 6 months and peanut from 4 to 11 months reduced the risk of egg allergy, peanut allergy and egg sensitization. PROSPERO systematic review registry (CRD42016033473).
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Affiliation(s)
- John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katrina Allen
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert Boyle
- Department of Paediatric Allergy, Imperial College London, London, UK
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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31
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Güngör D, Nadaud P, LaPergola CC, Dreibelbis C, Wong YP, Terry N, Abrams SA, Beker L, Jacobovits T, Järvinen KM, Nommsen-Rivers LA, O'Brien KO, Oken E, Pérez-Escamilla R, Ziegler EE, Spahn JM. Infant milk-feeding practices and food allergies, allergic rhinitis, atopic dermatitis, and asthma throughout the life span: a systematic review. Am J Clin Nutr 2019; 109:772S-799S. [PMID: 30982870 PMCID: PMC6500928 DOI: 10.1093/ajcn/nqy283] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND During the Pregnancy and Birth to 24 Months Project, the USDA and Department of Health and Human Services initiated a review of evidence on diet and health in these populations. OBJECTIVES The aim of these systematic reviews was to examine the relation of 1) never versus ever feeding human milk, 2) shorter versus longer durations of any human milk feeding, 3) shorter versus longer durations of exclusive human milk feeding prior to infant formula introduction, 4) feeding a lower versus higher intensity of human milk to mixed-fed infants, and 5) feeding a higher intensity of human milk by bottle versus breast with food allergies, allergic rhinitis, atopic dermatitis, and asthma. METHODS The Nutrition Evidence Systematic Review team conducted systematic reviews with external experts. We searched CINAHL, Cochrane, Embase, and PubMed for articles published between January 1980 and March 2016, dual-screened the results according to predetermined criteria, extracted data from and assessed the risk of bias for each included study, qualitatively synthesized the evidence, developed conclusion statements, and graded the strength of the evidence. RESULTS The systematic reviews numbered 1-5 above included 44, 35, 1, 0, and 0 articles, respectively. Moderate, mostly observational, evidence suggests that 1) never versus ever being fed human milk is associated with higher risk of childhood asthma, and 2) among children and adolescents who were fed human milk as infants, shorter versus longer durations of any human milk feeding are associated with higher risk of asthma. Limited evidence does not suggest associations between 1) never versus ever being fed human milk and atopic dermatitis in childhood or 2) the duration of any human milk feeding and allergic rhinitis and atopic dermatitis in childhood. CONCLUSIONS Moderate evidence suggests that feeding human milk for short durations or not at all is associated with higher childhood asthma risk. Evidence on food allergies, allergic rhinitis, and atopic dermatitis is limited.
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Affiliation(s)
- Darcy Güngör
- Panum Group, Bethesda, MD,Address correspondence to DG (e-mail: )
| | | | | | | | | | - Nancy Terry
- National Institutes of Health Library, Bethesda, MD
| | - Steve A Abrams
- Dell Medical School at the University of Texas, Austin, TX
| | - Leila Beker
- US Food and Drug Administration, contractor, College Park, MD
| | | | | | | | | | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA,Department of Nutrition, Harvard School of Public Health, Boston, MA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Ekhard E Ziegler
- Panum Group, Bethesda, MD,Department of Pediatrics, The University of Iowa, Iowa City, IA
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32
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Obbagy JE, English LK, Wong YP, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr 2019; 109:890S-934S. [PMID: 30982864 DOI: 10.1093/ajcn/nqy220] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo. OBJECTIVES The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis? METHODS The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed. CONCLUSIONS Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.
