Feast for thought: A comprehensive review of food allergy 2021-2023

Food allergens in immune systems

The immune system has a complex to protect the host from infection by various pathogens, including viruses, bacteria, fungi, and parasites. The immune system protects against infection by recognizing and destroying harmful foreign pathogens. As humans evolve over a long period of time, tolerance is formed to most foods that do not stimulate the immune system, but some foods induce immunity in certain individuals and cause allergic diseases. The immune system must understand the difference between foreign substances and your own body cells. There are different types of white blood cells, which are essential components of the immune system that protect the host from infection. Unlike other immune cells, mast cells and basophils are involved in food allergic reactions. This review article will look at peanut allergens, the most serious food allergies that threaten and irritate an individual's immune system, putting them at risk of life.

Di(2-ethylhexyl) Phthalate (DEHP) Exacerbates Food Allergy via Intestinal Barrier Dysfunction and Enhancing Allergic Sensitization

Di(2-ethylhexyl) phthalate (DEHP), a ubiquitous plasticizer, has raised concerns due to its potential role in exacerbating food allergy through chronic human exposure. The study aimed to investigate the potential effects of DEHP on ovalbumin (OVA)-induced food allergy and elucidate the underlying mechanisms related to intestinal barrier homeostasis. In OVA-sensitized BALB/c mice, DEHP exposure significantly exacerbated allergic responses by functioning as an immunoadjuvant, as evidenced by heightened anaphylactic symptoms, elevated serum levels of inflammatory mediators (IgE, IgG, IgG1, IgG2), and increased concentrations of histamine and monocyte chemoattractant protein-1 (MCP-1). Furthermore, DEHP disrupted intestinal barrier integrity and impaired mucin secretion. Administration of high-dose DEHP significantly downregulated the expression of tight junction proteins and mucins. Histopathological analysis revealed goblet cell depletion and diminished mucin production. The results suggest that DEHP exacerbated food allergy through a multifactorial mechanism involving intestinal barrier dysfunction and immune dysregulation. This study establishes a critical association between oral DEHP exposure and food allergy pathogenesis, providing insights into the interplay of environmental pollutants, intestinal immunity, and food allergy manifestation.

Non-allergenic mixed T cell epitope peptides for preventing Scy p 9 allergic reactions

Filamin c is an allergen with strong IgE-binding activity of Scylla paramamosain (named Scy p 9). In this study, the T cell epitopes of Scy p 9 were identified using the CD4+T lymphocyte proliferation assay in the mononuclear cells of the spleen allergic mice. Nine of the thirteen T cell epitope peptides that have been found have the ability to trigger the production of the Th1 cytokine (IFN-γ) and TGF-β. Meanwhile, the findings of the inhibitory Dot blot and basophil activation test of crab allergy patients showed that the mixed nine T cell epitope peptides lacked IgE-binding activity and was unable to stimulate the expression of CD63 and CD203c on the surface of basophils. Non-allergenic mixed T cell epitope peptides (NAMTEP) demonstrate the potential for preventing Scy p 9 allergies. According to the evaluation of the preventive effect of Scy p 9 allergy mouse model, mice challenged with oral administration of Scy p 9 after early injection of NAMTEP did not show any allergic symptoms. NAMTEP inhibited IgE generation and Th2 immune response, preventing Scy p 9 allergy reactions in mice. These results would provide a theoretical foundation for the specific prevention of allergens in crustacean aquatic products.

