Food allergy across the globe

The effect of infant cow's milk protein consumption on subsequent IgE-mediated cow's milk allergic outcomes in a high-risk pediatric population

BACKGROUND

Cow's milk allergy typically develops earlier than other food allergies. The timing of cow's milk introduction during infancy may impact the development of IgE-mediated food sensitivity and allergy.

OBJECTIVE

To explore the association between cow's milk consumption and the development of IgE-mediated and cow's milk sensitization and allergy in a high-risk pediatric population.

METHODS

This secondary analysis used data from the Consortium for Food Allergy Research (CoFAR2) cohort, a multi-center, cross sectional study, examining peanut allergy progression in high-risk infants with pre-existing egg and/or milk allergies and/or atopic dermatitis aged 3-15 months. Skin prick tests and a physician assessment were conducted at the first visit. Univariate and multivariate regression models assessed the impact of cow's milk introduction in the hospital and at home on subsequent milk sensitization and allergy.

RESULTS

Infants that did not consume milk formula had higher odds of developing milk sensitization (OR 2.17, CI 1.29-3.70, p < 0.05) and lower odds of developing milk allergy (OR 0.59, CI 0.38-0.92, p = 0.02) compared to those who started formula before four months. Starting formula after four months showed a slight, non-significant increase in milk sensitization (OR 1.07 CI 0.51-2.32, p > 0.05) and allergy (OR 1.78, CI 0.89-3.66, p > 0.05). Infants not introduced to cow's milk products by the first visit were significantly more likely to develop sensitization and allergy, compared to those introduced before four months of age (OR sensitization 5.92 CI 2.91-12.32, p < 0.001, OR allergy 1.95, CI 1.02-3.93, p < 0.05). Introducing cow's milk after four months also significantly increased sensitization odds compared to early introduction (OR 1.61 CI 0.74-352, p < 0.05).

CONCLUSION

Early introduction of cow's milk protein in at-risk infants may lower the risk of IgE-mediated milk sensitization and allergy. The timing of introduction is crucial in shaping sensitivity and allergy outcomes, highlighting the need for further research regarding infant dietary practices to reduce milk allergy development.

An expanded framework for Swab Touch Spray-Mass Spectrometry towards the detection of allergenic protein residues on food preparation surfaces

BACKGROUND

Ambient Mass Spectrometry (AMS) encompasses a group of techniques that have emerged as powerful strategies for direct, in-situ and high-throughput analysis, also in compliance with the principles of green analytical chemistry. Swab Touch Spray-Mass Spectrometry (Swab TS-MS) is a home-made AMS technique that involves the use of a medical swab as sampling tool and electrospray probe. To date, Swab TS-MS has been applied only for the analysis of small molecules, especially in forensic and medical fields, leaving the analysis of peptides and proteins still unexplored.

RESULTS

In the present study, the application framework of Swab TS-MS was expanded towards the detection of proteins, focusing on residues of allergenic ingredients as contaminants of food preparation surfaces. Lysozyme from chicken egg white was selected as case study of allergenic protein. Since none of the experimental conditions explored allowed the detection of intact lysozyme, a bottom-up procedure based on tryptic digestion for lysozyme detection by Swab TS-MS, operating in MS/high resolution (HR)MS tandem mode, was investigated. In parallel, liquid chromatography-tandem mass spectrometry was used to develop and characterize an in-situ digestion/swabbing strategy, allowing to reach a LOD value of 0.003 μg/cm2 of egg white powder consistent with that of lateral flow immunoassay technique. Finally, the developed in-situ digestion/swabbing procedure was coupled to the Swab TS-MS/HRMS method, permitting the direct analysis of egg white powder residues on stainless steel surfaces, reaching a LOD of 68 μg/cm2 egg white powder, corresponding to 2.4 μg/cm2 of lysozyme.

SIGNIFICANCE

This study should be intended as a first step for the application of Swab TS-MS technique in protein analysis: the developed in-situ digestion and sampling strategy suitable for Swab TS-MS direct analysis of food allergen has a valuable impact towards the availability of MS-based multiplexed detection tool useful for the development of efficient surface cleaning procedures.

Scientific developments in understanding food allergy prevention, diagnosis, and treatment

Food allergies (FAs) are adverse immune reactions to normally innocuous foods. Their prevalence has been increasing in recent decades. They can be IgE-mediated, non-IgE mediated, or mixed. Of these, the mechanisms underlying IgE-mediated FA are the best understood and this has assisted in the development of therapeutics. Currently there are two approved drugs for the treatment of FA, Palforzia and Omalizumab. Palfornia is a characterized peanut product used as immunotherapy for peanut allergy. Immunotherapy, involves exposure of the patient to small but increasing doses of the allergen and slowly builds immune tolerance to the allergen and increases a patient's allergic threshold. Omalizumab, a biologic, is an anti-IgE antibody which binds to IgE and prevents release of proinflammatory allergenic mediators on exposure to allergen. Other biologics, investigational vaccines, nanoparticles, Janus Kinase and Bruton's tyrosine kinase inhibitors, or DARPins are also being evaluated as potential therapeutics. Oral food challenges (OFC) are the gold standard for the diagnosis for FA. However, they are time-consuming and involve risk of anaphylaxis; therefore, alternative diagnostic methods are being evaluated. This review will discuss how the immune system mediates an allergic response to specific foods, as well as FA risk factors, diagnosis, prevention, and treatments for FA.

Analysis of epitopes and structural responses in egg allergen Gal d 1 using bioinformatic tools and molecular dynamics simulation

Egg allergy is a growing concern worldwide. Investigating the allergenic and molecular characteristics of egg allergen Ovomucoid (Gal d 1) can enhance our understanding of egg allergies. In this study, the B-cell linear epitopes of Gal d 1 were predicted by using different bioinformatic tools, based on the primary sequence properties of Gal d 1, and obtained 10 potential B-cell linear epitopes. Meanwhile, we conducted molecular dynamics (MD) simulations to apply thermal and an oscillating electric field treatments to Gal d 1 in order to comprehend the structural alterations of Gal d 1 intuitively. The results indicated that Gal d 1 was a thermally stable protein, while the secondary structure and surface characteristics of Gal d 1 were obviously influenced by the combination of thermal stress and electric field, which finally resulted in conformational changes. This study provided a new way to understand the development of hypoallergenic egg products.

Omalizumab reduces anaphylactic reactions and allows food introduction in food-allergic in children with severe asthma: An observational study

BACKGROUND

In Europe, Omalizumab (anti-IgE) is indicated for the treatment of moderate to severe asthma, but not for IgE-mediated food allergy (FA).

OBJECTIVE

We assessed the impact of Omalizumab on efficacy, safety, and quality of life (FA-QoL) in patients with moderate to severe asthma and who have a history of anaphylaxis to peanut, tree nuts, fish, egg, milk, and/or wheat.

METHODS

Food-allergic children (6-18 years) with moderate to severe asthma underwent oral food challenges (OFCs) to establish the threshold of reaction to the culprit food(s) at baseline (T0) and at 4-month intervals (T1, T2, and T3) during their first year of treatment with Omalizumab. We recorded the number and severity of food-allergic reactions, Asthma Control Test (ACT) scores, FA-QoL, and total IgE levels.