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Affiliation(s)
| | | | | | - Nancy F Butte
- USDA-Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | - David M Fleischer
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | | | - Frank R Greer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | | | - Eve E Stoody
- USDA, Food and Nutrition Service, Alexandria, VA
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33
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Hennessy Á, Hourihane JO, Malvisi L, Irvine AD, Kenny LC, Murray DM, Kiely ME. Antenatal vitamin D exposure and childhood eczema, food allergy, asthma and allergic rhinitis at 2 and 5 years of age in the atopic disease-specific Cork BASELINE Birth Cohort Study. Allergy 2018; 73:2182-2191. [PMID: 30085352 DOI: 10.1111/all.13590] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prospective studies of antenatal and infant vitamin D exposure and atopic disease from extensively characterised, disease-specific, maternal-infant cohorts with gold standard analysis of vitamin D status and clinically validated atopic outcomes are lacking. This study aimed to investigate associations between intrauterine vitamin D status and atopic outcomes in an extensively characterised, disease-specific, maternal-infant cohort. METHODS Circulating 25-hydroxyvitamin D (25(OH)D) was measured in maternal sera at 15 weeks of gestation (n = 1537) and umbilical cord blood (n = 1050) using a CDC-accredited LC-MS/MS platform, and the association with clinically validated atopic disease outcomes (eczema, food allergy, asthma, allergic rhinitis) at 2 and 5 years was explored using multivariable logistic regression. RESULTS Persistent eczema in the first 2 years of life was present in 5% of infants. Food allergy at 2 years was confirmed in 4%. The prevalence of aeroallergen sensitisation at 2 years was 8%. Asthma at 5 years was reported in 15% and allergic rhinitis in 5% of 5-year-olds. There were no significant differences in the distributions of maternal 25(OH)D at 15 weeks of gestation (mean [SD] 58.4 [26.2] and 58.5 [26.1] nmol/L) and cord 25(OH)D concentrations (mean [SD] 35.2 [17.8] and 35.4 [18.3] nmol/L) between children with and without atopic disease. Neither maternal (aOR [95% CI]: 1.02 [0.97, 1.08], P = 0.450) nor cord 25(OH)D (aOR [95% CI]: 1.00 [0.91, 1.09], P = 0.991) were significant predictors of atopic disease outcomes in fully adjusted models. CONCLUSION These data in a disease-specific cohort with prospectively collected, validated atopic outcomes do not support an association between antenatal exposure to vitamin D and atopic disease outcomes in childhood.
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Affiliation(s)
- Áine Hennessy
- Cork Centre for Vitamin D and Nutrition Research; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
| | - Jonathan O'B Hourihane
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
- Department of Paediatrics and Child Health; College of Medicine and Health; University College Cork; Cork Ireland
| | - Lucio Malvisi
- Cork Centre for Vitamin D and Nutrition Research; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
| | - Alan D. Irvine
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
- Department of Clinical Medicine; Trinity College; Dublin Ireland
- Department of Paediatric Dermatology; Our Lady's Children's Hospital; Dublin Ireland
- National Children's Research Centre; Dublin Ireland
| | - Louise C. Kenny
- Department of Women's and Children's Health; Institute of Translational Medicine; University of Liverpool; Liverpool UK
| | - Deirdre M. Murray
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
- Department of Paediatrics and Child Health; College of Medicine and Health; University College Cork; Cork Ireland
| | - Mairead E. Kiely
- Cork Centre for Vitamin D and Nutrition Research; School of Food and Nutritional Sciences; University College Cork; Cork Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
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34
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Maternal psychological distress during pregnancy and childhood health outcomes: a narrative review. J Dev Orig Health Dis 2018; 10:274-285. [PMID: 30378522 DOI: 10.1017/s2040174418000557] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.