The reduction effect on sensitization of sesame protein Ses i 3 of ultrasound-assisted glycation treatment through modulation of T cell differentiation

This study aimed to investigate the potential reduction on the sensitization of sesame protein Ses i 3 through ultrasound-assisted glycation. Ses i 3 was extracted and purified using an immunoaffinity column, and the allergenicity changes of Ses i 3 were assessed by a comprehensive strategy, and T cell polarization was also assessed in vivo. Results showed ultrasound-assisted glycation treated Ses i 3 was more easily digestible; and the cell degranulation model showed the histamine, tryptase, and β-hexosaminidase induced by ultrasound-assisted glycation treatment were significantly decreased; besides, the serological results demonstrated that a notable decrease in the binding ability of immunoglobulin E (IgE) and IgG; finally, a BALB/c mice model demonstrated an alleviation of allergic responses induced by ultrasonic-assisted glycation treatment. Meanwhile, the results in vivo also found that ultrasonic-assisted glycation treated Ses i 3 induced enhanced Helper T cell (TH) 1 cell differentiation while weakening TH2 cell differentiation, promoting TH1/TH2 balance polarization. Additionally, it induced stronger regulatory T (Treg) cell differentiation, and suppressed TH17 cell differentiation, promoting Treg/TH17 balance. This study demonstrated that the sensitization of Ses i 3 was reduced after ultrasonic-assisted glycation treatment, and this effect was associated with the modulation of T cell differentiation.

Screening and Interaction Analysis of Shark-Derived Nanobodies against Crayfish Major Allergen Pro c 2

Pro c 2 (arginine kinase) is a major allergen in crayfish (Procambarus clarkii). Shark-derived variable domains of new antigen receptors (VNARs) have advantages in developing allergen detection and immunotherapy. This study constructed a VNAR domain library from Chiloscyllium plagiosum immunized with Pro c 2. Three VNARs (VNAR-11, VNAR-20, and VNAR-29) against Pro c 2 obtained by screening the library were expressed in the HEK293F cells, fusing with the immunoglobulin (Ig) G1 Fc fragment (VNAR-Fc-11, VNAR-Fc-29, and VNAR-Fc-20). The VNAR-Fc fusions bound to Pro c 2 with an affinity KD ranging from 0.2131 ∼ 465.3 μM, with the ability to inhibit patients' IgE binding to Pro c 2. VNAR-20 and VNAR-29 displayed more stable binding with Pro c 2 during molecular dynamics simulation. The binding sites of the VNARs are distributed in the conserved IgE epitopes of arginine kinase. These achievements indicate the application potential of VNARs in allergen detection and allergy therapeutics.

Global aspects of celiac disease and food allergy

Celiac disease and food-allergy are both food-related chronic immune disorders with a common pathogenic link being breakdown in the gut tolerance to otherwise innocuous food antigens. Notwithstanding the similarities, there are significant differences in the pathogenesis of both disorders, which translates to variations in clinical presentations, diagnostic tools and disease epidemiology. The past few decades have witnessed a global increase in prevalence and incidence of both disorders, driven both by true rise due to epidemiological factors and unmasking of previously undiagnosed disease due to better diagnostics and health seeking behavior, related to economic factors. Worldwide as more cases are diagnosed, disparities in healthcare and resources available for disease management are increasingly becoming more relevant but are infrequently discussed. In this review we will discuss the global epidemiology of celiac disease and food allergy, their epidemiological risk factors and future directions for their improved diagnosis and management.

Leveraging an mRNA Platform for the Development of Vaccines Against Egg Allergy

Background: Food allergy (FA) poses a major global health issue due to the increasing prevalence and lack of effective prevention strategies. Allergen-specific immunotherapy (AIT) has emerged as a disease-modifying therapy for FA. However, due to long-term treatment duration and unexpected adverse reactions, only a minority of patients benefit from AIT. Therefore, effective prophylactic interventions are urgently needed for FA patients. Methods: In this proof-of-concept study, using a well-established mRNA platform, we developed mRNA vaccine candidates encoding for the major egg white allergen Gal d2 and comprehensively evaluated their prophylactic efficacy against anaphylaxis in a Gal d2-induced allergic mouse model. Results: Two vaccine formulations, Gal d2 mRNA vaccine and Gal d2-IL-10 mRNA vaccine, both demonstrated potent ability in inducing allergen-specific IgG and Th1-type T cells. Importantly, the two vaccine formulations showed promise in preventing the onset of allergic disease, which is indicated by prevention of body temperature decline during anaphylaxis. Conclusions: We provided preliminary proof-of-concept evidence showing that the mRNA platform is unique and holds promise for the development of anti-allergy vaccines. This is largely attributed to the capacities of mRNA vaccines in eliciting an allergen-blocking antibody, shifting Th2 towards Th1 immunity, as well as in generating peripheral tolerance. However, further investigations are required to better understand the mode of action.