RESULTS

In 65 patients allergic to 107 foods, the No Observed Adverse Events Level (NOAEL) at T1 increased: 243- and 488-fold for fresh and baked milk, respectively; 172- and 134-fold for raw and baked egg; 245-fold for hazelnut; 55-fold for peanut; 31-fold for wheat; and 10-fold for fish. Full tolerance was achieved in 66.4% of OFCs at T1, 58.3% at T2, and 75% at T3. Ninety-five foods were liberalized in the diet of 55 patients; the remaining 12 were introduced by 10 patients at least in traces. Throughout the study, 40 out of 65 were able to get a free diet. ACT increased from 17 (Q1-Q3: 15-17) to 23.6 (Q1-Q3: 23-25). The FA-QoL score in children ≤12 years decreased from 4.63 ± 0.74 to 2.02 ± 1.13, and in adolescents from 4.68 ± 0.92 to 1.90 ± 1.50.

CONCLUSIONS

During Omalizumab therapy, a safe reintroduction of allergenic foods is feasible.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT06316414.

Improved ovalbumin accurate quantitative performance in processed foods by full-length isotope-labeled protein

Ovalbumin (OVA) is a high-risk allergen with complex tertiary structure in food samples. Here, we developed an accurate UPLC-MS/MS-based assay to improve OVA quantitative performance in processed foods. Full-length isotope-labeled OVA proteins (OVA-I) were synthesized using stable isotope labeling by amino acids in cell culture (SILAC) technique and employed as functional internal standards to ensure similar cleavage sites between internal standards and analytes. Subsequently, OVA and OVA-I fully expose their key cleavage sites by using 10 mol/L urea denaturation to correct errors caused by structural variations in different food matrices, the possible denaturation mechanism was also explored. Three quantitative peptides were selected for OVA detection, achieving 88 %-117 % recoveries with RSDs <9.36 % across three different spiking levels. The LOQs were set as 5 μg/g. OVA risk assessment in Chinese general population exhibited high exposure risks with intake level of most processed foods ranged from 0.35 to 215.66 mg.

Barriers and Enablers of Dietary Reintroduction Following Negative Oral Food Challenge: A Scoping Review

BACKGROUND

After a negative oral food challenge (OFC), it is recommended for the individual to continue to consume the historical allergen regularly. However, the proportions of families achieving sustained reintroduction, and enablers and barriers for reintroduction, are currently unclear.

OBJECTIVE

To understand the frequency and definitions of optimal food reintroduction in children and adolescents after a negative OFC, and associated barriers and enablers.

METHOD

We conducted a scoping review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews of four databases (PubMed, Embase, CINAHL, and Web of Science) from 2000 until the present. Medical Subject Headings guided our systematic search, and dual screening and extraction were performed. We applied descriptive analysis to examine key themes aligned with our research questions.

RESULTS

In total, 2,270 articles were screened and 22 studies were included across nine countries. Peanuts were the most studied food (17 studies; 749 OFCs), followed by cow's milk (12 studies; 625 OFCs), hazelnut (four studies; 361 OFCs) and hen's egg (11 studies; 340 OFCs). What was considered to be a successful reintroduction was poorly and inconsistently described. Successful reintroduction (as defined by the authors) ranged from 14% to 86%, with failed reintroduction up to 50%. Nineteen studies (86%) examined barriers or enablers of reintroduction. Primary barriers were fear and anxiety as well as symptoms with reintroduction and aversion to or refusal of the food, whereas younger age, male sex, and guidance from clinicians were commonly reported enablers.

CONCLUSION

The number of families who do not reintroduce foods after OFC remains high, and clinicians need high-quality data to support families better.

Epicutaneous immunotherapy: A review of safety and efficacy

Epcutaneous immunotherapy (EPIT) is a novel, non-oral route of allergen immunotherapy, utilizing the skin and its robust density of epidermal Langerhans cells (LC) for antigen presentation. This space is non-vascularized and impermeable, which limits allergen exposure into the bloodstream but preserves antigen presentation to regional lymph nodes to generate gut-homing regulatory T cells. The EPIT patch utilizes natural water loss from the skin to absorb electrosprayed allergen through condensation. EPIT represents an alternative, non-oral route of immunotherapy for food allergy, with good efficacy and strong safety profiles across multiple phase 2 and 3 studies for milk and peanut. Efficacy appears the best in very young children (1-3 years old), which has been shown to continue to enhance with extended treatment duration up to 36 months. Efficacy in slightly older children ages 4-11 years of age is less clear, but appears to be better in children ages 4-7 years of age. In clinical trials of milk and peanut EPIT, most subjects experienced adverse effects, mainly mild-to-moderate skin reactions localized around the patch placement site, which improve with continued duration of wear. Rates of treatment-related anaphylaxis have been very low across all studies and ages, ranging from 1.6% to 4%, and were lowest in the infant and toddler population. While further studies of safety (1- to 3-year-olds) and efficacy (4- to 7-year-olds) are ongoing, EPIT is a potentially valuable addition to the current landscape of food allergy therapies, in particular for infants and toddlers where families may be seeking a non-oral route of treatment.

Advances in Mechanisms of Anaphylaxis in Wheat Allergy: Utility of Rodent Models

Wheat is a staple and nutritious food that is consumed globally. However, it is identified as a major allergenic food because of its capacity to trigger life-threatening systemic anaphylaxis. The specific mechanisms that underlie this systemic anaphylaxis in wheat allergy are incompletely understood. As a result, several rodent models have been developed to study anaphylaxis in wheat allergies. In this paper, we have conducted a comprehensive review of wheat-induced anaphylaxis using Google Scholar and PubMed databases with relevant keywords. The following objectives were addressed: (1) to determine the complexity of wheat-induced anaphylaxis; (2) to summarize the role of genetic susceptibility in wheat anaphylaxis; (3) to identify the environmental factors involved in the development of wheat anaphylaxis; (4) to map the current status of mechanisms involved in wheat anaphylaxis; (5) to identify the approaches, strengths, and limitations of rodent models of wheat anaphylaxis; and (6) to identify challenges and opportunities in this area of science. Our findings provide a comprehensive updated critical resource for the future research agenda in wheat allergy-associated anaphylaxis, particularly using rodent models as attractive pre-clinical tools.

LuLIPLEX: A Fast, Highly Sensitive, and Multiplexed Method for the Detection of IgE Against Major Allergens

BACKGROUND

Diagnosis of allergies is mostly based on the patient's clinical history and allergen provocation tests. Determination of specific IgE (sIgE) profiles can be performed to support allergy diagnosis. This is commonly done in vivo by the skin prick test or in vitro with automated systems. Several platforms exist to quantify sIgE levels, but all these methods require access to specific instruments, often delaying the test's results. The IgE luciferase-linked immunosorbent assay (LuLISA) allows bioluminescent quantification of IgE against peanut in microliter samples, but this method awaits extension to other allergens. This study aimed to validate a new method, named LuLIPLEX, for multiplexed bioluminescent detection of sIgE against 20 major molecular allergens.

METHODS

Quantification of sIgE against 12 recombinant or purified food allergens and eight aeroallergens was performed by LuLIPLEX versus standard IgE detection methods (ImmunoCAP, ISAC, ALEX, or NOVEOS). Multiplexed detection of IgE against these 20 allergens was performed within 45 min using 50 μL of serum, plasma, or whole blood samples.

RESULTS

A head-to-head comparison between LuLIPLEX and standard IgE detection methods showed a high correlation among all allergens tested. sIgE profiles in polysensitized subjects could be determined within 45 min in serum and plasma samples, as well as using a single drop of capillary blood.

CONCLUSIONS

LuLIPLEX is a rapid and sensitive method to quantify sIgE levels against multiple allergens. Given that the test is very fast and can be performed on small and inexpensive luminometers, the IgE LuLIPLEX could allow point-of-care testing of sIgE profiles in allergic subjects.

