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Issa M, Michaudel C, Guinot M, Grauso-Culetto M, Guillon B, Lecardonnel J, Jouneau L, Chapuis C, Bernard H, Hazebrouck S, Castelli F, Fenaille F, Gaultier E, Rivière G, Houdeau E, Adel-Patient K. Long-term exposure from perinatal life to food-grade TiO 2 alters intestinal homeostasis and predisposes to food allergy in young mice. Allergy 2024; 79:471-484. [PMID: 38010857 DOI: 10.1111/all.15960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Food allergy (FA) is an inappropriate immunological response to food proteins resulting from an impaired induction of oral tolerance. Various early environmental factors can affect the establishment of intestinal homeostasis, predisposing to FA in early life. In this context, we aimed to assess the effect of chronic perinatal exposure to food-grade titanium dioxide (fg-TiO2 ), a common food additive. METHODS Dams were fed a control versus fg-TiO2 -enriched diet from preconception to weaning, and their progeny received the same diet at weaning. A comprehensive analysis of baseline intestinal and systemic homeostasis was performed in offspring 1 week after weaning by assessing gut barrier maturation and microbiota composition, and local and systemic immune system and metabolome. The effect of fg-TiO2 on the susceptibility of progeny to develop oral tolerance versus FA to cow's milk proteins (CMP) was performed starting at the same baseline time-point, using established models. Sensitization to CMP was investigated by measuring β-lactoglobulin and casein-specific IgG1 and IgE antibodies, and elicitation of the allergic reaction by measuring mouse mast cell protease (mMCP1) in plasma collected after an oral food challenge. RESULTS Perinatal exposure to fg-TiO2 at realistic human doses led to an increased propensity to develop FA and an impaired induction of oral tolerance only in young males, which could be related to global baseline alterations in intestinal barrier, gut microbiota composition, local and systemic immunity, and metabolism. CONCLUSIONS Long-term perinatal exposure to fg-TiO2 alters intestinal homeostasis establishment and predisposes to food allergy, with a clear gender effect.
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Affiliation(s)
- Mohammad Issa
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Chloé Michaudel
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Marine Guinot
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Marta Grauso-Culetto
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Blanche Guillon
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Jérôme Lecardonnel
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, Jouy-en-Josas, France
| | - Luc Jouneau
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Céline Chapuis
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Hervé Bernard
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Stephane Hazebrouck
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
| | - Florence Castelli
- Université Paris-Saclay, CEA, INRAE - UMR Médicaments et Technologies pour la Santé (DMTS), Laboratoire d'Innovation en Spectrométrie de Masse, Saclay, France
| | - François Fenaille
- Université Paris-Saclay, CEA, INRAE - UMR Médicaments et Technologies pour la Santé (DMTS), Laboratoire d'Innovation en Spectrométrie de Masse, Saclay, France
| | - Eric Gaultier
- Toxalim UMR1331 (Research Centre in Food Toxicology), Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Gilles Rivière
- Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), Direction de l'Evaluation des Risques, Maisons-Alfort, France
| | - Eric Houdeau
- Toxalim UMR1331 (Research Centre in Food Toxicology), Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Karine Adel-Patient
- Université Paris-Saclay, CEA, INRAE, Département Médicaments et Technologies pour la Santé (DMTS), SPI/Laboratoire d'Immuno-Allergie Alimentaire, Gif-sur-Yvette, France
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Issa M, Rivière G, Houdeau E, Adel-Patient K. Perinatal exposure to foodborne inorganic nanoparticles: A role in the susceptibility to food allergy? FRONTIERS IN ALLERGY 2022; 3:1067281. [PMID: 36545344 PMCID: PMC9760876 DOI: 10.3389/falgy.2022.1067281] [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: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Food allergy (FA) is an inappropriate immune response against dietary antigens. Various environmental factors during perinatal life may alter the establishment of intestinal homeostasis, thereby predisposing individuals to the development of such immune-related diseases. Among these factors, recent studies have emphasized the chronic dietary exposure of the mother to foodborne inorganic nanoparticles (NP) such as nano-sized silicon dioxide (SiO2), titanium dioxide (TiO2) or silver (Ag). Indeed, there is growing evidence that these inorganic agents, used as food additives in various products, as processing aids during food manufacturing or in food contact materials, can cross the placental barrier and reach the developing fetus. Excretion in milk is also suggested, hence continuing to expose the neonate during a critical window of susceptibility. Due to their immunotoxical and biocidal properties, such exposure may disrupt the host-intestinal microbiota's beneficial exchanges and may interfere with intestinal barrier and gut-associated immune system development in fetuses then the neonates. The resulting dysregulated intestinal homeostasis in the infant may significantly impede the induction of oral tolerance, a crucial process of immune unresponsiveness to food antigens. The current review focuses on the possible impacts of perinatal exposure to foodborne NP during pregnancy and early life on the susceptibility to developing FA.
