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Sampson HA. The Riddle of Response to Cutaneous Allergen Exposure in Patients with Atopic Dermatitis. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00289-8. [PMID: 38740132 DOI: 10.1016/j.anai.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
The skin is the largest immunological organ in the body, containing immune cells that play a role in both food allergen sensitization and desensitization. The "dual allergen exposure hypothesis" posits that sensitization to food allergens may occur with cutaneous exposure on inflamed skin, eg, atopic dermatitis (AD), but early oral consumption generally leads to tolerance. However, only one-third of children with AD develop food allergy, suggesting a more complex mechanism for allergen sensitization. Emerging evidence suggests that the outcome of cutaneous allergen exposure is context-dependent and largely influenced by the state of the skin barrier, with healthy skin promoting natural tolerance. Current research supports the ability to induce desensitization through repeated application of allergen to the skin, known as epicutaneous immunotherapy (EPIT). Preclinical research with an occlusive patch has demonstrated a significantly reduced Th2-driven immunological response when applied to intact, uninflamed skin, and induction of a unique population of regulatory T cells that express a broader range of homing receptors, which may be able to maintain sustained protection. In clinical studies of children aged 1 through 11 years with peanut allergy, EPIT with an occlusive patch resulted in significant desensitization with no major differences in efficacy or safety between children with and without AD. These data begin to answer the conundrum of how allergen applied to the skin can lead to both sensitization and desensitization, and future studies should enable us to optimize the power of the skin as a complex immunological organ to treat allergic, autoimmune, and autoinflammatory disorders.
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Affiliation(s)
- Hugh A Sampson
- Department of Pediatrics, Division of Allergy and Immunology, Jaffe Food Allergy Research Institute; Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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2
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Braun C, Coutier L, Bégin P, Nosbaum A. Skin-centered strategies in food allergy prevention. Pediatr Allergy Immunol 2024; 35:e14130. [PMID: 38693814 DOI: 10.1111/pai.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024]
Abstract
While the early introduction of food allergens in the infant diet has been shown to be effective at preventing the development of food allergy (FA), its implementation in real life has been associated with various challenges. Interventions aimed at correcting skin barrier dysfunction have been explored in recent decades as a distinct or complementary mean to prevent allergic sensitization through the skin and subsequent development of FA. Studies assessing the application of emollient from birth have yielded conflicting results, and meta-analyses have demonstrated either no effect or only a slight positive effect on FA prevention. However, a careful review of the clinical trials reveals that different emollients were used, which may have explained some of the discrepancies between study results. Emollient application protocols also varied widely between studies. While firm conclusions cannot be drawn with regard to their overall efficacy at preventing FA, the available data provide valuable insight into the characteristics that could be associated with a more effective intervention. Namely, successful trials tended to use emollients with an acidic pH of 5.5, applied over the entire body, and combined with topical corticosteroids in affected areas. Consensus on the optimal strategy to restore skin barrier function could help improve the homogeneity and clinical relevance of future trials on this topic. In the meantime, clinicians should avoid products associated with worse outcomes.
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Affiliation(s)
- Camille Braun
- Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Pneumology, Allergy, Cystic Fibrosis, Hôpital Femme Mère Enfant, Bron, France
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, Lyon, France
| | - Laurianne Coutier
- Department of Pediatrics, Pneumology, Allergy, Cystic Fibrosis, Hôpital Femme Mère Enfant, Bron, France
- INSERM U1028 CNRS UMR 5292, Université Lyon 1, Lyon, France
| | - Philippe Bégin
- Section of Allergy and Clinical Immunology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
- Department of Medicine, Section of Allergy and Clinical Immunology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Audrey Nosbaum
- Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, Université Lyon 1, Lyon, France
- Department of Allergy and Clinical Immunology, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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3
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Berni Canani R, Caminati M, Carucci L, Eguiluz-Gracia I. Skin, gut, and lung barrier: Physiological interface and target of intervention for preventing and treating allergic diseases. Allergy 2024. [PMID: 38439599 DOI: 10.1111/all.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Abstract
The epithelial barriers of the skin, gut, and respiratory tract are critical interfaces between the environment and the host, and they orchestrate both homeostatic and pathogenic immune responses. The mechanisms underlying epithelial barrier dysfunction in allergic and inflammatory conditions, such as atopic dermatitis, food allergy, eosinophilic oesophagitis, allergic rhinitis, chronic rhinosinusitis, and asthma, are complex and influenced by the exposome, microbiome, individual genetics, and epigenetics. Here, we review the role of the epithelial barriers of the skin, digestive tract, and airways in maintaining homeostasis, how they influence the occurrence and progression of allergic and inflammatory conditions, how current treatments target the epithelium to improve symptoms of these disorders, and what the unmet needs are in the identification and treatment of epithelial disorders.
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Affiliation(s)
- Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Marco Caminati
- Allergy Unit and Asthma Centre, Verona Integrated University Hospital and Department of Medicine, University of Verona, Verona, Italy
| | - Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- CEINGE Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malága, Malaga, Spain
- Allergy Group, Biomedical Research Institute of Malaga (IBIMA)-BIONAND Platform, RICORS Inflammatory Diseases, Malaga, Spain
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Hervé PL, Dioszeghy V, Matthews K, Bee KJ, Campbell DE, Sampson HA. Recent advances in epicutaneous immunotherapy and potential applications in food allergy. FRONTIERS IN ALLERGY 2023; 4:1290003. [PMID: 37965375 PMCID: PMC10641725 DOI: 10.3389/falgy.2023.1290003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
Given the potent immunological properties of the skin, epicutaneous immunotherapy (EPIT) emerges as a promising treatment approach for inducing immune tolerance, particularly for food allergies. Targeting the highly immunocompetent, non-vascularized epidermis allows for the application of microgram amounts of allergen while significantly reducing the risk of allergen passage into the bloodstream, thus limiting systemic allergen exposure and distribution. This makes EPIT highly suitable for the treatment of potentially life-threatening allergies such as food allergies. Multiple approaches to EPIT are currently under investigation for the treatment of food allergy, and these include the use of allergen-coated microneedles, application of allergen on the skin pretreated by tape stripping, abrasion or laser-mediated microperforation, or the application of allergen on the intact skin using an occlusive epicutaneous system. To date, the most clinically advanced approach to EPIT is the Viaskin technology platform. Viaskin is an occlusive epicutaneous system (patch) containing dried native allergen extracts, without adjuvants, which relies on frequent application for the progressive passage of small amounts of allergen to the epidermis through occlusion of the intact skin. Numerous preclinical studies of Viaskin have demonstrated that this particular approach to EPIT can induce potent and long-lasting T-regulatory cells with broad homing capabilities, which can exert their suppressive effects in multiple organs and ameliorate immune responses from different routes of allergen exposure. Clinical trials of the Viaskin patch have studied the efficacy and safety for the treatment of life-threatening allergies in younger patients, at an age when allergic diseases start to occur. Moreover, this treatment approach is designed to provide a non-invasive therapy with no restrictions on daily activities. Taken together, the preclinical and clinical data on the use of EPIT support the continued investigation of this therapeutic approach to provide improved treatment options for patients with allergic disorders in the near future.
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Affiliation(s)
| | | | | | | | - Dianne E. Campbell
- DBV Technologies, Montrouge, France
- Department of Allergy and Immunology, University of Sydney, Sydney, NSW, Australia
| | - Hugh A. Sampson
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Turner AV, Smeekens JM. Environmental Exposure to Foods as a Risk Factor for Food Allergy. Curr Allergy Asthma Rep 2023; 23:427-433. [PMID: 37227666 DOI: 10.1007/s11882-023-01091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Many factors have been reported to contribute to the development of food allergy. Here, we summarize the role of environmental exposure to foods as a major risk factor for developing food allergy. RECENT FINDINGS Peanut proteins are detectable and biologically active in household environments, where infants spend a majority of their time, providing an environmental source of allergen exposure. Recent evidence from clinical studies and mouse models suggests both the airway and skin are routes of exposure that lead to peanut sensitization. Environmental exposure to peanut has been clearly associated with the development of peanut allergy, although other factors such as genetic predisposition, microbial exposures, and timing of oral feeding of allergens also likely contribute. Future studies should more comprehensively assess the contributions of each of these factors for a variety of food allergens to provide more clear targets for prevention of food allergy.