Industrial Trans Fatty Acids Promote the Development of Food Allergy in a Mouse Model

PURPOSE

The rising prevalence of food allergy (FA) has prompted investigations into dietary factors such as trans fatty acids (TFAs). While ruminant TFAs may protect against allergies, the role of industrial TFAs remains unclear. This study evaluated the effects of industrial TFAs on FA in a murine model.

METHODS

20 Balb/c mice were divided into 4 groups: control (standard diet), OVA (ovalbumin-sensitized, standard diet), TFAs (industrial TFA-enriched diet), and TFAs+OVA (TFA diet + OVA sensitization). After two weeks, OVA and TFAs+OVA groups underwent OVA sensitization/challenge. Symptoms (anal temperature drop, diarrhea), serum immunoglobulin E (tIgE, OVA-sIgE), cytokines, immune cell profiles, and gut microbiota were analyzed.

RESULTS

The incidence rates of anal temperature drop and diarrhea, the serum levels of tIgE, OVA-sIgE, interleukin-4 were significantly higher in the OVA and TFAs+OVA groups compared to the control group. The TFAs+OVA group had a higher degree of anal temperature drop and diarrhea score, and higher serum levels of tIgE and OVA-sIgE compared to the OVA group. The expression of interferon-γ mRNA and the numbers of Th1 cells increased in the spleen of the TFAs and TFAs+OVA group compared to the control group, whereas the numbers of spleen Th2 cells were significantly elevated in the TFAs, OVA, and TFAs+OVA groups compared to the control group. In addition, the numbers of mast cells (MCs) in the esophagus and intestinal mucosa, and the serum concentrations of MCs protease-1 were significantly increased in TFAs, OVA, and TFAs+OVA groups compared to the control group. Cecal microflora among these groups exhibited distinct patterns of differential diversity and composition.

CONCLUSIONS

Industrial TFAs may promote OVA-induced FA, Th1 and Th2-associated inflammation in mouse model, accompanied by the activation of MCs and intestinal microbiome dysbiosis.

Can exclusive breastfeeding in the first 4 months reduce food allergy?: A retrospective questionnaire study

BACKGROUND

IgE-mediated food allergy (FA) is a major global health concern. Although the early introduction of allergenic foods and breastfeeding are potential preventive strategies, the role of breast milk in reducing the incidence of FAs remains inconclusive.

OBJECTIVE

To investigate the impact of exclusive breastfeeding for the first 4 months compared with partial breastfeeding or cow's milk formula (CMF) on the development of IgE-mediated FAs in an Israeli cohort.

METHODS

A cross-sectional online survey in 3030 mothers with infants aged 6 to 24 months collected data on early feeding practices, allergen introduction, atopic conditions, and family history. It documented suspected allergic reactions, symptoms, and diagnostic procedures.

RESULTS

Of the 3030 mothers surveyed, 2920 provided complete feeding data for the first 4 months. Among them, 39.0% exclusively breastfed, 12.1% used CMF, and 48.9% partially breastfed. There were 392 infants with FAs, totaling 480 cases involving cow's milk, sesame, egg, or peanut. Of these cases, 122 (25.4%) were in the breastfeeding group, and 358 (74.6%) were in the other groups. Exclusively breastfed infants had lower odds of egg (odds ratio [OR] = 0.53), sesame (OR = 0.58), and peanut (OR = 0.53) allergies than others. The interaction between feeding patterns and atopic dermatitis (AD) related to these FAs was not significant. Exposure to CMF in the nursery, exclusively breastfed, was associated with higher odds of developing a cow's milk allergy. Delayed exposure to sesame in infants with AD has been linked to increased odds of developing a sesame allergy.

CONCLUSION

Exclusive breastfeeding may reduce the risk of IgE-mediated FA development, regardless of AD status.

Extracellular adenosine triphosphate: A new gateway for food allergy mechanism research?

Although various studies have been conducted, the detailed mechanisms of food allergy remain a topic of ongoing debate. Recently, researchers have reported that extracellular adenosine triphosphate (eATP), a member of damage-associated molecular patterns secreted by stressed cells, plays a critical role in the progression of asthma and atopic dermatitis. These studies suggest that dysregulated eATP significantly influences various aspects of disease progression, from bodily sensitization to the emergence of clinical manifestations. Given the shared pathogenic mechanisms among asthma, atopic dermatitis, and food allergies, we hypothesize that eATP may also serve as a crucial regulator in the development of food allergies. To elucidate this hypothesis, we first summarize the evidence and limitations of food allergy theories, then discuss the roles of eATP in allergic diseases. We conclude with speculative insights into the potential influence of eATP on food allergy development, aiming to inspire further investigation into the molecular mechanisms of food allergies.

Novel diagnostics in food allergy

Food allergy is increasing in prevalence, posing significant challenges for individuals and their families and adversely affecting their quality of life. Misdiagnosis can lead to unnecessary dietary and social limitations and increased food allergy risk, whereas failure to diagnose may result in life-threatening anaphylaxis. Therefore, a precise diagnosis is of the utmost importance; however, barriers exist at every stage of the diagnostic process. Diagnosis of food allergy relies on clinical history, IgE sensitization tests, and oral food challenge. Component testing and identification of optimal cutoffs have improved diagnostic accuracy. Nevertheless, many patients still require an oral food challenge, and better tests are needed to reduce this need. Novel ways of detecting biomarkers, such as the basophil activation test and peptide-specific IgE level, are transitioning into clinical practice. Future approaches may include the use of alternative biologic samples, novel laboratory technologies, and analytic tools (including artificial intelligence) to integrate test results and clinical information. Conscientious use of existing tests, access to tests with superior diagnostic accuracy, and combination of tests, can lead to improved precision of diagnosis of food allergy and timely introduction of tolerated foods into the diet. This review summarizes recent advances in novel approaches to food allergy diagnosis that can enhance clinical decision making both now and in the future.

Corydalis yanhusuo extract and its pharmacological substances alleviate food allergy by inhibiting mast cells activation via PLC/PKC/STAT3 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Food allergies have increasingly become a disease that affects global health and need for corresponding therapeutic drugs urgently. As a traditional Chinses medicine with a wide range of pharmacological effects, however, there was no clear research confirming therapeutic effect and pharmacological substances of Corydalis yanhusuo (YHS) on food allergies. Mast cells (MCs) are the main effector cells which mediate allergic and pseudo-allergic reactions.

MATERIALS AND METHODS

In this study, we investigated the effect of YHS extract on treating food allergy and its underlying mechanism. The inhibitory effect of YHS on MCs activation in vitro was evaluated by Ca2+ influx, degranulation, and cytokine release detection. The in vivo effect was investigated using the passive cutaneous anaphylaxis (PCA), active systemic allergy as well as OVA-induced food allergy mice. Western blot was performed to reveal the signaling pathway.

RESULTS

YHS extract showed an inhibitory effect on MCs activation and food allergy both in vitro and in vivo. PLC/PKC/STAT3 signaling pathway was suppressed by YHS extract in the disease. HPLC analysis revealed YHS extract contains corydaline and tetrahydropalmatine, and both compounds inhibited MCs activation induced by C48/80 in vitro.

CONCLUSION

YHS extract inhibited the MCs activation and food allergy via PLC/PKC/STAT3 pathway.

