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Lee HY, Nazmul T, Lan J, Oyoshi MK. Maternal influences on offspring food allergy. Immunol Rev 2024. [PMID: 39275992 DOI: 10.1111/imr.13392] [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] [Indexed: 09/16/2024]
Abstract
The prevalence of allergies has been globally escalating. While allergies could appear at any age, they often develop in early life. However, the significant knowledge gap in the field is the mechanisms by which allergies affect certain people but not others. Investigating early factors and events in neonatal life that have a lasting impact on determining the susceptibilities of children to develop allergies is a significant area of the investigation as it promotes the understanding of neonatal immune system that mediates tolerance versus allergies. This review focuses on the research over the recent 10 years regarding the potential maternal factors that influence offspring allergies with a view to food allergy, a potentially life-threatening cause of anaphylaxis. The role of breast milk, maternal diet, maternal antibodies, and microbiota that have been suggested as key maternal factors regulating offspring allergies are discussed here. We also suggest future research area to expand our knowledge of maternal-offspring interactions on the pathogenesis of food allergy.
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Affiliation(s)
- Hwa Yeong Lee
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanuza Nazmul
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Jinggang Lan
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Michiko K Oyoshi
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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2
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Guiddir T, Siberil A, Lepape F, Hacker M, Nemni A. Can cashew nut allergy resolve spontaneously? Clin Transl Allergy 2024; 14:e12385. [PMID: 39138025 PMCID: PMC11321836 DOI: 10.1002/clt2.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/28/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Tamazoust Guiddir
- Pulmonology and Allergology Pediatric UnitAP‐HPBicêtre HospitalLe Kremlin BicêtreFrance
| | - Audrey Siberil
- Pulmonology and Allergology Pediatric UnitAP‐HPBicêtre HospitalLe Kremlin BicêtreFrance
| | | | - Marion Hacker
- Children and Adult Allergology DepartmentRobert Ballanger HospitalAulnay‐sous‐BoisFrance
| | - Ariane Nemni
- Children and Adult Allergology DepartmentRobert Ballanger HospitalAulnay‐sous‐BoisFrance
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Oezguen N, Rider NL, Dowlin M, Singh I. Identifying Region-Specific Allergy Sensitization Clusters to Optimize Diagnosis and Reduce Costs. J Pediatr 2024; 270:113999. [PMID: 38431194 DOI: 10.1016/j.jpeds.2024.113999] [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: 10/10/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To delineate quantitatively the allergen sensitization patterns in a large pediatric cohort and inform the selection of a region-specific panel of allergen tests for timely and cost-effective in vitro atopy screening. STUDY DESIGN IgE levels for specific allergens from patients in the Texas Children's Health System were analyzed retrospectively. Statistical and network analyses were conducted to reveal sensitization patterns. RESULTS Network analysis of 114 distinct allergens among 12 065 patients identified 2 main groups of allergens: environmental and food. Approximately 67.5% of patients were sensitized to environmental allergens, 47.2% to food allergens, and 7.3% to at least 1 allergen from both groups. We identified a novel panel of 13 allergens that could detect sensitization in 95% of patients, whereas panels of 7 allergens within each category effectively identified sensitization in 95% of patients with specific sensitivities. This data-driven approach is estimated to reduce overall testing costs by 52%. In agreement with literature, we observed correlations among allergens within specific categories, such as pollen, shellfish, nuts, and dairy allergens. CONCLUSIONS This study provides insights into allergen sensitization patterns informing an algorithmic testing approach tailored for primary care settings. The use of a region and population-specific test panel can efficiently identify atopy, leading to more targeted testing. This strategy has the potential to refine laboratory testing, reduce costs, and improve the appropriateness of referrals to allergy specialists, ultimately enhancing diagnostic accuracy and resource allocation.
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Affiliation(s)
- Numan Oezguen
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX; Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Nicholas L Rider
- Department of Health Systems & Implementation Science, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Allergy-Immunology, The Carilion Clinic, Roanoke, VA
| | - Michael Dowlin
- Department of Pathology, Texas Children's Hospital, Houston, TX
| | - Ila Singh
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX; Department of Pathology, Texas Children's Hospital, Houston, TX.
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Şirin S, Özkan Kırgın B, Özmen S, Akelma Z. Evaluation of Allergic Reactions and Tolerance with Fruit and Vegetable Allergy in Children. Int Arch Allergy Immunol 2024:1-8. [PMID: 38865980 DOI: 10.1159/000539216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/02/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Despite the increasing prevalence of fruit and vegetable allergies in childhood over the past decades, the clinical course of reaction types and tolerance remain unclear. Our aim was to evaluate the clinical course, demographic characteristics, and tolerance rate of allergic reactions induced by fruits or vegetables. METHODS We conducted a retrospective, descriptive, cross-sectional study on patients who presented with suspected allergic reactions to fruit or vegetables. We used patient records to identify demographic data, skin prick test, prick-to-prick test, and oral food challenge test results and laboratory findings. RESULTS The study included 78 children with a median age of 61.5 months. Class 1 and 2 allergies were found in 65 and 13 cases, respectively. The most common allergens were potato (21.8%), banana (15.4%), peach (14.1%), and tomato (12.8%). Clinical symptoms included urticaria (75.6%), oral allergy syndrome (15.4%), angioedema (7.7%), and anaphylaxis (1.3%). Thirteen children achieved tolerance, while 61.7% did not. The median time to tolerance was 13.5 months after diagnosis, with a minimum of 9 months. Significant differences in reaction type, clinical presentation, pan-allergy to aeroallergens, and serum total IgE levels were found between the tolerant and non-tolerant groups (p = 0.006, 0.009, 0.005, and 0.001, respectively). CONCLUSION This is the first study to provide guidance on the tolerance rate and resolution time of fruit and vegetable allergies based on demographic and diagnostic parameters. Further research is needed to deepen our understanding of fruit and vegetable allergy.
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Affiliation(s)
- Seda Şirin
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
- Division of Pediatric Allergy and Immunology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Burcu Özkan Kırgın
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
| | - Serap Özmen
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
- Division of Pediatric Allergy and Immunology, Health Sciences University, Ankara, Turkey
| | - Zülfikar Akelma
- Pediatric Allergy and Immunology Clinic, Dr. Sami Ulus Children's Research and Training Hospital, Ankara, Turkey
- Division of Pediatric Allergy and Immunology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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5
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Røisgård S, Nopp A, Lindam A, Nilsson CA, West CE. Basophil allergen threshold sensitivity to casein (casein-specific CD-sens) predicts allergic reactions at a milk challenge in most but not all patients. Immun Inflamm Dis 2024; 12:e1265. [PMID: 38722265 PMCID: PMC11080960 DOI: 10.1002/iid3.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The basophil activation test is an emerging clinical tool in the diagnosis of cow's milk allergy (CMA). The aim was to assess the association between the basophil allergen threshold sensitivity to the major milk protein casein (casein-specific CD-sens), the levels of milk- and casein-specific Immunoglobulin E antibodies (IgE-ab), and the severity of allergic reactions at milk challenges. METHODS We enrolled 34 patients aged 5-15 (median 9) years who underwent a double-blind placebo-controlled milk-challenge (DBPCMC) as screening before inclusion in an oral immunotherapy study for CMA. The severity of the allergic reaction at the DBPCMC was graded using Sampson's severity score. Venous blood was drawn before the DBPCMC. Milk- and casein-specific IgE-ab were analyzed. Following in vitro stimulation of basophils with casein, casein-specific CD-sens, was determined. RESULTS Thirty-three patients completed the DBPCMC. There were strong correlations between casein-specific CD-sens and IgE-ab to milk (rs = 0.682, p < .001), and between casein-specific CD-sens and IgE-ab to casein (rs = 0.823, p < .001). There was a correlation between the severity of the allergic reaction and casein-specific CD-sens level (rs = 0.395, p = .041) and an inverse correlation between casein-specific CD-sens level and the cumulative dose of milk protein to which the patient reacted at the DBPCMC (rs = -0.418, p = .027). Among the 30 patients with an allergic reaction at the DBPCMC, 67% had positive casein-specific CD-sens, 23% had negative casein-specific CD-sens, and 10% were declared non-responders. CONCLUSION Two thirds of those reacting at the DBPMC had positive casein-specific CD-sens, but reactions also occurred despite negative casein-specific CD-sens. The association between casein-specific CD-sens and the severity of the allergic reaction and cumulative dose of milk protein, respectively, was moderate.
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Affiliation(s)
- Solveig Røisgård
- Department of Clinical SciencesPediatrics, Umeå UniversityUmeåSweden
| | - Anna Nopp
- Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Sachs Children and Youth HospitalSödersjukhusetStockholmSweden
| | - Anna Lindam
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development ÖstersundUmeå UniversityUmeåSweden
| | | | - Caroline A. Nilsson
- Clinical Science and EducationKarolinska InstitutetStockholmSweden
- Sachs Children and Youth HospitalSödersjukhusetStockholmSweden
| | - Christina E. West
- Department of Clinical SciencesPediatrics, Umeå UniversityUmeåSweden
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6
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Lieberman J, Muraro A, Blaiss M. How to diagnose IgE-mediated food allergy. Arch Dis Child Educ Pract Ed 2024:edpract-2023-325938. [PMID: 38453428 DOI: 10.1136/archdischild-2023-325938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
Immunoglobulin E (IgE)-mediated food allergy is an immune response, typically to a food protein. Accurate diagnosis reduces unnecessary dietary restrictions and economic and psychological burden on patients and caregivers but relies on a rigorous clinical history, specific IgE diagnostic tests and, where needed, oral food challenge. Increased awareness is needed around which patients to test for IgE-mediated food allergy, as well as terms commonly associated with IgE-mediated food allergy testing, in order to optimise patient diagnosis and management. Herein, we describe approaches to diagnosis of IgE-mediated food allergy, appropriate interpretation of results and risks of overtesting.