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Affiliation(s)
- Andrew V Turner
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, 116 Manning Dr., Mary Ellen Jones, Room 3310, Chapel Hill, NC, 27599, USA
| | - Johanna M Smeekens
- Division of Allergy and Immunology, Department of Pediatrics, University of North Carolina at Chapel Hill, 116 Manning Dr., Mary Ellen Jones, Room 3310, Chapel Hill, NC, 27599, USA.
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Epicutaneous Sensitization and Food Allergy: Preventive Strategies Targeting Skin Barrier Repair-Facts and Challenges. Nutrients 2023; 15:nu15051070. [PMID: 36904070 PMCID: PMC10005101 DOI: 10.3390/nu15051070] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
Food allergy represents a growing public health and socio-economic problem with an increasing prevalence over the last two decades. Despite its substantial impact on the quality of life, current treatment options for food allergy are limited to strict allergen avoidance and emergency management, creating an urgent need for effective preventive strategies. Advances in the understanding of the food allergy pathogenesis allow to develop more precise approaches targeting specific pathophysiological pathways. Recently, the skin has become an important target for food allergy prevention strategies, as it has been hypothesized that allergen exposure through the impaired skin barrier might induce an immune response resulting in subsequent development of food allergy. This review aims to discuss current evidence supporting this complex interplay between the skin barrier dysfunction and food allergy by highlighting the crucial role of epicutaneous sensitization in the causality pathway leading to food allergen sensitization and progression to clinical food allergy. We also summarize recently studied prophylactic and therapeutic interventions targeting the skin barrier repair as an emerging food allergy prevention strategy and discuss current evidence controversies and future challenges. Further studies are needed before these promising strategies can be routinely implemented as prevention advice for the general population.
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Atopic Dermatitis and Food Allergy: A Complex Interplay What We Know and What We Would Like to Learn. J Clin Med 2022; 11:jcm11144232. [PMID: 35887996 PMCID: PMC9317394 DOI: 10.3390/jcm11144232] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 12/07/2022] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus, eczematous lesions, and relapsing course. It presents with great clinical heterogeneity, while underlying pathogenetic mechanisms involve a complex interplay between a dysfunctional skin barrier, immune dysregulation, microbiome dysbiosis, genetic and environmental factors. All these interactions are shaping the landscape of AD endotypes and phenotypes. In the “era of allergy epidemic”, the role of food allergy (FA) in the prevention and management of AD is a recently explored “era”. Increasing evidence supports that AD predisposes to FA and not vice versa, while food allergens are presumed as one of the triggers of AD exacerbations. AD management should focus on skin care combined with topical and/or systemic treatments; however, in the presence of suspected food allergy, a thorough allergy evaluation should be performed. Food-elimination diets in food-allergic cases may have a beneficial effect on AD morbidity; however, prolonged, unnecessary diets are highly discouraged since they can lead to loss of tolerance and potentially increase the risk of IgE-mediated food allergy. Preventive AD strategies with the use of topical emollients and anti-inflammatory agents as well as early introduction of food allergens in high-risk infants seem promising in managing and preventing food allergy in AD patients. The current review aims to overview data on the complex AD/FA relationship and provide the most recent developments on whether food allergy interventions change the AD course and vice versa.
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9
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Laundry detergent promotes allergic skin inflammation and esophageal eosinophilia in mice. PLoS One 2022; 17:e0268651. [PMID: 35759448 PMCID: PMC9236249 DOI: 10.1371/journal.pone.0268651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
The prevalence of allergic diseases is on the rise, yet the environmental factors that contribute to this increase are still being elucidated. Laundry detergent (LD) that contains cytotoxic ingredients including microbial enzymes continuously comes into contact with the skin starting in infancy. An impaired skin barrier has been suggested as a route of allergic sensitization. We hypothesized that exposure of skin to LD damages the skin barrier resulting in systemic sensitization to allergens that enter through the impaired skin barrier. Mouse skin samples exposed in vitro to microbial proteases or LD exhibited physical damage, which was more pronounced in neonatal skin as compared to adult skin. Exposure of the skin to microbial proteases in vitro resulted in an increase in the levels of interleukin (IL)-33 and thymic stromal lymphopoietin (TSLP). BALB/c wild type mice epicutaneously exposed to LD and ovalbumin (OVA) showed an increase in levels of transepidermal water loss, serum OVA-specific immunoglobulin (Ig) G1 and IgE antibodies, and a local increase of Il33, Tslp, Il4 and Il13 compared with LD or OVA alone. Following intranasal challenge with OVA, mice epicutaneously exposed to LD showed an increase in allergen-induced esophageal eosinophilia compared with LD or OVA alone. Collectively, these results suggest that LD may be an important factor that impairs the skin barrier and leads to allergen sensitization in early life, and therefore may have a role in the increase in allergic disease.
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Zhao M, Liang Y, Song F, Ma L, Wang Y, Gao W, Tian J, Ying X, Shen C, Wang S, Jiao L, Wang Y, Sun X, Ma L, Ma X. Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD) versus standard antenatal care for prevention of atopic dermatitis: study protocol for a single-centre, investigator-blinded randomised controlled trial. BMJ Open 2022; 12:e048083. [PMID: 35078832 PMCID: PMC8796218 DOI: 10.1136/bmjopen-2020-048083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patient education serves an essential purpose in the long-term management of allergic diseases as a secondary prevention approach. However, evidence on using education for primary prevention is limited. This study aims to evaluate the effect of an educational intervention, that is, the Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD), on infantile allergic disease incidences compared with the standard care. METHODS AND ANALYSIS This is a single-centre randomised controlled trial of expecting mother-children dyads in Daxing Teaching Hospital of Beijing, China. A total of 2266 expecting mothers will be recruited. Expecting mothers enlisted in the birth registry of Daxing Teaching Hospital of Capital Medical University and intend to give birth at this location will be screened for eligibility. Women aged≥18 years with less than 14+6 weeks of pregnancy who intends to remain resident in Daxing district for at least 2 years postpartum will be entered into the run-in phase. Randomisation will take place at 30 weeks of gestation. Women at high risk for miscarriage or intend to have abortions will be excluded. The participants will be allocated into two groups (ie, the PAEPAD and the standard care group) by random allocation (1:1). The PAEPAD group will receive a multidisciplinary education of neonatal care, including standard education as the control group and additional information on skincare of infants, sun protection, topical corticosteroids and an overview of atopic dermatitis (AD), whereas the standard care group will receive the standard neonatal care education carried out by obstetricians. Participants will be followed for 2 years. The primary outcome will be infantile AD cumulative incidence at 2 years postpartum. Secondary outcomes will include other AD outcomes, atopic march outcomes, knowledge outcomes and other maternal and neonatal outcomes. Data collection will be carried out using both electronic and paper questionnaires. Biological samples will also be collected longitudinally. ETHICS AND DISSEMINATION The study design was approved by the ethical committee of Capital Medical University Daxing Teaching Hospital, Beijing, China. The trial results will be published in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ChiCTR registry (Trial ID: ChiCTR2000040463).