Insights into self-reported food allergies in Romanian schoolchildren

The prevalence of food allergy (FA) varies worldwide with an increasing rate in the last decades. Data of self-reported FA have been recorded by most European countries, the US, Canada and Australia, but not Romania. The aim of this study is to analyze the prevalence and severity of FA and to assess the extent of information the medical and teaching staff in schools have on students' medical history.

METHODS

A cross-sectional survey was performed in schoolchildren from Cluj-Napoca, Romania, using an online questionnaire delivered to their parents.

RESULTS AND CONCLUSIONS

Seven hundred and eight individuals completed the entire questionnaire. The prevalence of self-reported FA was 8.9%, 28.6% presented food-induced angioedema and 38.1% required ER presentation. Cow milk (36.5%), egg (9.5%), strawberry (20.6%) and nuts (2.7%)were the most frequent culprit foods. The lack of an appropriate and accurate communication with the medical and teaching staff in the school suggest the requirement for further measures for parents and children educations regarding food allergy detection and management.

Oral exposure to ovalbumin alters glucose metabolism in sensitized mice: upregulation of HIF-1α-mediated glycolysis

Food allergies are pathological adverse reactions against harmless dietary proteins. While studies have shown the involvement of host metabolic changes (e.g., lipid metabolism and amino acid metabolism) in the development of food allergy (FA), the adaptive changes in glucose metabolism induced by food allergen exposure remain largely unclear. In this study, BALB/c mice were sensitized intraperitoneally with an ovalbumin (OVA)/aluminum adjuvant, followed by oral OVA challenges to induce anaphylaxis. Increased levels of serum OVA-specific IgE and MCPT-1, and Th2 response bias were also presented in FA mice. Subsequently, the intestinal untargeted metabolomic analysis revealed the signature enrichment of glycolysis, manifested by increases in glycolytic metabolites including glucose-6-phosphate, fructose-6-phosphate, 2-phosphoglycerate, and lactate in FA mice. Consistently, the serum lactate level was found to be significantly elevated in allergic mice. Oral administration of OVA also upregulated the expression of critical metabolic enzymes in glycolysis, namely hexokinase 2, phosphoglycerate mutase 1, and lactate dehydrogenase. Moreover, the hypoxia inducible factor-1 (HIF-1) signaling pathway was activated in FA mice, and the expression of HIF-1α, known as the upstream regulator of glycolysis, was increased after oral OVA challenges. In vitro inhibition of HIF-1α was found to impede mast cell inflammatory responses to allergens. In summary, this study demonstrated that OVA-induced FA exhibited a glucose metabolic feature of HIF-1α-mediated glycolysis upregulation, suggesting the potential of HIF-1α/glycolysis targeted strategies in the alleviation of FA.

Confronting allergies: strategies for combating pollution and safeguarding our health

Increasing evidence demonstrates a robust link between environmental pollutants and allergic reactions, with air and indoor pollution exacerbating respiratory allergies and climate change intensifying seasonal allergies. Comprehensive action, including government regulations, public awareness, and individual efforts, is essential to mitigate pollution's impact on allergies and safeguard public health and ecological balance. Recent findings indicate a strong correlation between environmental pollutants and allergic reactions, with air pollution from vehicular emissions and industrial activities exacerbating respiratory allergies like asthma and allergic rhinitis. Additionally, indoor pollutants such as mold and volatile organic compounds are significant triggers of allergic responses, especially among vulnerable populations. Furthermore, climate change, driven by pollution, is intensifying seasonal allergies due to altered weather patterns and increased pollen production. This review emphasizes the critical importance of addressing pollution and allergies, highlighting the growing concerns in contemporary society. This review highlights the urgent need to address pollution and allergies, emphasizing their increasing significance in modern society and outlining effective allergy management strategies.

Synergistic Synbiotic-Containing Lactiplantibacillus plantarum and Fructo-Oligosaccharide Alleviate the Allergenicity of Mice Induced by Soy Protein

Prebiotics and probiotics have key roles in the intervention and treatment of food allergies. This study assesses the effect of Lactiplantibacillus plantarum synergistic fructo-oligosaccharide (Lp-FOS) intervention using an allergic mouse model induced by soy protein. The results showed that Lp synergistic FOS significantly decreased clinical allergy scores, inhibited specific antibodies (IgE, IgG, and IgG1), IL-4, IL-6, and IL-17A levels, and increased IFN-γ and IL-10 levels. Meanwhile, flow cytometry showed that Lp-FOS intervention inhibited the percentage of dendritic cell (DC) subsets in splenocytes and increased the Th1/Th2 and Treg/Th17 ratios. Furthermore, Lp-FOS intervention upregulated the mRNA levels of T-bet and Foxp3 and downregulated the mRNA levels of GATA3. Finally, non-targeted metabolomic analysis showed that Lp-FOS improved serum metabolic disorders caused by food allergies through regulating glycine, serine, and threonine metabolism, butanoate metabolism, glyoxylate and dicarboxylate metabolism, the biosynthesis of cofactors, and glycerophospholipid metabolism. These data showed that the combination formulation Lp-FOS could be a promising adjuvant treatment for food allergies.

Effect of Maillard reaction on the allergenicity of crude extract of Mactra quadrangularis

Food allergy incidents resulting from the consumption of Mactra quadrangularis is frequently reported. Investigating the impact of the Maillard reaction on the allergenicity of M. quadrangularis allergens is beneficial for the development of hypoallergenic mollusks aquatic products. This study examined the effects of the reaction products (Mactra-Xyl) on the allergenicity using Maillard reaction between crude extract (Mactra) of M. quadrangularis and xylose. The IgE-binding activity with sera from M. quadrangularis allergic patients and allergenicity potential by a mouse food allergy model of Mactra-Xyl were evaluated. Structural changes of Mactra-Xyl were analyzed by UV spectroscopy and surface hydrophobicity assessment, and the amino acid modification sites of the major allergen tropomyosin were further identified using LC-MS/MS. The sera results showed that the IgE-binding activity of Mactra-Xyl was reduced by 56.66 % ± 15.48 % compared to Mactra. In the BALB/c mouse food allergy model, the levels of specific IgE antibody and CD4+IL-4+ cells were significantly decreased, whereas the levels of IgG2a antibody and CD4+IFN-γ+ cells were observably increased in Mactra-Xyl group compared to those observed in Mactra group, thereby alleviating the allergic response. Furthermore, the UV fluorescence intensity and protein surface hydrophobicity of Mactra-Xyl were decreased. LC-MS/MS results revealed that 6 amino acid residues (K21, R77, K86, R140, K189, N202) on 4 IgE epitopes of tropomyosin in Mactra-Xyl were modified, the finding explain the reduced allergenicity of Mactra-Xyl. Therefore, this study provided a theoretical basis for the development of hypoallergenic M. quadrangularis products.

The Immune Regulatory Functions in B Cells Are Restored by CpG to Reduce Experimental Food Allergy

Dysfunctional immune regulation contributes to the pathogenesis of food allergy (FA). The mechanism behind regulatory B-cell dysfunction is unclear. CpG has immune regulatory functions. The purpose of this study is to use CpG to recover the immune suppressive functions of B cells in mice with FA. An FA mouse model was created using ovalbumin as the specific antigen. Flow cytometry was used to isolate B cells from the intestinal tissues. The immune regulatory functions of B cells were assessed using immunological approaches. The results showed that the FA response was linked to low IL-10 levels in gut lavage fluids of FA mice. FA mouse intestinal B cells produced lower amounts of IL-10 as compared with B cells isolated from naïve control mice. Impaired immune suppressive functions were observed in B cells isolated from the FA mouse intestine. The inducibility of the Il10 expression in naïve B cells of the intestine of FA mice was defective. The induction of Il10 expression in FA B cells could be restored by CpG through regulating the methylation status of the Cmip promoter. CpG promoted the therapeutic efficacy of allergen specific immunotherapy by restoring the induction of IL-10+ B cells in the intestine. The expression of Il10 in B cells of the FA mouse intestine was impaired. Administration of CpG could restore the expression of Il10 in B cells in the intestine and promote immunotherapy for FA.