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Affiliation(s)
- Jay Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Michael Blaiss
- Department of Allergy/Immunology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Kim H, Jeong K, Park M, Roh YY, Jung JH, Kim SY, Kim JD, Kim MJ, Kim YH, Sohn MH, Lee S, Kim KW. Predicting the Outcome of Pediatric Oral Food Challenges for Determining Tolerance Development. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2024; 16:179-190. [PMID: 38528385 DOI: 10.4168/aair.2024.16.2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Despite the risk of anaphylaxis, oral food challenges (OFCs) are performed clinically for various indications, particularly to confirm tolerance development. This study aimed to assess OFCs by relevant indications and build an outcome prediction model to help determine when to perform OFCs in children who are likely to have developed immune tolerance. METHODS In total, 432 pediatric OFCs were retrospectively analyzed according to indications. Clinical characteristics, serum total immunoglobulin (Ig) E, blood eosinophils, and specific IgE and IgG4 levels for food allergens were noted and compared. Machine learning was utilized to select the most important variables in determining the passage of the OFCs, and prediction models were constructed using the selected variables. RESULTS OFCs were most commonly performed to confirm tolerance development (number, %; 267, 61.8%). The most common food allergens tested were egg (191, 44.2%) and milk (135, 31.3%). Children who passed the egg challenges for confirming tolerance acquisition had significantly lower egg white-specific IgE level (P = 0.008). Similarly, those who passed milk challenges had significantly lower cow's milk-specific IgE (P = 0.002) and casein-specific IgE levels (P = 0.005). We developed a nomogram to predict the outcome of OFCs to determine the tolerance acquisition with the selected variables; lower food-specific IgE, higher total IgE, and younger age indicated a higher probability of passage. The area under the curve (95% confidence interval) was 0.623 (0.503-0.743) for egg and 0.734 (0.628-0.840) for milk. CONCLUSIONS Serum total IgE and food-specific IgE combined with age showed trends toward passing OFCs for confirming tolerance development. The constructed model may be used by clinicians as a practical guide for minimizing the risks of OFCs and a timely reintroduction for children with food allergies.
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Affiliation(s)
- Hamin Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunguk Jeong
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Mireu Park
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Young Roh
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hwa Jung
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Deok Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Innovation in Digital Healthcare, Yonsei University College of Medicine, Seoul, Korea.
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Wang Y, Hils M, Fischer A, Wölbing F, Biedermann T, Schnieke A, Fischer K. Gene-edited pigs: a translational model for human food allergy against alpha-Gal and anaphylaxis. Front Immunol 2024; 15:1358178. [PMID: 38469303 PMCID: PMC10925645 DOI: 10.3389/fimmu.2024.1358178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
The prevalence of food allergy is rising and is estimated to approach 10%. Red meat allergy is the first known food allergy elicited by immunoglobulin E (IgE) antibodies recognizing a carbohydrate. Due to the loss of function of the alpha-1,3-galactosyltransferase (GGTA1) gene in humans, the disaccharide galactose-α-1,3-galactose (α-Gal) cannot be synthesized and therefore became immunogenic. IgE sensitization is elicited through the skin by repetitive tick bites transmitting α-Gal. The underlying mechanisms regarding innate and adaptive immune cell activation, including the B-cell isotype switch to IgE, are poorly understood, requiring further research and physiologically relevant animal models. Here, we describe a new animal model of red meat allergy using percutaneous α-Gal sensitization of gene-edited GGTA1-deficient pigs. Total and α-Gal-specific IgG, IgG1, IgG2, IgG4, and IgE levels were tracked. Further key factors associated with allergic skin inflammation, type 2 immunity, and allergy development were measured in PBMCs and skin samples. Significant increases in α-Gal-specific IgG1 and IgE levels indicated successful sensitization to the allergen α-Gal. Intracutaneous sensitizations with α-Gal recruited lymphocytes to the skin, including elevated numbers of T helper 2 (Th2) cells. Finally, α-Gal-sensitized pigs not only recognized α-Gal as non-self-antigen following α-Gal exposure through the skin but also developed anaphylaxis upon antigen challenge. Based on the similarities between the porcine and human skin, this new large animal model for α-Gal allergy should help to unveil the consecutive steps of cutaneous sensitization and aid the development of prophylactic and treatment interventions.
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Affiliation(s)
- Ying Wang
- Chair of Livestock Biotechnology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Miriam Hils
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andrea Fischer
- Chair of Livestock Biotechnology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Florian Wölbing
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Angelika Schnieke
- Chair of Livestock Biotechnology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Konrad Fischer
- Chair of Livestock Biotechnology, School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
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Ota M, Hoehn KB, Fernandes-Braga W, Ota T, Aranda CJ, Friedman S, Miranda-Waldetario MG, Redes J, Suprun M, Grishina G, Sampson HA, Malbari A, Kleinstein SH, Sicherer SH, de Lafaille MAC. CD23 +IgG1 + memory B cells are poised to switch to pathogenic IgE production in food allergy. Sci Transl Med 2024; 16:eadi0673. [PMID: 38324641 PMCID: PMC11008013 DOI: 10.1126/scitranslmed.adi0673] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/15/2023] [Indexed: 02/09/2024]
Abstract
Food allergy is caused by allergen-specific immunoglobulin E (IgE) antibodies, but little is known about the B cell memory of persistent IgE responses. Here, we describe, in human pediatric peanut allergy, a population of CD23+IgG1+ memory B cells arising in type 2 immune responses that contain high-affinity peanut-specific clones and generate IgE-producing cells upon activation. The frequency of CD23+IgG1+ memory B cells correlated with circulating concentrations of IgE in children with peanut allergy. A corresponding population of "type 2-marked" IgG1+ memory B cells was identified in single-cell RNA sequencing experiments. These cells differentially expressed interleukin-4 (IL-4)- and IL-13-regulated genes, such as FCER2/CD23+, IL4R, and germline IGHE, and carried highly mutated B cell receptors (BCRs). In children with high concentrations of serum peanut-specific IgE, high-affinity B cells that bind the main peanut allergen Ara h 2 mapped to the population of "type 2-marked" IgG1+ memory B cells and included clones with convergent BCRs across different individuals. Our findings indicate that CD23+IgG1+ memory B cells transcribing germline IGHE are a unique memory population containing precursors of high-affinity pathogenic IgE-producing cells that are likely to be involved in the long-term persistence of peanut allergy.
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Affiliation(s)
- Miyo Ota
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
- Precision Immunology Institute (PrIISM), and Department of Immunology and Immunotherapy, ISMMS; New York, NY. 10029, USA
| | - Kenneth B. Hoehn
- Department of Pathology, Yale School of Medicine; New Haven, CT 06520, USA
| | - Weslley Fernandes-Braga
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
- Precision Immunology Institute (PrIISM), and Department of Immunology and Immunotherapy, ISMMS; New York, NY. 10029, USA
| | - Takayuki Ota
- Department of Dermatology, Janssen Research & Development LLC; San Diego, CA 92121, USA
| | - Carlos J. Aranda
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
- Precision Immunology Institute (PrIISM), and Department of Immunology and Immunotherapy, ISMMS; New York, NY. 10029, USA
| | - Sara Friedman
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
- Precision Immunology Institute (PrIISM), and Department of Immunology and Immunotherapy, ISMMS; New York, NY. 10029, USA
| | - Mariana G.C. Miranda-Waldetario
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
- Precision Immunology Institute (PrIISM), and Department of Immunology and Immunotherapy, ISMMS; New York, NY. 10029, USA
| | - Jamie Redes
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
- Precision Immunology Institute (PrIISM), and Department of Immunology and Immunotherapy, ISMMS; New York, NY. 10029, USA
- Graduate School of Biomedical Sciences, ISMMS; New York, NY 10029, USA
| | - Maria Suprun
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
| | - Galina Grishina
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
| | - Hugh A. Sampson
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
| | - Alefiyah Malbari
- Kravis Children’s Hospital, Department of Pediatrics, ISMMS; New York, NY 10029, USA
| | - Steven H. Kleinstein
- Department of Pathology, Yale School of Medicine; New Haven, CT 06520, USA
- Department of Immunobiology, Yale School of Medicine; New Haven, CT 06520, USA
- Program in Computational Biology & Bioinformatics, Yale University; New Haven, CT 06511, USA
| | - Scott H. Sicherer
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
| | - Maria A. Curotto de Lafaille
- Jaffe Food Allergy Institute, Division of Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai (ISMMS); New York, NY 10029, USA
- Precision Immunology Institute (PrIISM), and Department of Immunology and Immunotherapy, ISMMS; New York, NY. 10029, USA
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10
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Riggioni C, Ricci C, Moya B, Wong D, van Goor E, Bartha I, Buyuktiryaki B, Giovannini M, Jayasinghe S, Jaumdally H, Marques-Mejias A, Piletta-Zanin A, Berbenyuk A, Andreeva M, Levina D, Iakovleva E, Roberts G, Chu D, Peters R, du Toit G, Skypala I, Santos AF. Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy. Allergy 2024; 79:324-352. [PMID: 38009299 DOI: 10.1111/all.15939] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta-analyses to assess the accuracy of diagnostic tests for IgE-mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta-analyses were undertaken for food-test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double-blind placebo-controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2-sIgE had 92%, Cor a 14-sIgE 95%, Ana o 3-sIgE 94%, casein-sIgE 93%, ovomucoid-sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.