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Affiliation(s)
- Mutong Zhao
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yuan Liang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Fengli Song
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lili Ma
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Wanli Gao
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Jing Tian
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiangji Ying
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Chunping Shen
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shan Wang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Lei Jiao
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yang Wang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaoyan Sun
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lin Ma
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiuhua Ma
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
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Basketter DA, Kimber I. Enzymes and sensitization via skin exposure: A critical analysis. Regul Toxicol Pharmacol 2021; 129:105112. [PMID: 34973388 DOI: 10.1016/j.yrtph.2021.105112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
Some proteins, including enzymes, can induce allergic sensitization of various types, including allergic sensitization of the respiratory tract. There is now an increased understanding of the role that the skin plays in the development of IgE-mediated allergy and this prompts the question whether topical exposure to enzymes used widely in consumer cleaning products could result in allergic sensitization. Here, the evidence that proteins can interact with the skin immune system and the way they do so is reviewed, together with a consideration of the experience gained over decades of the use of enzymes in laundry and cleaning products. The conclusion drawn is that although transcutaneous sensitization to proteins can occur (typically through compromised skin) resulting in IgE antibody-mediated allergy, in practice such skin contact with enzymes used in laundry and cleaning products does not appear to pose a significant risk of allergic disease. Further, the evidence summarized in this publication support the view that proteins do not pose a risk of allergic contact dermatitis.
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Affiliation(s)
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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12
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Current Insights into Atopic March. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111067. [PMID: 34828780 PMCID: PMC8620020 DOI: 10.3390/children8111067] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022]
Abstract
The incidence of allergic diseases is increasing, and research on their epidemiology, pathophysiology, and the prevention of onset is urgently needed. The onset of allergic disease begins in infancy with atopic dermatitis and food allergy and develops into allergic asthma and allergic rhinitis in childhood; the process is defined as “atopic march”. Atopic march is caused by multiple immunological pathways, including allergen exposure, environmental pollutants, skin barrier dysfunction, type 2 inflammation, and oxidative stress, which promote the progression of atopic march. Using recent evidence, herein, we explain the involvement of allergic inflammatory conditions and oxidative stress in the process of atopic march, its epidemiology, and methods for prevention of onset.
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13
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Suaini NHA, Siah KTH, Tham EH. Role of the gut-skin axis in IgE-mediated food allergy and atopic diseases. Curr Opin Gastroenterol 2021; 37:557-564. [PMID: 34411036 DOI: 10.1097/mog.0000000000000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW In recent years, landmark clinical trials investigating the role of early oral exposure to food antigens for food allergy (FA) prevention have highlighted the importance of immunoregulatory pathways in the 'gut-skin axis'. This review highlights recent literature on the mechanisms of the immune system and microbiome involved in the gut-skin axis, contributing to the development of atopic dermatitis (AD), FA, allergic rhinitis (AR) and asthma. Therapeutic interventions harnessing the gut-skin axis are also discussed. RECENT FINDINGS Epicutaneous sensitization in the presence of AD is capable of inducing Th2 allergic inflammation in the intestinal tract and lower respiratory airways, predisposing one to the development of AR and asthma. Probiotics have demonstrated positive effects in preventing and treating AD, though there is no evident relationship of its beneficial effects on other allergic diseases. Prophylactic skin emollients use has not shown consistent protection against AD, whereas there is some evidence for the role of dietary changes in alleviating AD and airway inflammation. More randomized controlled trials are needed to clarify the potential of epicutaneous immunotherapy as a therapeutic strategy for patients with FA. SUMMARY The growing understanding of the gut-skin interactions on allergic disease pathogenesis presents novel avenues for therapeutic interventions which target modulation of the gut and/or skin.
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Affiliation(s)
| | - Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital
- Department of Medicine, Yong Loo Lin School of Medicine
| | - Elizabeth Huiwen Tham
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A STAR)
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS)
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS)
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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14
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Ziegler SF. Thymic stromal lymphopoietin, skin barrier dysfunction, and the atopic march. Ann Allergy Asthma Immunol 2021; 127:306-311. [PMID: 34153443 PMCID: PMC8419079 DOI: 10.1016/j.anai.2021.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Atopic dermatitis often precedes the development of other atopic diseases, and the atopic march describes this temporal relationship in the natural history of these diseases. Although the pathophysiological mechanisms that underlie this relationship are poorly understood, epidemiologic and genetic data have suggested that the skin might be an important route of sensitization to allergens. DATA SOURCES Review of recent studies on the role of skin barrier defects in systemic allergen sensitization. STUDY SELECTIONS Recent publications on the relationship between skin barrier defects and expression of epithelial cell-derived cytokines. RESULTS Animal models have begun to elucidate on how skin barrier defects can lead to systemic allergen sensitization. Emerging data now suggest that epithelial cell-derived cytokines, such as thymic stromal lymphopoietin, drive the progression from atopic dermatitis to asthma and food allergy. Skin barrier defects can lead to induction of epithelial cell-derived cytokines, which in turn leads to the initiation and maintenance of allergic inflammation and the atopic march. CONCLUSION Development of new biologic drug targeting type 2 cytokines provides novel therapeutic interventions for atopic dermatitis.
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Affiliation(s)
- Steven F Ziegler
- Center for Fundamental Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Department of Immunology, University of Washington School of Medicine, Seattle, Washington.
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15
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Krawiec M, Fisher HR, Du Toit G, Bahnson HT, Lack G. Overview of oral tolerance induction for prevention of food allergy-Where are we now? Allergy 2021; 76:2684-2698. [PMID: 33539570 DOI: 10.1111/all.14758] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 01/10/2023]
Abstract
Oral tolerance induction through early introduction of allergenic food has proven effective in randomized controlled trials. This new approach to weaning has been incorporated into many national and international infants' feeding guidelines. However, there are questions that require further discussion, such as, which foods should be introduced early, should the intervention be targeted to infants at high-risk or to the general population, and what is the ideal timing for early food introduction. This review examines the extent to which recent trials address these critical questions and highlights areas where further research is required.
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Affiliation(s)
- Marta Krawiec
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
| | - Helen R. Fisher
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
| | - George Du Toit
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Henry T. Bahnson
- Benaroya Research Institute and the Immune Tolerance Network Seattle USA
| | - Gideon Lack
- Department of Women and Children’s Health (Paediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Children’s Allergy Service Evelina London Guy’s and St Thomas’ Hospital London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
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16
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Kulis MD, Smeekens JM, Immormino RM, Moran TP. The airway as a route of sensitization to peanut: An update to the dual allergen exposure hypothesis. J Allergy Clin Immunol 2021; 148:689-693. [PMID: 34111450 DOI: 10.1016/j.jaci.2021.05.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 01/17/2023]
Abstract
Food allergies have increased at an alarming rate over the past 2 decades, indicating that environmental factors are driving disease progression. It has been postulated that sensitization to foods, in particular, peanut, occurs through impaired skin. Peanut allergens have been quantified in household dust and may be the culprit source. Indeed, TH2 cell-skewing innate cytokines can be driven by application of food antigens on both intact and impaired skin of mice, resulting in antigen-specific IgE production and anaphylaxis following allergen exposure. However, allergy induction through the skin can be prevented by induction of oral tolerance before skin exposure. These observations led to the dual allergen exposure hypothesis, according to which oral exposure to food antigens leads to tolerance and antigen exposure on impaired skin leads to allergy. Here, we propose the airway as an alternative route of sensitization in the dual allergen exposure hypothesis that leads to food allergy. Specifically, we will provide evidence from mouse models and human cell-based studies that together implicate the airway as a plausible route of sensitization.
