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Food Allergy
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Alison Cassin, Ashley Devonshire, Stephanie Ward, Meghan McNeill
Previously, delayed introduction of allergenic foods (until after 3 years of age) in individuals with a family history of food allergy was recommended to prevent the development of food allergies. These recommendations have been altered dramatically. In 2015, the results of a randomized controlled trial of early peanut introduction in infants considered to be high risk for peanut allergy revealed a significant reduction in the prevalence of peanut allergy among subjects randomized to regular consumption of peanut early in life. Recent guidelines now recommend testing infants with severe atopic dermatitis and/or egg allergy for the presence of peanut specific IgE, either by SPT or serum-specific IgE testing, prior to the oral introduction of peanut and that introduction should occur by 4–6 months of age. In patients with mild-to-moderate atopic dermatitis, peanut should be introduced into the diet at around 6 months of age or when developmentally appropriate (Chapter 5). Subsequent studies of early introduction of allergenic foods have also collectively shown a benefit for food allergy prevention with earlier introduction of egg; however, this has not yet been adopted into guidelines. Studies are currently underway to determine the benefit of early introduction of other highly allergenic foods. In general, the recommendation for healthy infants without increased risk of food allergy is to introduce a variety of foods in developmentally appropriate textures, including highly allergenic foods (Table 15.1).
Allergy–Asthma Practice
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Mark Holbreich, Pudupakkam K Vedanthan, PA Mahesh, Sitesh Roy
Food allergies now affect up to 8% of US children and a similar percentage of adults. The most common allergies in children are cow’s milk, eggs, peanuts, tree nuts, wheat, soy, fish and shellfish. In adults the most common food allergy is shellfish. The current understanding is that food allergy develops when a food protein touches abnormal skin in an infant as in atopic dermatitis. Most childhood food allergies with the exception of peanuts, tree nuts, fish and shellfish will be outgrown. Following the publication of the Learning Early About Peanut (LEAP) trial in England it is now recommended that infants with atopic dermatitis begin eating peanuts at 6 months of life to induce tolerance. Currently the treatment for children who have a severe food allergy is avoidance of the food and carrying injectable epinephrine. It is expected that over the next few years treatment for food allergies will change dramatically with the introduction of programs for Oral Induction of Tolerance (OIT). The first product AR 101, which is purified peanut protein, will be commercially available in the near future.
Nasal, bronchial, conjunctival, and food challenge techniques and epicutaneous immunotherapy of food allergy
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Mark W. Tenn, Matthew Rawls, Babak Aberumand, Anne K. Ellis
Food allergy (FA) is defined as an adverse reaction arising from a specific immune response that occurs reproducibly on exposure to a given food or food additive [75,76]. These symptoms are triggered by exposure to food allergens, which are characterized as specific components of food, such as proteins and chemical haptens. These food allergens are recognized by allergen-specific immune cells and elicit immunologic responses leading to the adverse reaction. FA is increasing in prevalence in most countries, particularly in more affluent regions [75]. Despite its ability to negatively affect quality of life and to cause significant morbidity and even death, very limited options remain for treatment of FA. The mainstay of treatment is avoidance of the allergen, treatment of symptoms, and periodic rechallenge to verify the persistence of the FA [75,77]. However, new, emerging food immunotherapy options are promising.
