Food allergy in early childhood increases the risk of pollen-food allergy syndrome

Background: The level of pollen in Korea has increased over recent decades. Research suggests that pollen-food allergy syndrome (PFAS) may be more frequent in childhood than previously recognized. We aimed to investigate the prevalence and characteristics of PFAS in children aged 6–10 years from a general population-based birth cohort. Methods: We analyzed 930 children from the COhort for Childhood Origin of Asthma and allergic diseases (COCOA) birth cohort. Allergic diseases were diagnosed annually by pediatric allergists. The skin prick tests were performed with 14 common inhalant allergens and four food allergens for children aged 3 and 7 years. Results: Of the 930 eligible children, 44 (4.7%) aged 6–10 years were diagnosed with. The mean age at onset was 6.74 years. PFAS prevalence was 7.2% among children with allergic rhinitis (AR) and 19.1% among those with pollinosis, depending on comorbidity. PFAS was more prevalent in schoolchildren with atopic dermatitis, food allergy, and sensitization to food allergens and grass pollen in early childhood. In schoolchildren with AR, only a history of food allergy before 3 years increased the risk of PFAS (aOR 2.971, 95% CI: 1.159–7.615). Conclusion: Food allergy and food sensitization in early childhood was associated with PFAS in schoolchildren with AR. Further study is required to elucidate the mechanism by which food allergy in early childhood affects the development of PFAS.

Sensitization to Food and Aeroallergens in Patients with Asthma, Allergic Rhinitis, Eczema and Urticaria

Background and Aims: Allergic disorders such as asthma, urticaria, eczema, and allergic rhinitis are common worldwide, and allergens are the most common etiology and exacerbating factors. So, This study aimed to find the allergens in these patients with skin prick tests. Materials and Methods: All the allergic cases referred to an allergic clinic in the north of Iran were visited by an allergist and clinical immunologist. Based on patient history, physical examination, and diagnosis, we select food allergens and aeroallergens. A standard skin prick test was performed on all patients, and all data was then analyzed SPSS 20. Results: Two thousand one hundred and twenty-eight cases entered the study with a mean age of 27.65 ± 15.52 years old. 1235 (58.04%) females and 893 males (41.96%) participated in this study. Prevalence of allergic rhinitis, asthma, urticaria, and eczema were 717 (33.7%), 611 (28.8%), 550 (25.8%), and 250 (11.7%), respectively. The most common aeroallergens were Dermatophagoides farinae (75.9%), Dermatophagoides pteronyssinus (65.4%), feather (56.1%), and Candida (51.1%), respectively, in all patients. The most common food allergens were egg white (31.1%), cacao (29.7%), and egg yolk (28.9%), respectively, in all cases. Conclusion: Both aeroallergens and food allergens were the most common in all allergens by skin prick test. Therefore, it is important to find the relationship between sensitization and allergy.

Chronic Milk-Dependent Food Protein-Induced Enterocolitis Syndrome in Children from West Pomerania Region

Characteristics of chronic milk-dependent food protein-induced enterocolitis syndrome (FPIES) in children from the region of Western Pomerania were studied. Prospectively, 55 children were diagnosed at a median of 2.2 months. The open food challenges (OFC), morphologies, milk-specific IgE (sIgE) (FEIA method, CAP system), and skin prick tests (SPTs) were examined. Vomiting and diarrhea escalated gradually but quickly led to growth retardation. Of the infants, 49% had BMI < 10 c, 20% BMI < 3 c; 25% had anemia, and 15% had hypoalbuminemia. During the OFCs we observed acute symptoms that appeared after 2–3 h: vomiting diarrhea and pallor. A total of 42% children required intravenous hydration. Casein hydrolysates or amino acids formulae (20%) were used in treatment. In 25% of children, SPT and milk sIgE were found, in 18%—other food SPTs, and in 14% allergy to other foods. A transition to IgE-dependent milk allergy was seen in 3 children. In the twelfth month of life, 62% of children had tolerance to milk, and in the twenty-fifth month—87%. Conclusions. Chronic milk-dependent FPIES resolves in most children. By the age of 2 children are at risk of multiple food sensitization, and those who have milk sIgE are at risk to transition to IgE-mediated milk allergy. Every OFC needs to be supervised due to possible severe reactions.