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Affiliation(s)
- Michael D Kulis
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC.
| | - Johanna M Smeekens
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC; University of North Carolina Food Allergy Initiative, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Robert M Immormino
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Timothy P Moran
- Department of Pediatrics, Division of Allergy and Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC
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17
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Sherenian MG, Kothari A, Biagini JM, Kroner JW, Baatyrbek Kyzy A, Johannson E, Atluri G, He H, Martin LJ, Khurana Hershey GK. Sensitization to peanut, egg or pets is associated with skin barrier dysfunction in children with atopic dermatitis. Clin Exp Allergy 2021; 51:666-673. [PMID: 33721370 DOI: 10.1111/cea.13866] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children with atopic dermatitis (AD) are often sensitized to food and aeroallergens, but sensitization patterns have not been analysed with biologic measures of disease pathogenicity. OBJECTIVE We sought to define allergen sensitization grouping(s) using unbiased machine learning and determine their associations with skin filaggrin (FLG) and transepidermal water loss (TEWL) (assesses skin barrier integrity), S100A8 and S100A9 expression (assesses skin inflammation) and AD severity. METHODS We studied 400 children with AD in the Mechanisms of Progression from Atopic Dermatitis to Asthma in Children (MPAACH) cohort to identify groupings of food and aeroallergen sensitizations. MPAACH is a paediatric AD cohort, aged 1-2, recruited through hospital/community settings between 2016 and 2018. We analysed these groupings' associations with AD biomarkers: skin FLG, S100A8 and S100A9 expression, total IgE, TEWL and AD severity. RESULTS An unbiased machine learning approach revealed five allergen clusters. The most common cluster (N = 131), SPTPEP, had sensitization to peanut, egg and/or pets. Three low prevalence clusters, which included children with allergen sensitization other than peanut, egg or pets, were combined into SPTOther . SPTNEG included children with no sensitization(s). SPTPEP children had higher median non-lesional TEWL (16.9 g/m2 /h) and IgE (90 kU/L) compared with SPTOTHER (8.8 g/m2 /h and 24 kU/L; p = .01 and p < .001) and SPTNEG (9 g/m2 /h and 26 kU/L; p = .003 and p < .001). SPTPEP children had lower median lesional (0.70) and non-lesional (1.09) FLG expression compared with SPTOTHER (lesional: 0.9; p = .047, non-lesional: 1.78; p = .01) and SPTNEG (lesional: 1.47; p < .001, non-lesional: 2.21; p < .001). There were no differences among groupings in S100A8 or S100A9 expression. CONCLUSIONS AND CLINICAL RELEVANCE In this largely clinic-based cohort of young children with AD, allergic sensitization to peanut, egg, cat or dog was associated with more severe disease and skin barrier function but not markers of cutaneous inflammation. These data need replicating in a population-based cohort but may have important implications for understanding the interaction between AD and allergic sensitization.
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Affiliation(s)
- Michael G Sherenian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Arjun Kothari
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jocelyn M Biagini
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John W Kroner
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Asel Baatyrbek Kyzy
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elisabet Johannson
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gowtham Atluri
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH, USA
| | - Hua He
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa J Martin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gurjit K Khurana Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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18
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Mechanisms Underlying the Skin-Gut Cross Talk in the Development of IgE-Mediated Food Allergy. Nutrients 2020; 12:nu12123830. [PMID: 33333859 PMCID: PMC7765270 DOI: 10.3390/nu12123830] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 02/07/2023] Open
Abstract
Immune-globulin E (IgE)-mediated food allergy is characterized by a variety of clinical entities within the gastrointestinal tract, skin and lungs, and systemically as anaphylaxis. The default response to food antigens, which is antigen specific immune tolerance, requires exposure to the antigen and is already initiated during pregnancy. After birth, tolerance is mostly acquired in the gut after oral ingestion of dietary proteins, whilst exposure to these same proteins via the skin, especially when it is inflamed and has a disrupted barrier, can lead to allergic sensitization. The crosstalk between the skin and the gut, which is involved in the induction of food allergy, is still incompletely understood. In this review, we will focus on mechanisms underlying allergic sensitization (to food antigens) via the skin, leading to gastrointestinal inflammation, and the development of IgE-mediated food allergy. Better understanding of these processes will eventually help to develop new preventive and therapeutic strategies in children.
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19
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Epigenetic alterations in skin homing CD4 +CLA + T cells of atopic dermatitis patients. Sci Rep 2020; 10:18020. [PMID: 33093567 PMCID: PMC7582180 DOI: 10.1038/s41598-020-74798-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
T cells expressing the cutaneous lymphocyte antigen (CLA) mediate pathogenic inflammation in atopic dermatitis (AD). The molecular alterations contributing to their dysregulation remain unclear. With the aim to elucidate putative altered pathways in AD we profiled DNA methylation levels and miRNA expression in sorted T cell populations (CD4+, CD4+CD45RA+ naïve, CD4+CLA+, and CD8+) from adult AD patients and healthy controls (HC). Skin homing CD4+CLA+ T cells from AD patients showed significant differences in DNA methylation in 40 genes compared to HC (p < 0.05). Reduced DNA methylation levels in the upstream region of the interleukin-13 gene (IL13) in CD4+CLA+ T cells from AD patients correlated with increased IL13 mRNA expression in these cells. Sixteen miRNAs showed differential expression in CD4+CLA+ T cells from AD patients targeting genes in 202 biological processes (p < 0.05). An integrated network analysis of miRNAs and CpG sites identified two communities of strongly interconnected regulatory elements with strong antagonistic behaviours that recapitulated the differences between AD patients and HC. Functional analysis of the genes linked to these communities revealed their association with key cytokine signaling pathways, MAP kinase signaling and protein ubiquitination. Our findings support that epigenetic mechanisms play a role in the pathogenesis of AD by affecting inflammatory signaling molecules in skin homing CD4+CLA+ T cells and uncover putative molecules participating in AD pathways.
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20
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Brough HA, Nadeau KC, Sindher SB, Alkotob SS, Chan S, Bahnson HT, Leung DYM, Lack G. Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? Allergy 2020; 75:2185-2205. [PMID: 32249942 DOI: 10.1111/all.14304] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 12/14/2022]
Abstract
There is increasing evidence regarding the importance of allergic sensitization through the skin. In this review, we provide an overview of the atopic march and immune mechanism underlying the sensitization and effector phase of food allergy. We present experimental models and human data that support the concept of epicutaneous sensitization and how this forms one half of the dual-allergen exposure hypothesis. We discuss specific important elements in the skin (FLG and other skin barrier gene mutations, Langerhans cells, type 2 innate lymphoid cells, IL-33, TSLP) that have important roles in the development of allergic responses as well as the body of evidence on environmental allergen exposure and how this can sensitize an individual. Given the link between skin barrier impairment, atopic dermatitis, food allergy, allergic asthma, and allergic rhinitis, it is logical that restoring the skin barrier and prevention or treating atopic dermatitis would have beneficial effects on prevention of related allergic diseases, particularly food allergy. We present the experimental and human studies that have evaluated this approach and discuss various factors which may influence the success of these approaches, such as the type of emollient chosen for the intervention, the role of managing skin inflammation, and differences between primary and secondary prevention of atopic dermatitis to achieve the desired outcome.
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Affiliation(s)
- Helen A. Brough
- Paediatric Allergy Group Department of Women and Children’s Health School of Life Course Sciences King’s College London St. Thomas’ Hospital London UK
- Paediatric Allergy Group Peter Gorer Department of Immunobiology School of Immunology & Microbial Sciences King’s College London Guys’ Hospital London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’ Hospital NHS Foundation Trust London UK
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Department of Medicine Division of Pulmonary and Critical Care Medicine Stanford University Stanford CA USA
- Department of Medicine Division of Allergy, Immunology and Rheumatology Stanford University Stanford CA USA
| | - Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Department of Medicine Division of Pulmonary and Critical Care Medicine Stanford University Stanford CA USA
| | - Shifaa S. Alkotob
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Department of Medicine Division of Pulmonary and Critical Care Medicine Stanford University Stanford CA USA
| | - Susan Chan
- Paediatric Allergy Group Department of Women and Children’s Health School of Life Course Sciences King’s College London St. Thomas’ Hospital London UK
- Paediatric Allergy Group Peter Gorer Department of Immunobiology School of Immunology & Microbial Sciences King’s College London Guys’ Hospital London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’ Hospital NHS Foundation Trust London UK
| | - Henry T. Bahnson
- Benaroya Research Institute and Immune Tolerance Network Seattle WA USA
| | - Donald Y. M. Leung
- Department of Pediatrics Division of Pediatric Allergy‐Immunology National Jewish Health Denver CO USA
| | - Gideon Lack
- Paediatric Allergy Group Department of Women and Children’s Health School of Life Course Sciences King’s College London St. Thomas’ Hospital London UK
- Paediatric Allergy Group Peter Gorer Department of Immunobiology School of Immunology & Microbial Sciences King’s College London Guys’ Hospital London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’ Hospital NHS Foundation Trust London UK
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21
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Lam H, Tergaonkar V, Ahn K. Mechanisms of allergen-specific immunotherapy for allergic rhinitis and food allergies. Biosci Rep 2020; 40:BSR20200256. [PMID: 32186703 PMCID: PMC7109000 DOI: 10.1042/bsr20200256] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/15/2022] Open
Abstract
Allergen-specific immunotherapy (AIT) is currently the only potential treatment for allergies including allergic rhinitis (AR) and food allergies (FA) that can modify the underlying course of the diseases. Although AIT has been performed for over a century, the precise and detailed mechanism for AIT is still unclear. Previous clinical trials have reported that successful AIT induces the reinstatement of tolerance against the specific allergen. In this review, we aim to provide an updated summary of the knowledge on the underlying mechanisms of IgE-mediated AR and FA as well as the immunological changes observed after AIT and discuss on how better understanding of these can lead to possible identification of biomarkers and novel strategies for AIT.