Deciphering the Cross-Reactivity of Tropomyosin across Three Molluscan Species: Insights into the Role of Conserved T-Cell and B-Cell Epitopes

Haliotis discus hannai tropomyosin (HTM), Alectryonella plicatula tropomyosin (ATM), and Mimachlamys nobilis tropomyosin (MTM) were reported as significant seafood allergens capable of eliciting severe allergic reactions. However, studies of cross-reactivity and epitope mapping among them are notably limited. This study discovered their cross-reactivity property through inhibition of IgG/IgE binding capacity and promotion of specific CD4+T-cell proliferation. For T-cell epitopes, 3, 4, and 3 epitopes were identified from the splenocytes of mice immunized with HTM, ATM, and MTM, respectively. In terms of B-cell epitopes, a combination of bioinformatics techniques and serological assays identified 4, 3, and 4 epitopes for HTM, ATM, and MTM, respectively. Sequence logo analysis revealed 2 conserved T-cell epitopes and 5 conserved B-cell epitopes, which may be critical for the observed cross-reactivity property. In conclusion, these findings provide crucial molecular evidence that could enhance the prevention of allergic reactions to aquatic mollusks.

Molecular Allergology: Epitope Discovery and Its Application for Allergen-Specific Immunotherapy of Food Allergy

The prevalence of food allergy continues to rise, posing a significant burden on health and quality of life. Research on antigenic epitope identification and hypoallergenic agent design is advancing allergen-specific immunotherapy (AIT). This review focuses on food allergens from the perspective of molecular allergology, provides an overview of integration of bioinformatics and experimental validation for epitope identification, highlights hypoallergenic agents designed based on epitope information, and offers a valuable guidance to the application of hypoallergenic agents in AIT. With the development of molecular allergology, the characterization of the amino acid sequence and structure of the allergen at the molecular level facilitates T-/B-cell epitope identification. Alignment of the identified epitopes in food allergens revealed that the amino acid sequence of T-/B-cell epitopes barely overlapped, providing crucial data to design allergen molecules as a promising form for treating (FA) food allergy. Manipulating antigenic epitopes can reduce the allergenicity of allergens to obtain hypoallergenic agents, thereby minimizing the severe side effects associated with AIT. Currently, hypoallergenic agents are mainly developed through synthetic epitope peptides, genetic engineering, or food processing methods based on the identified epitope. New strategies such as DNA vaccines, signaling molecules coupling, and nanoparticles are emerging to improve efficiency. Although significant progress has been made in designing hypoallergenic agents for AIT, the challenge in clinical translation is to determine the appropriate dose and duration of treatment to induce long-term immune tolerance.

Dietary AGEs and food allergy: insights into the mechanisms of AGEs-induced food allergy and mitigation strategies

Food allergy (FA) is a significant public health concern, with over one billion individuals globally affected, and its prevalence continues to rise. Advanced glycation end products (AGEs) are common hazards in various diet. Recent investigations have shown that AGEs could influence the pathogenesis of FA by interacting with AGEs receptors. This paper provides a comprehensive review of recent advances on diet AGEs, summarized the mechanisms of AGEs in regulating food allergy and mitigation strategies, analyzed the limitations of current research on AGEs and prospected the future research. AGEs could combine with the receptors for AGEs (RAGE) to induce oxidative stress, inflammation and allergic signaling pathways. AGEs can affect allergen epitopes and conformation and regulate intestinal flora in a non-receptor-dependent manner, as well as affect the intestinal barrier and Th1/Th2 immune balance through receptor-dependent pathways to regulate food allergy. Currently, the approaches to reduce the AGEs-induced food allergy mainly depended on improving food processing methods (e.g., low temperature, short time, low pH and non-thermal processing methods), natural AGEs inhibitors and RAGE inhibitors. This review elucidates the influences of AGEs on food allergy and mitigation strategies, which could provide novel insights into reducing food allergy induced by diet AGEs.