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Affiliation(s)
- Carmen Riggioni
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore City, Singapore
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-WEst University, Potchefstroom, South Africa
| | - Beatriz Moya
- Department of Allergy, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Dominic Wong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Evi van Goor
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Elkerliek Hospital, Helmond, The Netherlands
| | - Irene Bartha
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Betul Buyuktiryaki
- Division of Pediatric Allergy, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sashini Jayasinghe
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Hannah Jaumdally
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Andreina Marques-Mejias
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Alexandre Piletta-Zanin
- Division of Pediatric Specialties, Department of Women, Children and Adolescents, Geneva University Hospitals, Geneva, Switzerland
| | - Anna Berbenyuk
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Margarita Andreeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Daria Levina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ekaterina Iakovleva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
| | - Derek Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Peters
- Murdoch Children's Research Institute Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - George du Toit
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Isabel Skypala
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Alexandra F Santos
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, 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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11
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Jeong K, Lee S. Natural course of IgE-mediated food allergy in children. Clin Exp Pediatr 2023; 66:504-511. [PMID: 37321568 PMCID: PMC10694555 DOI: 10.3345/cep.2022.01004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 06/17/2023] Open
Abstract
The prevalence of food allergy and food-induced anaphylaxis in children is increasing worldwide. Cow's milk, hen's eggs, and wheat allergies in young children have a more favorable prognosis with a relatively early outgrow, while allergies to peanuts, tree nuts, and seafood are more likely to be persistent. Although our understanding of the mechanism underlying the resolution of food allergy is incomplete, the roles of dendritic cells, regulatory T cells, and regulatory B cells are important. Many past studies on the natural course of food allergy were retrospective analyses of specific study groups, but large-scale population-based prospective studies are now being published. This review summarizes recent studies of the natural course of cow's milk, hen's eggs, wheat, peanuts, tree nuts, soy, sesame, and seafood allergies. The potential factors affecting the natural course of food allergy include symptom severity on ingestion, age at diagnosis, allergic comorbidities, skin prick test reaction size or serum food-specific immunoglobulin (Ig) E levels, changes in sensitization degree, IgE epitope specificity, ratio of food-specific IgE to IgG4, food-specific IgA levels, component-resolved diagnostic profile, diet, gut microbiome, and interventions such as immunotherapy. Since food allergy places a significant burden on patients and their caregivers in daily life, clinicians should be able to provide relevant knowledge on the natural course of food allergy, appropriately evaluate its resolution, and offer therapeutic options whenever possible.
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Affiliation(s)
- Kyunguk Jeong
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
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12
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Kubota K, Nagakura KI, Ejiri Y, Sato S, Ebisawa M, Yanagida N. Natural history of cow's milk allergy in children aged 6-12 years. Pediatr Allergy Immunol 2023; 34:e14064. [PMID: 38146113 DOI: 10.1111/pai.14064] [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: 07/26/2023] [Revised: 10/29/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Approximately 50%-90% of children with immediate-type cow's milk allergy (CMA) acquire tolerance by pre-school age. We aimed to investigate the acquisition rate of CMA tolerance in children aged 6-12 years. METHODS We included children with CMA who persisted until the age of 6. Tolerance was defined as passing an oral food challenge with 200 mL of unheated cow's milk (CM) or consuming 200 mL of CM without symptoms, whereas persistent CMA was defined as fulfilling neither of these criteria by 12 years old. Children receiving oral immunotherapy (OIT) were excluded from the primary analysis. Risk factors associated with persistent CMA were assessed using Cox regression analysis. RESULTS Of 80 included children, 30 (38%) had previous CM anaphylaxis, and 40 (50%) had eliminated CM completely from their diet. The median CM-specific immunoglobulin E (sIgE) level at 6 years old was 12.0 kUA /L. Tolerance was acquired by 25 (31%) and 46 (58%) children by the age of 9 and 12 years, respectively. At baseline, persistent CMA was associated with higher CM-sIgE levels (hazard ratio 2.29, 95% confidence interval 1.41-3.73, optimal cutoff level 12.7 kUA /L), previous CM anaphylaxis (2.07, 1.06-4.02), and complete CM elimination (3.12, 1.46-6.67). No children with CMA who had all three risk factors (n = 14) acquired tolerance. CONCLUSION Except for OIT patients, more than half of children with CMA at 6 years old acquired tolerance by 12 years old. Children with CMA who have the risk factors are less likely to acquire tolerance.
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Affiliation(s)
- Kei Kubota
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Pediatrics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ken-Ichi Nagakura
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Ejiri
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Sakura Sato
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Motohiro Ebisawa
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Noriyuki Yanagida
- Clinical Research Center for Allergology and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
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13
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Germán-Sánchez A, Alonso-Llamazares A, García-González F, Matala-Ahmed B, Melgar-Reyes CS, Antepara-Ercoreca I. Diagnostic validity of specific immunoglobulin E levels to alpha-gal in alpha-gal syndrome: a cross-sectional analysis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:102. [PMID: 38037176 PMCID: PMC10691071 DOI: 10.1186/s13223-023-00856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The diagnosis of Alpha-gal Syndrome (AGS) is based on the presence of symptoms after being exposed to potential sources of alpha-gal together with values of specific IgE (sIgE) to alpha-gal ≥ 0.1 kUA/L or ≥ 0.35 kUA/L. The aim of this study was to evaluate the diagnostic validity of sIgE levels to alpha-gal ≥ 0.1 kUA/L for identifying AGS. METHODS This was a cross-sectional analysis of adult patients with available data on sIgE levels to alpha-gal, classified into two groups according to the presence (Group 1) or absence (Group 2) of symptoms after being exposed to potential sources of alpha-gal. Values of sIgE to alpha-gal ≥ 0.1 kUA/l were considered a positive result. A descriptive analysis of internal and external validity parameters was performed in the entire population and adjusted by sex. RESULTS The study included 33 individuals in Group 1 and 65 in Group 2, with a mean age of around 47 years. The analysis of internal validity parameters revealed a high sensitivity, specificity, and positive probability ratio, with higher sensitivity in men and higher specificity in women. The analysis of external validity parameters showed a high negative predictive value and global value in all populations and both sexes. However, the positive predictive value was relatively high in men, but low in women. CONCLUSIONS Our results suggest that sIgE levels ≥ 0.1 kUA/L may be a useful tool for the diagnosis of AGS, although other factors and diagnostic techniques should also be considered.
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Affiliation(s)
- Adrián Germán-Sánchez
- Allergy Department, Basurto University Hospital, Bilbao, Spain.
- Allergy Department, Castellon University General Hospital, Avda/ Benicassim, 128, Castelló de la Plana 12004 (Castelló, Castellon, Spain.
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14
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Miller MA, McMurray JC, Watson NL, Mikita CP, Schwartz DJ. Clarification of food allergy diagnosis at a military medical center using oral food challenges. Ann Allergy Asthma Immunol 2023; 131:674-676. [PMID: 37495015 DOI: 10.1016/j.anai.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Mechelle A Miller
- Department of Allergy, Immunology, and Immunizations, Walter Reed National Military Medical Center, Bethesda, Maryland.
| | - Jeremy C McMurray
- Department of Allergy, Immunology, and Immunizations, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nora L Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Cecilia P Mikita
- Department of Allergy, Immunology, and Immunizations, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - David J Schwartz
- Department of Allergy, Immunology, and Immunizations, Walter Reed National Military Medical Center, Bethesda, Maryland
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15
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Wanniang N, Boehm TM, Codreanu-Morel F, Divaret-Chauveau A, Assugeni I, Hilger C, Kuehn A. Immune signatures predicting the clinical outcome of peanut oral immunotherapy: where we stand. FRONTIERS IN ALLERGY 2023; 4:1270344. [PMID: 37849958 PMCID: PMC10577271 DOI: 10.3389/falgy.2023.1270344] [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: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Peanut allergy is a growing health concern that can cause mild to severe anaphylaxis as well as reduced quality of life in patients and their families. Oral immunotherapy is an important therapeutic intervention that aims to reshape the immune system toward a higher threshold dose reactivity and sustained unresponsiveness in some patients. From an immunological point of view, young patients, especially those under 3 years old, seem to have the best chance for therapy success. To date, surrogate markers for therapy duration and response are evasive. We provide a comprehensive overview of the current literature state regarding immune signatures evolving over the course of oral immunotherapy as well as baseline immune conditions prior to the initiation of treatment. Although research comparing clinical and immune traits in the first years of life vs. later stages across different age groups is limited, promising insights are available on immunological endotypes among peanut-allergic patients. The available data call for continued research to fill in gaps in knowledge, possibly in an integrated manner, to design novel precision health approaches for advanced therapeutic interventions in peanut allergy.
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Affiliation(s)
- Naphisabet Wanniang
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Theresa-Maria Boehm
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Françoise Codreanu-Morel
- Department of Allergology and Immunology, Centre Hospitalier de Luxembourg-Kanner Klinik, Luxembourg, Luxembourg
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, Children’s Hospital, University of Nancy, Vandœuvre-lès-Nancy, France
- EA3450 DevAH, Faculty of Medecine, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Isabela Assugeni
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Annette Kuehn
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
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16
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Bourgoin P, Busnel JM. Promises and Remaining Challenges for Further Integration of Basophil Activation Test in Allergy-Related Research and Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3000-3007. [PMID: 37634807 DOI: 10.1016/j.jaip.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
More than 20 years after having been initially proposed, the relevance and usefulness of basophil activation test (BAT) for the field of allergy research and testing were demonstrated on many occasions. Leveraging the fully open format of a flexible, whole blood-based functional assay, BAT has been shown to be equally important for fundamental research, clinical research, and diagnosis. Regardless of whether the focus of a study is on the characterization of the allergenic moiety, on the patient side, or on the study of the fundamental processes involved in the allergic disease or its treatment, BAT enables the gathering of very important insights. In spite of this, its full capabilities have yet to be leveraged. Various bottlenecks, including but not limited to assay logistics, robustness, flow cytometry access, and/or expertise, have indeed been limiting its development beyond experts and long-term users. Now, various initiatives, aiming at resolving these bottlenecks, have been launched. If successful, a broader use of BAT could then be contemplated. In such a situation, its more thorough integration in clinical practice has the potential to significantly change the allergic patient's journey.