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35
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Selby A, Munro A, Grimshaw KE, Cornelius V, Keil T, Grabenhenrich L, Clausen M, Dubakiene R, Fiocchi A, Kowalski ML, Papadopoulos NG, Reche M, Sigurdardottir ST, Sprikkelman AB, Xepapadaki P, Mills ENC, Beyer K, Roberts G. Prevalence estimates and risk factors for early childhood wheeze across Europe: the EuroPrevall birth cohort. Thorax 2018; 73:1049-1061. [PMID: 29748253 DOI: 10.1136/thoraxjnl-2016-209429] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/08/2018] [Accepted: 01/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preschool wheeze is an important problem worldwide. No comparative population-based studies covering different countries have previously been undertaken. OBJECTIVE To assess the prevalence of early childhood wheeze across Europe and evaluate risk factors focusing on food allergy, breast feeding and smoke exposure. METHODS Infants from nine countries were recruited into the EuroPrevall birth cohort. At 12 and 24 months, data on wheeze, allergic signs/symptoms, feeding, smoke exposure, infections and day care attendance were collected using questionnaires. Poisson regression was used to assess risk factors for wheeze. RESULTS 12 049 infants were recruited. Data from the second year of life were available in 8805 (73.1%). The prevalence of wheeze in the second year of life ranged from <2% in Lodz (Poland) and Vilnius (Lithuania) to 13.1% (95% CI 10.7% to 15.5%) in Southampton (UK) and 17.2% (95% CI 15.0% 19.5%) in Reykjavik (Iceland). In multivariable analysis, frequent lower respiratory tract infections in the first and second years of life (incidence rate ratio (IRR) 1.9 (95% CI 1.3 to 2.6) and 2.5 (95% CI 1.9 to3.4), respectively), postnatal maternal smoking (IRR 1.6, 95% CI 1.1 to 2.4), day care attendance (IRR 1.6, 95% CI 1.1 to 2.5) and male gender (IRR 1.3, 95% CI 1.0 to 1.7) were associated with wheeze. The strength of their association with wheeze differed between countries. Food allergy and breast feeding were not independently associated with wheeze. CONCLUSION The prevalence of early childhood wheeze varied considerably across Europe. Lower respiratory tract infections, day care attendance, postnatal smoke exposure and male gender are important risk factors. Further research is needed to identify additional modifiable risk factors that may differ between countries.
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Affiliation(s)
- Anna Selby
- Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alasdair Munro
- Department of Paediatrics, Royal Hampshire County Hospital, Winchester, UK
| | - Kate E Grimshaw
- Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Nutrition and Dietetics, Southampton Children's Hospital, Southampton, UK
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-Universitat Wurzburg, Wurzburg, Germany
| | - Linus Grabenhenrich
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.,Department for Dermatology, Venerology and Allergology, Charité University Medical Centre, Berlin, Germany
| | - Michael Clausen
- Children's Hospital, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ruta Dubakiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Nikolaos G Papadopoulos
- Allergy Unit, 2nd Paediatric Clinic, University of Athens, Athens, Greece.,Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - Marta Reche
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | - Aline B Sprikkelman
- Department of Pediatric Pulmonology and Allergology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | | | - E N Clare Mills
- Institute of Inflammation and Repair, Manchester Academic Health Science Centre, Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Kirsten Beyer
- Department of Paediatric Pulmonology and Immunology, Charité University Medical Centre, Berlin, Germany
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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36
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Martorano LM, Grayson MH. Respiratory viral infections and atopic development: From possible mechanisms to advances in treatment. Eur J Immunol 2018; 48:407-414. [PMID: 29244204 DOI: 10.1002/eji.201747052] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 11/10/2022]
Abstract
Atopic sensitization and allergic diseases are increasing in modernized countries. These diseases affect millions of individuals, but the mechanisms behind their development are not fully understood. One hypothesis relates to early life respiratory viral infections driving the development of atopic disease including asthma. This review presents the current state of the field, focusing on epidemiologic data supporting a role for early life respiratory viruses in the development of specific IgE, both against aeroallergens and the respiratory virus. Our own work using the Sendai mouse model is then summarized to provide a potential mechanistic explanation for how a respiratory viral infection could drive development of atopic sensitization and disease. We then discuss the components of this mechanistic pathway that have and have not been validated in humans. Finally, we discuss areas ripe for research, as well as potential and current therapeutics that might disrupt the link between respiratory viral infections in early life and atopic sensitization/disease.