Is hen's egg a significant allergen in adults too? Findings from an investigation into food allergy prevalence

INTRODUCTION

Data on adult food allergies (FAs) remain limited compared to the pediatric population, and this study investigates the prevalence and clinical characteristics of FAs among adults.

METHODS

This retrospective study included adults aged 18-80 diagnosed with FAs at the Immunology and Allergy Diseases Clinic of Ankara Bilkent City Hospital, Turkey, between 2019 and 2024.

RESULTS

During the study period, 10,505 patients were examined to diagnose and manage various allergic and immunologic conditions. Among these, 563 patients were suspected of having FAs, which was confirmed in 33 patients (mean age 34.74 ± 12.57 years; 60.6% female), yielding a frequency of 0.31%. The primary allergens identified included hen's egg (n = 6, 18.2%), fish and shellfish (n = 4, 12.1%), and various nuts such as peanuts (n = 2, 6.1%), hazelnut (n = 1, 3.0%), and almond (n = 1, 3.0%) as well as seeds like sesame (n = 2, 6.1%) and sweet corn (n = 2, 6.1%) and fruits such as banana (n = 4, 12.1%) and kiwi (n = 4, 12.1%). The median time interval between food consumption and allergic reactions was 10 minutes (2-120). Anaphylaxis was the most frequently observed clinical presentation (n = 24, 72.7%). Emergency treatments included antihistamines and steroids (n = 15, 65.2%), antihistamines, steroids, and epinephrine (n = 5, 21.7%), or epinephrine alone (n = 3, 13.0%). Egg allergy was the most prevalent allergen (n = 6, 18.2%), characterized by a rapid onset of allergic reactions (median of 5 minutes); two patients reacted regardless of cooking methods and four showed tolerance to thoroughly cooked eggs, with component-resolved diagnostics indicating sensitization to ovalbumin (Gal d2) but not ovomucoid (Gal d1).

CONCLUSION

Our study demonstrates a low frequency of FAs in adults yet highlights the seriousness of reactions like anaphylaxis. Hen's egg allergy was notably prevalent, underscoring the need for increased awareness and improved diagnostic strategies to effectively manage FAs in the adult population.

Optimized carbonylation treatment of Litopenaeus vannamei matrix decreased its immunoreactivity and improved edible quality, simultaneously

The study aimed to investigate how carbonylation affects the immunoreactivity and edible quality of the Litopenaeus vannamei matrix. The carbonylation treatment conditions of the shrimp matrix were optimized. Firstly, the treatment condition is optimized with 1.0 mmol/L malonaldehyde at 37 °C, 12 h. The optimized carbonylated shrimp showed lower immunoreactivity, carbonyl group, and free amino acids. Then the edible quality was evaluated, optimized carbonylated shrimp matrix presented better digestibility and the continuous digestion products showed lower immunoreactivity. Optimized carbonylated shrimp for the other sensory indicators showed better texture properties and an inviting appearance. Looser microstructure by scanning electron microscopy contributed to the higher digestibility, lower immunoreactivity, and better edible quality for optimized carbonylated shrimp matrix. Besides, more potentially modified amino acid residues exposed on the allergen surface may be the other reason. In conclusion, optimized carbonylation treatment reduced the immunoreactivity and improved the edible quality of shrimp.