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Affiliation(s)
- Pénélope Bourgoin
- Global Research Organization, Beckman Coulter Life Sciences, Marseille, France
| | - Jean-Marc Busnel
- Global Research Organization, Beckman Coulter Life Sciences, Marseille, France.
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Skypala IJ, Reese I, Durban R, Hunter H, Podesta M, Chaddad MCC, Santos AF, Agache I. Food allergy-A holistic approach to dietary management. A joint EAACI Research & Outreach Committee and INDANA review. Pediatr Allergy Immunol 2023; 34:e14019. [PMID: 37747742 DOI: 10.1111/pai.14019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Abstract
Following a diagnosis of IgE-mediated food allergy, to secure the best outcome, the patient should receive individualized advice tailored to their specific needs, which considers the type and presentation of the food involved, level of exclusion required, risk of cross-contamination and any variance required for age, ethnicity, financial issues, and lifestyle. Issues such as food labels "may contain" statements, and variation in the threshold of reaction and impact of cofactors should also be considered. Most important is the need to ensure that the diagnosis is robust, especially given the nutritional, psychological, and socioeconomic issues that can affect an individual with a diagnosis of food allergy. Unnecessary exclusion of one or more foods that have not triggered allergic reactions, especially in individuals with allergic comorbidities, can result in severe IgE-mediated reactions on re-exposure. Given that food allergies may change over time, the diagnosis should be reviewed, to determine whether resolution is likely, or new-food triggers are reported. Regular assessment is vital, especially during childhood, to ensure reintroduction occurs at an appropriate time, thus enabling increased diversity of the diet and improvement in the quality of life. For some, an IgE-mediated food allergy may necessitate the life-long exclusion of foods, and for others, a food habitually eaten suddenly triggers an allergic reaction in adult life. People of all ages, ethnicities, and socioeconomic backgrounds deserve individual advice on the management of their food allergy to support a healthy diet and improve quality of life.
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Affiliation(s)
- Isabel J Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, part of Guys & St Thomas NHS Foundation Trust, London, UK
- Inflammation, Repair & Development Section, National Heart & Lung Institute, Imperial College, London, UK
| | - Imke Reese
- Nutritional Counseling and Therapy, Focus on Allergology, Munich, Germany
| | - Raquel Durban
- Carolina Asthma & Allergy Center, Charlotte, North Carolina, USA
| | - Hannah Hunter
- Department of Allergy, Guys & St Thomas NHS Foundation Trust, London, UK
- Kings College, London, UK
| | | | | | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, UK
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
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18
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Barreto M, Tripodi S, Arasi S, Landi M, Montesano M, Pelosi S, Potapova E, Sfika I, Villella V, Travaglini A, Brighetti MA, Matricardi PM, Dramburg S. Factors predicting the outcome of allergen-specific nasal provocation test in children with grass pollen allergic rhinitis. FRONTIERS IN ALLERGY 2023; 4:1186353. [PMID: 37304166 PMCID: PMC10250668 DOI: 10.3389/falgy.2023.1186353] [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: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background Nasal provocation testing (NPT) is a reference methodology to identify the culprit allergen in patients with allergic rhinitis. Selecting the right allergen for NPT is particularly difficult in poly-sensitized patients with seasonal allergic rhinitis (SAR). Predictors of NPT outcomes may facilitate the proper use of this test or even substitute it. Objective To identify predictors of grass pollen NPT outcome from an array of clinical data, e-diary outcomes, and allergy test results in poly-sensitized pediatric patients with SAR. Methods Poly-sensitized, SAR patients with grass pollen allergy, participating in the @IT.2020 pilot project in Rome and Pordenone (Italy), participated in a baseline (T0) visit with questionnaires, skin prick testing (SPT), and blood sampling to measure total (ImmunoCAP, TFS, Sweden) and specific IgE antibodies to grass pollen extracts and their major allergenic molecules (ESEP, Euroimmun Labordiagnostika, Germany). During the pollen season, patients filled the AllergyMonitor® e-diary app measuring their symptoms, medication intake, and allergy-related well-being via the Visual Analogue Scale (VAS). After the pollen season (T1), patients answered clinical questionnaires and underwent a nasal provocation test (NPT) with grass pollen extract. Results We recruited 72 patients (age 14.3 ± 2.8 years, 46 males) sensitized to grass and/or other pollens, including olive (63; 87.5%) and pellitory (49; 68.1%). Patients positive to grass pollen NPT (61; 84.7%), compared to the negative ones, had worse VAS values in the e-diary, larger SPT wheal reactions, and higher IgE levels, as well as specific activity to timothy and Bermuda grass extracts, rPhl p 5 and nCyn d 1. A positive NPT to grass pollen was predicted by an index combining the specific activity of IgE towards Phl p 5 and Cyn d 1 (AUC: 0.82; p < 0.01; best cut-off ≥7.25%, sensitivity 70.5%, specificity: 90.9%). VAS results also predicted NPT positivity, although with less precision (AUC: 0.77, p < 0.01; best cut-off ≥7, sensitivity: 60.7%, specificity: 81.8%). Conclusions An index combining the specific activity of IgE to rPhl p 5 and nCyn d 1 predicted with moderate sensitivity and high specificity the outcome of a grass pollen NPT in complex, poly-sensitized pediatric patients with seasonal allergic rhinitis. Further studies are needed to improve the index sensitivity and to assess its usefulness for NPT allergen selection or as an alternative to this demanding test procedure.
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Affiliation(s)
- M. Barreto
- NESMOS Department, Faculty of Medicine and Psychology, Pediatric Unit Sant’Andrea Hospital, “Sapienza” University, Rome, Italy
| | - S. Tripodi
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
- Allergology Service, Policlinico Casilino, Rome, Italy
| | - S. Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - M. Landi
- Institute for Biomedical Research and Innovation, Pediatric National Healthcare System, Turin, Italy
| | - M. Montesano
- NESMOS Department, Faculty of Medicine and Psychology, Pediatric Unit Sant’Andrea Hospital, “Sapienza” University, Rome, Italy
| | | | - E. Potapova
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - I. Sfika
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - V. Villella
- Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy
| | - A. Travaglini
- Department of Biology, Tor Vergata University, Rome, Italy
| | | | - P. M. Matricardi
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - S. Dramburg
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Msallam R, Redegeld FA. Mast cells-fetal mast cells crosstalk with maternal interfaces during pregnancy: Friend or foe? Pediatr Allergy Immunol 2023; 34:e13943. [PMID: 37102389 DOI: 10.1111/pai.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 04/28/2023]
Abstract
Mast cells (MC) are hematopoietic immune cells that play a major role during allergic reactions in adults by releasing a myriad of vasoactive and inflammatory mediators. MC seed all vascularized tissues and are most prominent in organs with a barrier function such as skin, lungs, and intestines. These secreted molecules cause mild symptoms such as localized itchiness and sneezing to life-threatening symptoms (i.e., anaphylactic shock). Presently, despite the extensive research on Th2-mediated immune responses in allergic diseases in adults, we are still unable to determine the mechanisms of the role of MC in developing pediatric allergic (PA) disorders. In this review, we will summarize the most recent findings on the origin of MC and discuss the underappreciated contribution of MC in the sensitization phase to maternal antibodies during pregnancy in allergic reactions and other diseases such as infectious diseases. Then, we will lay out potential MC-dependent therapeutic strategies to be considered in future investigations to understand the remaining gaps in MC research for a better quality of life for these young patients.
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Affiliation(s)
- Rasha Msallam
- Next Gen of Immunology (NGIg) Consultancy, Dubai, UAE
| | - Frank A Redegeld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Patel N, Shreffler WG, Custovic A, Santos AF. Will Oral Food Challenges Still Be Part of Allergy Care in 10 Years' Time? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:988-996. [PMID: 36822320 PMCID: PMC10698627 DOI: 10.1016/j.jaip.2023.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
Oral food challenges (OFCs) are currently the definitive diagnostic procedure in food allergy. Their design has evolved over the decades to maximize safety, optimize convenience, and address several specific clinical questions. However, they are a resource-intensive investigation that carry a risk for severe allergic reaction in which fatal outcomes, although rare, have been reported. In this review, we explore the many roles that OFC fulfil in the clinical and research settings. We also discuss progress that has been made in developing alternative diagnostic tools and how far these have reached in offering a viable replacement to OFC in clinical practice. Finally, we discuss the ongoing importance of research OFC to improve the future diagnostic capabilities of novel diagnostic tools.
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Affiliation(s)
- Nandinee Patel
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Wayne G Shreffler
- Food Allergy Center and Center for Immunology and Inflammatory Disease, Massachusetts General Hospital/Harvard Medical School, Boston, Mass
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas' Hospital, London, United Kingdom.
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Drakouli AE, Kontele I, Poulimeneas D, Saripanagiotou S, Grammatikopoulou MG, Sergentanis TN, Vassilakou T. Food Allergies and Quality of Life among School-Aged Children and Adolescents: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:433. [PMID: 36979991 PMCID: PMC10047601 DOI: 10.3390/children10030433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Recently, besides the focus on the medical diagnosis and therapeutic interventions for food allergy (FA), the psychosocial aspects of this frequent condition have also been investigated. The current systematic review aimed to explore and synthesize the scientific evidence published from January 2015 to April 2022 on Health-Related Quality of Life (HRQoL) among children and adolescents with FAs. Twenty-eight research studies were included in the review, which was conducted on three databases (PubMed, Scopus and Cochrane Library). In most studies, the scores indicate an average level of HRQoL for children and adolescents with FAs, with girls and older children being more negatively affected than boys and younger ones, respectively. Few studies compared HRQoL between children with FA and healthy children, with 3 of them showing worse HRQoL for children with FAs. Immunotherapy has been found to improve the QoL of children with FAs. Anaphylaxis history, number of FAs, additional allergies, number and severity of symptoms were identified as the main factors with a negative impact on QoL. More comparative studies on the HRQoL of children and adolescents with FAs and healthy populations or children with other chronic diseases are required in order to improve QoL of children with FAs.