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Affiliation(s)
- Mohammad Issa
- Département Médicaments et Technologies Pour la Santé (MTS), SPI/Laboratoire d’Immuno-Allergie Alimentaire, Université Paris-Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | - Gilles Rivière
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES, Agence Nationale De Sécurité Sanitaire De l’alimentation, De l’environnement et du Travail), Direction de l’Evaluation des Risques, Maisons-Alfort, France
| | - Eric Houdeau
- Toxalim UMR1331 (Research Centre in Food Toxicology), Toulouse University, INRAE, ENVT, INP-Purpan, UPS, Toulouse, France
| | - Karine Adel-Patient
- Département Médicaments et Technologies Pour la Santé (MTS), SPI/Laboratoire d’Immuno-Allergie Alimentaire, Université Paris-Saclay, CEA, INRAE, Gif-sur-Yvette, France,Correspondence: Karine Adel-Patient
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3
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Dekker PM, Azad MB, Boeren S, Mandhane PJ, Moraes TJ, Simons E, Subbarao P, Turvey SE, Saccenti E, Hettinga KA. The human milk proteome and allergy of mother and child: Exploring associations with protein abundances and protein network connectivity. Front Immunol 2022; 13:977470. [PMID: 36311719 PMCID: PMC9613325 DOI: 10.3389/fimmu.2022.977470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The human milk proteome comprises a vast number of proteins with immunomodulatory functions, but it is not clear how this relates to allergy of the mother or allergy development in the breastfed infant. This study aimed to explore the relation between the human milk proteome and allergy of both mother and child. Methods Proteins were analyzed in milk samples from a subset of 300 mother-child dyads from the Canadian CHILD Cohort Study, selected based on maternal and child allergy phenotypes. For this selection, the definition of "allergy" included food allergy, eczema, allergic rhinitis, and asthma. Proteins were analyzed with non-targeted shotgun proteomics using filter-aided sample preparation (FASP) and nanoLC-Orbitrap-MS/MS. Protein abundances, based on label-free quantification, were compared using multiple statistical approaches, including univariate, multivariate, and network analyses. Results Using univariate analysis, we observed a trend that milk for infants who develop an allergy by 3 years of age contains higher abundances of immunoglobulin chains, irrespective of the allergy status of the mother. This observation suggests a difference in the milk's immunological potential, which might be related to the development of the infant's immune system. Furthermore, network analysis showed overall increased connectivity of proteins in the milk of allergic mothers and milk for infants who ultimately develop an allergy. This difference in connectivity was especially noted for proteins involved in the protein translation machinery and may be due to the physiological status of the mother, which is reflected in the interconnectedness of proteins in her milk. In addition, it was shown that network analysis complements the other methods for data analysis by revealing complex associations between the milk proteome and mother-child allergy status. Conclusion Together, these findings give new insights into how the human milk proteome, through differences in the abundance of individual proteins and protein-protein associations, relates to the allergy status of mother and child. In addition, these results inspire new research directions into the complex interplay of the mother-milk-infant triad and allergy.