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Affiliation(s)
- Hiu Yan Lam
- Laboratory of NF-κB Signaling, Institute of Molecular and Cell Biology (IMCB), 61 Biopolis Drive, Proteos, Singapore 138673, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore 117596, Singapore
| | - Vinay Tergaonkar
- Laboratory of NF-κB Signaling, Institute of Molecular and Cell Biology (IMCB), 61 Biopolis Drive, Proteos, Singapore 138673, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore 117596, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore 117596, Singapore
| | - Kwang Seok Ahn
- Department of Science in Korean Medicine, Kyung Hee University, 24 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
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22
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Events in Normal Skin Promote Early-Life Atopic Dermatitis-The MPAACH Cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2285-2293.e6. [PMID: 32302785 DOI: 10.1016/j.jaip.2020.03.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nonlesional skin in atopic dermatitis (AD) is abnormal, but the pathobiology of lesional and nonlesional skin and the definition of endotypes are poorly understood. OBJECTIVE To define lesional and nonlesional endotypes of AD by building the first US-based early-life prospective cohort of children with AD, the Mechanisms of Progression from AD to Asthma in Children cohort. METHODS We assessed lesional and nonlesional skin transepidermal water loss, filaggrin (FLG) and alarmin (S100A8, S100A9) expression, staphylococcal colonization, and patterns of aeroallergen and food sensitization to define nonlesional and lesional phenotypes and endotypes. RESULTS Pathophysiologic changes were present in lesional and nonlesional skin and were associated with SCORing for Atopic Dermatitis. Nonlesional skin had features characteristic of diseased skin including low FLG and high alarmin expression, and increased colonization with Staphylococcus aureus. In a multivariate model, nonlesional, but not lesional, FLG expression was associated with the development of cosensitization and moderate to severe AD. Lesional skin was characterized by further deficits in FLG expression (P < .001), but alarmin expression was the same as observed in nonlesional skin. CONCLUSIONS This study reveals that events in the nonlesional, not the lesional, skin promote the subsequent development of AD severity and cosensitization, which is a key risk factor for allergic comorbidities. Collectively, these data suggest the presence of a subclinical eczema endotype that may predispose to the development of allergic disease in the absence of overt eczema. This may represent a new definition of the atopic march that starts with skin barrier dysfunction rather than eczema.
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23
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Atopic dermatitis independently increases sensitization above parental atopy: The MPAACH study. J Allergy Clin Immunol 2020; 145:1464-1466. [PMID: 32035158 DOI: 10.1016/j.jaci.2020.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/13/2020] [Accepted: 01/25/2020] [Indexed: 11/21/2022]
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24
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Tham EH, Rajakulendran M, Lee BW, Van Bever HPS. Epicutaneous sensitization to food allergens in atopic dermatitis: What do we know? Pediatr Allergy Immunol 2020; 31:7-18. [PMID: 31541586 DOI: 10.1111/pai.13127] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/05/2019] [Accepted: 09/12/2019] [Indexed: 02/06/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease mainly affecting children, which has no definitive curative therapy apart from natural outgrowing. AD is persistent in 30%-40% of children. Epithelial barrier dysfunction in AD is a significant risk factor for the development of epicutaneous food sensitization, food allergy, and other allergic disorders. There is evidence that prophylactic emollient applications from birth may be useful for primary prevention of AD, but biomarkers are needed to guide cost-effective targeted therapy for high-risk individuals. In established early-onset AD, secondary preventive strategies are needed to attenuate progression to other allergic disorders such as food allergy, asthma, and allergic rhinitis (the atopic march). This review aims to describe the mechanisms underpinning the development of epicutaneous sensitization to food allergens and progression to clinical food allergy; summarize current evidence for interventions to halt the progression from AD to food sensitization and clinical food allergy; and highlight unmet needs and directions for future research.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Mohana Rajakulendran
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hugo P S Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
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25
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Kelleher MM, Tran L, Boyle RJ. Prevention of food allergy - skin barrier interventions. Allergol Int 2020; 69:3-10. [PMID: 31744689 DOI: 10.1016/j.alit.2019.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 01/01/2023] Open
Abstract
The relationship between infant skin health and food allergy pathogenesis is the focus of intense research activity, on the basis that interventions to improve infant skin health may potentially lead to the prevention of food allergy. Current evidence does not provide conclusive findings on the mechanisms of food allergy development but does support the possibility that food allergy develops through transcutaneous sensitisation to allergenic peptides. In this article, we review the evidence for this model of food allergy development, assess strategies currently being tested for prevention of food allergy through cutaneous interventions, and identify key knowledge gaps which might be explored in future work.
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26
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Asthma and Food Allergy: Which Risks? ACTA ACUST UNITED AC 2019; 55:medicina55090509. [PMID: 31438462 PMCID: PMC6780261 DOI: 10.3390/medicina55090509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/16/2022]
Abstract
Over the past few decades, an increase in the prevalence of asthma and food allergy has been observed in the pediatric population. In infants, food sensitization, particularly to egg, has increased the risk of developing allergic asthma. This is even more likely if sensitization to food allergens occurs early within the first few years of life. It is indeed known that both diseases may be present simultaneously in the pediatric population, but coexistence may negatively influence the severity of both conditions by increasing the risk of life-threatening asthmatic episodes as well as food-related anaphylaxis. Therefore, an accurate clinical and phenotype characterization of this high-risk group of children with both asthma and food allergy and a more aggressive management might lead to reducing related morbidity and mortality. The aim of this review is to provide an updated overview on the close link between food allergy and asthma and their negative mutual influence.
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27
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Verhoeckx K, Bøgh KL, Dupont D, Egger L, Gadermaier G, Larré C, Mackie A, Menard O, Adel-Patient K, Picariello G, Portmann R, Smit J, Turner P, Untersmayr E, Epstein MM. The relevance of a digestibility evaluation in the allergenicity risk assessment of novel proteins. Opinion of a joint initiative of COST action ImpARAS and COST action INFOGEST. Food Chem Toxicol 2019; 129:405-423. [PMID: 31063834 DOI: 10.1016/j.fct.2019.04.052] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 01/09/2023]
Abstract
The current allergenicity assessment of novel proteins is based on the EFSA GMO guidance. Recently, EFSA launched a new guidance document on allergenicity assessment of GM plants (2017). This document describes, amongst other topics, the new scientific and regulatory developments on in vitro protein digestibility tests. The EFSA GMO Panel stated that for in vitro protein digestibility tests, additional investigations are needed before any additional recommendation in the form of guidance can be provided. To this end, an interim phase is considered necessary to evaluate the revisions to the in vitro gastrointestinal digestion test, proposed by EFSA. This prompted the establishment of a joint workshop through two COST Action networks: COST Action ImpARAS and COST Acton INFOGEST. In 2017, a workshop was organised to discuss the relevance of digestion in allergenicity risk assessment and how to potentially improve the current methods and readouts. The outcome of the workshop is that there is no rationale for a clear readout that is predictive for allergenicity and we suggest to omit the digestion test from the allergenicity assessment strategy for now, and put an effort into filling the knowledge gaps as summarized in this paper first.