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Affiliation(s)
- Lisa M Martorano
- Division of Allergy & Immunology, Department of Pediatrics, The Ohio State University Wexner Medical Center & Nationwide Children's Hospital, Columbus, OH, USA
| | - Mitchell H Grayson
- Division of Allergy & Immunology, Department of Pediatrics, The Ohio State University Wexner Medical Center & Nationwide Children's Hospital, Columbus, OH, USA.,Center for Clinical and Translational Research, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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37
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Caffeic acid-assisted cross-linking catalyzed by polyphenol oxidase decreases the allergenicity of ovalbumin in a Balb/c mouse model. Food Chem Toxicol 2018; 111:275-283. [DOI: 10.1016/j.fct.2017.11.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/10/2017] [Accepted: 11/18/2017] [Indexed: 02/06/2023]
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38
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Vetander M, Protudjer JLP, Lilja G, Kull I, Hedlin G, van Hage M, Östblom E, Bergström A, Wickman M. Anaphylaxis to foods in a population of adolescents: incidence, characteristics and associated risks. Clin Exp Allergy 2017; 46:1575-1587. [PMID: 27790764 DOI: 10.1111/cea.12842] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/28/2016] [Accepted: 10/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Information about severe reactions to foods in adolescence is limited. OBJECTIVE To describe reactions to foods, including anaphylaxis, with regard to incidence, characteristics and associated risks, among 16-year-olds (adolescents) in a large, population-based birth cohort. METHODS Parent-reported questionnaire data from ages 2-3 months, and 1, 2 and 16 years were used (N = 3153). Anaphylaxis at age 16 years was defined per NIAID/FAAN criteria. Immunoglobulin E (IgE) antibodies to 14 common food and inhalant allergens were analysed at ages 4 (n = 2283) and 16 years (n = 2510). Among adolescents with food-related symptoms (FRS) and for whom blood was available (n = 221), 25 additional food allergen extracts or allergen components were analysed. Associations between reactions to foods, and sensitization and allergic multimorbidity were investigated. RESULTS In the 12 months prior to the 16-year assessment, 8.5% of adolescents had FRS. This included 0.8% (n = 24) adolescents who were classified as having anaphylaxis, yielding an incidence rate of 761/100 000 person-years. One-third of adolescents accessed health care during anaphylaxis. Allergic multimorbidity in infancy, as well as sensitization to foods and airborne allergens at age 4 years, was associated with an increased risk for FRS in adolescence. Peanuts and tree nuts were the most common culprit foods for anaphylaxis, and fruits and vegetables for non-anaphylactic reactions. Adolescents with anaphylaxis were significantly more likely to be sensitized to storage proteins (Ara h 2, Cor a 9, Cor a 14) and to be polysensitized to foods (P < 0.001 vs. non-anaphylactic reactions). CONCLUSIONS AND CLINICAL RELEVANCE The incidence of food-induced anaphylaxis during adolescence in our population-based birth cohort is higher than previously reported. Adolescents with anaphylaxis differ from adolescents with non-anaphylactic FRS with regard to culprit foods and sensitization. Adolescents with previous anaphylaxis are likely to be polysensitized to foods, particularly tree nut and peanut storage proteins, and which warrants consideration at follow-up.