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Affiliation(s)
- Pieter M. Dekker
- Food Quality and Design Group, Wageningen University and Research, Wageningen, Netherlands
- Laboratory of Biochemistry, Wageningen University and Research, Wageningen, Netherlands
| | - Meghan B. Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Sjef Boeren
- Laboratory of Biochemistry, Wageningen University and Research, Wageningen, Netherlands
| | | | - Theo J. Moraes
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Edoardo Saccenti
- Laboratory of Systems and Synthetic Biology, Wageningen University and Research, Wageningen, Netherlands
| | - Kasper A. Hettinga
- Food Quality and Design Group, Wageningen University and Research, Wageningen, Netherlands
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The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4447484. [PMID: 35774754 PMCID: PMC9239787 DOI: 10.1155/2022/4447484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
Objective: To study the effects of epidural anesthesia with different doses of dexmedetomidine and ropivacaine on postoperative hemodynamics and neonatal outcome of cesarean section parturients. Methods. A total of 90 parturients who underwent cesarean section admitted to our hospital from January 2019 to January 2020 were selected as the research objects and were divided into groups A, B, and C according to different dosages of dexmedetomidine, with 30 cases in each group. Groups A, B, and C were given dexmedetomidine 0.5 μg/kg, 0.8 μg/kg, 1.0 μg/kg, respectively, combined with 0.2% ropivacaine. The anesthesia effect, traction response, hemodynamic indexes, and neonatal Apgar score of the three groups were compared; the “Numerical Rating Scale (NRS) Score” was used to assess the postoperative pain of the parturients, and the “Ramsay Sedation Scale” was used to assess the sedation state of the parturients. Results. The superior anesthesia effect of group B was obtained compared with groups A and C (P < 0.05). Group B witnessed a lower degree of grade III stretching response, as compared to group A (P < 0.05). In comparison with groups A and C, superior results of the heart rate and mean artery pressure (MAP) of group B at T1 and T2 were obtained (P < 0.05). The neonatal Apgar score in group B was lower than those in groups A and C (P < 0.05), and the NRS score of group B was also lower than that of group A (P < 0.05). Compared with groups A and C, group B yielded a more favorable outcome in terms of the Ramsay score (P < 0.05). Conclusion. The use of medium-dose dexmedetomidine in cesarean section parturients is safer and can effectively reduce the impact on maternal hemodynamics, which is worthy of promotion and application.
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Schocker F, Jappe U. Breastfeeding: Maternally Transferred Allergens in Breast Milk: Protective or Sensitizing? Mol Nutr Food Res 2022; 66:e2200066. [PMID: 35619210 DOI: 10.1002/mnfr.202200066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/01/2022] [Indexed: 11/11/2022]
Abstract
According to a thorough literature search, the following allergen sources have been associated with allergy symptoms in the exclusively breastfed child: hen's egg, cow's milk, peanut, trout. Subsequently, several studies use the advantage of molecular allergology and investigate the potential transfer of single allergens into breastmilk. This is shown for caseins, whey proteins, gliadin, ovalbumin, ovomucoid, the peanut allergens Ara h 2 and Ara h 6, as well as the inhalant allergens Der p 1 and Blo t 5. It is still a matter of debate whether or not food allergens transferred via breastfeeding to the baby promote allergic sensitization or induce tolerance and via which mechanisms they may shift the immune response to the one or other side. Noteworthy, some breastfed children are described to be sensitized to foods before being exposed to solid foods, and this exposure may have occurred through breastmilk. In the light of these findings the investigation of food allergens transferred from the mother's diet into breastmilk and their impact on sensitization or allergy prevention remains a current topic in research. This review describes breastmilk in its composition and provides data on the identification of food allergens therein including human and mouse studies.