The Relationship between Aeroallergen Sensitization and Chronic Cough in School-Aged Children from General Population

Objective. Determining sensitivity to allergens is an essential step in diagnosing children with allergic diseases. Chronic cough has remained poorly understood with causative triggers. The purpose of our study was to shed light on the relationship between sensitization to aeroallergens and chronic cough. Methods. This population-based study examined children (aged 7 years to 13 years) between June and July 2016. The 1,259 children, 72 of whom (5.7%) had a chronic cough, and 1,187 of whom (94.3%) did not (controls), completed the questionnaire, but 1,051 children completed skin prick tests (SPTs) with eight aeroallergens. Results. There were positive SPT results to at least 1 allergen in 549 children (52.2%). Sensitization to house dust mite (HDM) was most common (chronic cough = 46.9 % ; controls = 47.2 % ), followed by pollen (chronic cough = 21.9 % ; controls = 16.5 % ) in both groups, but there was no difference in allergic profile and sensitization to aeroallergen ( P > 0.05 for all comparisons). Multivariable analysis with adjustment for confounding indicated that children who were in sensitization to pollen had an increased risk of chronic cough ( aOR = 2.387 ; 95% CI: 1.115 to 5.111; P = 0.025 ). Multivariable analysis with adjustment for confounding indicated that children who were exposed to current smoking ( aOR = 4.442 ; 95% CI: 1.831 to 10.776; P = 0.001 ) and mold ( aOR = 1.988 ; 95% CI: 1.168 to 3.383; P = 0.011 ) were associated with chronic cough. Conclusion. Sensitization to pollen should be considered as a potential contributing factor to the development of chronic cough in school-aged children.

Unusual Lysozyme-induced anaphylaxis in an egg-allergic child

A nine-year-old egg allergic child developed anaphylaxis after ingesting the lysozyme-containing over-the-counter-drug Lysopaine®. He complained of a sore throat without fever or cough. His mother administered him one sublingual tablet of the over-the-counter drug Lysopaine®, containing 20 mg lysozyme hydrochloride. A few minutes after intake of the drug, he developed anaphylaxis and received 300 mg intramuscular epinephrine. HE was not exposed to other allergens. The responsibility of lysozyme was confirmed by positive skin prick tests for Lysopaïne® and the presence of specific IgE against lysozyme. When giving this treatment to her son, his mother had no idea that it could contain egg protein and she did not perceive lysozyme as an allergenic protein. However, the box mentioned the presence of lysozyme and also specified “contains lysozyme extracted from egg”. Lysozyme, a minor egg allergen, may induce anaphylaxis in egg-allergic patients. Lysozyme can be found in many commonly consumed industrial food and drug products and its labelling may be misleading. Our observation highlights the importance of properly educating allergic patients to recognize allergens, even minor ones.

Does aeroallergen sensitivity and allergic rhinitis in children cause milder COVID-19 infection?

Background: There are conflicting data with regard to the impact of respiratory and allergic comorbidities on the course of novel coronavirus disease 2019 (COVID-19) in children. Objective: This study aimed to investigate the relationship between allergic diseases and COVID-19 severity in pediatric patients. Methods: Seventy-five pediatric patients with COVID-19 were classified according to clinical severity and evaluated in the allergy/immunology and pulmonology departments 1 to 3 months after the infection resolved. Blood was collected from the patients for a complete blood cell count and assessment of immunoglobulin and total immunoglobulin E (IgE) levels, and skin-prick tests and spirometry tests were performed. Results: A total of 75 patients ages 5‐18 years were evaluated. COVID-19 was asymptomatic/mild in 44 patients and moderate/severe/critical in 31 patients. Based on allergy evaluation, allergic rhinitis was diagnosed in 19 patients (25.3%), asthma in 10 patients (13%), and atopic dermatitis in 3 patients (4%). Aeroallergen sensitivity was detected in 26 patients (34.7%). COVID-19 infection was asymptomatic/mild in 15 patients with allergic rhinitis (78.9%) and in 21 with aeroallergen sensitivity (80.8%) (p = 0.038 and p = 0.005, respectively). There was no difference in severity between the patients with and without asthma (p = 0.550). The median (interquartile range) total IgE level was significantly higher in the asymptomatic/mild group (71.8 [30.7‐211.2]) (p = 0.015). There were no differences in terms of spirometry parameters. Conclusion: Aeroallergen sensitization and allergic rhinitis in children may be associated with a milder course of COVID-19. The knowledge that atopy is associated with less-severe COVID-19 outcomes in children may guide clinical risk classification.