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Affiliation(s)
| | - Katrine Lindholm Bøgh
- National Food Institute, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark.
| | | | - Lotti Egger
- Agroscope, Schwarzenburgstr. 161, 3003, Bern, Charlotte, Switzerland.
| | - Gabriele Gadermaier
- University of Salzburg, Department of Biosciences, Hellbrunnerstraße 34, 5020 Salzburg, Austria.
| | - Colette Larré
- INRA UR1268 BIA, Rue de la Géraudière, BP 71627, 44316 Nantes, France.
| | - Alan Mackie
- School of Food Science and Nutrition, University of Leeds, LS2 9JT, UK.
| | | | - Karine Adel-Patient
- UMR Service de Pharmacologie et Immunoanalyse, Laboratoire d'Immuno-Allergie Alimentaire, CEA, INRA, Université Paris-Saclay, F-91191, Gif-sur-Yvette Cedex, France.
| | | | - Reto Portmann
- Agroscope, Schwarzenburgstr. 161, 3003 Bern, Switzerland.
| | - Joost Smit
- Institute of Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584CM, Utrecht, the Netherlands.
| | - Paul Turner
- Section of Paediatrics, Imperial College London, London, United Kingdom.
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Michelle M Epstein
- Department of Dermatology, Experimental Allergy Laboratory, Medical University of Vienna, Waehringer Guertel 18-20 room 4P9.02, 1090, Vienna, Austria.
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28
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Hill DA, Spergel JM. The atopic march: Critical evidence and clinical relevance. Ann Allergy Asthma Immunol 2019; 120:131-137. [PMID: 29413336 DOI: 10.1016/j.anai.2017.10.037] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/16/2017] [Accepted: 10/31/2017] [Indexed: 01/18/2023]
Affiliation(s)
- David A Hill
- Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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30
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Ullmann N, Mirra V, Di Marco A, Pavone M, Porcaro F, Negro V, Onofri A, Cutrera R. Asthma: Differential Diagnosis and Comorbidities. Front Pediatr 2018; 6:276. [PMID: 30338252 PMCID: PMC6178921 DOI: 10.3389/fped.2018.00276] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 09/12/2018] [Indexed: 12/26/2022] Open
Abstract
Childhood asthma remains a multifactorial disease with heterogeneous clinical phenotype and complex genetic inheritance. The primary aim of asthma management is to achieve control of symptoms, in order to reduce the risk of future exacerbations and progressive loss of lung function, which results especially challenging in patients with difficult asthma. When asthma does not respond to maintenance treatment, firstly, the correct diagnosis needs to be confirmed and other diagnosis, such as cystic fibrosis, primary ciliary dyskinesia, immunodeficiency conditions or airway and vascular malformations need to be excluded. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Moreover, all possible risk factors or comorbidities (gastroesophageal reflux, rhinosinusitis, dysfunctional breathing and/or vocal cord dysfunction, obstructive sleep apnea and obesity) should be investigated. At the same time, the possible reasons for poor symptom control need to be find in all modifiable factors which need to be carefully assessed. Non-adherence to medication or inadequate inhalation technique, persistent environmental exposures and psychosocial factors are, currently, recognized as the more common modifiable factors. Based on these premises, investigation and management of asthma require specialist multidisciplinary expertise and a systematic approach to characterizing patients' asthma phenotypes and delivering individualized care. Moreover, since early wheezers are at higher risk of developing asthma, we speculate that precocious interventions aimed at early diagnosis and prevention of modifiable factors might affect the age at onset of wheezing, reduce the prevalence of persistent later asthma and determine long term benefits for lung health.
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Affiliation(s)
- Nicola Ullmann
- Paediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Department of Paediatrics, Paediatric Hospital “Bambino Gesù” Research Institute, Rome, Italy
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31
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Renand A, Farrington M, Whalen E, Wambre E, Bajzik V, Chinthrajah S, Nadeau KC, Kwok WW. Heterogeneity of Ara h Component-Specific CD4 T Cell Responses in Peanut-Allergic Subjects. Front Immunol 2018; 9:1408. [PMID: 29988522 PMCID: PMC6026622 DOI: 10.3389/fimmu.2018.01408] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/06/2018] [Indexed: 11/13/2022] Open
Abstract
Understanding the peanut-specific CD4 T cell responses in peanut-allergic (PA) subjects should provide new insights into the development of innovative immunotherapies for the treatment of peanut allergy. Although peanut-specific CD4 T cells have a TH2 profile in PA subjects, the immunogenicity of different Ara h components in eliciting specific CD4 T cell responses and the heterogeneity of these Ara h-reactive TH2 cells remains unclear. In this study, we investigated Ara h 1, 2, 3, 6, and 8-specific T cell responses in PA and sensitized non-peanut-allergic (sNPA) subjects, using the CD154 upregulation assay and the class II tetramer technology. In the PA group, T cells directed against Ara h 1, 2, 3, and 6 have a heterogeneous TH2 phenotype characterized by differential expression of CRTH2, CD27, and CCR6. Reactivity toward these different components was also distinct for each PA subject. Two dominant Ara h 2 epitopes associated with DR1501 and DR0901 were also identified. Frequencies of Ara h-specific T cell responses were also linked to the peanut specific-IgE level. Conversely, low peanut-IgE level in sNPA subjects was associated with a weak or an absence of the allergen-specific T cell reactivity. Ara h 8-specific T cell reactivity was weak in both PA and sNPA subjects. Thus, peanut-IgE level was associated with a heterogeneous Ara h (but not Ara h 8)-specific T cell reactivity only in PA patients. This suggests an important immunogenicity of each Ara h 1, 2, 3, and 6 in inducing peanut allergy. Targeting Ara h 1-, 2-, 3-, and 6-specific effector-TH2 cells can be the future way to treat peanut allergy.
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Affiliation(s)
- Amedee Renand
- Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
| | | | - Elizabeth Whalen
- Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
| | - Erik Wambre
- Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
| | - Veronique Bajzik
- Benaroya Research Institute at Virginia Mason, Seattle, WA, United States
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy Research at Stanford University, Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Division of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy Research at Stanford University, Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Division of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, United States
| | - William W Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States
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32
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Han H, Roan F, Ziegler SF. The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines. Immunol Rev 2018; 278:116-130. [PMID: 28658558 DOI: 10.1111/imr.12546] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis often precedes the development of other atopic diseases. The atopic march describes this temporal relationship in the natural history of atopic diseases. Although the pathophysiological mechanisms that underlie this relationship are poorly understood, epidemiological and genetic data have suggested that the skin might be an important route of sensitization to allergens. Animal models have begun to elucidate how skin barrier defects can lead to systemic allergen sensitization. Emerging data now suggest that epithelial cell-derived cytokines such as thymic stromal lymphopoietin (TSLP), IL-33, and IL-25 may drive the progression from atopic dermatitis to asthma and food allergy. This review focuses on current concepts of the role of skin barrier defects and epithelial cell-derived cytokines in the initiation and maintenance of allergic inflammation and the atopic march.