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Affiliation(s)
- Frauke Schocker
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Priority Research Area Asthma and Allergy, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research, Germany.,Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany
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Kosmeri C, Rallis D, Kostara M, Siomou E, Tsabouri S. Characteristics of Exogenous Allergen in Breast Milk and Their Impact on Oral Tolerance Induction. Front Pediatr 2022; 10:830718. [PMID: 35311039 PMCID: PMC8931296 DOI: 10.3389/fped.2022.830718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Food allergy is a common health problem in childhood since its prevalence was estimated to range from 6. 5 to 24.6% in European countries. Recently, a lot of research has focused on the impact of breastfeeding on oral tolerance induction. Since it was found that breast milk contains immunologically active food antigens, it would be very helpful to clarify the factors of antigen shedding that promotes oral tolerance. This narrative review aimed to summarize the latest evidence from experimental and human studies regarding allergen characteristics in human milk that may influence oral tolerance induction. A literature search in PubMed, MEDLINE, and Google Scholar was conducted. The diet of the mother was found to have a direct impact on allergen amount in the breastmilk, while antigens had different kinetics in human milk between women and depending on the antigen. The mode of antigen consumption, such as the cooking of an antigen, may also affect the allergenicity of the antigen in human milk. The dose of the antigen in human milk is in the range of nanograms per milliliter; however, it was found to have a tolerogenic effect. Furthermore, the presence of antigen-specific immunoglobulins, forming immune complexes with antigens, was found more tolerogenic compared to free allergens in experimental studies, and this is related to the immune status of the mother. While examining available data, this review highlights gaps in knowledge regarding allergen characteristics that may influence oral tolerance.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Maria Kostara
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Sophia Tsabouri
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
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Shamji MH, Valenta R, Jardetzky T, Verhasselt V, Durham SR, Würtzen PA, van Neerven RJ. The role of allergen-specific IgE, IgG and IgA in allergic disease. Allergy 2021; 76:3627-3641. [PMID: 33999439 PMCID: PMC8601105 DOI: 10.1111/all.14908] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022]
Abstract
Immunoglobulin E (IgE)‐mediated allergy is the most common hypersensitivity disease affecting more than 30% of the population. Exposure to even minute quantities of allergens can lead to the production of IgE antibodies in atopic individuals. This is termed allergic sensitization, which occurs mainly in early childhood. Allergen‐specific IgE then binds to the high (FcεRI) and low‐affinity receptors (FcεRII, also called CD23) for IgE on effector cells and antigen‐presenting cells. Subsequent and repeated allergen exposure increases allergen‐specific IgE levels and, by receptor cross‐linking, triggers immediate release of inflammatory mediators from mast cells and basophils whereas IgE‐facilitated allergen presentation perpetuates T cell–mediated allergic inflammation. Due to engagement of receptors which are highly selective for IgE, even tiny amounts of allergens can induce massive inflammation. Naturally occurring allergen‐specific IgG and IgA antibodies usually recognize different epitopes on allergens compared with IgE and do not efficiently interfere with allergen‐induced inflammation. However, IgG and IgA antibodies to these important IgE epitopes can be induced by allergen‐specific immunotherapy or by passive immunization. These will lead to competition with IgE for binding with the allergen and prevent allergic responses. Similarly, anti‐IgE treatment does the same by preventing IgE from binding to its receptor on mast cells and basophils. Here, we review the complex interplay of allergen‐specific IgE, IgG and IgA and the corresponding cell receptors in allergic diseases and its relevance for diagnosis, treatment and prevention of allergy.