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Affiliation(s)
- M Vetander
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - J L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - G Lilja
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - I Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - G Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - M van Hage
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - E Östblom
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - M Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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39
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Sicherer SH, Sampson HA. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol 2017; 141:41-58. [PMID: 29157945 DOI: 10.1016/j.jaci.2017.11.003] [Citation(s) in RCA: 838] [Impact Index Per Article: 119.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/31/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022]
Abstract
This review provides general information to serve as a primer for those embarking on understanding food allergy and also details advances and updates in epidemiology, pathogenesis, diagnosis, and treatment that have occurred over the 4 years since our last comprehensive review. Although firm prevalence data are lacking, there is a strong impression that food allergy has increased, and rates as high as approximately 10% have been documented. Genetic, epigenetic, and environmental risk factors are being elucidated increasingly, creating potential for improved prevention and treatment strategies targeted to those at risk. Insights on pathophysiology reveal a complex interplay of the epithelial barrier, mucosal and systemic immune response, route of exposure, and microbiome among other influences resulting in allergy or tolerance. The diagnosis of food allergy is largely reliant on medical history, tests for sensitization, and oral food challenges, but emerging use of component-resolved diagnostics is improving diagnostic accuracy. Additional novel diagnostics, such as basophil activation tests, determination of epitope binding, DNA methylation signatures, and bioinformatics approaches, will further change the landscape. A number of prevention strategies are under investigation, but early introduction of peanut has been advised as a public health measure based on existing data. Management remains largely based on allergen avoidance, but a panoply of promising treatment strategies are in phase 2 and 3 studies, providing immense hope that better treatment will be imminently and widely available, whereas numerous additional promising treatments are in the preclinical and clinical pipeline.
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Affiliation(s)
- Scott H Sicherer
- 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.
| | - Hugh A Sampson
- 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
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40
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Tong P, Gao L, Gao J, Li X, Wu Z, Yang A, Chen H. Iron-induced chelation alleviates the potential allergenicity of ovotransferrin in a BALB/c mouse model. Nutr Res 2017; 47:81-89. [DOI: 10.1016/j.nutres.2017.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
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41
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Sensing and responding to allergic response cytokines through a genetically encoded circuit. Nat Commun 2017; 8:1101. [PMID: 29062109 PMCID: PMC5653676 DOI: 10.1038/s41467-017-01211-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/30/2017] [Indexed: 12/18/2022] Open
Abstract
While constantly rising, the prevalence of allergies is globally one of the highest among chronic diseases. Current treatments of allergic diseases include the application of anti-histamines, immunotherapy, steroids, and anti-immunoglobulin E (IgE) antibodies. Here we report mammalian cells engineered with a synthetic signaling cascade able to monitor extracellular pathophysiological levels of interleukin 4 and interleukin 13, two main cytokines orchestrating allergic inflammation. Upon activation of transgenic cells by these cytokines, designed ankyrin repeat protein (DARPin) E2_79, a non-immunogenic protein binding human IgE, is secreted in a precisely controlled and reversible manner. Using human whole blood cell culturing, we demonstrate that the mammalian dual T helper 2 cytokine sensor produces sufficient levels of DARPin E2_79 to dampen histamine release in allergic subjects exposed to allergens. Hence, therapeutic gene networks monitoring disease-associated cytokines coupled with in situ production, secretion and systemic delivery of immunomodulatory biologics may foster advances in the treatment of allergies. The standard treatment for an allergic response is anti-histamines, steroids and anti-IgE antibodies. Here the authors present a genetic circuit that senses IL-4 and IL-13 and responses with DARPin production to bind IgE.