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Affiliation(s)
- Hongwei Han
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Florence Roan
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Steven F Ziegler
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, WA, USA
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33
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Weissler KA, Rasooly M, DiMaggio T, Bolan H, Cantave D, Martino D, Neeland MR, Tang MLK, Dang TD, Allen KJ, Frischmeyer-Guerrerio PA. Identification and analysis of peanut-specific effector T and regulatory T cells in children allergic and tolerant to peanut. J Allergy Clin Immunol 2018; 141:1699-1710.e7. [PMID: 29454004 DOI: 10.1016/j.jaci.2018.01.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Peanut allergy (PA) is potentially life-threatening and generally persists for life. Recent data suggest the skin might be an important route of initial sensitization to peanut, whereas early oral exposure to peanut is protective. In mice regulatory T (Treg) cells are central to the development of food tolerance, but their contribution to the pathogenesis of food allergy in human subjects is less clear. OBJECTIVE We sought to quantify and phenotype CD4+ peanut-specific effector T (ps-Teff) cells and peanut-specific regulatory T (ps-Treg) cells in children with and without PA or PS. METHODS ps-Teff and ps-Treg cells were identified from peripheral blood of children with PA, children with PS, and nonsensitized/nonallergic (NA) school-aged children and 1-year-old infants based on upregulation of CD154 or CD137, respectively, after stimulation with peanut extract. Expression of cytokines and homing receptors was evaluated by using flow cytometry. Methylation at the forkhead box protein 3 (FOXP3) locus was measured as a marker of Treg cell stability. RESULTS Differential upregulation of CD154 and CD137 efficiently distinguished ps-Teff and ps-Treg cells. A greater percentage of ps-Teff cells from infants with PA and infants with PS expressed the skin-homing molecule cutaneous lymphocyte antigen, suggesting activation after exposure through the skin, compared with NA infants. Although ps-Teff cells in both school-aged and infant children with PA produced primarily TH2 cytokines, a TH1-skewed antipeanut response was seen only in NA school-aged children. The frequency, homing receptor expression, and stability of ps-Treg cells in infants and school-aged children were similar, regardless of allergic status. CONCLUSIONS Exposure to peanut through the skin can prime the development of TH2 ps-Teff cells, which promote sensitization to peanut, despite the presence of normal numbers of ps-Treg cells.
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Affiliation(s)
- Katherine A Weissler
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Marjohn Rasooly
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Tom DiMaggio
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Hyejeong Bolan
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Daly Cantave
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - David Martino
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Melanie R Neeland
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Mimi L K Tang
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | - Thanh D Dang
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
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Tham EH, Shek LPC, Van Bever HP, Vichyanond P, Ebisawa M, Wong GW, Lee BW. Early introduction of allergenic foods for the prevention of food allergy from an Asian perspective-An Asia Pacific Association of Pediatric Allergy, Respirology & Immunology (APAPARI) consensus statement. Pediatr Allergy Immunol 2018; 29:18-27. [PMID: 29068090 DOI: 10.1111/pai.12820] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 10/03/2017] [Accepted: 10/15/2017] [Indexed: 12/29/2022]
Abstract
Emerging evidence for the early introduction of allergenic foods for the prevention of food allergies, such as peanut allergy in Western populations, has led to the recent publication of guidelines in the USA and Europe recommending early peanut introduction for high-risk infants with severe eczema or egg allergy. Peanut allergy is, however, much less prevalent in Asia compared to the West. Varying patterns of food allergy are seen even within Asian countries-such as a predominance of wheat allergy in Japan and Thailand and shellfish allergy in Singapore and the Philippines. Customs and traditions, such as diet and infant feeding practices, also differ between Asian populations. Hence, there are unique challenges in adapting guidelines on early allergenic food introduction to the Asian setting. In this paper, we review the evidence and discuss the possible approaches to guide the timely introduction of allergenic food in high-risk infants in Asia.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Lynette Pei-Chi Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Hugo Ps Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - Pakit Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Gary Wk Wong
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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35
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Blom LH, Juel-Berg N, Larsen LF, Hansen KS, Poulsen LK. Circulating allergen-specific T H2 lymphocytes: CCR4 + rather than CLA + is the predominant phenotype in peanut-allergic subjects. J Allergy Clin Immunol 2017; 141:1498-1501.e5. [PMID: 29225086 DOI: 10.1016/j.jaci.2017.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/17/2017] [Accepted: 10/25/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Lars H Blom
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark.
| | - Nanna Juel-Berg
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark; Department of Pediatrics, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Lau Fabricius Larsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Kirsten S Hansen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark; Department of Pediatrics, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
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36
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Tordesillas L, Berin MC, Sampson HA. Immunology of Food Allergy. Immunity 2017; 47:32-50. [DOI: 10.1016/j.immuni.2017.07.004] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/29/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
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38
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Foong RX, du Toit G, Fox AT. Asthma, Food Allergy, and How They Relate to Each Other. Front Pediatr 2017; 5:89. [PMID: 28536690 PMCID: PMC5422552 DOI: 10.3389/fped.2017.00089] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/10/2017] [Indexed: 11/17/2022] Open
Abstract
The association between atopic diseases is well known, and previous research has shown that having one atopic disease can predispose to having another. The link between asthma and food allergy has been well researched, but the exact relationship between the two atopic conditions is not fully understood. Food allergic infants are at increased risk for the development of asthma and are at risk of food-induced asthmatic episodes and also anaphylaxis. Having a diagnosis of both food allergy and asthma has also been shown to have an effect on the severity of a patient's disease including being at greater risk of severe asthmatic episodes. Therefore, understanding the relationship between these two conditions in order to treat and manage these children safely is crucial to clinicians.
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Affiliation(s)
- Ru-Xin Foong
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK.,Institute of Child Health, University College of London, London, UK
| | - George du Toit
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Adam T Fox
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
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39
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The Use of Epicutaenous Patch Testing in the Evaluation of Gastrointestinal Disease. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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Abstract
Food allergy is receiving increased attention in recent years. Because there is currently no known cure for food allergy, avoiding the offending food is the best defense for sensitive individuals. Type I food allergy is mediated by food proteins, and thus, theoretically, any food protein is a potential allergen. Variability of an individual's immune system further complicates attempts to understand allergen-antibody interaction. In this article, we briefly review food allergy occurrence, prevalence, mechanisms, and detection. Efforts aimed at reducing/eliminating allergens through food processing are discussed. Future research needs are addressed.
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Affiliation(s)
- Shridhar K Sathe
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida 30306-1493;
| | - Changqi Liu
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida 30306-1493;
| | - Valerie D Zaffran
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, Florida 30306-1493;
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41
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Benedé S, Blázquez AB, Chiang D, Tordesillas L, Berin MC. The rise of food allergy: Environmental factors and emerging treatments. EBioMedicine 2016; 7:27-34. [PMID: 27322456 PMCID: PMC4909486 DOI: 10.1016/j.ebiom.2016.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 01/08/2023] Open
Abstract
Food allergy has rapidly increased in prevalence, suggesting an important role for environmental factors in disease susceptibility. The immune response of food allergy is characterized by IgE production, and new findings from mouse and human studies indicate an important role of the cytokine IL-9, which is derived from both T cells and mast cells, in disease manifestations. Emerging evidence suggests that route of exposure to food, particularly peanut, is important. Exposure through the skin promotes sensitization while early exposure through the gastrointestinal tract promotes tolerance. Evidence from mouse studies indicate a role of the microbiome in development of food allergy, which is supported by correlative human studies showing a dysbiosis in food allergy. There is no approved treatment for food allergy, but emerging therapies are focused on allergen immunotherapy to provide desensitization, while pre-clinical studies are focused on using adjuvants or novel delivery approaches to improve efficacy and safety of immunotherapy. Emerging evidence suggests that route of exposure to food allergens in early life determines sensitization versus tolerance. The microbiota and dietary factors appear to play a key role in susceptibility to food allergy. Immunotherapy applied via different routes is currently the most promising form of experimental treatment for food allergy.