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Affiliation(s)
- Artemis-Eirini Drakouli
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
| | - Ioanna Kontele
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, University of the Peloponnese, 24100 Kalamata, Greece
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece
| | | | - Maria G. Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Theodoros N. Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
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22
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Aguilera-Insunza R, Iturriaga C, Mariñanco A, Venegas L, Aravena G, Perez-Mateluna G, Baptista-Dias N, Borzutzky A, Wandersleben T. High prevalence of lupin allergy among patients with peanut allergy: Identification of γ-conglutin as major allergen. Ann Allergy Asthma Immunol 2023; 130:225-232. [PMID: 36191849 DOI: 10.1016/j.anai.2022.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lupin is a protein-rich legume with a growing presence in the food market worldwide. With increased consumption, lupin allergy (LA) reports are also rising. Uncertainties exist on the cross-reactivity between peanut and lupin, the allergenic potential of different lupin species, and sensitization patterns among different populations. OBJECTIVE To evaluate the molecular basis of LA and to determine lupin allergens from 3 different species that may be involved in peanut allergy (PA) cross-reactivity. METHODS A total of 43 subjects with PA, those with LA, or controls without food allergy were evaluated with skin prick tests (SPTs) and specific IgEs (sIgEs). Lupin-sensitized subjects were offered a lupin oral food challenge (OFC). Immunoblots and enzyme-linked immunosorbent assays were performed on sera from lupin-sensitized subjects. RESULTS In this study, 44% of the PA subjects were confirmed to have LA by OFC. Anaphylaxis was the most frequent manifestation after lupin consumption, with a minimal eliciting dosage of 1 g lupin flour. There was no difference in lupin sIgE or SPT wheal size between lupin-sensitized and confirmed LA subjects or in the severity of symptoms among confirmed LA subjects. Sera from lupin-sensitized subjects uniformly reacted to all 3 different lupin species. Immunoblotting and enzyme-linked immunosorbent assays revealed immunoglobulin E binding to α- and γ-conglutin in all analyzed sera, whereas α- and β-conglutin recognition was variable. CONCLUSION Our findings reveal a high prevalence of LA among PA subjects, emphasizing lupin must be labeled as an allergen in foods. Owing to high variability in lupin-sIgE and lupin-SPT results, LA diagnosis may require OFC. In our population, γ-conglutin is the major allergen of lupin.
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Affiliation(s)
- Raquel Aguilera-Insunza
- Department of Immunology and Rheumatology, School of Medicine, Pontificia Universidad, Católica de Chile, Santiago, Chile
| | - Carolina Iturriaga
- Translational Allergy and Immunology Laboratory, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Angélica Mariñanco
- Departamento de Ciencias Químicas y Recursos Naturales, Universidad de La Frontera, Temuco, Chile
| | - Luis Venegas
- Translational Allergy and Immunology Laboratory, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Guillermo Perez-Mateluna
- Translational Allergy and Immunology Laboratory, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nathalia Baptista-Dias
- Scientific and Technological Bioresource Nucleus, BIOREN, Universidad de La Frontera (UFRO), Temuco, Chile
| | - Arturo Borzutzky
- Translational Allergy and Immunology Laboratory, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Instituto Milenio en Inmunología e Inmunoterapia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Traudy Wandersleben
- Departamento de Ciencias Químicas y Recursos Naturales, Universidad de La Frontera, Temuco, Chile.
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23
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Ota M, Hoehn KB, Ota T, Aranda CJ, Friedman S, Braga WF, Malbari A, Kleinstein SH, Sicherer SH, Curotto de Lafaille MA. The memory of pathogenic IgE is contained within CD23 + IgG1 + memory B cells poised to switch to IgE in food allergy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.25.525506. [PMID: 36747707 PMCID: PMC9900782 DOI: 10.1101/2023.01.25.525506] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Food allergy is caused by allergen-specific IgE antibodies but little is known about the B cell memory of persistent IgE responses. Here we describe in human pediatric peanut allergy CD23 + IgG1 + memory B cells arising in type 2 responses that contain peanut specific clones and generate IgE cells on activation. These 'type2-marked' IgG1 + memory B cells differentially express IL-4/IL-13 regulated genes FCER2 / CD23, IL4R , and germline IGHE and carry highly mutated B cell receptors (BCRs). Further, high affinity memory B cells specific for the main peanut allergen Ara h 2 mapped to the population of 'type2-marked' IgG1 + memory B cells and included convergent BCRs across different individuals. Our findings indicate that CD23 + IgG1 + memory B cells transcribing germline IGHE are a unique memory population containing precursors of pathogenic IgE. One-Sentence Summary We describe a unique population of IgG + memory B cells poised to switch to IgE that contains high affinity allergen-specific clones in peanut allergy.
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24
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Cafarotti A, Giovannini M, Begìn P, Brough HA, Arasi S. Management of IgE-mediated food allergy in the 21st century. Clin Exp Allergy 2023; 53:25-38. [PMID: 36200952 PMCID: PMC10092460 DOI: 10.1111/cea.14241] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
The 21st century has seen the propulsion of research in the field of food allergy, which has driven real changes in the clinical approach. Allergen immunotherapy has been recommended for the active management of food allergy. Data have shown promising additional methods of treatment, including biologics. Efforts have been devoted to the risk stratification of food allergy and the standardization of the assessment of food-allergic severity. Alternative routes of administration of epinephrine are under investigation to minimize any mechanical issue and the fear of injections. Evidence-based guidelines have been published by the main international societies in the field of anaphylaxis and food allergy management and new updates are in preparation. In the coming years, treatment options that are currently in pre-clinical or early clinical evaluation will hopefully lead to safe and effective disease-modifying therapies for food allergy in clinical practice. The identification of reliable biomarkers and the standardization of definitions and measurement approaches, alongside a shared decision-making with patients and families, will be key for the development of personalized care and to help minimize the substantial burden of food allergy.
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Affiliation(s)
- Arianna Cafarotti
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Philippe Begìn
- Allergy, Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Allergy and Clinical Immunology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Stefania Arasi
- Allergy Unit - Area of Translational Research in Pediatric Specialities, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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25
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Kostecka M, Kostecka-Jarecka J, Kostecka J, Iłowiecka K, Kolasa K, Gutowska G, Sawic M. Parental Knowledge about Allergies and Problems with an Elimination Diet in Children Aged 3 to 6 Years. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111693. [PMID: 36360421 PMCID: PMC9689114 DOI: 10.3390/children9111693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Allergic diseases are highly prevalent, and they can exert a significant influence on the patients’ physical and mental well-being, thus affecting the quality of their lives and society as a whole. The aim of this study was to evaluate parental knowledge about allergens, allergy symptoms, and treatment of allergies, and to identify problems with adherence to an elimination diet and the underlying difficulties. Twelve kindergartens and the parents of 1350 preschoolers took part in the first stage of the study. In a screening trial, allergies were diagnosed in 197 children, and their parents participated in the second stage of the study. The child’s age at the onset of the first symptoms was significantly correlated with allergy type. Age was significantly correlated with selected symptoms of an allergic reaction, and skin allergies were more prevalent in younger children. Erythema, skin reddening, and urticaria occurred more frequently in children aged 3−4 years (OR 1.45; 95%CI 1.24−1.77, p < 0.05) and were diagnosed in skin tests (OR 1.36; 95%CI 1.22−1.59, p < 0.05). Allergies to numerous food items were associated with a long-term elimination diet (OR 1.89; 95%CI 1.33−2.19, p < 0.01), as well as problems with preparing safe meals, shopping for food, or dietary adherence when eating out. According to the respondents, lack of support from other family members and compliance with dietary restrictions in kindergartens and when eating out posed the greatest barriers to dietary adherence. Parents do not have sufficient knowledge about environmental allergens and effective strategies for coping with acute allergic reactions, including anaphylactic shock. Children with diagnosed food allergies should enjoy a similar quality of life to their healthy peers, which is why the parents should be educated about diet therapy, duration of treatment, and safe food substitutes.
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Affiliation(s)
- Malgorzata Kostecka
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
- Correspondence: ; Tel.: +48-814-456-846
| | | | - Julianna Kostecka
- Faculty of Medicine, Medical University of Lublin, Chodźki 19, 20-093 Lublin, Poland
| | - Katarzyna Iłowiecka
- Department of Food and Nutrition, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
| | - Katarzyna Kolasa
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
| | - Gabriela Gutowska
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
| | - Magdalena Sawic
- Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland
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26
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Sindher SB, Long A, Chin AR, Hy A, Sampath V, Nadeau KC, Chinthrajah RS. Food allergy, mechanisms, diagnosis and treatment: Innovation through a multi-targeted approach. Allergy 2022; 77:2937-2948. [PMID: 35730331 DOI: 10.1111/all.15418] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023]
Abstract
The incidence of food allergy (FA) has continued to rise over the last several decades, posing significant burdens on health and quality of life. Significant strides into the advancement of FA diagnosis, prevention, and treatment have been made in recent years. In an effort to lower reliance on resource-intensive food challenges, the field has continued work toward the development of highly sensitive and specific assays capable of high-throughput analysis to assist in the diagnosis FA. In looking toward early infancy as a critical period in the development of allergy or acquisition of tolerance, evidence has increasingly suggested that early intervention via the early introduction of food allergens and maintenance of skin barrier function may decrease the risk of FA. As such, large-scale investigations are underway evaluating infant feeding and the impact of emollient and steroid use in infants with dry skin for the prevention of allergy. On the other end of the spectrum, the past few years have been witness to an explosive increase in clinical trials of novel and innovative therapeutic strategies aimed at the treatment of FA in those whom the disease has already manifested. A milestone in the field, 2020 marked the approval of the first drug, oral peanut allergen, for the indication of peanut allergy. With a foundation of promising data supporting the safety and efficacy of single- and multi-allergen oral immunotherapy, current efforts have turned toward the use of probiotics, biologic agents, and modified allergens to optimize and improve upon existing paradigms. Through these advancements, the field hopes to gain footing in the ongoing battle against FA.