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42
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Elbert NJ, Duijts L, den Dekker HT, de Jong NW, Nijsten TEC, Jaddoe VWV, de Jongste JC, van Wijk RG, Tiemeier H, Pasmans SGMA. Maternal psychiatric symptoms during pregnancy and risk of childhood atopic diseases. Clin Exp Allergy 2017; 47:509-519. [PMID: 28109169 DOI: 10.1111/cea.12889] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/29/2016] [Accepted: 12/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal psychiatric symptoms during pregnancy might affect the developing immune system and subsequent risk of childhood atopic diseases. OBJECTIVE Our aim was to examine the associations of maternal psychiatric symptoms during pregnancy with allergic sensitization, allergy and eczema in children until age 10 years. METHODS This study among 5205 children was performed in a population-based prospective cohort from foetal life onwards. We assessed maternal and paternal psychiatric symptoms (overall, depressive, anxiety) during pregnancy and at 36 months after delivery, and maternal psychiatric symptoms at 2 and 6 months after delivery using the Brief Symptom Inventory. Inhalant and food allergic sensitization were measured by skin prick tests, and physician-diagnosed inhalant and food allergy or eczema by questionnaires from birth until age 10 years. We used multivariate logistic regression, multinomial logistic regression or generalized estimating equation models where appropriate. RESULTS We observed no association of maternal psychiatric symptoms during pregnancy with allergic sensitization. Maternal overall psychiatric, depressive and anxiety symptoms during pregnancy were associated with an increased risk of inhalant allergy only (adjusted odds ratio (95% confidence interval) 1.96 (1.44, 2.65), 1.58 (1.25, 1.98) and 1.61 (1.27, 2.03), respectively, per 1-unit increase). Maternal overall psychiatric and anxiety symptoms during pregnancy were associated with an increased risk of eczema (1.21 (1.05, 1.39) and 1.15 (1.02, 1.29), respectively, per 1-unit increase). Effect estimates did not materially change when maternal psychiatric symptoms after delivery, or paternal psychiatric symptoms during pregnancy and after delivery were taken into account. CONCLUSIONS AND CLINICAL RELEVANCE Maternal psychiatric symptoms during pregnancy were associated with increased risks of childhood inhalant allergy and eczema, independent of maternal psychiatric symptoms after delivery and of paternal psychiatric symptoms.
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Affiliation(s)
- N J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - N W de Jong
- Department of Internal Medicine, Division of Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - T E C Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - R Gerth van Wijk
- Department of Internal Medicine, Division of Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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43
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Wood RA. Advances in food allergy in 2015. J Allergy Clin Immunol 2016; 138:1541-1547. [DOI: 10.1016/j.jaci.2016.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 12/17/2022]
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44
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McGowan EC, Matsui EC, Peng R, Salo PM, Zeldin DC, Keet CA. Racial/ethnic and socioeconomic differences in self-reported food allergy among food-sensitized children in National Health and Nutrition Examination Survey III. Ann Allergy Asthma Immunol 2016; 117:570-572.e3. [PMID: 27788892 DOI: 10.1016/j.anai.2016.08.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/14/2016] [Accepted: 08/30/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Emily C McGowan
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth C Matsui
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Päivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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45
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Ponce M, Diesner SC, Szépfalusi Z, Eiwegger T. Markers of tolerance development to food allergens. Allergy 2016; 71:1393-404. [PMID: 27286276 DOI: 10.1111/all.12953] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 12/30/2022]
Abstract
IgE-mediated reactions to food allergens are the most common cause of anaphylaxis in childhood. Although allergies to cow's milk, egg, or soy proteins, in contrast to peanut and tree nut allergens, resolve within the first 6 years of life in up to 60% due to natural tolerance development, this process is not well understood. At present, there is no cure or treatment for food allergy that would result in an induction of tolerance to the symptom-eliciting food. Avoidance, providing an emergency plan and education, is the standard of treatment. Oral immunotherapeutic approaches have been proven reasonable efficacy; however, they are associated with high rates of side-effects and low numbers of patients achieving tolerance. Nevertheless, mechanisms that take place during oral immunotherapy may help to understand tolerance development. On the basis of these therapeutic interventions, events like loss of basophil activation and induction of regulatory lymphocyte subsets and of blocking antibodies have been described. Their functional importance at a clinical level, however, remains to be investigated in detail. Consequently, there is eminent need to understand the process of tolerance development to food allergens and define biomarkers to develop and monitor new treatment strategies for food allergy.