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Affiliation(s)
- Sara Benedé
- Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Belen Blázquez
- Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Chiang
- Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leticia Tordesillas
- Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Cecilia Berin
- Jaffe Food Allergy Institute, Immunology Institute, Mindich Child Health Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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42
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43
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Role of Maternal Dietary Peanut Exposure in Development of Food Allergy and Oral Tolerance. PLoS One 2015; 10:e0143855. [PMID: 26656505 PMCID: PMC4675539 DOI: 10.1371/journal.pone.0143855] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/10/2015] [Indexed: 01/09/2023] Open
Abstract
Background The impact of maternal ingestion of peanut during pregnancy and lactation on an offspring’s risk for peanut allergy is under debate. Objective To investigate the influence of maternal dietary peanut exposure and breast milk on an offspring’s allergy risk. Methods Preconceptionally peanut-exposed C3H/HeJ females were either fed or not fed peanut during pregnancy and lactation. The offsprings’ responses to peanut sensitization or oral tolerance induction by feeding antigen prior to immunization were assessed. We also assessed the impact of immune murine milk on tolerance induction pre- or post-weaning. For antigen uptake studies, mice were gavaged with fluorescent peanut in the presence or absence of immune murine milk; Peyer’s patches were harvested for immunostaining. Results Preconceptional peanut exposure resulted in the production of varying levels of maternal antibodies in serum (and breast milk), which were transferred to the offspring. Despite this, maternal peanut exposure either preconceptionally or during pregnancy and lactation, when compared to no maternal exposure, had no impact on peanut allergy. When offspring were fed peanut directly, dose-dependent tolerance induction, unaltered by maternal feeding of peanut, was seen. Although peanut uptake into the gut-associated lymphoid tissues was enhanced by immune milk as compared to naïve milk, tolerance induction was not affected by the co-administration of immune milk either pre- or post-weaning. Conclusion Maternal peanut exposure during pregnancy and lactation has no impact on the development of peanut allergy in the offspring. Tolerance to peanut can be induced early, even pre-weaning, by giving moderate amounts of peanut directly to the infant, and this is neither enhanced nor impaired by concurrent exposure to immune milk.
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44
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Abstract
Food allergy is a growing public health problem that is estimated to affect 4% to 8% of children and 5% of adults. In this review, we discuss our current understanding of the pathophysiology of food allergy, from oral tolerance, to sensitization, and lastly the elicitation of an allergic response. As much of the existing evidence for the mechanisms of food allergy is derived from animal models, we include these studies where relevant. In addition, whenever possible, we review similar evidence involved in human disease and provide applications for consideration in clinical practice.
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45
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Affiliation(s)
- M. C. Berin
- Pediatric Allergy and Immunology; Icahn School of Medicine at Mount Sinai; New York NY USA
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46
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Izadi N, Luu M, Ong PY, Tam JS. The Role of Skin Barrier in the Pathogenesis of Food Allergy. CHILDREN (BASEL, SWITZERLAND) 2015; 2:382-402. [PMID: 27417371 PMCID: PMC4928763 DOI: 10.3390/children2030382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 02/08/2023]
Abstract
Food allergy is a serious public health problem with an increasing prevalence. Current management is limited to food avoidance and emergency treatment. Research into the pathogenesis of food allergy has helped to shape our understanding of how patients become sensitized to an allergen. Classically, food sensitization was thought to occur through the gastrointestinal tract, but alternative routes of sensitization are being explored, specifically through the skin. Damaged skin barrier may play a crucial role in the development of food sensitization. Better understanding of how patients initially become sensitized may help lead to the development of a safe and effective treatment for food allergies or better prevention strategies.
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Affiliation(s)
- Neema Izadi
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
| | - Minnelly Luu
- Department of Dermatology, Keck School of Medicine, University of Southern California.
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California.
| | - Jonathan S Tam
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California.
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47
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IgE-Mediated Food Allergy. Mucosal Immunol 2015. [DOI: 10.1016/b978-0-12-415847-4.00084-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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48
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Tordesillas L, Goswami R, Benedé S, Grishina G, Dunkin D, Järvinen KM, Maleki SJ, Sampson HA, Berin MC. Skin exposure promotes a Th2-dependent sensitization to peanut allergens. J Clin Invest 2014; 124:4965-75. [PMID: 25295541 DOI: 10.1172/jci75660] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 09/04/2014] [Indexed: 01/21/2023] Open
Abstract
Sensitization to foods often occurs in infancy, without a known prior oral exposure, suggesting that alternative exposure routes contribute to food allergy. Here, we tested the hypothesis that peanut proteins activate innate immune pathways in the skin that promote sensitization. We exposed mice to peanut protein extract on undamaged areas of skin and observed that repeated topical exposure to peanut allergens led to sensitization and anaphylaxis upon rechallenge. In mice, this epicutaneous peanut exposure induced sensitization to the peanut components Ara h 1 and Ara h 2, which is also observed in human peanut allergy. Both crude peanut extract and Ara h 2 alone served as adjuvants, as both induced a bystander sensitization that was similar to that induced by the atopic dermatitis-associated staphylococcal enterotoxin B. In cultured human keratinocytes and in murine skin, peanut extract directly induced cytokine expression. Moreover, topical peanut extract application induced an alteration dependent on the IL-33 receptor ST2 in skin-draining DCs, resulting in Th2 cytokine production from T cells. Together, our data support the hypothesis that peanuts are allergenic due to inherent adjuvant activity and suggest that skin exposure to food allergens contributes to sensitization to foods in early life.
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49
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Brough HA, Cousins DJ, Munteanu A, Wong YF, Sudra A, Makinson K, Stephens AC, Arno M, Ciortuz L, Lack G, Turcanu V. IL-9 is a key component of memory TH cell peanut-specific responses from children with peanut allergy. J Allergy Clin Immunol 2014; 134:1329-1338.e10. [PMID: 25112699 DOI: 10.1016/j.jaci.2014.06.032] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 06/15/2014] [Accepted: 06/26/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Differentiation between patients with peanut allergy (PA) and those with peanut sensitization (PS) who tolerate peanut but have peanut-specific IgE, positive skin prick test responses, or both represents a significant diagnostic difficulty. Previously, gene expression microarrays were successfully used to identify biomarkers and explore immune responses during PA immunotherapy. OBJECTIVE We aimed to characterize peanut-specific responses from patients with PA, subjects with PS, and atopic children without peanut allergy (NA children). METHODS A preliminary exploratory microarray investigation of gene expression in peanut-activated memory TH subsets from 3 children with PA and 3 NA children identified potential PA diagnostic biomarkers. Microarray findings were confirmed by using real-time quantitative PCR in 30 subjects (12 children with PA, 12 children with PS, and 6 NA children). Flow cytometry was used to identify the TH subsets involved. RESULTS Among 12,257 differentially expressed genes, IL9 showed the greatest difference between children with PA and NA children (45.59-fold change, P < .001), followed by IL5 and then IL13. Notably, IL9 allowed the most accurate classification of children with PA and NA children by using a machine-learning approach with recursive feature elimination and the random forest algorithm. Skin- and gut-homing TH cells from donors with PA expressed similar TH2- and TH9-associated genes. Real-time quantitative PCR confirmed that IL9 was the highest differentially expressed gene between children with PA and NA children (23.3-fold change, P < .01) and children with PS (18.5-fold change, P < .05). Intracellular cytokine staining showed that IL-9 and the TH2-specific cytokine IL-5 are produced by distinct TH populations. CONCLUSION In this study IL9 best differentiated between children with PA and children with PS (and atopic NA children). Mutually exclusive production of IL-9 and the TH2-specific cytokine IL-5 suggests that the IL-9-producing cells belong to the recently described TH9 subset.
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Affiliation(s)
- Helen A Brough
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - David J Cousins
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Alina Munteanu
- Faculty of Computer Science, University of Iasi, Iasi, Romania
| | - Yuen Fei Wong
- Genomics Centre, King's College London, London, United Kingdom
| | - Asha Sudra
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Kerry Makinson
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Alick C Stephens
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Matthew Arno
- Genomics Centre, King's College London, London, United Kingdom
| | - Liviu Ciortuz
- Faculty of Computer Science, University of Iasi, Iasi, Romania
| | - Gideon Lack
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom
| | - Victor Turcanu
- Division of Asthma, Allergy and Lung Biology, King's College London, and Guys' Hospital, London, United Kingdom; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, and Guys' Hospital, London, United Kingdom.
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Food Allergy and the Oral Immunotherapy Approach. Arch Immunol Ther Exp (Warsz) 2014; 63:31-9. [DOI: 10.1007/s00005-014-0304-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 05/15/2014] [Indexed: 12/17/2022]
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