Peanut allergy: risk factors, immune mechanisms, and best practices for oral immunotherapy success
Published in Expert Review of Clinical Immunology, 2023
Jyothi Tirumalasetty, Suzanne Barshow, Laurie Kost, Lu Morales, Reyna Sharma, Carlos Lazarte, Kari C. Nadeau
Optimizing pOIT at any age begins with a detailed review of the patient’s medical and allergic history and a physical exam. The history should include a complete list of the patient’s food allergies and the date and severity of each reaction. Those with a history of severe reactions resulting in intubation, neurological compromise, or prolonged hospitalization should consider continued avoidance or alternative forms of therapy such as SLIT, EPIT, or biologics, since these conditions may put them at high risk for adverse reactions to pOIT. Diagnosis of IgE-mediated food allergy should be confirmed with sIgE, SPT, and possibly OFCs prior to starting OIT. Of note, this evaluation should be done close to initiation of OIT, especially in young children, as markers of sensitization can change rapidly in this age group. Atopic individuals, such as those with atopic dermatitis as described earlier, are at increased risk of developing sensitization to peanut compared to non-atopic individuals. This can present as life-threatening allergy to peanuts or the more mild pollen food syndrome (PFS), which occurs in pollen-sensitized patients and is characterized by immediate oropharyngeal symptoms upon eating raw plant foods that share homology with pollen proteins [49,50]. It is important to clinically differentiate life-threatening food allergy from PFS when selecting candidates for pOIT. Positive component testing to Ara h 8, which cross-reacts with birch Bet v 1, can help distinguish patients with PFS from patients with primary peanut allergy [51].
Rural environment reduces allergic inflammation by modulating the gut microbiota
Published in Gut Microbes, 2022
Zhaowei Yang, Zhong Chen, Xinliu Lin, Siyang Yao, Mo Xian, Xiaoping Ning, Wanyi Fu, Mei Jiang, Naijian Li, Xiaojun Xiao, Mulin Feng, Zexuan Lian, Wenqing Yang, Xia Ren, Zhenyu Zheng, Jiefeng Zhao, Nili Wei, Wenju Lu, Marjut Roponen, Bianca Schaub, Gary W. K. Wong, Zhong Su, Charles Wang, Jing Li
A serum specific IgE (sIgE) test was performed by drawing a blood sample from a vein. For determination of allergen sensitizations, sIgE against five groups of food mixtures (epcx1, epcx2, epcx3, fx5, and fx6; Thermo Fisher Scientific, Waltham, MA USA) was measured, followed by assessment of 27 individual food allergens and 6 airborne allergens. Food allergens included egg, milk, fish, wheat, maize, rice, sesame, buckwheat, peanut, soy, hazelnut, shrimp, crab, tomato, carrot, apple, kiwi, celery, melon, mustard, mango, banana, peach, poppy, lentil, walnut, and sunflower. Airborne allergens included house dust mites (Dermatophagoides pteronyssinus), cockroaches (Blatella germanica), cat dander, birch (Betula verrucosa), timothy grass (Phleum pratense), mugwort (Artemisia vulgaris), and Parietaria pollen. A panel of 18 food allergens (mango, crab, egg, date, mussel, orange, milk, soybean, hazelnut, shrimp, wheat, peanut, fish, peach, beef, apple, lemon, and tomato) and 5 airborne allergens (house dust mite, cockroach, cat dander, timothy grass, mugwort and cat dander) were used for the SPT (ALK, Horsholm, Denmark). A positive skin reaction was defined as a wheal size ≥ 3 mm after elimination of the negative control. The determination of sIgE was considered positive if the sIgE level was greater than 0.35 kU/L.
Kidney-bean (Phaseolus Vulgaris) Dependent, Exercise-induced Anaphylaxis in Patients Comorbid with Mugwort (Artemisia Vulgaris) Pollinosis
Published in Immunological Investigations, 2021
In patients with pollen-induced respiratory allergy, cross-reactivity between pollens and foods may induce food allergies with symptoms ranging from oral allergy syndrome to severe anaphylaxis. Cross-reactions between mugwort–celery, mugwort–spice, mugwort–peach, mugwort–chamomile, and mugwort–mustard have all been identified (Popescu 2015). In the cross-reactions between mugwort-peach, it has been suggested that mugwort lipid transfer protein (Art v 3) has an important role in the pollinosis of patients allergic to peach lipid transfer protein (Pru p3) (Sanchez-Lopez et al. 2014). However, no research has been published on the cross-reactivity between mugwort and kidney beans. Herein our immunoblot-inhibition assay clearly indicated for the first time the cross-reactivity between mugwort and kidney bean seeds.