Purified components of red-edge tea polysaccharide alleviate food allergy in mice by regulating intestinal homeostasis

Previous studies found red-edge tea polysaccharides (RETPS)-3 and 4 have anti-allergic effects. To investigate the anti-food allergy activity of the RETPS-3/4, the ovalbumin-induced Balb/c mouse food allergy model was established. Food allergy symptoms, serum inflammatory factors, spleen and intestinal pathology were analyzed. The proportion of lymphocyte clusters was measured by flow cytometry. The intestinal flora of mice was examined using the 16S rDNA method. The results showed that RETPS-3/4 alleviated food allergy symptoms in mice, relieved intestinal injury, and reduced the contents of ovalbumin-specific immunoglobulin E, mast cell protease, and histamine in the serum of mice. In addition, RETPS-3/4 regulated the proportion of Th2 cells in mouse mesenteric lymph nodes and the abundance of Lactobacillus_muris and Prevotella. These results showed that RETPS-3/4 had anti-food allergy activity and could be developed as a functional anti-food allergy product.

Edible Insects as an Alternative Source of Nutrients: Benefits, Risks, and the Future of Entomophagy in Europe-A Narrative Review

According to projections by the Food and Agriculture Organization of the United Nations, the global population will reach 9 billion by 2050. This raises concerns about the ability to feed such a population. In view of the above, it is necessary to search for alternative food sources. Edible insects are rich in complete protein, essential fatty acids, vitamins and micronutrients. Despite this, entomophagy is not common in Europe. In 2021, the European Union approved Acheta domesticus, Tenebrio molitor, Locusta migratoria, and Alphitobius diaperinus for consumption. However, their consumption may also be associated with certain hazards, e.g., food allergies. The purpose of this review is to present existing knowledge, discuss the possible dangers of consuming insects, and identify areas for further research. Studies in Asian populations indicate that edible insects may be responsible for 4.2-19.4% of food allergies and 18% of fatal food-induced anaphylaxis. There are also increasing reports from Europe of food allergies to edible insects. A thorough understanding of allergens, their properties, and the mechanisms of food allergies associated with edible insects' consumption is essential for ensuring consumers' safety. In the future, it would be worthwhile to investigate the effects of heat treatment on the allergenicity of insect proteins.

Prediction, identification, and analysis of major B-cell linear epitopes of bomb m 6 from silkworm pupa

Bomb m 6 is one of the most representative allergens in silkworm pupae. The aim of the present study was to investigate the B-cell linear epitopes of Bomb m 6. Sequence propensity- and machine learning-based strategies were first used to predict 12 and 8 candidate epitopes, respectively. Then, 46 overlapping peptides [P1-P46; length, 15 amino acids (AAs); offset, 5 AAs] spanning the Bomb m 6 sequence were synthesized and tested for IgE/IgG reactivity by dot blotting. Seven IgE-binding epitopes and six IgG-binding epitopes were identified. AA61-80, AA136-150, and AA146-150 were identified as the shared dominant IgE/IgG-binding epitopes. The epitopes contain mainly α-helix and β-sheet structures and high proportions of hydrophobic AAs, and are distributed in charged regions. The major peptides of the epitopes were poorly resistant to simulated gastrointestinal fluid digestion. These findings provide a reference for the prevention of and immunotherapy for silkworm pupa allergy.

New dietary trends and alternative proteins: the emergence of novel food allergens

PURPOSE OF REVIEW

New dietary trends driven by environmental and health considerations will undoubtedly lead to the emergence of novel food allergens. Assessment of the allergenic risk of new or modified protein-containing food sources and ingredients, as well as surveillance of emerging food allergies, is then required.

RECENT FINDINGS

Developments of in silico and in vitro models apprehending protein capacity to cross-react with other homologous proteins and to induce a de novo allergic sensitization are ongoing to better integrate multiple parameters such as 3D structural information or major histocompatibility complex class II (MHC-II) presentation propensity. However, the effects of food matrices and food processing still need to be addressed in these models. Consequently, clinical and postmarket surveillance remain of critical importance to alert on emergent food allergies, which are modulated by regional dietary practices.