Characterization and Sensitivity Test of the Allergenic Pollen Proteins from Litchi Chimensis Plant

Pollen of Litchi chinensis (Litchi) is a major aeroallergen of Bangladesh. Pollen of this fruits plant was collected from full bloomed flower growing in different places of Rajshahi in Bangladesh. Pollen protein was extracted and partial purified by means of long-term PBS extraction, salting out, dialysis, gel filtrations and DEAE-Cellulose chromatography and the protein was designated as LFPP (Litchi flowers pollen protein). Gel filtration of the purified pollen protein gives two main peaks. The major peak gives four bands on SDS-PAGE. The enzyme (pectate lyase) proteins after gel filtration again re-purified by Ion exchange chromatography, a single band in the protein profile of LFPP, (M.W. 28kDa) was the major allergenic component of Litchi chinensis (Litchi) flower pollen. The homogeneity and the molecular weight of the protein were estimated by SDS-PAGE, and Gel filtration was 28kDa. The allergenic protein was identified by skin prick tests and showed the pectate lyase (Pel) activity. Skin-prick tests also revealed highest degree of sensitivity to the Nawabgang sample giving positive response in 80% of the patients. Skin reactivity ranged between 1+ and 3+.

Evidence of IgE-Mediated Cross-Reactions between Anisakis simplex and Contracaecum osculatum Proteins

Fish consumers may develop allergic reactions following the ingestion of fish products containing nematode larvae within the genus Anisakis. Sensitized patients may cross-react with proteins from insects, mites and mollusks, leading to allergic reactions even in the absence of the offending food. Potential cross-reactivity in Anisakis-allergic patients with larval proteins from other zoonotic parasites present in freshwater and sea fish should be investigated due to an increasing occurrence in certain fish stocks, particularly Contracaecum osculatum. In this work, we evaluated IgE-cross reactions by in vivo (skin prick tests with parasites extracts) and in vitro methods (IgE-ELISA and IgE-immunoblot). In vivo skin prick tests (SPT) proved the reactivity of Anisakis-sensitized patients when exposed to C. osculatum antigens. Sera from Anisakis-sensitized patients confirmed the reaction with somatic antigens (SA) and excretory/secretory proteins (ES) from C. osculatum. Only anecdotal responses were obtained from other freshwater worm parasites. Consequently, it is suggested that Anisakis-sensitized humans, especially patients with high levels of specific anti-Anisakis antibodies, may react to C. osculatum proteins, possibly due to IgE-mediated cross-reactivity.

Is Body Mass Index Related to Skin Reactivity to Histamine but not to Specific Allergens? A 2-Year Follow-up Study on Korean Children

Background Skin prick tests are widely used to diagnose allergic sensitization. The influence of obesity on the skin prick test result has not been clearly established, even though the association between allergic disease and obesity is relatively well known. Objective To determine whether a change in body mass index (BMI) contributes to skin reactivity to histamine and allergens in a skin prick test, we performed a 2-year follow-up study on Korean children. Methods Skin prick tests for common aeroallergens were performed on elementary school students from Jeju Island, Korea. BMI was calculated using weight and height after measuring both, and demographic characteristics were surveyed. The same tests were repeated after 2 years. Results The sensitization rate increased during the 2 years between tests and the children’s mean BMI also increased, along with their age. The wheal sizes induced by Dermatophagoides pteronyssinus, Dermatophagoides farinae, Japanese cedar, and histamine were significantly increased during 2 years; however, only the histamine reaction associated with increased BMI had statistical significance. Furthermore, other variables—including the number of sensitized allergens—were not related to histamine skin reactivity. Conclusion Histamine skin reactivity increased in children over time and some allergens showed increased specific reactions; however, BMI gain is a specific predictor of histamine reactivity. Further studies are needed to elucidate the clinical significance of these changes.