'You grow with the allergy': a grounded theory study of families' experiences with food allergy risk or diagnosis in early childhood

OBJECTIVE

Childhood food allergy is increasing in western societies. Preventing and managing food allergies is therefore essential for both parents and children. Given the limited previous research on parents' experiences of food allergy prevention in early childhood, this study aimed to develop a grounded theory to understand the experiences and interactions of families whose children are at risk of, or have been diagnosed with, food allergy.

DESIGN

Using a constructivist grounded theory approach, we used initial, focused and theoretical coding, as well as constant comparative analysis and memoing to interpret our data.

SETTING

Thematic interviews were conducted in Germany between March and September 2022.

PARTICIPANT

We included 28 carers (25 mothers and 3 fathers) of children aged 0-3 years diagnosed with food allergy or at risk of food allergy. We recruited participants using snowball and theoretical sampling.

RESULTS

We developed a theory that we named 'negotiating uncertainty in childhood food allergy'. This theory describes the experiences and interactions of families with a child at risk or diagnosed with food allergy with the central phenomena of negotiation uncertainty. Negotiation is used to transform perceived challenges of uncertainty into feelings of competence in relation to (the prevention of) food allergy. Core themes included 'parental roles', 'healthcare', 'childcare', 'informal support' and 'family routines'. To cope with the challenges, parents relied on two main resources: self-efficacy and health literacy.

CONCLUSION

The study highlights the dynamic process of negotiation within families at risk of or coping with paediatric food allergy. Furthermore, our findings highlight the need to promote parental health literacy.

Household Food Allergen Exclusion Practices and Food Allergy-Related Psychosocial Functioning

This cross-sectional study examines households that exclude allergens by specific food allergy and the association of food allergy-related psychosocial functioning.

Breastfeeding Duration Is Not Associated With Offspring Inflammatory Bowel Disease Risk in Three Population-Based Birth Cohorts

BACKGROUND & AIMS

Breastfeeding is critical for offspring health and development. Although many observational studies report a protective effect between breastfeeding and inflammatory bowel disease (IBD), the relationship is not well-understood.

METHODS

We used prospectively collected data from 3 population-based birth cohorts (Danish National Birth Cohort, Norwegian Mother, Father, and Child Cohort, and All Babies in Southeast Sweden) and cross-linked national registers to ascertain the impact of breastfeeding duration on offspring IBD risk in each country, using adjusted Cox proportional regression analyses. We performed meta-analyses to determine pooled estimates.

RESULTS

We included 148,737 offspring and 169,510 offspring in analyses of exclusive and any breastfeeding duration, respectively. During median follow-up of 16.3-22.3 years, between 1996 and 2021, 543 offspring were diagnosed with IBD. In each country, there was no association between exclusive breastfeeding duration and offspring IBD risk after adjusting for birth year (Denmark), offspring sex, parental IBD status, maternal education, smoking during pregnancy, age at delivery, mode of delivery, preterm birth, and small for gestational age. The pooled adjusted hazard ratio for IBD was 1.24 (95% confidence interval, 0.94-1.62; Q = 0.16, I2 = 0.0%) and 1.02 (95% confidence interval, 0.85-1.21; Q = 1.45, I 2= 0.0%) among offspring breastfed exclusively for ≥6 months and <4 months, respectively, compared with 4-5 months. Similarly, we found null associations in pooled analyses of any breastfeeding duration and IBD, subtypes Crohn's disease and ulcerative colitis, as well as in cohort-specific analyses.

CONCLUSIONS

In prospectively collected data from 3 population-based birth cohorts, the duration of exclusive or any breastfeeding was not associated with offspring IBD risk.

An Overview of Adherence-What It Is and Why It Is Important

Asthma, allergic rhinitis, and food allergy are common allergic diseases, yet adherence to many management options remains poor, leading to worse health outcomes and financial implications for society and health systems. The underlying causes of nonadherence are numerous, ranging from patient-specific factors to broader socioeconomic and systems-based factors. In this review, we aim to discuss the definition of adherence, which can be divided into 3 components: initiation, implementation, and persistence, as well as to review various methods of measuring adherence. Subsequently, we will review the epidemiology of adherence to asthma and allergic rhinitis medications, allergen immunotherapy, and oral immunotherapy. Finally, we will discuss the multifaceted etiology of poor adherence and its subsequent impact on patients and society.

The epithelial barrier theory and its associated diseases

The prevalence of many chronic noncommunicable diseases has been steadily rising over the past six decades. During this time, over 350,000 new chemical substances have been introduced to the lives of humans. In recent years, the epithelial barrier theory came to light explaining the growing prevalence and exacerbations of these diseases worldwide. It attributes their onset to a functionally impaired epithelial barrier triggered by the toxicity of the exposed substances, associated with microbial dysbiosis, immune system activation, and inflammation. Diseases encompassed by the epithelial barrier theory share common features such as an increased prevalence after the 1960s or 2000s that cannot (solely) be accounted for by the emergence of improved diagnostic methods. Other common traits include epithelial barrier defects, microbial dysbiosis with loss of commensals and colonization of opportunistic pathogens, and circulating inflammatory cells and cytokines. In addition, practically unrelated diseases that fulfill these criteria have started to emerge as multimorbidities during the last decades. Here, we provide a comprehensive overview of diseases encompassed by the epithelial barrier theory and discuss evidence and similarities for their epidemiology, genetic susceptibility, epithelial barrier dysfunction, microbial dysbiosis, and tissue inflammation.

Molecular allergology: a clinical laboratory tool for precision diagnosis, stratification and follow-up of allergic patients

Identification of the molecular culprits of allergic reactions leveraged molecular allergology applications in clinical laboratory medicine. Molecular allergology shifted the focus from complex, heterogeneous allergenic extracts, e.g. pollen, food, or insect venom, towards genetically and immunologically defined proteins available for in vitro diagnosis. Molecular allergology is a precision medicine approach for the diagnosis, stratification, therapeutic management, follow-up and prognostic evaluation of patients within a large range of allergic diseases. Exclusively available for in vitro diagnosis, molecular allergology is nonredundant with any of the current clinical tools for allergy investigation. As an example of a major application, discrimination of genuine sensitization from allergen cross-reactivity at the molecular level allows the proper targeting of the culprit allergen and thus dramatically improves patient management. This review aims at introducing clinical laboratory specialists to molecular allergology, from the biochemical and genetic bases, through immunological concepts, to daily use in the diagnosis and management of allergic diseases.