SUMMARY

Monitoring of the emergence of food allergens requires close collaborations between allergologists, consumers, patient associations and food safety authorities. We also need to get a consensus on an acceptable level of allergenic risk that offers the possibility to develop and market innovative and sustainable food products.

Feeding Docosahexaenoic Acid and Arachidonic Acid during Suckling and Weaning Contributes to Oral Tolerance Development by Beneficially Modulating the Intestinal Cytokine and Immunoglobulin Levels in an Allergy-Prone Brown Norway Rat Model

BACKGROUND

Suckling and weaning arachidonic acid (ARA) + docosahexaenoic acid (DHA) supplementation promoted oral tolerance (OT) development in pups, however, the effect of it on the intestine to promote OT development remains unknown.

OBJECTIVE

We aimed to explore the impact of this supplementation on intestinal fatty acid composition, structure, and indicators that are supportive of OT development.

METHODS

Allergy-prone Brown Norway dams were randomly assigned to a control (0% ARA, 0% DHA) or ARA + DHA diet (0.45% ARA, 0.8% DHA) during suckling (0-3 wk). At weaning (3-8 wk), offspring were randomly assigned to a control (0% ARA, 0% DHA) or ARA + DHA diet (0.5% ARA, 0.5% DHA). At 3 wk, offspring in each group received an oral gavage of sucrose or ovalbumin (OVA) solution for five consecutive days. At 7 wk, all offspring received an intraperitoneal OVA injection. At 8 wk, offspring were terminated to evaluate jejunum morphology and measure mucosal food allergy-related secretory immunoglobulin A (sIgA) and cytokines, ileum phospholipid and triglyceride fatty acid compositions, and fecal calprotectin.

RESULTS

Weaning ARA + DHA resulted in a higher percentage of DHA in ileum phospholipids and triglycerides (both P < 0.001), without affecting the percentage of ARA. Despite no lasting effect of suckling ARA + DHA on the DHA content in ileum phospholipids, a programming effect was found on the allergy-related intestinal immune profile [higher concentrations of mucosal IL-2 (P = 0.049) and sIgA (P = 0.033)]. OVA treatment resulted in a lower concentration of mucosal IL-6 (P = 0.026) regardless of dietary interventions. Offspring fed ARA + DHA during suckling and/or weaning had a higher concentration of mucosal transforming growth factor-beta (TGF-β) after OVA treatment but this was not observed in offspring fed control diets during suckling and weaning (P = 0.04).

CONCLUSIONS

Early life dietary ARA + DHA supplementation to allergy-prone rats enhanced the DHA concentration in intestinal phospholipids (weaning period) and increased the mucosal sIgA, IL-2, and TGF-β levels (suckling and weaning period), indicating its ability to create a tolerogenic intestinal environment to support OT development.

The Relationship Between Asthma and Food Allergies in Children

Asthma and food allergy are two complex allergic diseases with an increasing prevalence in childhood. They share risk factors, including atopic family history, atopic dermatitis, allergen sensitization, and T2 inflammatory pathways. Several studies have shown that in children with a food allergy, the risk of developing asthma, particularly in early childhood, is high. Food allergen intake or the inhalation of aerosolized allergens can induce respiratory symptoms such as bronchospasm. Patients with both conditions have an increased risk of severe asthma exacerbations, hospitalization, and mortality. The current management of clinical food hypersensitivity primarily involves the dietary avoidance of food allergens and the use of self-injectable adrenaline for severe reactions. Poorly controlled asthma limits the prescription of oral immunotherapy to foods, which has emerged as an alternative therapy for managing food allergies. Biological therapies that are effective in severe asthma have been explored for treating food allergies. Omalizumab improves asthma control and, either alone or in combination with oral immunotherapy, increases the threshold of allergen tolerance. Understanding the interplay between asthma and food allergy is crucial for developing successful treatment approaches and ameliorating patient results.