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Affiliation(s)
- M. Ponce
- Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - S. C. Diesner
- Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Z. Szépfalusi
- Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - T. Eiwegger
- Department of Pediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
- Division of Immunology and Allergy, Food allergy and Anaphylaxis Program; The Department of Paediatrics; Hospital for Sick Children; Research Institute, Physiology and Experimental Medicine Program; The University of Toronto; Toronto ON Canada
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46
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Faber MA, Donné I, Herrebosch E, Sabato V, Hagendorens MM, Bridts CH, De Clerck LS, Ebo DG. Sensitization profiles to peanut allergens in Belgium; cracking the code in infants, children and adults. Acta Clin Belg 2016; 71:32-7. [PMID: 27075794 DOI: 10.1080/17843286.2015.1109170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Peanut allergy shows distinct clinical patterns that can be predicted by component resolved diagnosis. However, data about peanut sensitization profiles in populations with a broad age stratification are scarce. METHODS Sera of 89 peanut allergic patients (age 1-70 years), 21 infants (<1 year) with atopic dermatitis (AD) sensitized to peanut, 24 age matched peanut-tolerant individuals with positive specific IgE (sIgE) to peanut and 15 healthy individuals were tested for sIgE reactivity to rAra h 1, rAra h 2, rAra h 3, rAra h 8, rAra h 9 and rBet v 1 (FEIA ImmunoCAP, Thermo Fisher Scientific). RESULTS In infants with AD, Ara h 1, Ara h 2 and Ara h 3 enabled to explain 14/21 (67%) of peanut sensitizations. No sensitization to Ara h 8 or Bet v 1 was observed. Patients with generalized reactions were more frequently sensitized to Ara h 1, Ara h 2 and Ara h 3 compared to patients with an oral allergy syndrome (OAS) and peanut-tolerant patients. Sensitization to Ara h 8 was significantly more observed in patients with an OAS. Ara h 2 showed to be the best marker to distinguish patients with generalized reactions from patients with an OAS and/or peanut sensitized patients but tolerating the legume. CONCLUSION Sensitization to Ara h 1, Ara h 2 and Ara h 3 can have an early onset and is predominantly associated with a more severe outcome. Ara h 2 is the best marker of a generalized peanut allergy.
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47
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Metcalfe JR, D'Vaz N, Makrides M, Gold MS, Quinn P, West CE, Loh R, Prescott SL, Palmer DJ. Elevated IL-5 and IL-13 responses to egg proteins predate the introduction of egg in solid foods in infants with eczema. Clin Exp Allergy 2016; 46:308-16. [DOI: 10.1111/cea.12608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J. R. Metcalfe
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
| | - N. D'Vaz
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Telethon KIDS Institute; The University of Western Australia; Perth WA Australia
| | - M. Makrides
- Women's & Children's Health Research Institute; Adelaide SA Australia
- Healthy Mothers, Babies and Children; South Australian Health and Medical Research Institute; Adelaide SA Australia
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - M. S. Gold
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
- Children, Youth and Women's Health Service; Adelaide SA Australia
| | - P. Quinn
- Children, Youth and Women's Health Service; Adelaide SA Australia
| | - C. E. West
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Department of Clinical Sciences; Pediatrics; Umeå University; Umea Sweden
| | - R. Loh
- Department of Immunology; Princess Margaret Hospital; Perth WA Australia
| | - S. L. Prescott
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Telethon KIDS Institute; The University of Western Australia; Perth WA Australia
- Department of Immunology; Princess Margaret Hospital; Perth WA Australia
| | - D. J. Palmer
- School of Paediatrics and Child Health; The University of Western Australia; Perth WA Australia
- Women's & Children's Health Research Institute; Adelaide SA Australia
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Hoyt AEW, Medico T, Commins SP. Breast Milk and Food Allergy: Connections and Current Recommendations. Pediatr Clin North Am 2015; 62:1493-507. [PMID: 26456446 DOI: 10.1016/j.pcl.2015.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Breast milk, a living source of nutrition for babies, complements a baby's immune system, supplementing undeveloped defenses with immune factors while creating the foundation for the innate and adaptive immune systems. Such immune development includes tolerance of the environment and, in the case of food allergy, a lack of tolerance. Recent research questions the previous opinion that breast milk is protective against food allergy. This article reviews the immature immune system, the immunology and nutrition of breast milk, the literature exploring breast milk and food allergy, and the current recommendations regarding breast milk and the prevention of food allergy.