Nutritional Considerations of Plant-Based Diets for People With Food Allergy

Plant-based diets (PBD) have been reported throughout history, but are increasingly common in current times, likely in part due to considerable emphasis on climate change and human health and wellness. Many dietary organisations around the world endorse well-planned, nutritionally adequate PBD, which exclude some or all forms of animal-based foods. However, special attention must be given to patients who follow PBD and also have food allergy (FA), as avoidance may increase the risk of developing nutritional deficiencies, including poor growth in children, weight loss in adults and vitamin and mineral deficiencies. Given the increasing prevalence of both PBD and food allergen avoidance diets, healthcare providers are likely to counsel patients with FA who also follow a PBD. In this review, an overview of PBD in patients with FA is provided, including recent trends, macro- and micronutrient needs, and growth for children and weight gain considerations for adults. With regard to a PBD, special attention should be given to ensure adequate fat and protein intake and improving the bioavailability of several minerals such as iron, zinc, iodine, calcium and magnesium, and vitamins such as A, B2, B12 and D. Although the collective data on growth amongst children following a PBD are varied in outcome and may be influenced in part by the type of PBD, growth must be regularly monitored and in adults weight gain assessed as part of any clinical assessment in those people with FA.

Utility of epitope-specific IgE, IgG4, and IgG1 antibodies for the diagnosis of wheat allergy

BACKGROUND

The bead-based epitope assay has been used to identify epitope-specific (es) antibodies and successfully used to diagnose clinical allergy to milk, egg, and peanut.

OBJECTIVE

We sought to identify es-IgE, es-IgG4, and es-IgG1 of wheat proteins and determine the optimal peptides to differentiate wheat-allergic from wheat-tolerant using the bead-based epitope assay.

METHODS

Children and adolescents who underwent an oral food challenge to confirm their wheat allergy status were enrolled. Seventy-nine peptides from α-/β-gliadin, γ-gliadin, ω-5-gliadin, and high- and low-molecular-weight glutenin were commercially synthesized and coupled to LumAvidin beads (Luminex Corporation, Austin, Tex). Machine learning methods were used to identify diagnostic epitopes, and performance was evaluated using the DeLong test.

RESULTS

The analysis included 122 children (83 wheat-allergic and 39 wheat-tolerant; 57.4% male). Machine learning coupled with simulations identified wheat es-IgE, but not es-IgG4 or es-IgG1, to be the most informative for diagnosing wheat allergy. Higher es-IgE binding intensity correlated with the severity of allergy phenotypes, with wheat anaphylaxis exhibiting the highest es-IgE binding intensity. In contrast, wheat-dependent exercise-induced anaphylaxis showed lower es-IgG1 binding intensity than did all the other groups. A set of 4 informative epitopes from ω-5-gliadin and γ-gliadin were the best predictors of wheat allergy, with an area under the curve of 0.908 (sensitivity, 83.4%; specificity, 88.4%), higher than the performance exhibited by wheat-specific IgE (area under the curve = 0.646; P < .001). The predictive ability of our model was confirmed in an external cohort of 71 patients (29 allergic, 42 nonallergic), with an area under the curve of 0.908 (sensitivity, 75.9%; specificity, 90.5%).

CONCLUSIONS

The wheat bead-based epitope assay demonstrated greater diagnostic accuracy compared with existing specific IgE tests for wheat allergy.

Omalizumab Implementation in Practice: Lessons Learned From the OUtMATCH Study

In February 2024, omalizumab was approved by the U.S. Food and Drug Administration for the treatment of food allergy, based on data from the landmark phase 3 clinical trial, Omalizumab as Monotherapy and as Adjunct Therapy in Children and Adults (OUtMATCH). In this Rostrum, OUtMATCH investigators share their perspectives on the trial results, the implications for translation into daily practice, and on remaining gaps in the field. The study met its primary and key secondary end points, demonstrating a large effect size in multiallergen desensitization compared with placebo; yet there were some participants who did not respond, and the percentage of responders tolerating all 3 food allergens was lower than that for single foods. Clinicians are likely to have many questions about appropriate patient selection, monitoring for treatment responsiveness, and how to manage off-label considerations such as dietary incorporation or cotreatment with oral immunotherapy. Additional research is needed to answer these remaining questions and ensure that the translation of omalizumab in real-world practice leads to high-quality outcomes.

Interpreting epidemiologic distribution of total and specific IgE levels for food allergy in Southern China from 2004 to 2023: understanding the mechanisms and focusing on prevention

BACKGROUND

The burgeoning prevalence of food allergy-related diseases is closely associated with geographical allergen distribution and societal lifestyle paradigms. This study aims to shed light on the distribution patterns of specific IgE (sIgE) and total IgE (tIgE) reactivity to common food allergens in the Southern Chinese populace.

METHODS

Employing an analytical technique spanning two decades, we conducted specific IgE and total IgE on serum samples harvested from patients with food allergy-related pathologies at First Affiliated Hospital of Guangzhou Medical University from 2004 to 2023. This comprehensive examination of eight prototypical food allergens: egg white, milk, wheat, sesame, peanut, soybean, shrimp, and crab.

RESULTS

Our analysis showed a 100% positivity rate for sIgE and an 86.54% positivity rate for tIgE. Milk had the highest positive response rate, followed by egg white and shrimp. Age-stratified data indicated that milk sensitization peaked in children aged 2 years or younger, while egg white sensitization peaked between 3 and 5 years of age. Sensitization rates for the remaining six allergens increased with age. Additionally, co-sensitization was observed between milk, egg white, crab, and shrimp with other allergens.

CONCLUSION

In common allergens of Southern China, egg white, milk, and shrimp ascend as the dominant subjects, underlining their imperative role in food allergy pathogenesis. This landscape-wide allergenic profiling, segregated across age clusters and enhanced by co-sensitization data, augments our power for early diagnosis and strategic intervention in food allergy diseases.

Egg White Diet Induces Severe Allergic Enteritis in an Animal Model Driven by Caspase-3 and Gasdermin C-Mediated Mucosal Alarmin Secretion

Allergic enteritis is an important phenotype of food allergies. However, there is not a suitable animal model for deeply exploring the natural progression and mechanism of allergic enteritis. In our study, we successfully developed an allergic enteritis animal model by feeding mice with an egg white diet. Following the dietary challenge, allergic mice displayed typical food allergy manifestations, including decreased core temperature, aversion to the allergenic diet, and elevated levels of serum sIgE and mMCP-1. Notably, these dietary challenged mice exhibited severe gut damage, characterized by disrupted intestinal microstructure, tissue inflammation, and edema that were evident morphologically. Moreover, upon exposure to food allergens, we observed a marked increase in caspase-3 and GSDMC levels in allergic mice. These two active proteins were found to be colocalized in damaged mucosal enterocytes and were associated with the secretion of epithelial sourced alarmins, such as IL25 and TSLP. Further data on the cellular and molecular levels suggest that such severe food-induced enteritis is mediated by the caspase-3-GSDMC pathway. We believe that this established animal model provides a valuable tool for advancing research on the mechanisms of food allergies.

Safety and adherence of early oral immunotherapy for peanut allergy in a primary care setting: a retrospective cross-sectional study

BACKGROUND

Peanut allergy is a common food allergy with potentially life-threatening implications. Early oral immunotherapy for peanut allergy (P-EOIT) has been shown to be effective and safe in research and specialty clinic settings. Provision of P-EOIT in primary care would make it available to more patients. We sought to assess the safety of P-EOIT in a primary care setting by documenting the rates of peanut-related allergic reactions leading to emergency department (ED) visits and use of epinephrine. We also examined adherence by assessing the percentage of patients reaching maintenance phase and continuing ingestion after one year of P-EOIT.

METHODS

This retrospective study included all patients aged less than 36 months who started P-EOIT at a primary care allergy clinic in New Brunswick, Canada, from 2016 to 2020. The population included patients who (1) had a history of an allergic reaction to peanuts with a positive skin prick test or positive peanut specific IgE level (ps-IgE) or (2) no history of ingestion and a baseline ps-IgE ≥5 kU/L. Patients had biweekly clinic visits with graded increases in peanut protein up to a maintenance dose of 300 mg of peanut protein daily. A blinded retrospective review of paper charts and electronic medical records was conducted along with phone interviews regarding ED visits and epinephrine use.