Hospitalizations for Food-Induced Anaphylaxis Between 2016 and 2021: Population-Based Epidemiologic Study

BACKGROUND

Food-induced anaphylaxis (FIA) is a major public health problem resulting in serious clinical complications, emergency department visits, hospitalization, and death.

OBJECTIVE

This study aims to assess the epidemiology and the trends in hospitalizations because of FIA in Spain between 2016 and 2021.

METHODS

An observational descriptive study was conducted using data from the Spanish National Hospital discharge database. Information was coded based on the International Classification of Diseases, Tenth Revision. The study population was analyzed by gender and age group and according to food triggers, clinical characteristics, admission to the intensive care unit, severity, and in-hospital mortality. The annual incidence of hospitalizations because of FIA per 100,000 person-years was estimated and analyzed using Poisson regression models. Multivariable logistic regression models were constructed to identify which variables were associated with severe FIA.

RESULTS

A total of 2161 hospital admissions for FIA were recorded in Spain from 2016 to 2021. The overall incidence rate was 0.77 cases per 100,000 person-years. The highest incidence was found in those aged <15 years (3.68), with lower figures among those aged 15 to 59 years (0.25) and ≥60 years (0.29). Poisson regression showed a significant increase in incidence from 2016 to 2021 only among children (3.78 per 100,000 person-years vs 5.02 per 100,000 person-years; P=.04). The most frequent food triggers were "milk and dairy products" (419/2161, 19.39% of cases) and "peanuts or tree nuts and seeds" (409/2161, 18.93%). Of the 2161 patients, 256 (11.85%) were hospitalized because FIA required admission to the intensive care unit, and 11 (0.51%) patients died in the hospital. Among children, the most severe cases of FIA appeared in patients aged 0 to 4 years (40/99, 40%). Among adults, 69.4% (111/160) of cases occurred in those aged 15 to 59 years. Multivariable logistic regression showed the variables associated with severe FIA to be age 15 to 59 years (odds ratio 5.1, 95% CI 3.11-8.36), age ≥60 years (odds ratio 3.87, 95% CI 1.99-7.53), and asthma (odds ratio 1.71,95% CI 1.12-2.58).

CONCLUSIONS

In Spain, the incidence of hospitalization because of FIA increased slightly, although the only significant increase (P=.04) was among children. Even if in-hospital mortality remains low and stable, the proportion of severe cases is high and has not improved from 2016 to 2021, with older age and asthma being risk factors for severity. Surveillance must be improved, and preventive strategies must be implemented to reduce the burden of FIA.

Allergenic Biomarkers in the Molecular Diagnosis of IgE-Mediated Wheat Allergy

IgE-mediated wheat allergy can take on various forms, including childhood food allergy to wheat, wheat-dependent exercise-induced anaphylaxis in young adults, baker's respiratory allergy/asthma in workers exposed to wheat flour inhalation, and contact urticaria that is caused by hydrolyzed wheat proteins in some cosmetics, and that is sometimes associated with a food allergy. Singleplex and multiplex immunoassays detect specific IgE antibodies to wheat allergenic molecular biomarkers such as omega-5 gliadin Tri a 19, lipid transfer protein Tri a 14, and alpha-amylase inhibitors. The fluorescence enzyme immunoassay with capsulated cellulose polymer solid-phase coupled allergens is a commonly used singleplex assay. Multiplex methods include the ELISA-based macroarray immunoassay using nano-bead technology and a microarray immunoassay on polymer-coated slides. Another promising diagnostic tool is the basophil activation test performed with omega-5 gliadin and other wheat protein types. Detailed comprehension of the structural and immunological features of the numerous wheat allergens significant in clinical settings is imperative for advancing diagnostic biomarkers for IgE-mediated wheat allergies.