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Affiliation(s)
- Alice E W Hoyt
- University of Virginia, PO Box 801355, 409 Lane Road MR-4 Building, Room 5051, Charlottesville, VA 22908, USA
| | - Tegan Medico
- University of Virginia, PO Box 801355, 409 Lane Road MR-4 Building, Room 5051, Charlottesville, VA 22908, USA
| | - Scott P Commins
- University of North Carolina School of Medicine, Department of Medicine, Division of Rheumatology, Allergy and Immunology, 3300 Thurston Building, CB 7280, Chapel Hill, NC 27599-7280, USA.
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49
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Prince BT, Mandel MJ, Nadeau K, Singh AM. Gut Microbiome and the Development of Food Allergy and Allergic Disease. Pediatr Clin North Am 2015; 62:1479-92. [PMID: 26456445 PMCID: PMC4721650 DOI: 10.1016/j.pcl.2015.07.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The impact of gut microbiome on human development, nutritional needs, and disease has become evident with advances in the ability to study these complex communities of microorganisms, and there is growing appreciation for the role of the microbiome in immune regulation. Several studies have examined associations between changes in the commensal microbiota and the development of asthma, allergic rhinitis, and asthma, but far less have evaluated the impact of the microbiome on the development of food allergy. This article reviews the human gastrointestinal microbiome, focusing on the theory and evidence for its role in the development of IgE-mediated food allergy and other allergic diseases.
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Affiliation(s)
- Benjamin T. Prince
- Department of Pediatrics, Division of Allergy and Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois,Department of Medicine, Division of Allergy and Immunology, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mark J. Mandel
- Department of Microbiology-Immunology, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kari Nadeau
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Anne Marie Singh
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, 225 East Chicago Avenue, #60, Chicago, IL 60611, USA; Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, #60, Chicago, IL 60611, USA.
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50
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Starkl P, Marichal T, Gaudenzio N, Reber LL, Sibilano R, Tsai M, Galli SJ. IgE antibodies, FcεRIα, and IgE-mediated local anaphylaxis can limit snake venom toxicity. J Allergy Clin Immunol 2015; 137:246-257.e11. [PMID: 26410782 DOI: 10.1016/j.jaci.2015.08.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/25/2015] [Accepted: 08/05/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Type 2 cytokine-related immune responses associated with development of antigen-specific IgE antibodies can contribute to pathology in patients with allergic diseases and to fatal anaphylaxis. However, recent findings in mice indicate that IgE also can enhance defense against honeybee venom. OBJECTIVE We tested whether IgE antibodies, IgE-dependent effector mechanisms, and a local anaphylactic reaction to an unrelated antigen can enhance defense against Russell viper venom (RVV) and determined whether such responses can be influenced by immunization protocol or mouse strain. METHODS We compared the resistance of RVV-immunized wild-type, IgE-deficient, and Fcer1a-deficient mice after injection of a potentially lethal dose of RVV. RESULTS A single prior exposure to RVV enhanced the ability of wild-type mice, but not mice lacking IgE or functional FcεRI, to survive challenge with a potentially lethal amount of RVV. Moreover, IgE-dependent local passive cutaneous anaphylaxis in response to challenge with an antigen not naturally present in RVV significantly enhanced resistance to the venom. Finally, we observed different effects on resistance to RVV or honeybee venom in BALB/c versus C57BL/6 mice that had received a second exposure to that venom before challenge with a high dose of that venom. CONCLUSION These observations illustrate the potential benefit of IgE-dependent effector mechanisms in acquired host defense against venoms. The extent to which type 2 immune responses against venoms can decrease pathology associated with envenomation seems to be influenced by the type of venom, the frequency of venom exposure, and the genetic background of the host.
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Affiliation(s)
- Philipp Starkl
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Thomas Marichal
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Nicolas Gaudenzio
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Laurent Lionel Reber
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Riccardo Sibilano
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Joseph Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, Calif.
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