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Affiliation(s)
- Sayantani B Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
| | - Andrew Long
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
| | - Andrew R Chin
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
| | - Angela Hy
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
| | - R Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, USA
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27
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Diem L, Neuherz B, Rohrhofer J, Koidl L, Asero R, Brockow K, Diaz Perales A, Faber M, Gebhardt J, Torres MJ, Jensen‐Jarolim E, Zehetmayer S, Untersmayr E. Real-life evaluation of molecular multiplex IgE test methods in the diagnosis of pollen associated food allergy. Allergy 2022; 77:3028-3040. [PMID: 35485989 PMCID: PMC9790655 DOI: 10.1111/all.15329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/13/2022] [Accepted: 03/26/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Diagnosis of food allergies is challenging, as combining information from specific IgE (sIgE)-sensitization pattern and skin prick tests (SPTs) with clinical history is necessary for a personalized management of allergic patients. The aim of this study was to compare two molecular tests, the ImmunoCAP ISAC (ISAC) and the Allergy Explorer, version 2 (ALEX2 ) in the context of pollen food syndrome (PFS) diagnosis in a real-life scenario, to assess the benefit of multiplex testing in PFS patients. METHODS Diagnosis of food allergy was performed in 53 patients. Allergen-sIgE concentrations were measured with ISAC and ALEX2 . Results for sIgE were statistically compared with each other, with SPT results and with clinical presentation of the patients. RESULTS Using ISAC as reference test for sIgE measurements, the average sensitivity of ALEX2 for PR-10 allergens was 83.2% and the average specificity 88.0%. If only low sIgE concentrations were included, the sensitivity was 60.8% and the specificity 91.1%. Apple and hazelnut sensitizations were confirmed in most patients by concordance of sIgE and SPT results. Significant correlations were shown between clinical symptoms and Mal d 1- and Gly m 4-sIgE levels measured by both tests and for Cor a 1-sIgE levels measured by ALEX2 . In eight patients, profilin related symptoms were supported by Hev b 8-sensitization. CONCLUSION Multiplex testing is beneficial to understand patient-specific individual sensitization profiles and to providing personalized management recommendations. In the future, custom-designed test kits might enable reducing costs of multiplex testing for specific patient groups without compromising the diagnostic value.
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Affiliation(s)
- Luisa Diem
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Bellinda Neuherz
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Johanna Rohrhofer
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Larissa Koidl
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Riccardo Asero
- Ambulatorio di AllergologiaClinica San CarloPaderno Dugnano (MI)Italy
| | - Knut Brockow
- Department of Dermatology and Allergy BiedersteinFaculty of MedicineTechnical University of MunichMunichGermany
| | - Araceli Diaz Perales
- Centro de Biotecnología Y Genómica de Plantas (CBGP, UPM‐INIA)Universidad Politécnica de Madrid (UPM) ‐Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA)MadridSpain,Departamento de Biotecnología‐Biología VegetalEscuela Técnica Superior de Ingeniería AgronómicaAlimentaria y de Biosistemas. Universidad Politécnica de Madrid (UPM)MadridSpain
| | | | - Julia Gebhardt
- Department of Dermatology and Allergy BiedersteinFaculty of MedicineTechnical University of MunichMunichGermany
| | - María José Torres
- Allergy UnitHospital Regional Universitario de MálagaUniversidad de Málaga‐IBIMA‐BIONANDMálagaSpain
| | - Erika Jensen‐Jarolim
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria,The Interuniversity Messerli Research Institute of the University of Veterinary Medicine ViennaMedical University of Vienna, and University of ViennaViennaAustria,AllergyCareAllergy Diagnosis and Study CenterViennaAustria
| | - Sonja Zehetmayer
- Center for Medical StatisticsInformatics and Intelligent Systems (Institute of Medical Statistics)Medical University of ViennaViennaAustria
| | - Eva Untersmayr
- Institute for Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
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28
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Vaz-Rodrigues R, Mazuecos L, de la Fuente J. Current and Future Strategies for the Diagnosis and Treatment of the Alpha-Gal Syndrome (AGS). J Asthma Allergy 2022; 15:957-970. [PMID: 35879928 PMCID: PMC9307871 DOI: 10.2147/jaa.s265660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
The α-Gal syndrome (AGS) is a pathognomonic immunoglobulin E (IgE)-mediated delayed anaphylaxis in foods containing the oligosaccharide galactose-α-1,3-galactose (α-Gal) such as mammalian meat or dairy products. Clinical presentation of AGS can also comprise immediate hypersensitivity due to anticancer therapy, gelatin-containing vaccines or mammalian serum-based antivenom. The IgE initial sensitization is caused by hard-bodied tick bites and symptomatic individuals typically develop delayed pruritus, urticaria, angioedema, anaphylaxis, malaise or gut-related symptoms. Due to inapparent presentation, delayed reactions and a wide variety of patients´ clinical history, the AGS diagnosis and treatment remain challenging. This review covers not only current diagnostic methods used for AGS such as the skin prick test (SPT), the oral food challenge (OFC), anti-α-Gal IgE levels measurement and the basophil activation test (BAT), but also potentially relevant next-generation diagnostic tools like the mast cell activation test (MAT), the histamine-release (HR) assay, omics technologies and model-based reasoning (MBR). Moreover, it focuses on the therapeutical medical and non-medical methods available and current research methods that are being applied in order to elucidate the molecular, physiological and immune mechanisms underlying this allergic disorder. Lastly, future treatment and preventive tools are also discussed, being of utmost importance for the identification of tick salivary molecules, with or without α-Gal modifications, that trigger IgE sensitivity as they could be the key for further vaccine development. Bearing in mind climate change, the tick-host paradigm will shift towards an increasing number of AGS cases in new regions worldwide, which will pose new challenges for clinicians in the future.
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Affiliation(s)
- Rita Vaz-Rodrigues
- SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ciudad Real, 13005, Spain
| | - Lorena Mazuecos
- SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ciudad Real, 13005, Spain
| | - José de la Fuente
- SaBio (Health and Biotechnology), Instituto de Investigación en Recursos Cinegéticos IREC (CSIC-UCLM-JCCM), Ciudad Real, 13005, Spain.,Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
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29
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Gao H, Jorgensen R, Raghunath R, Ng PKW, Gangur V. An Adjuvant-Free Mouse Model Using Skin Sensitization Without Tape-Stripping Followed by Oral Elicitation of Anaphylaxis: A Novel Pre-Clinical Tool for Testing Intrinsic Wheat Allergenicity. FRONTIERS IN ALLERGY 2022; 3:926576. [PMID: 36238931 PMCID: PMC9552944 DOI: 10.3389/falgy.2022.926576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/25/2022] [Indexed: 12/11/2022] Open
Abstract
Wheat is a major food allergen per the regulatory bodies of various nations. Hypersensitivity reactions to wheat have been steadily increasing for reasons that are not completely understood. Wheat-allergy models typically use adjuvants to induce sensitization to wheat proteins followed by an intraperitoneal challenge to elicit anaphylaxis. Although these models are very useful, they lack the ability to reveal the intrinsic allergenicity potential of wheat. To improve the mouse model of wheat allergy, we tested the hypothesis that repeated skin application of salt-soluble protein extract (SSPE) from durum wheat will clinically sensitize the mice to oral anaphylaxis to SSPE. Balb/c mice were bred and maintained on a plant-protein-free diet and used in the experiments. Adult female mice were exposed to SSPE once a week for 9 weeks via a solution on intact skin. Sensitization was measured by SSPE-specific IgE (sIgE) antibody and total IgE (tIgE) levels. Oral anaphylaxis was quantified by hypothermic shock response (HSR), and mucosal mast cell response (MMCR) was quantified by measuring MMCP-1 after oral challenge. Using single mouse data, correlation analyses were performed to determine the relationship among the allergenicity readouts. Spleen cytokines were quantified using a protein microarray method. Our results show that (i) repeated skin exposures to SSPE elicited robust increases in the sIgE and tIgE levels; (ii) skin exposure to SSPE was sufficient to sensitize mice for oral anaphylaxis and MMCR; (iii) both HSR and MMCR showed a strong correlation with each other, as well as with sIgE, and a modest correlation with tIgE levels; (iv) selected Th2/Th17/Th1 cytokines were elevated in skin-sensitized mice; and (v) oral allergen-challenged mice showed selective elevation of IL-6 and a panel of chemokines compared to saline-challenged mice. Together, we report the development and characterization of a novel adjuvant-free wheat-allergy mouse model that uses skin sensitization without tape-stripping followed by oral elicitation of anaphylaxis. Furthermore, validation of quantifiable wheat allergenicity readouts makes this model particularly suitable as a pre-clinical testing tool to assess the intrinsic sensitization/oral-anaphylaxis elicitation potential of novel wheat proteins (e.g., processed wheat) and to develop hypo/non-allergenic wheat products.