RESULTS

All 69 consented patients reached maintenance dose over a median of 29 weeks, and 66 patients (95.7%) were still regularly consuming peanut protein after 1 year of maintenance. One patient had a peanut ingestion-related ED visit requiring epinephrine during the escalation phase of peanut protein dosing (1.4%). During the first year of maintenance phase, no patients had peanut ingestion-related ED visits nor required epinephrine.

CONCLUSION

Early oral immunotherapy for peanut allergy in a primary care setting appears to be safe and our findings suggest that it does not lead to an increased burden of emergency department visits. Our population had high adherence rates, with the majority achieving maintenance dose and staying on this dose for one year.

Food Allergy: Epidemiology, Pathogenesis, Diagnosis, and Treatment

Food allergy (FA) is a complex disease characterized by an immunological adverse reaction that may occur following exposure to apparently harmless food allergens [...].

IBD functions as a double-edged sword for food allergy in BALB/c mice model

Inflammatory bowel disease (IBD) and food allergy (FA) increase in tandem, but the potential impact of IBD on FA remains unclear. We sought to determine the role of IBD on FA. We first assessed the changes of FA-related risk factors in dextran sulphate sodium salt (DSS) induced colitis mice model. Then, we evaluated the role of IBD on FA in mice. FA responses were determined using a clinical allergy score, body temperature change, serum antibody levels, cytokines level and mouse mast cell protease 1 (MMCP-1) concentration. Accumulation of regulatory T cells was tested using flow cytometry. Intestinal changes were identified by histology, immunohistochemistry, gene expression and gut microbial community structure. In DSS-induced colitis mice model, we found the intestinal damage, colonic neutrophil infiltration, and downregulation of splenic Th2 cytokines and Tregs in mesenteric lymph nodes (MLN). Moreover, we also found that IBD can alleviate the FA symptoms and lead to the significant downregulation of Th2 cytokines, serum IgE and MMCP-1. However, IBD exacerbates intestinal injury and promotes the gene expression levels of IL-33 and IL-5 in the small intestine, damages the intestinal tissue structure and aggravates intestinal dysbiosis in FA. IBD functions as a double-edged sword in FA. From the perspective of clinical symptoms and humoral immune responses, IBD can reduce FA response by downregulating Th2 cytokines. But from the perspective of the intestinal immune system, IBD potentially disrupts intestinal tolerance to food antigens by damaging intestinal tissue structure and causing intestinal dysbiosis.

Long-chain fatty acids block allergic reaction against lipid transfer protein Sola l 7 from tomato seeds

Due to the benefits of tomato as an antioxidant and vitamin source, allergy to this vegetable food is a clinically concerning problem. Sola l 7, a class I lipid transfer protein found in tomato seeds, has been identified as an allergen linked to severe anaphylaxis. However, the role of lipid binding in Sola l 7-induced allergy remains unclear. Here, the three-dimensional structure of recombinant Sola l 7 (rSola l 7) has been elucidated using nuclear magnetic resonance spectroscopy (NMR). Its interaction with free fatty acids has been deeply studied; fluorescence emission spectroscopy revealed that different long-chain fatty acids interact with the protein, affecting the only tyrosine residue present in Sola l 7. On the contrary, no changes in the overall secondary structure were observed after the analysis of the circular dichroism spectra in the presence of fatty acids. Unsaturated oleic and linoleic fatty acids presented higher affinity and promoted more significant changes than saturated or short-chain fatty acids. 1H-15N HSQC NMR spectra allowed to determine the regions of the protein that were modified when rSola l 7 interacts with the fatty acids, suggesting epitope modification after the interaction. For corroboration, IgG and IgE binding to rSola l 7 were assessed in the presence of free fatty acids, revealing that both IgE and IgG binding were significantly lower than in their absence, suggesting a potential protective role of unsaturated fatty acids in tomato allergy.

Buckwheat Allergy in Asia

PURPOSE OF REVIEW

Buckwheat (BW) allergy is a significant issue in Asia. This review delves into three types of BW allergy: immediate food allergy; food-dependent, exercise-induced anaphylaxis (FDEIA) as a subset of immediate food allergy; and food protein-induced enterocolitis syndrome (FPIES); by comparing data from Asian and non-Asian countries.

RECENT FINDINGS

Most studies on BW have been published in Japan and Korea, and only a few studies on the topic have been done outside Asia. To date, seven components of common BW (Fagopyrum esculentum) and four components of Tartary BW (Fagopyrum tartaricum) have been implicated in BW allergy. Although BW-sIgE has limited utility for evaluating immediate BW allergy, Fag e 3-specific IgE, one of the components of common BW, and the skin prick test are diagnostically useful. The present review aims to shed light on the current state of knowledge, highlight research gaps, and suggest future directions in the management and understanding of BW allergy.

Using a survey, analyzing the current situation of allergic March in elementary and junior high school students of oyama and tochigi cities, Japan

BACKGROUND

Over the past few decades, allergic diseases have become more prevalent and impact around 20% of the global population. There is clinical significance of allergic march as it places a burden on the quality of life of children and their families.

OBJECTIVES

To assess the current situation of allergy conditions experienced by children attending elementary and junior high schools in Oyama and Tochigi cities, Japan.

METHODS

A letter was sent to parents informing them about an opt-in online survey concerning children's allergies along with a weblink and a QR code. A video explained the survey process and informed parents that their replies could not be retracted. Parents who had watched the explanation video and answered yes to participating were considered to have provided consent for the survey.

RESULTS

A total of 2038 valid replies were gathered. Allergic Rhinitis was the most commonly diagnosed allergy, followed by Asthma, Food Allergy, and Atopic Dermatitis. Around 70% of the children were affected by the allergies, of whom half had been affected by multiple allergies. Most children affected by Atopic Dermatitis, Food Allergy or Asthma were affected by other allergies. Atopic Dermatitis and Food Allergy were mostly diagnosed before Asthma and Allergic Rhinitis.

CONCLUSIONS

Children who are diagnosed with either Atopic Dermatitis or a Food Allergy will likely be affected by other allergies later in life. Allergic march perpetuated an earlier peak diagnosis incident rate for allergic rhinitis. Allergic Rhinitis can occur independently from other allergies compared to Atopic Dermatitis, Food Allergy and Asthma.

Current perspective on allergen immunotherapy for food allergies

Food allergies are an increasing global problem and societal issue. In addition to the potential for severe allergic reactions from accidental ingestion, food allergies impose a significant burden on the quality of life, nutrition, cost of living, and social activities of both those afflicted and their caregivers. Strict avoidance of allergens and use of emergency medications to treat allergic reactions are the traditional management and treatment strategies; however, significant progress has been made in recent years toward better treatment of food allergies. Many clinical trials on food allergen immunotherapy (oral, epicutaneous, and sublingual) have revealed its efficacy in increasing reaction thresholds and desensitization. These positive results led to the first FDA approval of peanut oral immunotherapy (OIT). However, safer and more effective approaches are required, and adjunct treatments and allergen modifications are being considered. More than 100 facilities in Japan conduct OIT, and numerous studies on it have been reported. Unlike in Europe and the US, stepwise oral food challenges with dietary guidance are conducted separately from the OIT. This review describes the current perspectives on allergen immunotherapy for the treatment of food allergies, focusing on evidence from Japan.