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Affiliation(s)
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
- Laboratory of Immunopathology Department of Clinical Immunology and Allergology Sechenov First Moscow State Medical University Moscow Russia
- NRC Institute of Immunology FMBA of Russia Moscow Russia
- Karl Landsteiner University of Health Sciences Krems Austria
| | | | - Valerie Verhasselt
- School of Molecular Sciences University of Western Australia Perth WA Australia
| | | | | | - R.J. Joost van Neerven
- Wageningen University & Research Wageningen The Netherlands
- FrieslandCampina Amersfoort The Netherlands
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Macchiaverni P, Rekima A, van den Elsen L, Renz H, Verhasselt V. Allergen shedding in human milk: Could it be key for immune system education and allergy prevention? J Allergy Clin Immunol 2021; 148:679-688. [PMID: 34310930 DOI: 10.1016/j.jaci.2021.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 02/02/2023]
Abstract
In addition to being a source of nutrients for the developing newborn, human milk contains thousands of bioactive compounds, which influence infant health in the short-term as exemplified by its major benefits on infectious disease prevention. Many of the human milk compounds also have the required characteristics to instruct immune development and guide long-term health. Prebiotics, probiotics, and varied antimicrobial molecules all have the potential to shape the composition and function of the establishing gut microbiota, which is known to be a major determinant of immune function. Another and less explored way human milk can instruct long-term immunity is through antigen shedding. Here, we will review the evidence that antigens from maternal environment and more specifically from allergen sources are found in human milk. We will discuss data from rodent models and birth cohorts showing that allergen shedding in breast milk may influence long-term allergy risk. We will uncover the variables that may underlie heterogeneity in oral tolerance induction and allergy prevention in children breast-fed by allergen-exposed mothers. We will focus on the parameters that control antigen transfer to breast milk, on the unique biological characteristics of allergens in breast milk, and on the milk bioactive compounds that were found to influence immune response in offspring. We propose this understanding is fundamental to guide maternal interventions leading to lifelong allergen tolerance.
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Affiliation(s)
- Patricia Macchiaverni
- School of Medicine and Biomedical Sciences, University of Western Australia, Perth, Australia; Telethon Kids Institute, Perth, Australia
| | - Akila Rekima
- School of Medicine and Biomedical Sciences, University of Western Australia, Perth, Australia; Telethon Kids Institute, Perth, Australia
| | - Lieke van den Elsen
- School of Medicine and Biomedical Sciences, University of Western Australia, Perth, Australia; Telethon Kids Institute, Perth, Australia
| | - Harald Renz
- Institute of Laboratory Medicine, Philipps Universität Marburg, Marburg, Germany; Member of the Universities of Giessen and Marburg Lung Center (UGMLC), Marburg, Germany; German Center for Lung Research (DZL), Marburg, Germany; In Vivo Planetary Health, Worldwide Universities Network (WUN), West New York
| | - Valerie Verhasselt
- School of Medicine and Biomedical Sciences, University of Western Australia, Perth, Australia; Telethon Kids Institute, Perth, Australia; In Vivo Planetary Health, Worldwide Universities Network (WUN), West New York.
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Zepeda-Ortega B, Goh A, Xepapadaki P, Sprikkelman A, Nicolaou N, Hernandez REH, Latiff AHA, Yat MT, Diab M, Hussaini BA, Setiabudiawan B, Kudla U, van Neerven RJJ, Muhardi L, Warner JO. Strategies and Future Opportunities for the Prevention, Diagnosis, and Management of Cow Milk Allergy. Front Immunol 2021; 12:608372. [PMID: 34177882 PMCID: PMC8222906 DOI: 10.3389/fimmu.2021.608372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/04/2021] [Indexed: 12/31/2022] Open
Abstract
The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.
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Affiliation(s)
- Benjamin Zepeda-Ortega
- Pediatric Allergist Private Practice, Angeles Lomas Hospital Huixquilucan Mexican State, Mexico City, Mexico
| | - Anne Goh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Aline Sprikkelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | | | - Miu Ting Yat
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, China
| | - Mohamed Diab
- Pediatric Department Faculty of Medicine, Children Hospital Cairo University, Cairo, Egypt
| | - Bakr Al Hussaini
- Department of Pediatrics, Abdul Aziz University Hospital, Jeddah, Saudi Arabia
| | - Budi Setiabudiawan
- Department of Child Health, Faculty of Medicine, Univesitas Padjadjaran, Bandung, Indonesia.,Department of Pediatrics, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - R J Joost van Neerven
- R&D, FrieslandCampina, Amersfoort, Netherlands.,Wageningen University & Research, Wageningen, Netherlands
| | - Leilani Muhardi
- Medical Affairs, Friesland Campina AMEA, Singapore, Singapore
| | - John O Warner
- Inflammation Repair and Development, National Heart and Lung Institute Imperial College, London, United Kingdom.,Paediatrics, University of Cape Town, Cape Town, South Africa
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