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Affiliation(s)
- Haoran Gao
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Rick Jorgensen
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Rajsri Raghunath
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Perry K. W. Ng
- Cereal Science Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Venu Gangur
- Food Allergy and Immunology Laboratory, Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
- *Correspondence: Venu Gangur
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30
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Chua GT, Chan ES, Yeung J, Cameron SB, Soller L, Williams BA, Chomyn A, Vander Leek TK, Abrams EM, Mak R, Wong T. Patient selection for milk and egg ladders using a food ladder safety checklist. Allergy Asthma Clin Immunol 2022; 18:51. [PMID: 35692059 PMCID: PMC9188637 DOI: 10.1186/s13223-022-00696-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
A food ladder is a form of home-based dietary advancement therapy that gradually increases exposure to an allergenic food through the gradual introduction of egg or milk containing food with increasing quantity and allergenicity from extensively heated forms, such as baked goods, to less processed products. While widely considered safe, the food ladder is not risk-free and most of the egg and milk ladder studies only included preschoolers with mild egg and milk allergies, and with no or well-controlled asthma. We propose a Food Ladder Safety Checklist to assist with patient selection using “4 A's” based on available evidence for food ladders, including Age, active or poorly controlled Asthma, history of Anaphylaxis, and Adherence.
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Affiliation(s)
- Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, New Clinical Building, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong,, SAR, China. .,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, SAR, China. .,Department of Paediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Edmond S Chan
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Joanne Yeung
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Scott B Cameron
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Community Allergy Clinic, Victoria, BC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Brock A Williams
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Food, Nutrition, and Health, Faculty of Land and Food Systems, University of British Columbia, Vancouver, BC, Canada
| | - Alanna Chomyn
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Timothy K Vander Leek
- Department of Pediatrics, Pediatric Allergy & Asthma, University of Alberta, Edmonton, AB, Canada
| | - Elissa M Abrams
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada
| | - Raymond Mak
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Tiffany Wong
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
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31
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Xie Q, Xue W. IgE-Mediated food allergy: Current diagnostic modalities and novel biomarkers with robust potential. Crit Rev Food Sci Nutr 2022; 63:10148-10172. [PMID: 35587740 DOI: 10.1080/10408398.2022.2075312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Food allergy (FA) is a serious public health issue afflicting millions of people globally, with an estimated prevalence ranging from 1-10%. Management of FA is challenging due to overly restrictive diets and the lack of diagnostic approaches with high accuracy and prediction. Although measurement of serum-specific antibodies combined with patient medical history and skin prick test is a useful diagnostic tool, it is still an imprecise predictor of clinical reactivity with a high false-positive rate. The double-blind placebo-controlled food challenge represents the gold standard for FA diagnosis; however, it requires large healthcare and involves the risk of acute onset of allergic reactions. Improvement in our understanding of the molecular mechanism underlying allergic disease pathology, development of omics-based methods, and advances in bioinformatics have boosted the generation of a number of robust diagnostic biomarkers of FA. In this review, we discuss how traditional diagnostic modalities guide appropriate diagnosis and management of FA in clinical practice, as well as uncover the potential of the latest biomarkers for the diagnosis, monitoring, and prediction of FA. We also raise perspectives for precise and targeted medical intervention to fill the gap in the diagnosis of FA.
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Affiliation(s)
- Qiang Xie
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, P.R. China
| | - Wentong Xue
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, P.R. China
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32
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De Vlieger L, Nuyttens L, Matton C, Diels M, Verelst S, Leus J, Coppens K, Sauer K, Dilissen E, Coorevits L, Matthys C, Schrijvers R, Raes M, Bullens DMA. Guided Gradual Egg-Tolerance Induction in Hen's Egg Allergic Children Tolerating Baked Egg: A Prospective Randomized Trial. FRONTIERS IN ALLERGY 2022; 3:886094. [PMID: 35769568 PMCID: PMC9234941 DOI: 10.3389/falgy.2022.886094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Over the last few years, studies have shown that the majority of egg allergic children tolerate baked egg (e.g., cake), and that consuming baked egg accelerates the resolution of egg allergy. However, few prospective studies demonstrate the step-wise reintroduction of egg at home after developing baked egg tolerance. Although this could have a positive impact on the children's quality of life and nutrition. Additionally, research supporting the theoretical concept that heating in the presence or absence of wheat causes reduced allergenicity of egg proteins is limited. Objective To investigate the clinically most favorable duration of gradual egg-tolerance induction in baked egg tolerant children at home, with regard to complete raw egg tolerance. Methods Baked egg tolerant children above 12 months of age were randomly assigned to a short- or long arm protocol. In the short arm, egg-tolerance induction was studied over 18 months compared to 30 months in the long arm. Children were guided through this protocol involving the step-wise introduction of increasingly allergenic forms of egg starting with baked egg offered as cake, followed by hard-boiled egg, omelet/waffle/pancake, soft-boiled egg, and finally raw egg. We hereby designed this protocol based on the influence of thermal processing in the presence or absence of wheat on egg proteins, as investigated by ELISA, SDS-PAGE, and immunoblotting. At inclusion, children either passed an in-hospital cake challenge or had ovomucoid sIgE ≤1.2 kUA/L, which was considered safe for introduction at home. Results Gel electrophoresis revealed that the ovalbumin band became weaker with heating, while the ovomucoid band remained stable. In accordance, the IgE-binding to ovalbumin decreased with extensive heating, as opposed to ovomucoid. However, heating in the presence of wheat led to a decreased IgE reactivity to ovomucoid. Of the 78 children in the intention-to-treat group, 39 were randomized to each arm. Fifty-eight children reached the raw egg tolerance endpoint, of which 80% were in the short arm and 69% in the long arm. Within the short arm, the median time to raw egg tolerance was 24 months (95% CI, 21–27 months) compared to 30 months (95% CI, 28–32 months) in the long arm (p = 0.005). No grade IV reactions or cases of eosinophilic esophagitis were observed. The short arm was considered to be non-inferior to the long arm. Conclusion Our gradual short arm protocol appears to be safe and allows clinicians to guide baked egg tolerant children toward raw egg tolerance at home. The allergenicity of the egg proteins was affected by heating temperature and duration, as well as the presence of wheat.
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Affiliation(s)
- Liselot De Vlieger
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- *Correspondence: Liselot De Vlieger
| | - Lisa Nuyttens
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Marianne Diels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Sophie Verelst
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Jasmine Leus
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, AZ Maria Middelares, Ghent, Belgium
| | - Katrien Coppens
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Imelda Hospital, Bonheiden, Belgium
| | - Kate Sauer
- Department of Pediatrics, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Ellen Dilissen
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Lieve Coorevits
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Christophe Matthys
- Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc Raes
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Dominique M. A. Bullens
- Department of Microbiology, Immunology and Transplantation, Allergy and Immunology Research Group, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
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Terlouw S, van Boven FE, Borsboom-van Zonneveld M, de Graaf-in ‘t Veld C, van Splunter ME, van Daele PLA, van Maaren MS, Schreurs MWJ, de Jong NW. Homemade Food Allergen Extracts for Use in Skin Prick Tests in the Diagnosis of IgE-Mediated Food Allergy: A Good Alternative in the Absence of Commercially Available Extracts? Nutrients 2022; 14:nu14030475. [PMID: 35276832 PMCID: PMC8839075 DOI: 10.3390/nu14030475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The skin prick test (SPT) is the first step in the diagnosis of an immunoglobulin E (IgE)-mediated food allergy. The availability of commercial food allergen extracts is very limited, resulting in a need for alternative extraction methods of food allergens. The objective of this study was to compare the SPT results of homemade food allergen extracts with commercially available extracts. Methods: Adult patients with a suspected food allergy were included. Food allergen-specific symptoms were scored using a questionnaire. SPTs were performed with homemade and commercially available extracts (ALK-Abelló, Kopenhagen, Denmark) from almond, apple, hazelnut, peach, peanut, and walnut. Serum-specific IgE was measured with ISAC or ImmunoCAP™. Intra-class correlation coefficients (ICC) between the SPT results of both extract methods were calculated. The proportion of agreement with food allergen-specific symptoms was analyzed. Results: Fifty-four patients (mean age 36; range 19–69 years; female/male: 42/12) were included. The intra-class correlation coefficient (ICC) between the SPT results of both extract methods were strong for hazelnut 0.79 (n = 44) and walnut 0.78 (n = 31), moderate for apple 0.74 (n = 21) and peanut 0.66 (n = 28), and weak for almond 0.36 (n = 27) and peach 0.17 (n = 23). The proportion of agreement between SPT results and food allergen-specific symptoms was comparable for homemade and commercially available extracts, except for peach; 0.77 versus 0.36, respectively. Conclusion: In the diagnostic procedures to identify an IgE-mediated food allergy, homemade extracts from hazelnut and walnut appear to be a good alternative in the absence of commercially available food allergen extracts.
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Affiliation(s)
- Severina Terlouw
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Correspondence: ; Tel.: +31-640149222
| | - Frank E. van Boven
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Monika Borsboom-van Zonneveld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Catharina de Graaf-in ‘t Veld
- Department of Allergology, Albert Schweitzer Hospital, 3331 LZ Zwijndrecht, The Netherlands; (M.B.-v.Z.); (C.d.G.-i.‘t.V.)
| | - Marloes E. van Splunter
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Paul L. A. van Daele
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Maurits S. van Maaren
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
| | - Marco W. J. Schreurs
- Laboratory Medical Immunology, Department of Immunology, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands;
| | - Nicolette W. de Jong
- Internal Medicine, Allergology & Clinical Immunology, Erasmus MC, University Medical Centre, 3015 GD Rotterdam, The Netherlands; (F.E.v.B.); (M.E.v.S.); (P.L.A.v.D.); (M.S.v.M.); (N.W.d.J.)