Evaluation of a Novel Detection Method for Allergen-Specific IgE Antibodies with IgE Receptor Crosslinking Using Rat Food Allergy Model

The specific detection of serum IgE antibodies specific to allergens (sIgE Abs) that can crosslink the plural high-affinity IgE receptor (FcεRIα) molecules on the surface of mast cells or basophils with a multivalent allergen can reduce the false-positive diagnoses observed in chemiluminescent and fluorescence enzyme immunoassays for type-I allergic patients. In this study, we detected sIgE Abs to the egg-allergen ovalbumin (OVA) and the wheat-allergen gluten in the sera of rats sensitized with each allergen using an amplified luminescence proximity homogeneous assay by crosslinking (AlphaCL). OVA and gluten were reacted with each sIgE Ab in the sera. Then, acceptor and donor beads labeled with the human FcεRIα were added to the reacted solution. The luminescence intensity for anti-OVA IgE Abs in the sera with the removal of IgG Abs was observed in five of seven (71.4%) of the sensitized rats, whereas no signals were observed in any of the unsensitized rats. The AlphaCL could also detect anti-gluten sIgE Abs in the sera of sensitized rats, but not of unsensitized rats. In conclusion, we successfully detected sIgE Abs in the sera of rats sensitized to two allergens using the AlphaCL. This detection method has the potential to be used as a new diagnostic tool for type-I allergic patients.

Breastfeeding and risk of food allergy and allergic rhinitis in offspring: a systematic review and meta-analysis of cohort studies

The association between breastfeeding and the occurrence of allergic rhinitis (AR) and food allergy (FA) in offspring remains inconclusive. This review aims to comprehensively explore the potential relationships between various patterns and durations of breastfeeding and allergic diseases in offspring. We systematically searched PubMed, EMBASE, Cochrane, WOS databases, and Google Scholar for observational studies published up to March 30, 2023, that investigated the link between breastfeeding and allergies in offspring. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI). Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were calculated employing an appropriate model based on the degree of heterogeneity. A total of 68 studies, encompassing 772,142 children, were ultimately included. The findings indicated that breastfeeding for more than 6 months was associated with a reduced risk of AR (OR = 0.88, 95% CI: 0.79 to 0.98) but posed a risk for FA (OR = 1.69, 95% CI: 1.27 to 2.25). Exclusive breastfeeding exhibited a protective effect against AR (OR = 0.94, 95% CI: 0.90 to 0.97), whereas non-breastfeeding was identified as a risk factor for AR (OR = 1.48; 95% CI: 1.03 to 2.12). No significant association was observed between breastfeeding patterns and FA.

CONCLUSION

Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, large prospective high-quality studies are needed to investigate the potential risk of FA in children with prolonged breastfeeding.

WHAT IS KNOWN

• The impact of breastfeeding on allergic rhinitis and food allergy in offspring is controversial. • Previous meta-analyses fail to prove the effect of breastfeeding on food allergy in offspring of all ages.

WHAT IS NEW

• Breastfeeding for more than 6 months proves to be an effective preventive measure against AR. However, it potentially elevates the risk of FA in children. Non-breastfeeding is linked to an increased risk of AR in children, but there is no evidence of an association between breastfeeding patterns and FA in children. • The impact of breastfeeding on allergic rhinitis and food allergy in offspring may vary with the time and pattern of breastfeeding.

Food allergy in a changing dietary landscape: A focus on the Asia Pacific region

Recent studies have provided compelling evidence to suggest that various environmental factors play a significant role in the development of food allergies. As our society experiences rapid economic growth, increased urbanization, and a shift towards a more Westernized diet, the incidence of food allergies is also on the rise and the pattern is gradually evolving. This review will delve into the changes in the epidemiology of food allergies within the Asia-Pacific region and the various dietary practices and factors that are postulated to play a role in the rise in food allergies over the years. Although there have been important advancements in the field of food allergies, there are still numerous uncertainties regarding the intricate relationship between diet and food allergies. Specifically, the role of epigenetic factors in influencing the susceptibility to food allergies, as evidenced by studies that assessed the impact of migration and rural-urban dynamics, is not fully understood. Addressing this knowledge gap presents an opportunity to develop more effective prevention and treatment strategies that could greatly benefit individuals living with food allergies.

Targeting inhibitory Siglec-3 to suppress IgE-mediated human basophil degranulation

BACKGROUND

Sialic acid-binding immunoglobulin-like lectin-3 (Siglec-3 [CD33]) is a major Siglec expressed on human mast cells and basophils; engagement of CD33 leads to inhibition of cellular signaling via immunoreceptor tyrosine-based inhibitory motifs.

OBJECTIVE

We sought to inhibit human basophil degranulation by simultaneously recruiting inhibitory CD33 to the IgE-FcεRI complex by using monoclonal anti-IgE directly conjugated to CD33 ligand (CD33L).

METHODS

Direct and indirect basophil activation tests (BATs) were used to assess both antigen-specific (peanut) and antigen-nonspecific (polyclonal anti-IgE) stimulation. Whole blood from donors with allergy was used for direct BAT, whereas blood from donors with nonfood allergy was passively sensitized with plasma from donors with peanut allergy in the indirect BAT. Blood was incubated with anti-IgE-CD33L or controls for 1 hour or overnight and then stimulated with peanut, polyclonal anti-IgE, or N-formylmethionyl-leucyl-phenylalanine for 30 minutes. Degranulation was determined by measuring CD63 expression on the basophil surface by flow cytometry.

RESULTS

Incubation for 1 hour with anti-IgE-CD33L significantly reduced basophil degranulation after both allergen-induced (peanut) and polyclonal anti-IgE stimulation, with further suppression after overnight incubation with anti-IgE-CD33L. As expected, anti-IgE-CD33L did not block basophil degranulation due to N-formylmethionyl-leucyl-phenylalanine, providing evidence that this inhibition is IgE pathway-specific. Finally, CD33L is necessary for this suppression, as monoclonal anti-IgE without CD33L was unable to reduce basophil degranulation.

CONCLUSIONS

Pretreating human basophils with anti-IgE-CD33L significantly suppressed basophil degranulation through the IgE-FcεRI complex. The ability to abrogate IgE-mediated basophil degranulation is of particular interest, as treatment with anti-IgE-CD33L before antigen exposure could have broad implications for the treatment of food, drug, and environmental allergies.

What molecular allergy teaches us about genetics and epidemiology of allergies

PURPOSE OF REVIEW

To delineate pertinent information regarding the application of molecular allergology within the realm of both genetic and epidemiological facets of allergic diseases.

RECENT FINDINGS

The emergence of molecular allergy has facilitated the comprehension of the biochemical characteristics of allergens originating from diverse sources. It has allowed for the exploration of sensitization trajectories and provided novel insights into the influence of genetics and environmental exposure on the initiation and development of allergic diseases. This review delves into the primary discoveries related to the genetics and epidemiology of allergies, facilitated by the application of molecular allergy. It also scrutinizes the impact of environmental exposure across varied geoclimatic, socioeconomic, and lifestyle contexts. Additionally, the review introduces specific models of molecular allergy within the realms of plants and animals.

SUMMARY

The utilization of molecular allergy in clinical practice holds crucially acknowledged diagnostic and therapeutic implications. From a research standpoint, there is a growing need for the widespread adoption of molecular diagnostic tools to achieve a more profound understanding of the epidemiology and natural progression of allergic diseases.