Virus-like Particles as Vaccines for Allergen-Specific Therapy: An Overview of Current Developments

Immune engineering and modulation are the basis of a novel but powerful tool to treat immune diseases using virus-like particles (VLPs). VLPs are formed by the viral capsid without genetic material making them non-infective. However, they offer a wide variety of possibilities as antigen-presenting platforms, resulting in high immunogenicity and high efficacy in immune modulation, with low allergenicity. Both animal and plant viruses are being studied for use in the treatment of food allergies. These formulations are combined with adjuvants, T-stimulatory epitopes, TLR ligands, and other immune modulators to modulate or enhance the immune response toward the presented allergen. Here, the authors present an overview of VLP production systems, their immune modulation capabilities, and the applicability of actual VLP-based formulations targeting allergic diseases.

Implementing Food Oral Immunotherapy Into Clinical Practice: Quality and Safety Perspectives From a US Academic Center

Oral immunotherapy (OIT) is an accessible procedure for practicing allergy/immunology providers, yet rigorous safety standards are limited in the clinical setting. By exploring the transition from research to clinical practice OIT, we review relevant safety considerations necessary for the clinical provider. We offer a perspective on clinical benefits and considerations at the individual, collaboration, and policy levels from the vantage of a large academic OIT program, and we propose several practical start-up checklists and clerical considerations for practicing providers. Awareness of the local population and front-end planning is necessary to improve the accessibility of this procedure in clinical practice among racial and socioeconomic minority populations. Sharing and merging OIT protocols, procedural methods, and electronic medical record order sets may increase harmonization among OIT-providing institutions and further our abilities to pool safety and outcomes data, ultimately enhancing the safety and efficacy of clinical OIT.

The Role of Regulatory T Cells in Allergic Diseases: Collegium Internationale Allergologicum (CIA) Update 2024

BACKGROUND

Allergy represents a major health problem of increasing prevalence worldwide with a high socioeconomic impact. Our knowledge on the molecular mechanisms underlying allergic diseases and their treatments has significantly improved over the last years. The generation of allergen-specific regulatory T cells (Tregs) is crucial in the induction of healthy immune responses to allergens, preventing the development and worsening of allergic diseases.

SUMMARY

In the last decades, intensive research has focused on the study of the molecular mechanisms involved in Treg development and Treg-mediated suppression. These mechanisms are essential for the induction of sustained tolerance by allergen-specific immunotherapy (AIT) after treatment discontinuation. Compelling experimental evidence demonstrated altered suppressive capacity of Tregs in patients suffering from allergic rhinitis, allergic asthma, food allergy, or atopic dermatitis, as well as the restoration of their numbers and functionality after successful AIT.

KEY MESSAGE

The better understanding of the molecular mechanisms involved in Treg generation during allergen tolerance induction might well contribute to the development of novel strategies for the prevention and treatment of allergic diseases.

Adverse Food Reactions in Inflammatory Bowel Disease: State of the Art and Future Perspectives

Limited knowledge is available about the relationship between food allergies or intolerances and inflammatory bowel disease (IBD). Clinicians frequently encounter patients who report food allergies or intolerances, and gastroenterologists struggle distinguishing between patients with organic disorders and those with functional disorders, which the patients themselves may associate with specific dietary components. This task becomes even more arduous when managing patients with significant underlying organic conditions, like IBD. The aim of this review is to summarize and emphasize any actual associations between food allergies and intolerances and inflammatory diseases, such as ulcerative colitis and Crohn's disease. Through a narrative disceptation of the current literature, we highlight the increased prevalence of various food intolerances, including lactose, fructose, histamine, nickel, and non-celiac gluten sensitivity, in individuals with IBD. Additionally, we explore the association between increased epithelial barrier permeability in IBD and the development of food sensitization. By doing so, we aim to enhance clinicians' awareness of the nutritional management of patients with IBD when facing complaints or evidence of food allergies or intolerances.