- Department of Pediatric Allergology, Sophia Children Hospital, Erasmus Medical Centre, 3015 GD Rotterdam, The Netherlands
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Jang H, Kim EG, Kim M, Kim SY, Kim YH, Sohn MH, Kim KW. Metabolomic profiling revealed altered lipid metabolite levels in childhood food allergy. J Allergy Clin Immunol 2021; 149:1722-1731.e9. [PMID: 34843802 DOI: 10.1016/j.jaci.2021.10.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/26/2021] [Accepted: 10/26/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The pathophysiology of childhood food allergy (FA) and its natural history are poorly understood. Clarification of the underlying mechanism may help identify novel biomarkers and strategies for clinical intervention in children with FA. OBJECTIVE This study aimed to identify metabolites associated with the development and resolution of FA. METHODS The metabolomic profiles of 20 children with FA and 20 healthy controls were assessed by liquid chromatography-tandem mass spectrometry. Comparative analysis was performed to identify metabolites associated with FA and FA resolution. For subjects with FA, serum samples were collected at the time of diagnosis and after resolution to identify the changes in metabolite levels. The selected metabolites were then quantified in a quantification cohort to validate the results. Finally, genome-wide association analysis of the metabolite levels was performed. RESULTS The study demonstrated a significantly higher level of sphingolipid metabolites and a lower level of acylcarnitine metabolites in children with FA than those in healthy controls. At diagnosis, subjects with resolving FA had a significantly high level of omega-3 metabolites and a low level of platelet-activating factors compared to persistent FA. However, the level of omega-3 metabolites decreased in children with resolving FA but increased in children with persistent FA during the same time. The quantification data of omega-3-derived resolvins, platelet-activating factor, and platelet-activating factor acetylhydrolase activity further supported these results. CONCLUSION The lipid metabolite profile is closely related to childhood FA and FA resolution. This study suggests potential predictive biomarkers and provides insight into the mechanisms underlying childhood FA.
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Affiliation(s)
- Haerin Jang
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Brain Korea 21 PLUS Project for Medical Science, Seoul, Korea
| | - Eun Gyul Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Brain Korea 21 PLUS Project for Medical Science, Seoul, Korea
| | - Mina Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Brain Korea 21 PLUS Project for Medical Science, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Brain Korea 21 PLUS Project for Medical Science, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Gangnam Severance Hospital, Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Brain Korea 21 PLUS Project for Medical Science, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Brain Korea 21 PLUS Project for Medical Science, Seoul, Korea.
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35
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Ngai NA, Leung ASY, Leung JCH, Chan OM, Leung TF. Identification of predictors for persistence of immediate-type egg allergy in Chinese children. Asia Pac Allergy 2021; 11:e41. [PMID: 34786371 PMCID: PMC8563105 DOI: 10.5415/apallergy.2021.11.e41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Egg allergy is one of the most common food allergies in childhood with increasing prevalence in Hong Kong. While ample studies were published on its optimal diagnosis, there was limited data on predictors for the natural history of egg allergy in Asian populations. Objective This study aimed to characterize the clinical course and outcome of children with egg allergy and identify its prognostic factors. Methods All Chinese children with immediate-type egg allergy being followed since ≥3 years old in allergy clinic of our university-affiliated teaching hospital were reviewed to determine if they outgrew egg allergy at the latest follow-up. The predictive values of clinical and atopic factors for resolution of egg allergy were analyzed on Kaplan-Meier curves, and factors independently associated with persistent egg allergy was analyzed by logistic regression. Results Seventy-six patients with median (interquartile range) age 8.9 years (6.3–13.0 years) were recruited. They initially presented with egg-allergic reactions at 1.0 years (0.7–1.7 years). Fifty-four children (71%) were able to tolerate egg at a median of 36 months from initial reaction. Patients with concomitant peanut allergy and those with initial reaction at ≥1 year old were more likely to have persistent egg allergy (p = 0.015 and p = 0.027 respectively). Skin prick test wheal ≥6 mm to egg yolk and egg white individually as well as to both egg yolk and egg white were predictors for egg allergy persistence (respective, p < 0.001, p = 0.001, and p = 0.001 by log-rank tests). Logistic regression showed that initial SPT ≥ 6 mm to egg yolk was the only independent predictor for persistent egg allergy (B = 2.59 ± 0.98, p = 0.008). Conclusion Most Chinese children with immediate-type egg allergy can tolerate egg in long run. SPT wheal size to egg, concomitant peanut allergy and initial presentation after infancy may predict egg allergy persistence.
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Affiliation(s)
- Noelle Anne Ngai
- Department of Paediatrics, Prince of Wales Hospital, Shatin, Hong Kong
| | - Agnes Sze Yin Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Oi Man Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
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36
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Briceno Noriega D, Teodorowicz M, Savelkoul H, Ruinemans-Koerts J. The Basophil Activation Test for Clinical Management of Food Allergies: Recent Advances and Future Directions. J Asthma Allergy 2021; 14:1335-1348. [PMID: 34754200 PMCID: PMC8572092 DOI: 10.2147/jaa.s237759] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022] Open
Abstract
The basophil activation test (BAT) is an ex vivo functional assay that measures by flow cytometry the degree of basophil degranulation after stimulation with an allergen. In recent years, there has been an increased interest in the diagnostic value of the BAT as it has the potential to mimic the clinical phenotype of sIgE sensitized patients, in contrast to allergen-specific IgE levels. This diagnostic potential would be of particular interest for food allergies present early in life such as peanut, cow’s milk and eggs, which require an expensive, time-consuming and patient unfriendly oral food challenge (OFC) for diagnosis. However, routine applications of the BAT for clinical use are not yet feasible due to the lack of standardized protocols and large clinical validation studies. This review will summarize the current data regarding the application of the BAT in food allergy (FA) for cow’s milk, egg and peanut, being the most common causes of FA in children. Additionally, it will discuss the hurdles for widespread clinical use of the BAT and possible future directions for this diagnostic procedure.
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Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Malgorzata Teodorowicz
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Huub Savelkoul
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands
| | - Janneke Ruinemans-Koerts
- Cell Biology and Immunology Group, Wageningen University & Research, Wageningen, the Netherlands.,Laboratory of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, the Netherlands
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37
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Eigenmann P. Comments on asthma development and prognosis, and diagnosis of cow's milk allergy. Pediatr Allergy Immunol 2021; 32:1401-1404. [PMID: 34595776 DOI: 10.1111/pai.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
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38
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Maruyama N. Components of plant-derived food allergens: Structure, diagnostics, and immunotherapy. Allergol Int 2021; 70:291-302. [PMID: 34092500 DOI: 10.1016/j.alit.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022] Open
Abstract
A large number of plant-derived food allergen components have been identified to date. Although these allergens are diverse, they often share common structural features such as numerous disulfide bonds or oligomeric structures. Furthermore, some plant-derived food allergen components cross-react with pollen allergens. Since the relationship between allergen components and clinical symptoms has been well characterized, measurements of specific IgE to these components have become useful for the accurate clinical diagnosis and selection of optimal treatment methods for various allergy-related conditions including allergy caused by plant-derived foods. Herein, I have described the types and structures of different plant allergen components and outlined the diagnosis as well as treatment strategies, including those reported recently, for such substances. Furthermore, I have also highlighted the contribution of allergen components to this field.
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Affiliation(s)
- Nobuyuki Maruyama
- Food Quality Design and Development Laboratory, Graduate School of Agriculture, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan.
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39
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Gargano D, Appanna R, Santonicola A, De Bartolomeis F, Stellato C, Cianferoni A, Casolaro V, Iovino P. Food Allergy and Intolerance: A Narrative Review on Nutritional Concerns. Nutrients 2021; 13:1638. [PMID: 34068047 PMCID: PMC8152468 DOI: 10.3390/nu13051638] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Adverse food reactions include immune-mediated food allergies and non-immune-mediated intolerances. However, this distinction and the involvement of different pathogenetic mechanisms are often confused. Furthermore, there is a discrepancy between the perceived vs. actual prevalence of immune-mediated food allergies and non-immune reactions to food that are extremely common. The risk of an inappropriate approach to their correct identification can lead to inappropriate diets with severe nutritional deficiencies. This narrative review provides an outline of the pathophysiologic and clinical features of immune and non-immune adverse reactions to food-along with general diagnostic and therapeutic strategies. Special emphasis is placed on specific nutritional concerns for each of these conditions from the combined point of view of gastroenterology and immunology, in an attempt to offer a useful tool to practicing physicians in discriminating these diverging disease entities and planning their correct management. We conclude that a correct diagnostic approach and dietary control of both immune- and non-immune-mediated food-induced diseases might minimize the nutritional gaps in these patients, thus helping to improve their quality of life and reduce the economic costs of their management.
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Affiliation(s)
- Domenico Gargano
- Allergy and Clinical Immunology Unit, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (D.G.); (F.D.B.)
| | - Ramapraba Appanna
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Antonella Santonicola
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Fabio De Bartolomeis
- Allergy and Clinical Immunology Unit, San Giuseppe Moscati Hospital, 83100 Avellino, Italy; (D.G.); (F.D.B.)
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Antonella Cianferoni
- Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Vincenzo Casolaro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (R.A.); (A.S.); (C.S.); (V.C.)
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Eigenmann P. Risk factors for bronchiolitis and asthma, and COVID-19 symptoms in young children. Pediatr Allergy Immunol 2021; 32:215-218. [PMID: 33522012 PMCID: PMC8014648 DOI: 10.1111/pai.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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41
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Ngai NA, Leung ASY, Leung JCH, Man Chan O, Leung TF. Identification of predictors for persistence of immediate-type egg allergy in Chinese children. Asia Pac Allergy 2021. [DOI: 10.5415/apallergy.2021.11.e50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Noelle Anne Ngai
- Department of Paediatrics, Prince of Wales Hospital, Shatin, Hong Kong
| | - Agnes Sze Yin Leung
- Dpartment of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Oi Man Chan
- Dpartment of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Fan Leung
- Dpartment of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
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